Search results for: posterior division

Authors: Halimah Al Hifzi, Waseem Al-Talalwah, Shorok Al Dorazi, Hassan Al Mousa, Zainab Al-Hashim, Roger Soames

Abstract:

The obturator artery is one branches of anterior division of the internal iliac artery. It passes on the lateral wall of pelvis to escape into thigh region via obturator foremen. Based on previous research studies, it found to be extremely variable in origin and course. It may arise from internal or external iliac artery. The current study includes 82 dissected specimens to investigate the origin of the obturator artery and explain the clinical importance. The obturator artery arises from the internal iliac artery in 75% either from its anterior or posterior division in 46.9% or 25% respectively. Further, it arises neither from the anterior nor posterior division of the internal iliac artery but it arises between them in 3.1%. In 25%, the obturator artery arises from the external iliac artery. In case of aneurysmectomy of posterior division, carries a high risk of insufficient of vascular supply for demand structures such as proximal adductors attachment and hip joint. Therefore, vascular surgeons have to pay attention to the posterior division being an origin of the obturator artery beside its usual three classical branches: superior gluteal, iliolumbar and lateral sacral arteries. Further, the obturator artery arising from the external iliac system is in great dangerous of laceration in case of anterior pelvic fracture. Therefore, it may lead to haemorrhagic shock threatening life.

Keywords: obturator artery, external iliac, internal iliac artery, anterior division, posterior division, superior gluteal, iliolumbar and lateral sacral, pubic fracture, aneurysm, shock

Procedia PDF Downloads 315

Authors: Raid Hommady, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

Abstract:

The iliolumbar artery is a regular branch of posterior division of the internal iliac artery. The present study investigate 82 specimens to identify the origin of iliolumbar artery. The present study targets the sciatic nerve root supply from iliolumbar artery based on its origin and course. In present study, the ililumbar artery arose from the posterior division of internal iliac artery in 52.2%. In few cases, it arose from dorsomedial aspect of the internal iliac artery in 28.8%. In few cases, the iliolumbar artery arose from the dorsal aspects of the internal iliac artery as well as from the common and external iliac artery 1.7%. Also, the iliolumbar artery arose from the sciatic artery as well as from superior and inferior gluteal arteries in 5.1%. Conversely, it found to be congenital absent in 8.5%. Therefore, the posterior trunk of the internal iliac artery is the most common origin of the iliolumbar artery. With the origin variability of the iliolumbar artery, there is a vascular supply variability of the lumbosacral trunk and sacral root of sciatic nerve. The iliolumbar artery provides vascular supply for lumbosacral trunk 57.3% in whereas the sacral root in 5.1%. As a result, surgeons should pay attention to these variations to decrease iatrogenic fault.

Keywords: iliolumbar, sciatic artery, internal iliac, external iliac, posterior division

Procedia PDF Downloads 285

Authors: Waseem Al Talalwah, Shorok Ali Al Dorazi, Roger Soames

Abstract:

The inferior gluteal artery is a largest branch of the anterior division of internal iliac artery. It escapes from the pelvic cavity through the greater sciatic foramen below the lower edge of piriformis. In gluteal region, it provides several muscular branches to gluteal maximus and articular branch to hip joint. Further, it provides sciatic branch to sciatic nerve. Present study explores the origin of the inferior gluteal artery of 41 cadavers in Centre for Anatomy and Human Identification, University of Dundee, UK. It arose directly from the anterior division of internal iliac artery in 39% and 45.7% indirectly as with the internal pudendal artery. Further, it arose indirectly from anterior division with internal pudendal and obturator arteries in 1.5% referred as obturatogluteopudendal trunk in 1.5%. Therefore, it arose from the anterior division of the internal iliac artery in 86.2%. However, it found to be as a branch of the posterior division of internal iliac artery in 7.7% which is either a direct branch in 6.2% as or indirect branch (as from the sciatic artery) in 1.5%. It neither arose from anterior or posterior division in 1.5% as from gluteopudendal trunk arising from the internal iliac artery bifurcation site. In few cases, the inferior gluteal artery found to be congenital absence in 4.6% which is compensated by the persistent sciatic artery. Therefore, radiologists have to aware of the origin variability of the inferior gluteal artery to alert surgeons. Knowing the origin of the inferior gluteal artery may help the surgeons to avoid iatrogenic sciatic neuropathy or gluteal claudication due to prolonged ligation in pelvic procedures such as removing prostate or of uterine fibroid.

Keywords: inferior gluteal artery, internal pudendal, sciatic nerve, sciatic artery, gluteal claudication, sciatic neuopathy

Procedia PDF Downloads 637

Authors: Christen Kutz

Abstract:

Objective: The aim of this study is to review a case series of 4 high-level Olympic and Division 1 wrestlers who experienced debilitating posterior circulation ischemic strokes during or after a competitive wrestling event and to identify risk factors, etiology and outcomes of stroke in young, healthy elite wrestlers. Background: Stroke occurs in one in 10,000 people under age 64. In young adults, the most common causes of stroke are cardiac embolism, hypercoagulable state, and vasculopathy. One-third of these strokes occur in young, fit individuals. There is little published literature about ischemic strokes that occur in wrestlers. Based on the nature of wrestling, the risk of injury or dissection to neurovascular structures may be a possible theory, but very few case reports exist. Methodology: 4 wrestlers under the age of 44 with a known history of ischemic stroke participated in individual interviews either in person or virtually. Each of the wrestlers provided their demographic information, wrestling background, clinical presentation at the time of stroke, imaging results, identification of potential risk factors, acute treatment and recovery. Results: 3 white male Division 1 wrestlers (2 Lehigh University, 1 Lock Haven University) and 1 black male 2008 Olympian experienced posterior circulation strokes. Case #1 felt a “pop” while wrestling (lateral medullary infarct, possible vertebral artery dissection); Case #2 awoke with severe vertigo, sweating, and vomiting after wrestling the previous day (left cerebellar infarct, (+) protein S deficiency); Case #3 severe vertigo, ataxia, and sensation of impending doom after wrestling earlier that week (left cerebellar infarct, hypoplastic left vertebral artery (+) anti-cardiolipin antibodies). Case #4 severe dizziness, confusion (left cerebellar stroke, vertebral artery dissection, small PFO). Conclusion: 3 wrestlers were started on anti-platelet therapy, risk factors were modified, and returned to their sport. 1 wrestler was placed on anti-coagulation and retired from competition.

