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Thoracic Spine Anatomy

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121. An Overview of Clinical Applications of 3-D Printing and Bioprinting

. 75 Because the spine has complex anatomy and is surrounded by delicate structures, 3-DP models and devices that help surgeons plan and accurately execute procedures could also help improve patient outcomes. 76 It has been reported that, as case complexity increased, so did the benefits of using 3-DP such as reduced operative time and perioperative blood loss. 3-DP surgical guides were reported to help mitigate the risks of procedures. 76 The use of 3-DP in neurosurgery 75 includes the development (...) models have been developed for infrarenal and juxtarenal arteries, abdominal aortic aneurysm, and thoracic aorta pathology and 3-DP of vessel pathologies have been used to better understand anatomy and post-surgical complications. 78 Plastic and Reconstructive Surgery 3-DP is being studied and used in plastic and reconstructive surgery for procedural planning, the creation of surgical tools, and the customization of implants. 3-DP has been studied or used in maxillofacial surgery, dental implant

2019 CADTH - Issues in Emerging Health Technologies

122. Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD)

of 0.5% solution, are the most common anesthetic types and dosages used in SGB. 39 To avoid potential serious adverse effects of inaccurate needle placement to the anatomy surrounding the stellate ganglion, use of image-guidance techniques such as ultrasound, fluoroscopy, or computed tomography are recommended to help visualize the injection area. SGB performance also requires the availability of continuous vital sign monitoring technology and resuscitative equipment and personnel to monitor (...) used these as our general guideposts: = 15-point reduction on the Clinically-Administered PTSD Scale (CAPS), 56 a = 10-point reduction on the PTSD Checklist (PCL) 57 and a = 30% reduction in general 58 o Intermediate benefits: Change in symptom scale scores for PTSD, depression, functional status, quality of life · Harms: Complications including arrhythmia; hypotension; hematoma due to injury to adjacent vascular structures; thoracic duct injury; injection of local anesthetic into the intravascular

2017 Veterans Affairs Evidence-based Synthesis Program Reports

123. Physiologic Predictors of Severe Injury: Systematic Review

of risk and match patient risk to hospital transport decisions. The first step is to assess variables such as level of consciousness, circulation, and respiration. This assessment is combined with the results of the second step, an assessment of the anatomy of the injury. The combined results of steps 1 and 2 are used to identify the most seriously injured patients who “should be transported preferentially to the highest level of care within the defined trauma system.” 5 The initial triage criteria (...) in the current guidelines are physiologic status and level of consciousness. Measures, monitors, and tools are needed to facilitate assessment of physiologic status because, unlike the anatomy of the injury, physiologic status cannot be directly observed. Thresholds indicating need for major level trauma care have been operationalized in the triage guidelines as Glasgow Coma Scale (GCS) =13, systolic blood pressure (SBP) 29 breaths per minute (>20 in infants aged less than 1 year) or need for ventilatory

2018 Effective Health Care Program (AHRQ)

124. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

in those guidelines but chose instead to provide current suggestions or considerations for clinical practice and to clarify previous discrepancies if present. Anatomy and Embryology of the RV Several developmental and anatomic features distinguish the RV from the LV. , The RV and RV outflow tracts originate from cells of the secondary (anterior) heart field, whereas the LV and left atria originate from the primary heart field. The identification of the secondary heart field has provided new insight (...) in afterload. Response of the RV and LV to an experimental increase in afterload. Note the comparatively steep decline in stroke volume associated with increases in pressure compared with the smaller reductions seen in LV stroke volume associated with similar pressure increments. Reprinted with permission of the American Thoracic Society. Copyright © 2018, American Thoracic Society. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part one. Am J Respir Crit Care Med

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2018 American Heart Association

