Pericardiocentesis: a clinical anatomy review.

The safe and successful performance of pericardiocentesis demands a working and specific knowledge of anatomy. Misunderstanding of anatomy may result in failure or serious complications. This review attempts to aid understanding of the anatomical framework, pitfalls, and complications of pericardiocentesis. Pericardiocentesis is carried out for aspiration of blood from the pericardial cavity in cases of cardiac tamponade and symptomatic pericardial effusion. In addition, this technique may be used for the diagnosis of neoplastic effusions, purulent pericarditis, and introduction of cytotoxic agents into the pericardial space. Most complications of the procedure are due to the needle penetrating the heart and surrounding structures such a coronary arteries, lungs, stomach, colon, and liver. These complications, if severe, may result in pneumothorax, hemothorax, arrhythmias, infections or arterial bleeding. Therefore, the more fluid or blood there is between the myocardium and pericardium--within the pericardial cavity--the less chance of complications. With a thorough knowledge of the complications, regional anatomy and rationale of the technique, and adequate experience, a pericardiocentesis can be carried out safely and successfully.

Proximal great saphenous vein cut down: an evaluation of techniques and anatomical considerations.

Cut-down techniques by which emergency venous access can be achieved are important, particularly, in the resuscitation of haemodynamically depleted patients where percutaneous access to collapsed veins is a problem. The aim was to evaluate the efficacy of different methods that are used to locate the proximal great saphenous vein in the thigh and to describe the vein's immediate course. A further component was to identify the position of the valves in the proximal great saphenous vein. Needles were placed in 42 cadaver thighs as defined by the techniques identified from the literature and surgical practice. After a detailed dissection, the vein's relation to these needles was measured and the course of the vein and number of valves noted in relation to easily identifiable landmarks. Landmarks in 2.5-cm intervals on a line from the pubic tubercle to the adductor tubercle of the femur were used. The rule of two's, an experimental method by one of the authors, along with Dronen's second method localized the vein most successfully. The course of the vein was scrutinized and found to have a rather direct course as it proceeded medially toward the saphenous hiatus. The largest population of valves could be found in the proximal 5 cm (76%) with a valve in the confluence of the great saphenous vein and the femoral vein being the most common. Valve populations were found to decrease in number from proximal to distal, which would have implications with the placement of catheters into the vein for fluid resuscitation.

Central venous catheterization--an anatomical review of a clinical skill. Part 2. Internal jugular vein via the supraclavicular approach.

The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the internal jugular veins. CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.

Superficial radial nerve injury during standard K-wire fixation of uncomplicated distal radial fractures.

This study determines the incidence of superficial radial nerve injury after Kirchner wire insertion. An experienced orthopedic surgeon inserted the K-wires into the radii of 92 adult cadavers. Subsequent dissection of the area exposed the superficial radial nerve and any observed nerve injury was documented. It is clear from the results that nerve injury may still occur as a result of K-wire insertion; however, the current method of K-wire insertion still proves to be a reliable and safe procedure for fixation of distal radial fractures.

[Avoidable visual impairment in The Netherlands: the project "Vision 2020 Netherlands" of the World Health Organization]. / Vermijdbare slechtziendheid in Nederland: het project 'Vision 2020 Netherlands' van de Wereldgezondheidsorganisatie.

In the year 2004 there were an estimated 220,000-320,000 people in The Netherlands with visual impairment. In 150,000-220,000 (70%) of them the visual impairment is either curable or could have been prevented. Those most at risk are people with intellectual disabilities, elderly people in care institutions, elderly people in general and diabetics. 'Vision 2020 Netherlands', an initiative of the World Health Organization, was launched to eliminate avoidable visual impairment in the Netherlands by the year 2020 by means of awareness campaigns, implementation of screening programmes and by expanding eye care capacity through efficient cooperation between the professional groups involved in eye care.

Congenital myotonic dystrophy; a report on thirteen cases and a review of the literature.

The congenital variant of myotonic dystrophy (CMD) is a severe disease with a high mortality. CMD is only seen in the offspring of mothers who themselves have myotonic dystrophy (MD). We present 13 patients with clinical symptoms of CMD and neuropathological findings of five of them. The most characteristic symptoms during pregnancy are reduced fetal movements and polyhydramnios. In the neonatal period generalized hypotonia, facial weakness, hyporeflexia, feeding and respiratory difficulties are present. Most of the children have a characteristic tented upper lip. The symptoms greatly diminish after a few weeks. All the children who survive the neonatal period are psychomotor retarded. On pathological examination no specific features were found in muscle tissue or in the brain. The pathogenesis and the cause of the maternal inheritance of CMD is not clear. A review of the literature is provided.

Enlargement of the photorefractive keratectomy optical zone.

