Role of computed tomography in diagnosis and clarifying the classification of patello-femoral malalignment

The role of the conventiomal axial radiographs of the patellofemoral joint in assessing patients suffering from peripatellar pain is limited. Therefore Computed Tomography [CT] was used to evaluate 40 patients with persistent patello-femoral pain, and ten asymptomatic volunteers as a control group. Mid patellar transaxial cuts were taken for all of them at 0, 15, 30 and 45 dgress of knee flexion. The congruence angle, the patellar tilt angle and the femoral trochlear angle were obtained from each image. According to the values of these three angles, patients were classified using Merchant's classification of patello-femoral malalignment into: Type I malalignment [patellar subluxation only - 12 cases]. Type II malalignment [patellar subluxation and tilt - 10 cases]. Type III malalignment [patellar tilt only - 13 cases]. The CT has a significant advantage in diagnosing and identifying the different patterns of patello-femoral malalignment particularly when surgical realignment is planned

Transvaginal sonohysterography: a technique for uterine evaluation in cases with recurrent abortion

To assess the diagnostic accuracy of transvaginal sonohysterography in the detection of uterine cavitary abnormalities in patients with recurrent abortion. A total of 117 patients with at least two consecutive abortions were enrolled in a prospective case-controlled study. Patients underwent transvaginal ultrasonography, saline-contrast transvaginal sonohysterography and hysterosalpingography for the evaluation of the uterine cavity. The results of the three techniques were compared with those revealed by hysteroscopy. Suspected uterine anomalies were confirmed by laparoscopy. Thirty-nine patients [33.3%] demonstrated uterine cavitary lesions. Sonohysterography was found to be highly sensitive [100%] and specificity [100%] in screening the uterine cavity based on hysteroscopic confirmation. Transvaginal ultrasonography and hysterosalpingography had lower sensitivity [41.0% and 74.4%, respectively] and so were able to detect 13.7% and 27.3% of uterine pathologies respectively. Sonohysterography, also, properly defined the size and location of any uterine outgrowths. No patient required preprocedural analgesia nor antibiotics and none had postprocedural pelvic infection. Sonohysterography represents an easy, noninvasive, tolerable and highly sensitive method for the diagnosis of uterine cavitary abnormalities in patients with recurrent abortion

Ultrasound assessment of postoperatpive residual urine volume improving accuracy through a new calculation method

Postmicturition catheterization is the usual method for assessment of postoperative residual urine volume. Ultrasonography, though non-invasive, comfortable and safe compared with catheterization, is still accused as being inaccurate. The present study attempted to revive the ultrasound method by improving its accuracy through the usage of the combined formulae for volume estimation of the ellipsoid utilizing the most reliable measurement parameters. One hundred and fifty postoperative female patients were investigated. The ultrasound-estimated volumes were compared with the actual volumes measured following catheterization. Nonsignificant differences were detected at volumes between 100 cc. and 300 cc. [P > 0.05]. Significant differences were detected at urine volumes below 100 cc. [P < 0.01]. Such error was not due to missing positive cases [sensitivity 100%], but was due to underestimation in 8.9% of cases with urine volumes larger than 100 c.c. [specificity 91.1%]. Similarly, though the sensitivity of ultrasound was 100% at volumes above 300 c. c, significant differences were detected between ultrasonography and catheterization [P < 0.05]. This was due to overestimation in 2.1% of cases with urine volumes less than 300 cc [specificity 57.9%]. Through the usage of the present calculation method, ultrasonography may, therefore, be considered an accurate method of estimation of postoperative residual urine volume

Percutaneous drainage of hepatic abscesses

Eighteen patients with hepatic abscesses have been drained percutaneously by ultrasonographic guided technique. Five patients had amebic abscesses, while 13 patients suffered from pyogenic abscesses. The patients were not requiring surgical procedure for a concomitant or a primary cause and were entered the trial after failure of medical treatment. The average time required for catheter drainage ranged from 5 to 16 days. Three cases [16.7%] required replacement of the catheter. Two patients [11.2%] required surgical intervention, for surgical drainage in one case and to deal with subhepatic peritonitis resulted from spillage of infection during percutaneous drainage in the second case. Mild hemorrhage was reported inside one abscess cavity [5.6%], which was stopped conservatively. The success cure rate was 77.7% which reached up to 88.8% after replacement of a wider catheter. It is concluded that Percutaneous drainage is an effective method for draining hepatic abscesses not requiring a concomitant surgical procedure and not responding to medical treatment. However, surgical intervention may be required at any time with that technique