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@#Introduction: Bigliani classification is used for determination of acromial morphology, but poor interobserver reliability has been reported on conventional radiographs. This study aims to assess inter- and intraobserver reliability using magnetic resonance imaging (MRI). Materials and methods: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed. Results: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively). Conclusion: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani’s classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.
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ABSTRACT Objectives: To define the normal ranges of the thicknesses of the skin and subcutaneous tissues via ultrasonography, and determine whether the current syringe needle-lengths used for the subcutaneous injections were appropriate. Methods: The thicknesses of the skin and subcutaneous tissues of 2244 students were measured at the left arm using ultrasonography. The patients were divided into three groups based on their age: 6-8, 9-12 and 13-17 years. Results: The thicknesses of the skin, subcutaneous tissue and skin-subcutaneous tissue were found to be positively correlated with their age, body mass index (BMI) and body surface area. All these were observed to be gender related. There was the possibility to make intramuscular injections for 50%, 25% and 25% of boys within the age groups of 6-8, 9-12 and 13-17 years, respectively. For girls, the risk of intramuscular injection was 25% for all the age groups. Conclusion: The study showed that the skin and skin-subcutaneous tissue thicknesses varied as a function of the patients' age, gender, BMIs and body surface areas.
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Blood flow velocity waveforms were recorded by color Doppler ultrasound from intraplacental villous and umbilical arteries in 20 normal and 23 severe preeclamptic pregnancies. The results of the resistance index measurements in intraplacental villous arteries were 0.51 +/- 0.037 and 0.55 +/- 0.052 in healthy controls and preeclamptics respectively, which was not significantly different. Resistance indices showed a decrease through the umbilical cord from fetus to placenta in both groups. We also noted that Doppler examination of the umbilical cord might be an early indicator of fetal compromise. Detectable intraplacental villous flows were in normal limits even in patients with abnormally high umbilical resistance indices and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise. We conclude that Doppler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia.