There is a significant variety of vascular conduits options for coronary bypass surgery. Adequate graft selection is the most important factor for the success of the intervention. To ensure ...durability, permeability, and bypass function, there must be a morphological similarity between the graft and the coronary artery. The objective of this review was to analyze the morphological characteristics of the grafts that are most commonly used in coronary bypass surgery and the coronary arteries that are most frequently occluded. We included clinical information regarding the characteristics that determine the behavior of the grafts and its permeability over time. Currently, the internal thoracic artery is the standard choice for bypass surgery because of the morphological characteristics of the wall that makes less prone to developing atherosclerosis and hyperplasia. The radial and right gastroepiploic arteries are the following second and third best options, respectively. The ulnar artery is the preferred choice when other conduits are not feasible.
Purpose
To determine, identify and measure the structures of the menisco-tibio-popliteus-fibular complex (MTPFC) with magnetic resonance imaging (MRI) in knees without structural abnormalities or a ...history of knee surgery.
Methods
One-hundred-and-five knees without prior injury or antecedent surgery were analyzed by means of MRI. The average age was 50.1 years ± 14.8. All the measurements were performed by three observers. The peripherical structures of the lateral meniscus body were identified to determine the location, size, and thickness of the entire MTPFC. The distance to other “key areas” in the lateral compartment was also studied and compared by gender and age.
Results
The lateral meniscotibial ligament (LMTL) was found in 97.1% of the MRIs, the popliteofibular ligament (PFL) in 93.3%, the popliteomeniscal ligaments (PML) in 90.4% and the meniscofibular ligament (MFL) in 39%. The anteroposterior distance of the LMTL in an axial view was 20.7 mm ± 3.9, the anterior thickness of the LMTL was 1.1 mm ± 0.3, and the posterior thickness of the LMTL 1.2 mm ± 0.1 and the height in a coronal view was 10.8 mm ± 1.9. The length of the PFL in a coronal view was 8.7 mm ± 2.5, the thickness was 1.4 mm ± 0.4 and the width in an axial view was 7.8 mm ± 2.2.
Conclusions
The MTPFC has a constant morphological and anatomical pattern for three of its main ligaments and can be easily identified and measured in an MRI; the MFL has a lower prevalence, considering a structure difficult to identify by 1.5 T MRI.
Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have ...historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.
Polymorphic eruption of pregnancy in Mexico Dominguez‐Serrano, Angela J.; Quiroga‐Garza, Alejandro; Jacobo‐Baca, Guillermo ...
International journal of dermatology,
March 2019, Letnik:
58, Številka:
3
Journal Article
Recenzirano
Background
Currently, the exact incidence of Polymorphic Eruption of Pregnancy (PEP) in the Mexican population is unknown. PEP tends to manifest in the abdomen, primarily in the stretch marks caused ...by distension. It is characterized by severely pruritic urticarial‐like papules that converge in plaques, extending to the buttocks and proximal thighs. Our study determined its incidence, along with other common dermatoses in pregnancy.
Methods
Patients between 14 and 45 years of age were evaluated. In each patient, a complete medical history and physical examination was performed with emphasis on skin and adnexa. Patients were followed until the end of their pregnancy.
Results
A total of 217 women were included. PEP was identified in three patients (1.38%), all primigravida, with single fetus pregnancy, and all concluded their pregnancy by vaginal delivery. The neonates were 2 females and 1 male. No other gestational pathologies were identified.
Conclusions
We identified a higher incidence of PEP than reported, without association to complications or need for medical management. There may be an association between high maternal weight and the presence of PEP, however a larger sample is needed.
Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head‐down tilt (Trendelenburg position) and head rotation on ...the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross‐sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head‐rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5‐min rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78 cm2 with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59 cm2. A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA.
Near‐peer teaching has been widely implemented in medical schools and the benefits for the near‐peer teachers (NPTs), the students, and the institution have been well documented. However, NPT ...training methods and perceptions of such have been limited. A four‐year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A “Clinical Anatomy and Surgical Training Diploma” was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near‐peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.