125. Chronic Dyspnea : Noncardiovascular Origin

or chest wall. Initial imaging. Radiography Chest Pleural effusion is often diagnosed by a chest radiograph, and volume can reasonably be estimated [76]. A radiograph is somewhat limited in its ability to determine the exact location of an abnormality, whether parenchymal, pleural, or extrapleural. A chest radiograph may reveal structural abnormalities of the sternum, ribs, and thoracic spine that may predispose toward dyspnea. CT Chest CT is superior to radiographs in detecting and characterizing (...) Be Appropriate O US chest May Be Appropriate O CT chest with IV contrast Usually Not Appropriate ??? CT chest without and with IV contrast Usually Not Appropriate ??? CT chest without IV contrast Usually Not Appropriate ??? ACR Appropriateness Criteria ® 3 Chronic Dyspnea-Noncardiovascular Origin CHRONIC DYSPNEA-NONCARDIOVASCULAR ORIGIN Expert Panel on Thoracic Imaging: Barbara L. McComb, MD a ; James G. Ravenel, MD b ; Robert M. Steiner, MD c ; Jonathan H. Chung, MD d ; Jeanne B. Ackman, MD e ; Brett Carter

2018 American College of Radiology

126. Acutely Limping Child Up To Age 5

imaging study [44]. Large field-of-view coronal T1-weighted and fluid-sensitive sequences covering from the pelvis and hips to the ankles may be performed to identify any abnormality. Inclusion of the lower thoracic spine and lumbar spine should be considered if lower extremity or hip pathology is not found and symptoms persist, as some patients with discitis may not have localized symptoms to the back [45-48]. Once localized, additional MRI sequences with smaller fields of view can be performed (...) (Disagreement) ? Radiography lumbar spine Usually Not Appropriate ?? Radiography pelvis Usually Not Appropriate ?? US hips Usually Not Appropriate O US lower extremity Usually Not Appropriate O CT lower extremity with IV contrast Usually Not Appropriate ???? CT lower extremity without and with IV contrast Usually Not Appropriate ????? CT lower extremity without IV contrast Usually Not Appropriate ???? MRI lower extremity without and with IV contrast Usually Not Appropriate O MRI lower extremity without IV

2018 American College of Radiology

127. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart

require a peer-to-peer conversation include: ¾ CT brain and CT sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent

2018 AIM Specialty Health

128. Appropriate Use Criteria: Imaging of the Head & Neck

sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice (...) a, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006;296(10):1274-1283. 31. Devenney E, Neale H, Forbes RB. A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? J Headache Pain. 2014;15(1):49. 32. Donington J, Ferguson M,Thoracic Oncology Network of American College of Chest Physicians; Workforce on Evidence-Based Surgery of Society of Thoracic Surgeons, et al. American College of Chest

2018 AIM Specialty Health

129. Appropriate Use Criteria: Imaging of the Chest

al. Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation–initial experience. Radiology. 2005; 234(3): 702-709. 33. Kanne JP, Jensen LE, Mohammed TL, et al.; American College of Radiology Expert Panel on Thoracic Imaging. ACR appropriateness Criteria® radiographically detected solitary pulmonary nodule. J Thorac Imaging. 2013;28(1):W1-W3. 34. Kazerooni EA. High-resolution CT of the lungs. AJR Am J Roentgenol. 2001;177(3):501-519. 35 (...) circumstances that support the medically necessity of performing all imaging studies simultaneously. Examples of multiple imaging studies that may require a peer-to-peer conversation include: ¾ CT brain and CT sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral

2018 AIM Specialty Health

130. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice (...) with endovascular stent graft ? Suspected complication of an aneurysm/dilation, such as aneurysmal rupture or infection—requiring urgent imaging ? Prior to transcatheter aortic valve implantation/replacement (TAVI or TAVR), unless advanced imaging has been performed for this indication within the preceding 60 days Aortic dissection ? May evaluate with either CT or CTA ? Usually results from subdiaphragmatic extension of a thoracic aortic dissection Thrombosis in the systemic and portal venous circulations

2018 AIM Specialty Health

131. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

treatment to a higher dose, the IGRT group was noted to have similar genitourinary and gastrointestinal toxicities. Pre-treatment corrective left-right, anteroposterior and superoinferior shifts were required in 15%, 6% and 19% of cases respectively supporting the use of pre- treatment imaging. The ACR-ASTRO practice parameter for IGRT indicates that “when the target is not clearly visible and bony anatomy is not sufficient for adequate target alignment, fiducial markers may be needed.” For soft tissue (...) radiotherapy in their Health Policy Coding Guidance document. A recent study of the setup accuracy for lung cancer treatment showed that when compared to tattoos, using cone beam CT registration to the spine and carina improved target coverage approximately 50% of the time. Even using skin tattoos, however, the combined lung and nodal targets were found to be within the PTV over 97% of the time. Tumor motion during the breathing cycle needs to be evaluated and managed when highly conformal radiation