Keywords: stroke, wrestling, Olympic, posterior circulation

Procedia PDF Downloads 36

Authors: Nawaf Al-Kharashi, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

Abstract:

Superior gluteal artery is one of the largest branches of posterior division of the internal iliac artery. It passes between the lumbosacral and first sacral root to escape from the pelvic cavity through the grater sciatic foramen just above the piriformis. The current study includes 41 cadaver investigates the origin and branch of the superior gluteal artery and clarify the clinical significance. In present study, the superior gluteal artery arises from the posterior division of the internal iliac artery directly in 82.5% whereas it arises indirectly as from the sciatic artery in 15.9%. However, it is congenital absence in 1.6% which is compensated by sciatic artery. The sciatic nerve gains vascular supply from superior gluteal artery in two ways either during its course or giving lateral sacral artery in 27% and lumbar branches in 1.6%. It also supplies the adductors group and iliacus via giving obturator artery in 14.3% and in 1.6% respectively. The superior gluteal artery usually passes between lumbosacral trunk and first sacral root in 82.5% whereas it does not passes the sciatic roots as it arises behind them in 15.9%. With a variability of the superior gluteal artery origin, there is a variability of sciatic nerve roots supply. Further, the superior gluteal artery arising from sciatic artery behind the sciatic roots carries a high risk of intra-pelvic bleeding in case of posterior pelvic fracture. Prolonged ligation of the superior gluteal artery which gives lateral sacral artery may result in sciatic neuropathy. Therefore, surgeons have to be aware of the superior gluteal artery variation in origin, course and branches to reduce the iatrogenic faults.

Keywords: internal pudendal artery, inferior gluteal artery, superior gluteal artery, internal iliac artery. sciatic neuropathy, sciatic nerve

Procedia PDF Downloads 319

Authors: Manduth Ramchander

Abstract:

Evaluating expressions involving multiplication and division can give rise to the fallacy that brackets can be arbitrarily inserted into expressions involving multiplication and division. The aim of this article was to draw upon mathematical theory to prove that brackets cannot be arbitrarily inserted into expressions involving multiplication and division and in particular in expressions where division precedes multiplication. In doing so, it demonstrates that the notion that two different answers are possible, when evaluating expressions involving multiplication and division, is indeed a false one. Searches conducted in a number of scholarly databases unearthed the rules to be applied when removing brackets from expressions, which revealed that consideration needs to be given to sign changes when brackets are removed. The rule pertaining to expressions involving multiplication and division was then extended upon, in its reverse format, to prove that brackets cannot be arbitrarily inserted into expressions involving multiplication and division. The application of the rule demonstrates that an expression involving multiplication and division can have only one correct answer. It is recommended that both the rule and its reverse be included in the curriculum, preferably at the juncture when manipulation with brackets is introduced.

Keywords: brackets, multiplications and division, operations, order

Procedia PDF Downloads 123

Authors: Adel Yasky, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

Abstract:

The internal pudendal artery is a standard branch of the anterior division of the internal iliac artery. The current study includes 41 cadavers to investigate the origin and branches of the internal pudendal artery and its clinical significances. The internal pudendal artery arose directly from the anterior division of the internal iliac artery in 48.3% while it arose indirectly in 48.5%. However, the internal pudendal artery arose from the posterior division of internal iliac artery in 1.6%. Moreover, it arose internal iliac artery bifurcation site in 1.6%. Further, the internal pudendal artery supplied the urinary bladder in 17.1%. Also, the internal pudendal artery supplied the rectum 33.5% respectively. It gave uterine and vaginal arteries in 9.4% and 7.8% respectively. Finally, it supplied the sciatic nerve via giving lateral sacral branch in 1.6%. Internists, surgeons and radiologists have to be aware of the variability to decrease iatrogenic injury. Therefore, unnecessary proximal ligation should be avoided at the site of indirect origin of the internal pudendal artery to prevent sciatic neuropathy. Further, intrapelvic bleeding as result of laceration of internal pudendal branches during hysterectomy, prostatectomy or proctectomy should be expected. Therefore, this study increases the awareness of surgeons leading to minimize iatrogenic faults,

Keywords: internal pudendal artery, inferior gluteal artery, superior gluteal artery, internal iliac artery, impotence, decreased libido

Procedia PDF Downloads 322

Authors: Tien-Ching Yao, Ching-Ching Lu

Abstract:

Understanding human language processing is one of the main challenges of current cognitive neuroscience. The aims of the present study were to use a sentence decision task combined with event-related potentials to investigate the psychological reality of "cross-sentence patterns." Therefore, we take the math word problems the experimental materials and use the ERPs' P600 component to verify. In this study, the experimental material consisted of 200 math word problems with three different conditions were used ( multiplication word problems、division word problems type 1、division word problems type 2 ). Eighteen Mandarin native speakers participated in the ERPs study (14 of whom were female). The result of the grand average waveforms suggests a later posterior positivity at around 500ms - 900ms. These findings were tested statistically using repeated measures ANOVAs at the component caused by the stimulus type of different questions. Results suggest that three conditions present significant (P < 0.05) on the Mean Amplitude, Latency, and Peak Amplitude. The result showed the characteristic timing and posterior scalp distribution of a P600 effect. We interpreted these characteristic responses as the psychological reality of "cross-sentence patterns." These results provide insights into the sentence processing issues in linguistic theory and psycholinguistic models of language processing and advance our understanding of how people make sense of information during language comprehension.

Keywords: language processing, sentence comprehension, event-related potentials, cross-sentence patterns

Procedia PDF Downloads 119

Authors: Mahdi Farajzadeh Ajirlou

Abstract:

Ordinary fetal brain development can be considered by in vivo attractive reverberation imaging (MRI) from the 18th gestational week (GW) to term and depends fundamentally on T2-weighted and diffusion-weighted (DW) arrangements. The foremost commonly suspected brain pathologies alluded to fetal MRI for assist assessment are ventriculomegaly, lost corpus callosum, and anomalies of the posterior fossa. Brain division could be a crucial to begin with step in neuroimage examination. Within the case of fetal MRI it is especially challenging and critical due to the subjective introduction of the hatchling, organs that encompass the fetal head, and irregular fetal movement. A few promising strategies have been proposed but are constrained in their execution in challenging cases and in realtime division. Fetal MRI is routinely performed on a 1.5-Tesla scanner without maternal or fetal sedation. The mother lies recumbent amid the course of the examination, the length of which is ordinarily 45 to 60 minutes. The accessibility and continuous approval of standardizing fetal brain development directions will give critical devices for early discovery of impeded fetal brain development upon which to oversee high-risk pregnancies.

Keywords: brain, fetal, MRI, imaging

Procedia PDF Downloads 43

Authors: Peter Jean-Paul, Shanaz Wahid

Abstract:

The problem of division by zero can be stated as: “what is the value of 0 x 1/0?” This expression has been considered undefined by mathematicians because it can have two equally valid solutions either 0 or 1. Recently semi-structured complex number set was invented to solve “division by zero”. However, whilst the number set had some merits it was considered to have a poor theoretical foundation and did not provide a quality solution to “division by zero”. Moreover, the set lacked consistency in simple algebraic calculations producing contradictory results when dividing by zero. To overcome these issues this research starts by treating the expression " 0 x 1/0" as a quantum mechanical system that produces two tangled results 0 and 1. Dirac Notation (a tool from quantum mechanics) was then used to redefine the unstructured unit p in semi-structured complex numbers so that p represents the superposition of two results (0 and 1) and collapses into a single value when used in algebraic expressions. In the process, this paper describes a new number set called Quantum Semi-structured Complex Numbers that provides a valid solution to the problem of “division by zero”. This research shows that this new set (1) forms a “Field”, (2) can produce consistent results when solving division by zero problems, (3) can be used to accurately describe systems whose mathematical descriptions involve division by zero. This research served to provide a firm foundation for Quantum Semi-structured Complex Numbers and support their practical use.

Keywords: division by zero, semi-structured complex numbers, quantum mechanics, Hilbert space, Euclidean space

Procedia PDF Downloads 123

Authors: Hema Lattupalli

Abstract:

Introduction: A bony bridge extends from the lateral mass of the atlas to postero medial margin of vertebral artery groove, termed as a posterior bridge of atlas or posterior ponticulus. The foramen formed by the bridge is called as arcuate foramen or retroarticulare superior. Another bony bridge sometimes extends laterally from lateral mass to posterior root of transverse foramen forming and additional groove for vertebral artery, above and behind foramen transversarium called Lateral bridge or ponticulus lateralis. When both posterior and lateral are present together it is called as Posterolateral ponticuli. Aim and Objectives: The aim of the present study is to detect the presence of such Bridge or Ponticuli called as Lateral, Posterior and Posterolateral reported by earlier investigators in atlas vertebrae. Material and Methods: The study was done on 100 Atlas vertebrae from the Department of Anatomy Narayana Medical College Nellore, and also from SVIMS Tirupati was collected over a period of 2 years. The parameters that were studied include the presence of ponticuli, complete and incomplete and right and left side ponticuli. They were observed for all these parameters and the results were documented and photographed. Results: Ponticuli were observed in 25 (25%) of atlas vertebrae. Posterior ponticuli were found in 16 (16%), Lateral in 01 (01%) and Posterolateral in 08(08%) of the atlas vertebrae. Complete ponticuli were present in 09 (09%) and incomplete ponticuli in 16 (16%) of the atlas vertebrae. Bilateral ponticuli were seen in 10 (10%) and unilateral ponticuli were seen in 15 (15%) of the atlas vertebrae. Right side ponticuli were seen in 04 (04%) and Left side ponticuli in 05 (05%) of the atlas vertebrae respectively. Interpretation and Conclusion: In the present study posterior complete ponticuli were said to be more than the lateral complete ponticuli. The presence of Bilateral Incomplete Posterior ponticuli is higher and also Atlantic ponticuli. The present study is to say that knowledge of normal anatomy and variations in the atlas vertebra is very much essential to the neurosurgeons giving a message that utmost care is needed to perform surgeries related to craniovertebral regions. This is additional information to the Anatomists, Neurosurgeons and Radiologist. This adds an extra page to the literature.