PURPOSE: To evaluate the safety and efficacy of a photorefractive keratectomy (PRK) re-treatment procedure that enlarges the optical zone and treats undercorrection. SETTING: Rotterdam Eye Hospital and Medisch Centrum Alkmaar, The Netherlands. METHODS: This study evaluated 16 eyes that had PRK for myopia with the Summit excimer laser that resulted in a mean undercorrection of -2.82 diopters (D). Patients also reported impaired night vision including difficulty in driving, halos, and stray light and ghost images. These phenomena persisted after spectacle correction of residual refractive error, necessitating further treatment with a larger ablation zone. With a VISX 20/20 excimer laser, the optical zone was enlarged to 6.0 mm and undercorrection treated with a 6.0 mm ablation. RESULTS: At 13.5 months after re-treatment, mean reduction in myopia was 1.70 D, resulting in a residual undercorrection of -1.08 D. In seven eyes, final refraction was within 1.00 D of emmetropia. Only two patients continued to report night-driving problems. CONCLUSIONS: Re-treating undercorrections combined with enlarging the ablation zone resulted in a reduction in myopia from a mean of 2.82 to 1.08 D. Subjective reports of halos and stray light images were decreased in all cases.

Enzyme activities of the mitochondrial energy generating system in skeletal muscle tissue of preterm and fullterm neonates.

Quadriceps muscle specimens from autopsy of 28 neonates (gestational age 25-42 weeks) were investigated to determine pyruvate and malate oxidation rates and several enzymes of the mitochondrial oxidative process. In general, the levels of all mitochondrial parameters measured, including carnitine levels, were lower in the neonates who died within the first week of life than those in the control group (age > 5 years). Pyruvate and malate oxidation rates (P < 0.05), activities of pyruvate dehydrogenase complex (P < 0.10) and succinate: cytochrome c oxidoreductase (P < 0.05) increased significantly with gestational age. Pyruvate oxidation rates (P < 0.05) as well as activities of citrate synthase (P < 0.05) and NADH:Q1 oxidoreductase (P < 0.05) were significantly lower in the group of very preterm infants at an age of 1-7 days compared with very preterm infants at an age between 3-8 weeks. We conclude from our study that special reference values are necessary for a correct biochemical diagnosis of mitochondrial encephalomyopathies in the neonatal period. Differences between preterm and fullterm children of the same age (1 week) indicate a maturational process in human muscle tissue during gestation. Comparison of two different age groups within the very preterm neonates point to a postnatal maturation of the mitochondrial energy metabolism, at least in preterm neonates.

One-year morbidity in very premature infants: prognostic value of duration of pregnancy, birthweight and neonatal morbidity.

Morbidity in the first year of life of 120 infants, born before the 34th wk of pregnancy, was studied in relationship to both duration of pregnancy and birthweight. Moreover, the interrelationships of morbidity in three time-periods (first-hour, first 28 days and first year after delivery) were studied. The major handicap rate at one year was 5%, without major handicaps in infants born before 29 wk or weighing less than 1250 g. This finding seems to justify intensive treatment of even the youngest and smallest infants. Significantly more morbidity in the first 28 days of life was found when intervention within the first hour after delivery was necessary, indicating that morbidity in the first hour after delivery may be a prognostic bad sign for morbidity in the first 28 days of life. However, no significant differences in handicap rates at one year of age were found in infants with and without morbidity in the first hour or in the first 28 days. This indicates that early morbidity will not necessarily be followed by morbidity in later life, but, on the other hand, absence of early morbidity does not preclude handicaps later on.

Survival probabilities of infants delivered prior to the 34th week of pregnancy as estimated by means of a logistic model.

Survival of 188 infants born alive before the 34th wk of pregnancy is assessed in relation both to birthweight and duration of pregnancy. A logistic model is used which describes, based on these parameters, probabilities of 1-yr survival of relatively small populations in a continuous way. Although there may be differences between measured and estimated birthweight, this method might enable the perinatologist to estimate before birth the survival probabilities if he knows the duration of pregnancy and estimated birthweight.

Evaluation of clinical relevance of a problem-orientated head and neck module.

Current trends in medical education focus on outcomes-based learning as a means to facilitate student learning. The aim of this study was to evaluate a clinically applied module in head and neck anatomy for third-year dental students. The module linked clinical examination, regional dental blocks simulated on cadaver specimens, radiographic images and clinical case scenarios. A Likert-type questionnaire, completed by all students (n = 49), was used to evaluate student perceptions of this module objectively. The results indicate that an average number of students found that clinical examination received sufficient time (mean: 2.98) during the module, while a substantial number of students agreed that the integration of dental procedures stimulated them to study specific regional anatomy (mean: 3.82) and increased their interest in their future careers as dentists (mean: 4.04). The radiographs improved their understanding of anatomy (mean: 3.41) while the clinical case studies were a positive learning experience (mean: 3.10). The majority of students (mean: 4.12) felt that they were continuously made aware that they were studying appropriate matter for their future work as dentists. It seems evident that the integration of clinically relevant content facilitates and encourages the understanding of anatomy.

[Noninvasive blood pressure determination in newborn infants]. / Non-invasieve bloeddrukmeting bij de pasgeborene.

In 69 newborns (birth weight 900-3820 grams; gestational age 27-41 weeks) the Dinamap device was used to establish normative values for systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for this indirect, non-invasive blood pressure monitoring system. Reference values for the first day after delivery in different birth weight groups are given and the changes during the first three days of life are shown. Blood pressure variability as a possible additional parameter in neonatal monitoring was found to be independent of birth weight and gestational age.