Role of magnetic resonance imaging in assessment of acetabular and femoral version in developmental dysplasia of the hip / Papel da ressonância magnética na avaliação da versão acetabular e femoral na displasia do desenvolvimento do quadril

Abstract Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

Resumo Objetivo: Avaliar o papel da ressonância magnética (RM) na avaliação da versão femoral e acetabular na displasia do desenvolvimento do quadril (DDQ). Materiais e Métodos: Estudo transversal de 20 pacientes consecutivos com DDQ (27 quadris displásicos) que foram examinados com RM. Nos quadris displásicos e normais (grupos DDQ e comparação, respectivamente), avaliamos os seguintes parâmetros: anteversão acetabular óssea (AAO), anteversão acetabular cartilaginosa (AAC), anteversão femoral, índice de Mckibbin ósseo (IMO), índice de Mckibbin cartilaginoso (IMC) e espessura da cartilagem acetabular anterior e posterior. Resultados: A AAO foi significativamente maior nos quadris displásicos. A AAC, anteversão femoral, IMO e IMC não diferiram significativamente entre os quadris normais e displásicos. Nos grupos DDQ e comparação, a AAO foi significativamente menor que a AAC, o IMO foi significativamente menor que o IMC, e a cartilagem acetabular posterior foi significativamente mais espessa que a anterior. Conclusão: Nossos achados confirmam que a RM é uma ferramenta valiosa para a avaliação da versão femoral e acetabular na DDQ. A avaliação pré-operatória por RM tem grande potencial para melhorar o planejamento das osteotomias pélvicas e femorais.

role of multi-detector computed tomography in the assessment of cystic and cavitary pulmonary lesions

Lung cysts and cavities are well defined lesions with definable walls containing air or fluid. The differential diagnosis is broad including congenital, idiopathic, infective or neoplastic lesions. Multidetector row CT is primary non-invasive evaluation of cystic and cavitary lesions. To assess the role of multi-detector computed tomography [MDCT] in evaluation of cystic and cavitary lesions in the lung. The study was conducted on 63 patients with cystic or cavitary pulmonary lesions and subjected to MDCT. The study included 33 patients with infective lesions, 13 patients with idiopathic lesions, eight patients with congenital lesions, seven patients with neoplastic lesions and two patients with pseudocystic lesions proved to be due to diaphragmatic hernias. MDCT is an accurate safe diagnostic modality in assessing cystic and cavitary lung lesions; it can assess wall thickness, size, contents and surrounding parenchyma

Hand osteoarthritis: correlation between functional evaluation, imaging and disease activity

This study aimed at investigating the relationship between functional evaluation, imaging and disease activity in hand Osteoarthritis. Twenty-five patients fulfilling the ACR criteria for classification of hand osteoarthritis were enrolled in this study. Full demographic data was obtained and all patients underwent thorough rheumatologic examination which included tender joint count as well as node count. The patients completed the AUSCAN questionnaire. Grip and pinch strength was measured bilaterally. Postero-anterior hand radiographs were taken and power doppler ultrasonography was performed on both hands. They all had ESR and ultrasensitive CRP measured. Seventeen patients [68%] had tender joints, 22 patients [88%] had nodes. Kellgren-Lawrence grading of the x-rays ranged from 2- 4. Grip and pinch strength were not correlated with OA severity or disease activity. Seventeen patients [68%] had positive power doppler findings indicative of synovitis. There was no correlation between doppler findings and hand function. Twenty-three patients [92%] had elevated ESR and twenty-four patients [96%] had elevated ultrasensitive CRP. There was a positive correlation between CRP and OA severity. However, CRP did not correlate with hand function. Tender joint count was positively correlated with pain, stiffness and functional disability [AUSCAN]. Tender joints also correlated with ESR. There was no correlation between tender joint count and power doppler findings. Tender joint count correlates well with lab findings and AUSCAN scoring. However, hand function measured both objectively and subjectively does not correlate with acute phase reactants or power doppler ultrasonography and radiographic findings in hand OA. It seems that hand function does not reflect disease activity or severity