Keywords: atlas vertebra, ponticuli, posterior arch, arcuate foramen

Procedia PDF Downloads 340

Authors: Kevin Syam, Devendra K. Chauhan, Mandeep Singh Dhillon

Abstract:

Background: The posterior horn of medial meniscus (PHMM) is a secondary stabilizer against anterior translation of tibia. Cadaveric studies have revealed increased strain on the ACL graft and greater instrumented laxity in Posterior horn deficient knees. Clinical studies have shown higher prevalence of radiological OA after ACL reconstruction combined with menisectomy. However, functional outcomes in ACL reconstructed knee in the absence of Posterior horn is less discussed, and specific role of posterior horn is ill-documented. This study evaluated functional and radiological outcomes in posterior horn preserved and posterior horn sacrificed ACL reconstructed knees. Materials: Of the 457 patients who had ACL reconstruction done over a 6 year period, 77 cases with minimum follow up of 18 months were included in the study after strict exclusion criteria (associated lateral meniscus injury, other ligamentous injuries, significant cartilage degeneration, repeat injury and contralateral knee injuries were excluded). 41 patients with intact menisci were compared with 36 patients with absent posterior horn of medial meniscus. Radiological and clinical tests for instability were conducted, and knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and the Orthopadische Arbeitsgruppe Knie score (OAK). Results: We found a trend towards significantly better overall outcome (OAK) in cases with intact PHMM at average follow-up of 43.03 months (p value 0.082). Cases with intact PHMM had significantly better objective stability (p value 0.004). No significant differences were noted in the subjective IKDC score (p value 0.526) and the functional OAK outcome (category D) (p value 0.363). More cases with absent posterior horn had evidence of radiological OA (p value 0.022) even at mid-term follow-up. Conclusion: Even though the overall OAK and subjective IKDC scores did not show significant difference between the two subsets, the poorer outcomes in terms of objective stability and radiological OA noted in the absence of PHMM, indicates the importance of preserving this important part of the meniscus.

Keywords: ACL, functional outcome, knee, posterior of medial meniscus

Procedia PDF Downloads 331

Authors: A-Reum Shin, Heon-Seock Cynn, Ji-Hyun Lee, Da-Eun Kim

Abstract:

Round shoulder posture (RSP) is a position of scapular protraction and elevation, which may appear as scapular winging, and humeral internal rotation. Flexed posture (FP) may also affect RSP because FP is characterized by hyperkyphosis, forward head posture, and height reduction. The aim of this study was to investigate the effect of scapular posterior tilting exercise with prone trunk extension on round shoulder posture, activities of lower trapezius and serratus anterior, flexed posture, and thoracic erector spinae activity in subjects with round shoulder posture. Fifteen subjects with round shoulder posture were recruited in this study. Activities of lower trapezius, serratus anterior and thoracic erector spinae were measured during both scapular posterior tilting exercise and scapular posterior tilting exercise with prone trunk extension using electromyography, and round shoulder posture and flexed posture were measured immediately after each exercises using caliper. When the prone trunk extension was applied, the round shoulder posture and flexed posture significantly decreased, activities of lower trapezius and thoracic erector spinae significantly increased (p < 0.05) compared with the scapular posterior tilting exercise alone. There was no significant difference in serratus anterior activity between two exercises. Thus, prone trunk extension could be effective method to improve round shoulder posture during scapular posterior tilting exercise in subjects with round shoulder posture.

Keywords: flexed posture, prone trunk extension, round shoulder posture, scapular posterior tilting

Procedia PDF Downloads 184

Authors: Karen Cilliers, Benedict J. Page

Abstract:

Limited research focuses on the anatomy of the posterior cerebral artery (PCA) and its cortical branches, even though there can be variation in the presence, size, and origin. The PCA branching pattern has not been adequately reported, and the true division point remains unclear. Anomalies of the PCA have been described in the previous literature; however, few examples have been reported. Furthermore, possible differences between right and left, sex, population and age groups may exist. Therefore, the aim of this study was to report on these aspects from a South African population. One hundred and twenty-six hemispheres were obtained consisting of 86 males and 38 females, between the ages of 22 and 84 (average 45 years of age). This comprised of three population groups, namely coloured (n=74), black (n=38), white (n=10) and two unknown cases. The PCA was injected with an isotonic saline and a colored silicone. The external diameter was measured with a digital micrometer, and length was measured with a string and a ruler. Presence and origins of the cortical branches were similar to the literature; however, duplications, triplications, and unusual origins were observed. The diameter and lengths indicated significant differences between the right and left sides, sex, population and age groups. Branching patterns were identified and compared to the prevalence from previous studies. Two fenestrations were observed in the P2A segment. The presence, size, origin, branching pattern and anomalies of the PCA were investigated in this study. The diameter and length can be significantly different, especially between the right and left-hand side. Changes in the diameter and length can be indicative of certain neuropathological conditions and can play a role in aneurysms formation. Adequate knowledge of the normal and abnormal PCA anatomy is crucial for surgery in the vicinity of the PCA. Therefore, future studies should focus on these aspects.

