RESUMEN
It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.
RESUMEN
The dorsal metacarpal veins are frequently cannulated. Cannulation success is determined by several variable anatomic features. The objective of this study is to classify, for the first time, the anatomic variants of the dorsal metacarpal veins. In this cross-sectional study, 520 university students and staff were conveniently recruited. The dorsal metacarpal veins in 1040 hands were studied. Venous visibility was enhanced by either tourniquet application or near-infrared illumination. Variant patterns of the dorsal metacarpal veins were classified. The final analysis included 726 hands, for an exclusion rate of 30 %. Eight pattern types were identified. Three anatomic features informed the variation. Bilateral symmetry of the dorsal metacarpal veins was present in 352 participants (83 % of the total). The overall frequency distribution of variants in both hands was similar (P = 0.8). The frequency distribution of variants was subject to sexual dimorphism (P = 0.001), ethnic variation (P < 0.001), and technical variation (P < 0.001). The anatomic variants of the dorsal metacarpal veins were sorted into decreasingly frequent primary, secondary, and tertiary groups. The groups may signify a progressive increase in difficulty of peripheral cannulation, in the mentioned order. As such, primary patterns are the most common and likely the easiest to cannulate, while tertiary patterns are the least common and likely the most difficult to cannulate. The preceding premise, in tandem with the bilateral asymmetry of the veins, is clinically significant. With cannulation difficulty likely signifying an underlying tertiary pattern, the contralateral dorsal metacarpal veins are probabilistically characterized by a primary pattern and are, as such, the easier option for peripheral venous cannulation.
Asunto(s)
Variación Anatómica , Mano/irrigación sanguínea , Huesos del Metacarpo/irrigación sanguínea , Venas/anatomía & histología , Adulto , Cateterismo Periférico , Estudios Transversales , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
AIM: To study the epidemiology of gastric malignancies in Jordan as a model for Middle East countries where such data is scarce. METHODS: Pertinent epidemiological and clinicopathological data for 201 patients with gastric malignancy in north of Jordan between 1991 and 2001 were analyzed. RESULTS: Male: female ratio was 1.8:1. The mean age was 61.2 years, and 8.5% of the patients were younger than 40 years of age. The overall age-adjusted incidence was 5.82/100 000 population/year. The age specific incidence for males raised from 1.48 in those aged 30-39 years to 72.4 in those aged 70-79 years. Adenocarcinomas, gastric lymphomas, malignant stromal tumors, and carcinoids were found in 87.5%, 8%, 2.5%, and 2% respectively. There was an average of 10.1-month delay between the initial symptoms and the diagnosis. Only 82 patients underwent curative gastrectomy. Among adenocarcinoma groups, Lauren intestinal type was the commonest (72.2%) and the distal third was the most common localization (48.9%). The mean follow up for patients with gastric adenocarcinoma was 25.1 mo (range 1-132 mo). The 5-year survival rates for stages I (n=15), II (n=41), III (n=59), and IV (n=53) were 67.3%, 41.3%, 5.7%, and 0% respectively (P=0.0001). The overall 5 year survival was 21.1%. CONCLUSION: Despite low incidence, some epidemiological features of gastric cancer in Jordan mimic those of high-risk areas. Patients are detected and treated after a relatively long delay. No justification in favor of a possible gastric cancer screening effort in Jordan is supported by our study; rather, the need of an earlier diagnosis and subsequent better care.