2018 AIM Specialty Health

132. Exam Series: Guide to the Shoulder Exam

injury may manifest as asymmetric weak distal pulses, parasthesias, or an expanding hematoma. The risk of vascular injury is higher in displaced fractures and in elderly patients with atherosclerosis. Nerve injury can present with weakness, parasthesias, and muscular atrophy. Thoracic outlet syndrome occurs with compression of the trunk of the brachial plexus and subclavian vessels in the tissue between the neck and axilla. Neck exam : Degenerative cervical spine injuries may compress nerve roots (...) deformities of the clavicle or acromioclavicular joint indicates fracture or separation. Winging of the scapula, best appreciated when the patient pushes up against a wall, indicates damage to the serratus anterior muscle and injury to the long thoracic nerve. Palpation : Beginning at the sternum palpate the sternoclavicular joint assessing for stability, warmth, and tenderness. Systemically move across the clavicle to the acromioclavicular joint, then palpate around the head of the humerus

2018 CandiEM

133. Exam Series: Guide to the Back Exam

for paraspinal muscles and providing protection to the spinal canal. The 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 fused vertebrae in both the sacrum and coccyx articulate at facet joints and intervertebral discs. The posterior longitudinal ligament and anterior longitudinal ligament limit flexion and extension of the spine, while the intertransverse ligament provides support to the transverse processes. The spinal column runs until L1-L2, after which it splits into the cauda equina. Cervical nerve (...) and CVA tenderness may indicate renal pathology. Inspection : Examine the patient’s posture. Asymmetry in the shoulder height may indicate scoliosis, which becomes more pronounced during the Adam’s Forward Bend test where the patient bends forward at the hips with straight legs. A lateral view of the back reveals the four natural curves of the spine – cervical lordosis, thoracic kyphosis, lumbar lordosis, and coccygeal kyphosis. Examine the paraspinal muscles for swelling, atrophy, erythema, or other

2018 CandiEM

134. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain

patients who benefit from ketamine in the acute pain setting fall into several categories. The first group of patients is those who are undergoing painful surgery, after which the expected postoperative pain rating is considered to be in the severe range. Examples of surgical procedures in which the benefits seem to be the greatest include upper abdominal surgery and thoracic surgery; orthopedic limb, spine, intra-abdominal, and lower abdominal procedures also appear to be painful enough to warrant (...) ). Loftus and colleagues found ketamine reduced postoperative and long-term opioid use in opioid-dependent patients undergoing spine surgery, whereas another study reported that opioid-tolerant patients undergoing multiple different surgeries who received ketamine experienced improved average pain ratings postoperatively. There are also less impressive and negative studies in this patient population. In studies examining the use of low-dose ketamine added to opioid patient-controlled analgesia

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2018 American Society of Regional Anesthesia and Pain Medicine

135. Evaluation and Management of Right-Sided Heart Failure

focuses on the evaluation and management of RHF. Some topics may have been reviewed in other clinical practice guidelines and scientific statements published by other working groups, including the American College of Cardiology/AHA task forces. The writing committee saw no need to reiterate the recommendations contained in those guidelines but chose instead to provide current suggestions or considerations for clinical practice and to clarify previous discrepancies if present. Anatomy and Embryology (...) compared with the smaller reductions seen in LV stroke volume associated with similar pressure increments. Reprinted with permission of the American Thoracic Society. Copyright © 2018, American Thoracic Society. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part one. Am J Respir Crit Care Med . 1994;150:883–852. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society. In the setting of left-sided heart

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2018 International Society for Heart and Lung Transplantation