Heme oxygenase-carbon monoxide system in patients with cirrhosis: relation to splanchnic hemodynamics

Carbon monoxide [CO], an end product of the heme-oxygnase [HO] pathway,is a potent vasodilator and an important modulator of vascular cell function. The present work was designed to study the HO-1/CO system in patients with cirrhosis in relation to severity of liver disease, blood viscosity and splanchnic haemodynamics. Plasma HO-1 levels and blood carboxyhaemoglobin [COHB] concentration,an index of CO production were measured in 30 patients with liver cirrhosis and variable degrees of hepatic dysfunction and in 15 healthy subjects as a controls group. Both patients and control were non smokers. Blood viscosity was measured using the red blood cell pipette viscometer. The blood volume of the portal vein,superior mesenteric artery and splenic artery as well as pusatility index of the arteries were measured using doppler ultrasonography. Plasma [HO-1] levels and blood carboxy haemoglobin concentration were significantly higher in patients with liver cirrhosis than in healthy subjects [p< 0.001]. Also, patients who had esophageal varices, history of bleeding varices, portal hypertensive gastropathy and ascites showed significant increase in HO-1/COHB levels compared with those who did not have these complications [p < 0.001]. The increases in plasma HO-1 level and COHB level showed positive correlation with Child-Pugh score, blood viscosity and the increases in the blood flow volume of the portal vein, superior mesenteric artery and splenic artery and inverse correlation with the decreases in the pulsatility index and the resistive index of the arteries in patients with liver cirrhosis [P< 0.05]. Increased HO-1 activity with enhanced endogenous CO generation may play a role in the development of splanchnic vasodilation and serious manifestations of portal hypertension in liver cirrhosis

High thoracic epidural analgesia improves postoperative cardiac outcome in ischemic patients undergoing major abdominal surgery

Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. High thoracic epidural analgesia [HTEA], owing to its selective blockade of cardiac sympathetic innervation, has been used for treatment of medically or surgically refractory angina pectoris. However; its use in patients with coronary artery disease [CAD] undergoing non cardiac surgery has not been adequately investigated. The aim was to investigate the effect of HTEA on postoperative cardiac morbidity in patients with symptomatic CAD undergoing major abdominal surgery as opposed to a technique with comparable analgesic effect namely: Low thoracic epidural analgesia [LTEA]. After approval, thirty patients with symptomatic CAD undergoing major abdominal surgery were included. Before general anesthesia, they were randomly allocated to have HTEA or LTEA for both intra and postoperative pain relief. In addition to haemodynamic measurements, postoperative cardiac morbidity was investigated by comparing the preoperative ECG, echocardiography and troponin I with the postoperative ones done one the first, third and seventh days. Data were expressed as mean [SE]. Cardiac morbidity was only diagnosed in 13.3% of patients in the HTEA group. In the LTEA group, 53.3% were found to have new ischemic changes and 13.3% developed postoperative MI. No cardiac mortality was reported in either group. Absolute risk reduction was 53.3% and the number needed to treat was found to be 2. HTEA in patients with CAD undergoing non-cardiac surgery has resulted in a reduced postoperative cardiac morbidity. It may be worthwhile establishing this technique, unless contra indicated, in such patients

I.V. paracetamol [perfalgan] infusion for postoperative analgesia after laparoscopic cholecystectomy