Keywords: branching, cortical branches, fenestration, posterior cerebral artery

Procedia PDF Downloads 186

Authors: Samuel J. Ahmad, Michael Zhu, Andrew J. Kobets

Abstract:

Segmentation tools continue to advance, evolving from manual methods to automated contouring technologies utilizing convolutional neural networks. These techniques have evaluated ventricular and hemorrhagic volumes in the past but may be applied in novel ways to assess posterior fossa-associated pathologies such as Chiari malformations. Herein, we summarize literature pertaining to segmentation in the context of this and other posterior fossa-based diseases such as trigeminal neuralgia, hemifacial spasm, and posterior fossa syndrome. A literature search for volumetric analysis of the posterior fossa identified 27 papers where semi-automated, automated, manual segmentation, linear measurement-based formulas, and the Cavalieri estimator were utilized. These studies produced superior data than older methods utilizing formulas for rough volumetric estimations. The most commonly used segmentation technique was semi-automated segmentation (12 studies). Manual segmentation was the second most common technique (7 studies). Automated segmentation techniques (4 studies) and the Cavalieri estimator (3 studies), a point-counting method that uses a grid of points to estimate the volume of a region, were the next most commonly used techniques. The least commonly utilized segmentation technique was linear measurement-based formulas (1 study). Semi-automated segmentation produced accurate, reproducible results. However, it is apparent that there does not exist a single semi-automated software, open source or otherwise, that has been widely applied to the posterior fossa. Fully-automated segmentation via such open source software as FSL and Freesurfer produced highly accurate posterior fossa segmentations. Various forms of segmentation have been used to assess posterior fossa pathologies and each has its advantages and disadvantages. According to our results, semi-automated segmentation is the predominant method. However, atlas-based automated segmentation is an extremely promising method that produces accurate results. Future evolution of segmentation technologies will undoubtedly yield superior results, which may be applied to posterior fossa related pathologies. Medical professionals will save time and effort analyzing large sets of data due to these advances.

Keywords: chiari, posterior fossa, segmentation, volumetric

Procedia PDF Downloads 67

Authors: Ozge Tahran, Sevgi Sevi Yesilyaprak

Abstract:

Objective: The aim of the study was to investigate the effect of the Wilk’s modified two different stretching exercises on posterior shoulder tightness, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). Method: This study was carried out on 67 patients who have more than 15° difference in shoulder internal rotation range of motion between two sides and had been diagnosed as SIS. Before treatment, all patients were randomly assigned into three groups. Standard physiotherapy programme was applied to the Group 3 (n=23), standard physiotherapy program with Wilk’s modified cross-body stretching exercises were applied to Group 1 (n=22), and standard physiotherapy program with Wilk’s modified sleeper stretching exercises were applied to Group 2 (n= 23). All the patients received 20 sessions of physiotherapy during 4 weeks, 5 days in a week by a physiotherapist. The patients continued their exercises at home at the weekends. Pain severity, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality with Constant and Murley Score (CMS) and disability level with The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were evaluated before and after physiotherapy programme. Results: Before treatment, demographic and anthropometric characteristics were similar in groups and there was no statistical difference (p > 0.05). It was determined that pain severity decreased, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality, and disability were improved after physiotherapy in both groups (p < 0.05). Group 1 and 2 had better results in terms of reduction of pain severity during activity, increase in shoulder rotation range of motion, posterior shoulder mobility and upper extremity functionality and improvement in upper extremity disability, compared to Group 3 (p < 0.05). Conclusion: Modified posterior shoulder stretching exercises in addition to standard physiotherapy programme is more effective for reduction of pain during activity, to improve shoulder rotation range of motion, posterior shoulder mobility, and upper extremity functionality in patients with SIS compared to standard physiotherapy programme alone.

Keywords: modified posterior shoulder stretching exercises, posterior shoulder tightness, shoulder complex, subacromial impingement syndrome

Procedia PDF Downloads 151

Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

Abstract:

Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

Procedia PDF Downloads 275

Authors: Mohammad Alobaidy, David Nicoll, Tracey Wilkinson

Abstract:

Background: Many patients suffer postoperative knee stability after total knee arthroplasty (joint replacement) involving posterior cruciate ligament (PCL) sacrificing or retaining, but is not clear whether the meniscofemoral ligaments (MFLs) are retained during these procedures; their function in terms of knee stability is not well established in the literature. Purpose: Macroscopic, detailed, morphometric investigation of the anterior and posterior MFLs of the knee joint was undertaken to assist understanding of knee stability after total knee arthroplasty and ligament reconstruction. Methods: Dissection of eighty Thiel embalmed knees from 19 male and 21 female cadavers was conducted, mean age 77 (range 47-99 years). The origin and insertion of the anterior and posterior MFLs were measured using high accuracy, calibrated, digital Vernier calipers at 0.01mm. Results: The means were: anterior meniscofemoral ligament (aMFL) length 28.4 ± 2.7mm; posterior meniscofemoral ligament (pMFL) length 29 ± 3.7mm; aMFL femoral width 6.4 ± 1.7mm, mid-distance ligament width 4 ± 1.1mm, meniscal ligament width 3.9 ± 1.2mm; pMFL femoral width 5.6 ± 1.5mm, mid-distance ligament width 4.1 ± 1.1mm, meniscal ligament width 4.1 ± 1.3mm. Some of the male measurements were larger than female, with significant differences in the length of the aMFL femoral length p<0.01 and pMFL femoral length p<0.007, and width of the pMFL mid-distance p<0.04. Conclusion: This study may help explore the role of the meniscofemoral ligaments in knee stability after total knee arthroplasty with a posterior cruciate ligament retaining prosthesis. Anatomical information for Thiel embalmed knees may aid orthopaedic surgeons in ligament reconstruction.