136. CRACKCast E176 – Pediatric Musculoskeletal Disorders

are the investigations in a complete skeletal survey (shownotes) The standard skeletal survey [from Uptodate] Appendicular skeleton Humeri (AP) Forearms (AP) Hands (PA) Femurs (AP) Lower legs (AP) Feet (AP) Axial skeleton Thorax (AP, lateral, right and left oblique views to include ribs, thoracic spine and upper lumbar spine) Ribs (oblique views) Abdomen (AP, to include pelvis) Lumbosacral spine (lateral) Skull (frontal and lateral) Cervical spine (lateral, if not completely visualised on lateral skull) Technique (...) CRACKCast E176 – Pediatric Musculoskeletal Disorders CRACKCast E176 – Pediatric Musculoskeletal Disorders - CanadiEM CRACKCast E176 – Pediatric Musculoskeletal Disorders In by Adam Thomas May 10, 2018 Children can injure themselves just like adults, but their growing anatomy can be quite different. Today, let’s explore Rosen’s chapter 175 on paediatric musculoskeletal disorders. Shownotes – Text in italics is from Rosen’s 9 th edition, chapter 175 Key concepts [podcasted items in bold

2018 CandiEM

137. Imaging Guidelines

Imaging Guidelines ACS TQIP BEST PRACTICES GUIDELINES IN IMAGING ER AS 1988 THE AMERICAN SOCIETY OFTable of Contents Introduction 3 1. Overview 4 Part 1: General Issues 4 Part 2: Contrast Considerations 8 Part 3: Sedation 10 2. Brain Imaging 15 3. Cervical Spine Imaging 21 4. Imaging for Blunt Cerebrovascular Injury 32 5. Chest Imaging 36 6. Abdominal Imaging 40 7 . Genitourinary Imaging 45 8. Thoracic and Lumbar Spine Imaging 48 9. Whole-Body CT Imaging 51 10. Imaging in Orthopaedic Trauma 56 (...) ) and/or extraperitoneal pelvis (pelvis radiograph). These radiographs allow the treating physician to expeditiously assess for, and immediately intervene in, life-threatening conditions such as cardiac tamponade, pneumothorax, or hemothorax. Perform a chest radiograph in all trauma patients with potential for thoracic injury and for evaluation of any tubes and lines placed during resuscitation. In the experienced provider’s hands, FAST may have sensitivities higher than a conventional chest radiograph

2018 American College of Surgeons

138. Paediatric Urology

or 3 years. J Urol, 2007. 178: 1589. 75. Novaes, H.F., et al. Single scrotal incision orchiopexy - a systematic review. Int Braz J Urol, 2013. 39: 305. 76. Docimo, S.G. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol, 1995. 154: 1148. 77. Ziylan, O., et al. Failed orchiopexy. Urol Int, 2004. 73: 313. 78. Prentiss, R.J., et al. Undescended testis: surgical anatomy of spermatic vessels, spermatic surgical triangles and lateral spermatic ligament. J Urol (...) . Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study. J Pediatr Urol, 2014. 10: 605. 91. Kirsch, A.J., et al. Surgical management of the nonpalpable testis: the Children’s Hospital of Philadelphia experience. J Urol, 1998. 159: 1340. 92. Fowler, R., et al. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg, 1959. 29: 92. 93. Koff, S.A., et al. Treatment of high undescended testes by low

2018 European Association of Urology

139. Renal Cell Carcinoma

in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics, 2001. 21 Spec No: S237. 96. Wittekind Ch., et al. TNM supplement, A Commentary on Uniform Use. Wittekind Ch., Greene F., Henson D.E., Hutter R.V., Sobin L.H., Editors. 2012, Wiley-Blackwell. 97. Klatte, T., et al. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy. Eur Urol, 2015. 68: 980. 98. Spaliviero, M., et al. An Arterial Based Complexity

2018 European Association of Urology

140. Intralaminar screw insertion of thoracic spine in children with severe spinal deformities: two case reports. (PubMed)

Intralaminar screw insertion of thoracic spine in children with severe spinal deformities: two case reports. Case report.To describe a technique of thoracic fixation in pediatric cases with anatomy not amenable to hooks and pedicle screws.Intralaminar screws have been described in cervical and lumbar spines. There is only 1 report of the use of thoracic intralaminar screws being used for kyphotic deformity in adult patients.We performed fixation of the thoracic spine using laminar screws in 2 (...) patients with severe spinal deformities in whom pedicle screws and hooks failed to maintain the desired correction. Clinical and radiologic features of both cases are reported. The surgical technique is described.Intralaminar screws of the thoracic spine were successfully placed in 2 children with severe spinal deformities to achieve proximal fixation. Neither dorsal nor ventral cortical bone violations of the laminae were identified. In 1 case, pedicles were too small and sclerotic to accommodate

2009 Spine

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