Endovascular management of radial artery loop for neuroangiography: Case series

Background Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly. Methods We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed. Results A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure. Conclusions A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.

Navigating radial artery loops in neurointerventions

BackgroundAlthough studies continue to demonstrate lower complications in neurointerventions using transradial access (TRA) compared with transfemoral approaches, anatomic radial variants can be difficult to navigate and remain one of the frequent causes of access site conversion.ObjectiveTo evaluate predictors of TRA failure in neuroendovascular patients with radial loops and suggest a protocol for managing these anomalies.MethodsA prospective collection of patients undergoing TRA at participating institutions from July 2018 to September 2020 was reviewed. Patients with a radial loop were identified. Patient demographics and procedural characteristics were evaluated to determine predictors of both TRA failure and successful reduction of the radial loop.ResultsWe identified 32 transradial neurointerventions in which patients had radial loops. Twenty-two (68.8%) were identified by diagnostic angiography, and the majority were performed for evaluation or treatment of an aneurysm (56.3%). TRA failure occurred in 13 (40.6%) of the cohort and happened more frequently in patients over 60 years of age (p=0.01) and those with recurrent radial artery diameters ≤2 mm (p=0.02). Of the 19 patients who had successful TRA, 12 (63.2%) procedures were performed through the recurrent radial artery.ConclusionAlthough radial loops are associated with high transradial failure rates, our results suggest that the presence of a loop is not an absolute contraindication to TRA. Therefore, we recommend attempting loop navigation using our protocol. Patient age, vascular tortuosity, and recurrent radial artery size should help dictate when to convert to an alternative access site.

Predicting the degree of difficulty of the trans-radial approach in cerebral angiography

BackgroundTo evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult.MethodsA total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty.ResultsThe presence of a proximal radial loop had a higher conversion to femoral access (p<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were associated with more difficult trans-radial cerebral angiography and increased fluoroscopy time-per-vessel.ConclusionThe presence of a proximal radial loop, large diameter aortic arch, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans-radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans-radial angiography.

VARIATION DIFFERENCES OF PHALANX DISTAL FINGER PRINT PATTERN ON KLEPTOMANIA PATIENS AND NON-PATIENTS IN POLICE RESORT JEMBER

Phalanx distal pattern is a curve appeared and formed an unchangeable pattern unless it is caused by a severe trauma. Phalanx distal patterns are classified into 9, namely, Plain Arch, Tentarch, Ulnar loop, and Accidental. In order to find out suspect’s identity, Indonesia Autometic Print Identification System (INAFIS) used 3 stages, which one of them is to determine pattern variation. Phalanx distal fingerprint on human can be utilized as to identify a person, whereas no one has resembled phalanx distal fingerprint even on twins. In this research, the researcher analyzed tendentious pattern variation of phalanx distal pattern on kleptomaniac in police resort office Jember. Generally, phalanx distal fingerprint pattern found on kleptomaniac tendentiously has unique pattern plain arch as the third most apparent pattern beside unlar loop and whorl, meanwhile it was found radial loop on non-patient as the third most apparent beside unlar loop and whorl which generally was phalanx distal fingerprint.

Dermatoglyphics Pattern on Breast Cancer Patients in Dharmais Cancer Hospital

Dermatoglyphics is a study of the epidermal ridge in fingers, palms, soles, toes, and formed under genetic control at the beginning of the development of the fetus around 6–7 weeks and continues until 20–21 weeks. The development of the breast begins in a 6-week-old fetus in the epidermis and at the bottom of the mesenchyme. The development of the finger ridges and breast occurs at six weeks of gestation, and the abnormal genomes can be detected at this period and observed through dermatoglyphics. The purpose of this study was to determine the dermatoglyphic patterns of breast cancer patients in Dharmais Cancer Hospital from 12 December 2018 to 1 January 2019. The study was a descriptive study with a purposive sampling method for the determination of the sample. The quantitative data collected using questionnaires while the prints of dermatoglyphic patterns were from the fingertips of the respondent. From 100 respondents, the left-hand fingers and right-hand fingers dominated by radial loop pattern with the most significant percentage on the middle finger 62% and 77%, respectively. While the ring finger dominated by the plain whorl pattern 43%. In conclusion, the dermatoglyphics pattern on breast cancer patients in Dharmais Cancer Hospital dominated by a radial loop pattern. POLA DERMATOGLIFI TANGAN PASIEN KANKER PAYUDARA DI RUMAH SAKIT KANKER DHARMAISDermatoglifi merupakan ilmu yang mempelajari tentang pola sulur pada jari, telapak tangan, telapak kaki, dan jari kaki yang terbentuk di bawah kontrol genetik pada awal perkembangan usia janin sekitar 6–7 minggu serta terus berkembang sampai usia 20–21 minggu. Perkembangan payudara dimulai pada janin berusia 6 minggu dalam bentuk gumpalan padat yang berada di epidermis dan di bagian bawah mesenkim. Perkembangan sulur dermal dan payudara terjadi pada usia kehamilan enam minggu dan genom tidak abnormal dapat dideteksi pada periode ini dan dapat teramati melalui dermatoglifi. Tujuan penelitian ini mengetahui pola dermatoglifi pada pasien kanker payudara di Rumah Sakit Kanker Dharmais dari tanggal 12 Desember 2018 hingga 1 Januari 2019. Penelitian ini merupakan studi deskriptif dengan metode purposive sampling untuk penentuan sampel. Data kuantitatif diperoleh dengan menggunakan kuesioner, sedangkan cetakan pola dermatoglifi berasal dari ujung jari tangan responden. Dari 100 responden, jari tangan kiri dan jari tangan kanan didominasi oleh pola radial loop dengan persentase terbesar pada jari tengah sebesar 62% dan 77% masing-masing. Sementara jari manis didominasi oleh pola plain whorl sebesar 43%. Simpulan, pola dermatoglifi pada pasien kanker payudara di Rumah Sakit Kanker Dharmais didominasi oleh pola radial loop.

STUDI PENGARUH REKONFIGURASI LOOP SCHEME TERHADAP KEANDALAN PENYULANG BLAHKIUH DAN PENYULANG PANGLAN

Abstract—To improve reliability, the do loop system reconfiguration scheme to Blahkiuh feeders and feeders Panglan, by analyzing the calculation SAIFI and SAIDI, can the economy in terms of pressing / kWh minimize the number of unsold losses. Analysis of calculation results Blahkiuh feeders and feeder reconfiguration Panglan before result Blahkiuh feeder SAIFI 16.534 times/customers/year and the results SAIDI 35.894 hours/customer/year so the numbers of unsold kWh losses from the calculation not save 227,640.841 kWh energy equivalent to Rp 318,718,182.6, while for the results obtained Panglan feeder SAIFI 23.59 times/customer/year, the results of SAIDI 87.39 hours/ customer/year and the calculation results energy not save 238,037.099 kWh equivalent to Rp 364,672,835.7. After reconfiguration can minimize the number of SAIFI / SAIDI and losses, the results obtained Blahkiuh feeder SAIFI 2,089 times/ customers/year and the results SAIDI of 4.27 hours/customer/year, results energy not save 13369.314 kWh equivalent to Rp 20,481,733.86. For Panglan feeder SAIFI results obtained 1,218 times/customers/year and the results SAIDI 1,242 hours/ customer/year, results energy not save 3880.571 kWh equivalent to Rp 5,945,033.22. Intisari— Untuk meningkatkan keandalan maka dilakukan rekonfigurasi sistem loop scheme pada penyulang Blahkiuh dan penyulang Panglan, dengan menganalisa perhitungan SAIFI dan SAIDI, ditinjau dari segi ekonomi mampukah menekan/ memperkecil angka kerugian kWh yang tidak terjual. Hasil Analisa perhitungan penyulang Blahkiuh dan penyulang Panglan sebelum rekonfigurasi diperoleh hasil SAIFI penyulang Blahkiuh 16,534 kali/pelanggan/tahun dan hasil SAIDI 35,894 jam/pelanggan/tahun sehingga angka kerugian kWh tidak terjual dari hasil perhitungan energy not save 227.640,841 kWh setara dengan Rp 318.718.182,6, sedangkan untuk penyulang Panglan diperoleh hasil SAIFI 23,59 kali/pelanggan/tahun, hasil SAIDI 87,39 jam/pelanggan/tahun dan hasil perhitungan energy not save 238.037,099 kWh setara dengan Rp 364.672.835,7. Setelah rekonfigurasi dapat memperkecil angka SAIFI/SAIDI dan kerugian yang dialami, pada penyulang Blahkiuh didapat hasil SAIFI 2,089 kali/pelanggan/tahun dan hasil SAIDI 4,27 jam/pelanggan/tahun, hasil energy not save 13.369,314 kWh setara dengan Rp 20.481.733,86. Untuk penyulang Panglan didapat hasil SAIFI 1,218 kali/pelanggan/tahun dan hasil SAIDI 1,242 jam/pelanggan/tahun, hasil energy not save 3.880,571 kWh setara dengan Rp 5.945.033,22. Kata Kunci : Sistem radial, Loop scheme, SAIFI/SAIDI, Energy not save [Turnitin Chek 12% 13042017]

Gambaran Pola Sidik Jari dan Sudut Axial Triradius Digital (ATD) pada Anak Sekolah Dasar Negeri 144, Talang Betutu, Palembang, Sumatera Selatan

Pola sidik jari, sulur tangan dan sudut triradius setiap orang memiliki keunikan dan khas untuk setiap individu. Tidak akan ada individu yang sama. Penelitian ini bertujuan mengetahui bagaimana pola sidik jari dan sudut ATD pada anak SD N 144, Talang Betutu, Palembang. Penelitian ini merupakan penelitian deskriptif dengan sampel diperoleh 72 orang secara total smpling. Gambar pola sidik jari dan sudut ATD responden diperoleh dengan cara meletakkan ke sepuluh jari tangan dan kedua telapak tangan responden di bantalan cap tinta kemudian diletakkan pada lembar observasi untuk dilakukan analisis. Hasil penelitian didapatkan 4 pola sidik jari pada responden yaitu radial loop, ulnar loop, whorl, dan tented arch. Frekuensi terbanyak adalah pola whorl (62,8%), dan yang paling sedikit adalah tented arch (4,2%). Responden dengan sudut ATD <30? pada tangan kanan sebesar 5,6% dan tangan kiri sebesar 3%, dengan distribusi sudut ATD terbanyak dengan besaran 30-50? yaitu sebesar 93,1%.