Keywords: anterior and posterior meniscofemoral ligaments, morphometric analysis, Thiel embalmed knees, knee arthroplasty

Procedia PDF Downloads 327

Authors: Ratnakar Rao, Subair Khan, Hari Haran

Abstract:

Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

Procedia PDF Downloads 231

Authors: Yasuyuki Takahashi, Hirotaka Shimada, Takao Kanzaki

Abstract:

A Dual-detector SPECT system is widely by use of myocardial SPECT studies. With 180-degree (180°) acquisition, reconstructed images are distorted in the posterior wall of myocardium due to the lack of sufficient data of posterior projection. We hypothesized that quality of myocardial SPECT images can be improved by the addition of data acquisition of only a few posterior projections to ordinary 180° acquisition. The proposed acquisition method (180° plus acquisition methods) uses the dual-detector SPECT system with a pair of detector arranged in 90° perpendicular. Sampling angle was 5°, and the acquisition range was 180° from 45° right anterior oblique to 45° left posterior oblique. After the acquisition of 180°, the detector moved to additional acquisition position of reverse side once for 2 projections, twice for 4 projections, or 3 times for 6 projections. Since these acquisition methods cannot be done in the present system, actual data acquisition was done by 360° with a sampling angle of 5°, and projection data corresponding to above acquisition position were extracted for reconstruction. We underwent the phantom studies and a clinical study. SPECT images were compared by profile curve analysis and also quantitatively by contrast ratio. The distortion was improved by 180° plus method. Profile curve analysis showed increased of cardiac cavity. Analysis with contrast ratio revealed that SPECT images of the phantoms and the clinical study were improved from 180° acquisition by the present methods. The difference in the contrast was not clearly recognized between 180° plus 2 projections, 180° plus 4 projections, and 180° plus 6 projections. 180° plus 2 projections method may be feasible for myocardial SPECT because distortion of the image and the contrast were improved.

Keywords: 180° plus acquisition method, a few posterior projections, dual-detector SPECT system, myocardial SPECT

Procedia PDF Downloads 260

Authors: Li-Hsueh Chen

Abstract:

Efficient operation is more and more important for managers of hotels. Unlike the manufacturing industry, hotels cannot store their products. In addition, many hotels provide room service, and food and beverage service simultaneously. When efficiencies of hotels are evaluated, the internal structure should be considered. Hence, based on the operational characteristics of hotels, this study proposes a DEA model to simultaneously assess the efficiencies among the room production division, food and beverage production division, room service division and food and beverage service division. However, not only the enhancement of efficiency but also the adjustment of scale can improve the performance. In terms of the adjustment of scale, scale elasticity or returns to scale can help to managers to make decisions concerning expansion or contraction. In order to construct a reasonable approach to measure the efficiencies and scale elasticities of hotels, this study builds an alternative variable-returns-to-scale-based two-stage network DEA model with the combination of parallel and series structures to explore the scale elasticities of the whole system, room production division, food and beverage production division, room service division and food and beverage service division based on the data of international tourist hotel industry in Taiwan. The results may provide valuable information on operational performance and scale for managers and decision makers.

Keywords: efficiency, scale elasticity, network data envelopment analysis, international tourist hotel

Procedia PDF Downloads 195

Authors: Malik Muhammad Arslan, Muneeb Ullah, Dai Shihan, Faizan Khan, Xiaodong Yang

Abstract:

Internet Service Providers are driving endless demands for higher bandwidth and data throughput as new services and applications require higher bandwidth. Users want immediate and accurate data delivery. This article focuses on converting old conventional networks into passive optical networks based on time division and wavelength division multiplexing. The main focus of this research is to use a hybrid of time-division multiplexing and wavelength-division multiplexing to improve network efficiency and performance. In this paper, we design an 80 Gbps Passive Optical Network (PON), which meets the need of the Next Generation PON Stage 2 (NGPON2) proposed in this paper. The hybrid of the Time and Wavelength division multiplexing (TWDM) is said to be the best solution for the implementation of NGPON2, according to Full-Service Access Network (FSAN). To co-exist with or replace the current PON technologies, many wavelengths of the TWDM can be implemented simultaneously. By utilizing 8 pairs of wavelengths that are multiplexed and then transmitted over optical fiber for 40 Kms and on the receiving side, they are distributed among 256 users, which shows that the solution is reliable for implementation with an acceptable data rate. From the results, it can be concluded that the overall performance, Quality Factor, and bandwidth of the network are increased, and the Bit Error rate is minimized by the integration of this approach.

Keywords: bit error rate, fiber to the home, passive optical network, time and wavelength division multiplexing

Procedia PDF Downloads 41

Authors: Xiyao Shan, Pavlos Evangelidis, Adam Kositsky, Naoki Ikeda, Yasuo Kawakami

Abstract:

The human triceps surae (two bi-articular gastrocnemii and one mono-articular soleus) have aponeuroses in the posterior and anterior aspects of each muscle, where the anterior aponeuroses of the gastrocnemii adjoin the posterior aponeurosis of the soleus, possibly contributing to the intermuscular force transmission between gastrocnemii and soleus. Since the mechanical behavior of these aponeuroses at different knee- and ankle-joint positions remains unclear, the purpose of this study was to clarify this through observations of the localized changes in passive stiffness of the posterior aponeuroses, muscle belly and adjoining aponeuroses of the medial gastrocnemius (MG) induced by different knee and ankle angles. Eleven healthy young males (25 ± 2 yr, 176.7 ± 4.7 cm, 71.1 ± 11.1 kg) participated in this study. Each subject took either a prone position on an isokinetic dynamometer while the knee joint was fully extended (K180) or a kneeling position while the knee joint was 90° flexed (K90), in a randomized and counterbalanced order. The ankle joint was then passively moved through a 50° range of motion (ROM) by the dynamometer from 30° of plantar flexion (PF) to 20° of dorsiflexion (DF) at 2°/s and the ultrasound shear-wave velocity was measured to obtain shear moduli of the posterior aponeurosis, MG belly, and adjoining aponeuroses. The main findings were: 1) shear modulus in K180 was significantly higher (p < 0.05) than K90 for the posterior aponeurosis (across all ankle angles, 10.2 ± 5.7 kPa-59.4 ± 28.7 kPa vs. 5.4 ± 2.2 kPa-11.6 ± 4.1 kPa), MG belly (from PF10° to DF20°, 9.7 ± 2.2 kPa-53.6 ± 18.6 kPa vs. 8.0 ± 2.7 kPa-9.5 ± 3.7 kPa), and adjoining aponeuroses (across all ankle angles, 17.3 ± 7.8 kPa-80 ± 25.7 kPa vs. 12.2 ± 4.5 kPa-52.4 ± 23.0 kPa); 2) shear modulus of the posterior aponeuroses significantly increased (p < 0.05) from PF10° to PF20° in K180, while shear modulus of MG belly significantly increased (p < 0.05) from 0° to PF20° only in K180 and shear modulus of adjoining aponeuroses significantly increased (p < 0.05) across the whole ROM of ankle both in K180 and K90. These results suggest that different knee-joint positions can affect not only the bi-articular gastrocnemius but also influence the mechanical behavior of aponeuroses. In addition, compared to the gradual stiffening of the adjoining aponeuroses across the whole ROM of ankle, the posterior aponeurosis became slack in the plantar flexed positions and then was stiffened gradually as the knee was fully extended. This suggests distinct stiffening for the posterior and adjoining aponeuroses which is joint position-dependent.

Keywords: aponeurosis, plantar flexion and dorsiflexion, shear modulus, shear wave elastography

Procedia PDF Downloads 160

Authors: Damla Tas, Robert Rudolf

Abstract:

Fast economic development and women empowerment in Korea have contributed to an unprecedented family and gender crisis, with Korean fertility rates at a global record low. This study explores the predictors and time trends of Korean women’s attitudes toward family formation and the household division of labor by using the Korean Longitudinal Survey of Women and Families from 2007 to 2018. Results indicate that education, age, marital status, and motherhood are significantly associated with women’s attitudes toward family formation and gender attitudes toward the intrahousehold division of labor. In addition, more educated women and those aged 26 to 45 are less likely to support traditional marriage and traditional household division of labor statements. Unmarried and divorced women are more likely to support progressive values and roles. Also, retrospective factors such as mothers’ schooling and parents’ relationship are significantly associated with gender role ideology. Our findings also indicate a downward trend in the number of Korean women stating one must have children. The study suggests that Korean families and society need to adjust to women’s changing preferences concerning their societal roles toward less traditional. Hence, a new agreement between men and women is needed on how work can be divided more equally.

Keywords: marriage, family formation, intrahousehold division of labor, gender role attitudes, Korea

Procedia PDF Downloads 42

Authors: Mosaad Hamouda, Kamal Khalaf, Zaker Mousa

Abstract:

National projects are considered Egypt's future vision in investing its various resources and the best way to bring about a developmental renaissance that constitutes a quantum leap because of its developmental impact on the planning regions, which it achieves in attracting and localizing investments to achieve urban development, and what this has a noticeable impact on dividing those regions in order to achieve a developmental balance or at least reduce the severity of the disparities between them, by measuring the impact of these projects, which appear in the per capita share of the various developmental variables, and also analyzing global and local experiences so that a balanced division of the country’s regions can be reached, and the research finds a set of planning foundations that are compatible with the settlement of these national projects in the future.

Keywords: national projects, regional development, division of regions, development disparities

Procedia PDF Downloads 87

Authors: Tan Dexian Arthur, James Wei Ming Kwek, Ian Loh, Lee Tee Sin

Abstract:

Statement of the Problem: Mucoceles most commonly affect the frontal sinus, which results from chronic obstruction of the sinus ostium or cystic dilatation of mucous glands with ductal obstruction. They are known to cause bony erosion of the sinus walls, which can lead to large defects. These defects were typically managed by obliteration or cranialization of the frontal sinus. Although short term outcomes of conservative management of significant posterior table defects from fractures are promising, there have been no studies on the long-term outcomes of large dehiscences in the posterior wall of the frontal sinus. Methodology & Findings : Computed Tomography (CT) Paranasal Sinuses images were analyzed and found complete spontaneous osteogenesis of a large dehiscent frontal sinus posterior wall, secondary to a large mucocele, 9 years from functional endoscopic sinus surgery with the defect managed conservatively. Conclusion & Significance: The dura is well known for its osteogenic properties. Prior studies have showed that dura could induce osteogenesis in cutaneous tissue in the absence of other central nervous system structures. It was also demonstrated that osteogenesis and chondrogenesis were possible in zygomatic fractures by transplanting neonatal dura grafts to the bony defects in rats. Extrapolating from these studies, the authors postulate that the presence of dura beneath the bony deformity of the posterior frontal sinus wall had likely initiated the osteogenesis and restored the bony defect in the patient. In our literature review, we did not find any reports of spontaneous osteogenesis of large frontal sinus defects. While our experience is incidental, it reinforces the osteogenetic potential of an intact dura and further highlights that selected large defects of the posterior wall of the frontal sinus can be conservatively managed.