Spatial learning and memory are used by all individuals who need to move in a space. Morris water maze (MWM) is an accepted method for its evaluation in murine models and has many protocols, ranging ...from the classic parameters of latency, distance, and number of crossings to the platform zone, to other more complex methods involving computerized trajectory analysis. Algorithm-based SS analysis is an alternative that enriches traditional classic parameters. We developed a non-computerized parameter-based Search Strategy Algorithm (SSA), to classify strategies and detect changes in spatial memory and learning. For this, our algorithm was validated using young and aged rats, evaluated by two observers who classified the trajectories of the rats based on the effectiveness, localization, and precision to reach the platform. SSA is classified into 10 categories, classified by effectiveness, initial direction, and precision. Traditional measurements were unable to show significant differences in the learning process. However, significant differences were identified in SSA. Young rats used a direct search strategy (SS), while aged rats preferred indirect ones. The number of platform crossings was the only variable to show the difference in the intermediate probe trial. The parameter-based algorithm represents an alternative to the computerized SS methods to analyze the spatial memory and learning process in young and age rats. We validate the use of SSA as an alternative to computerized SS analysis spatial learning acquisition. We demonstrated that aged rats had the ability to learn spatial memory tasks using different search strategies. The use of SSA resulted in a reliable and reproducible method to analyze MWM protocols.
Introduction
Central venous catheterization (CVC) is procedure used in hospital settings for patient monitoring, diagnostic, and therapeutic means. The right internal jugular vein (RIJV) is the first ...choice recommended, with ultrasound (US)‐guided as the gold standard. This method is not always available, especially in rural settings or developing countries, and complications are still frequent even under expert hands.
The head‐down tilt (Trendelenburg) position involves elevation of the lower limbs to favor venous return and increase neck veins regurgitation. Evidence is scarce and contradicting regarding the safety of degree of inclination and head rotation.
The objective of this study was to determine the effects of different degrees of Trendelenburg and head rotation on the RIJV and right common carotid artery (RCCA).
Methods
An experimental, longitudinal, prospective, analytical study was performed. Healthy adults of both sexes were recruited to voluntarily participate.
Inclusion criteria: adults between 18 and 29 years of age, with normal vital signs, and a BMI ≤24.9. Those with RIJV pathology, anatomical variations, neck surgeries, COVID, or metabolic diseases were excluded.
Neck US‐imaging was performed, obtaining cross‐sectional area (CSA) measurements of RIJV and RCCA, and their relationship, at the inferior level of the thyroid cartilage. Randomization at Trendelenburg positions of 0°, 5°, 10° and 15° and left head‐rotation of 0°, 45° and 90° in each inclination were performed. Vital signs and oxygen saturation were monitored between each position, as well questioning for discomfort symptoms.
Results
Measurement of the RIJV and RCCA area was performed in 54 healthy participants (30 men), age range 21‐32. RIJV basal CSA was 1.0±0.5mm2 in a supine position (0°) without head rotation (0°). Trendelenburg angle and head‐rotation increased the CSA of the RIJV in a statistically significant way, obtaining the greatest area in a 15° Trendelenburg position and maximum rotation (Table 1). This, in turn, had no statistically significant difference with 10° Trendelenburg and 45° rotation (Table 2).
Conclusions
A 5º, 10º, or 15º Trendelenburg position and contralateral head rotation increase RIJV CSA. Head rotation also changes the location of the vein anterior to the RCCA at maximum rotation, but not significantly at 45º.
Although the greatest area obtained is achieved at the 15º Trendelenburg position with 90º head rotation, this position is uncomfortable and does not have statistical difference with 10º Trendelenburg position with 45 to 90º head rotation, which represents an increase of the initial diameter of 60% of CSA, making it a feasible position.
Although Ultrasound‐guided catheterization is the gold‐standard, Trendelenburg position and 45º head rotation help increase RIJV diameter, to create a safer procedure.
Significance and implications
This study provides anatomical evidence of RIJV changes with Trendelenburg and head rotation. Most international guidelines focus on CVC approach, and fail to mention patient positioning. The publishing of this data will aid with future versions of CVC guidelines.
PDF