Keywords: paranasal sinus mucocele, mucocele, osteogenesis, dehiscence

Procedia PDF Downloads 34

Authors: Hakim Derradji, M’Hammedi Yousra, Sabrou Abdelmalek, Tabet Nacer

Abstract:

Introduction: This is a retrospective study carried out at the Central Hospital of Army from 2017 to 2022. Its objective is to demonstrate the best surgical method for the management of obstructive hydrocephalus secondary to a posterior fossa tumor in children, in pre, per, and post-operative. Patients and Methods: During this period, 24 children (over 1 year old) were admitted for treatment of the posterior fossa tumor with obstructive secondary hydrocephalus and the majority of whom benefited from VCS followed by surgery and excision, the rest, received after evacuation from other hospital structures, were managed there beforehand with ventriculoperitoneal diversion or external drainage. We found that the way hydrocephalus is managed has implications for subsequent management, hence the need for this study to determine the effectiveness of different surgical procedures used in the treatment of hydrocephalus in these patients. The evaluation is made on the basis of revision rate, complications, survival, and radiological evaluation. Results: 6 patients (25%) received a ventriculoperitoneal shunt (VPD), 15 patients (62%) underwent a ventriculocysternostomy (VCS), and 3 patients (12.5%) received temporary ventricular drainage before or during tumor excision. The post-operative results were almost similar. Nevertheless, a high failure rate (25%) was observed. No deaths are recorded. In total, 75% of children who had a DVP were reoperated. The revision by VCS was performed, in addition to the 4 patients benefiting from a DVP, with one patient having received external drainage, and only one revision of a VCS was recorded. In the two patients who received external drainage, restoration of CSF outflow was observed following tumor resection. Conclusion: VCS is indicated in the first intention in the treatment of hydrocephalus secondary to a posterior fossa tumor, in view of the satisfactory results obtained and the high failure rate in DVP, especially with the presence of metastatic cells in the peritoneum, but can be considered as a second-line treatment.

Keywords: posterior fossa tumor, obstructive hydrocephalus, DVP, VCS

Procedia PDF Downloads 78

Authors: Naira Ghambaryan, Gagik Hakobyan

Abstract:

Purpose:The study was to evaluate the survival rate of short implants (5-6 mm) functionalized with UV radiation placed in the posterior segments of the atrophied maxilla. Materials and Methods:The study included 47 patients with unilateral/bilateral missing teeth and vertical atrophy of the posterior maxillary area. A total of 64 short UV-functionalized implants and 62 standard implants over 10 mm in length were placed in patients. The clinical indices included the following parameters: ISQБ MBL, OHIP-G scale. Results: For short implants, the median ISQ at placement was 62.2 for primary stability, and the median ISQ at 5 months was 69.6 ISQ. For standart implant, the mean ISQ at placement was 64.3 ISQ, and ISQ after 5 months was 71.6 ISQ. Аfter 6 months mean MBL short implants 0.87 mm, after 1 year, 1.13 mm, after 5 year was 1.48 mm. Аfter 6 months, mean MBL standard implants 0.84 mm, after 1 year, 1.24 mm, after 5 year was 1.58 mm. Mean OHIP-G scores -patients satisfaction with the implant at 4.8 ± 0.3, satisfaction with the operation 4.6 ± 0.4; satisfaction with prosthetics 4.7 ± 0.5. Cumulative 5-year short implants rates was 96.7%, standard implants was 97.4%, and prosthesis cumulative survival rate was 97.2%. Conclusions: Short implants with ultraviolet functionalization for prosthetic rehabilitation of the posterior resorbed maxilla region is a reliable, reasonable alternative to sinus lift, demonstrating fewer complications, satisfactory survival of a 5-year follow-up period, and reducing the number of additional surgical interventions and postoperative complications.

Keywords: short implant, ultraviolet functionalization, atrophic posterior maxilla, prosthodontic rehabilitation

Procedia PDF Downloads 48

Authors: Zahoor Ahmad

Abstract:

Casteism has played a pivotal role in the social setup and political manipulations in Punjab. This tradition dates back to pre-British history. A number of scholars produced valuable work attributing the caste prejudice and division among the local communities. As a matter of fact, the history of Punjab witnessed a tangible economic, Muslim-non-Muslim, hatred culture towards low-profile castes & professions, and so on. It is obvious that caste ridden system already existed in Punjab before the advent of the British, who tremendously supported the same, and this division evidently affected every aspect of the political as well as social life of the region. This article highlights the characteristics of different castes and the contemptuous behavior of the low castes & professions in the area further, how the caste system influenced the local people and their culture.

Keywords: casteism, caste prejudice, division, Punjab

Procedia PDF Downloads 60

Authors: Luksanaporn Krungkraipetch

Abstract:

One hundred cataract patients with phacoemulsification were enrolled in the study to compare of visual acuity outcome and complication after phacoemulsification between diabetic and non-diabetic patients at Burapha University Hospital, Chonburi, Thailand. Fifty patients were diabetic (type II) group and 50 patients were non-diabetic group. All cases were operated by one doctor with the same pre-operative care, operation (phacoemulsification), and post-operative care. Visual acuity and complication after surgery were assessed after the operation for two years. There were no significant differences in demographic data between the two groups. The visual outcome values ≥ 2 lines and ≥ 20/40 had no significant differences between two groups after two years of surgery. The complication rate in diabetic group had cystoid macular edema 16%, rupture posterior capsule 8%, posterior capsule opacity 2%, uveitis 2 %, and 2% endophthalmitis. The non-diabetic group had cystoid macular edema 12%, rupture posterior capsule 8%, uveitis 2%, posterior capsule opacity 2%, and 2% wound leak. Comparison of visual acuity outcome and complication after phacoemulsification between diabetic and non-diabetic patients had no statistical significant differences between these two groups. It was found that cystoid macular edema was the most common complication in both groups and 10% of retinopathy progression was seen.

Keywords: cataract, visual acuity, cataract extraction, phacoemulsification, diabetic retinopathy

Procedia PDF Downloads 313