The adequacy of postoperative laparoscopic cholecystectomy pain control is one of the most important factors in determining when a patient can be safely discharged from the outpatient facility. The purpose of this study was to compare the quality of analgesia and side effects of intravenous paracetamol [perfalgan] 1 g versus intravenous meperidine 100 mg for postoperative analgesia after ambulatory laparoscopic cholecystectomy. The study comprised eighty patients, ASA physical status I or II, age 20-60 years, undergoing elective cholecystectomy under general anesthesia at Benha University Hospital. Before the end of the operation and after removal of the gall bladder, patients were randomly allocated to one of two equal groups, [Group 1] patients received 1g/100ml I.V. paracetamol [Perfalgan] in 15 minutes and [Group 2] patients received 100 mg meperidine [pethidine] I.V. in 15 minutes. Most of the patients [72.5%] in paracetamol group had a VAS Score more than five at six hour after the operation. But in meperidine group [Group 2] the pain intensity increases after 15 minutes and made a peak level in the second hour after the operation. Patients with a VAS score more than five a rescue analgesic was given to the patient. The time to the first request for supplemental analgesia after injection of the study drugs was approximately three times longer in the paracetamol compared with meperidine. Total analgesic consumption 24 hours postoperatively was higher in meperidine group. 16 [40%] of patients in meperidine group [Group 2] were taken three doses of rescue analgesic but 12 [30%] of patients in paracetamol group [Group 1] take three doses of rescue analgesics. 10 [25%] patients in meperidine and 6 [15%] in paracetamol group had nausea. No respiratory depression, vertigo, ataxia, itching, somnolance and headache was observed. Our results indicate that iv paracetamol 1g has better analgesic potency and less side effects than 100 mg meperidine for postoperative analgesia after ambulatory laparoscopic cholecystectomy

Intravenous sedation prior to peribulbar anesthesia for cataract surgery in elderly patients

Cataract surgery, a common operation in the elderly, is frequently performed under regional anesthesia. Dexmedetomidine, a sedativeanalgesic, is devoid of respiratory depressant effects. This study was to compare the effects of dexmedetomidine sedation with those of midazolam sedation in patients undergoing cataract surgery under peribulbar anesthesia and to assess if iv sedation [using dexmedetomidine or midazolam] prior to peribulbar anesthesia minimizes the pain or discomfort, when compared with placebo [saline]. 60 patients were undergoing elective cataract surgeries under local anesthesia randomized into three equal groups to receive one of the following: dexmedetomidine Group D, midazolam Group M and saline Group S. Sedation was titrated to a Ramsay sedation score of 3. Mean arterial pressure [MAP], heart rate [HR], readiness for recovery room discharge [time to Aldrete score of 10], and patients' and surgeons' satisfaction [on a scale of 1-7] were determined. The three groups were similar in age, sex, ASA physical status and mean axial length of the globe. 10 minutes post block the MAP decreased in Group D compared to Group M and S where there was a highly significant difference [P < 0.01] [between Group D and M] and a Very highly significant difference [P < 0.0001] [between Group S and D]. The heart rate also decreased in Group D compared to Group M and S where there was a significant difference [P < 0.01] [between Group D and M] and a Very highly significant difference [P < 0.0001] [between Group S and D]. As regard SpO2 there was no significant difference between the Groups throughout the operation. There were no differences in HR between treatment groups in the recovery period; however, MAP was significantly lower throughout the period of recovery in the dexmedetomidine group. There was no difference between treatment groups in the time to achieve an Aldrete score of 10 and the time to eligibility for PACU discharge. In conclusion, this study demonstrates that iv dexmedetomidine or midazolam appears to be a suitable agent for sedation in patients undergoing cataract surgery, reduced the perception of pain associated with the performance of peribulbar anesthesia and attenuated haemodynamic responses. In the recovery room, dexmedetomidine was associated with an analgesia-sparing effect, slightly increased sedation, but no compromise of respiratory function or psychomotor responses

Local anesthesia with sedation for ambulatory anorectal surgery

Anorectal surgery is extremely painful and it is a challenge to the anesthetist and surgeon. Most patients are anxious about pain during and after the surgery. We tried in this study to solve this problem especially for patients who may have some problems with general anesthesia or contraindications to regional anesthesia. In this study our aim was to compare between the local anesthesia [which is not a common technique in our hospital], spinal anesthesia and general anesthesia for anorectal operations. We selected 87 patients for the study. The patients were allowed to choose between the three methods of anesthesia and then categorized according to their choice. 31 patients choose the local anesthesia and were categorized as [LA] group. 28 patients choose spinal anesthesia and were categorized as [SA] group. The third group was the general anesthesia [GA] group including 28 patients. Patient's satisfaction and intraoperative and postoperative VAS also reported. The operative time ranged from 23 to 55 [23 +/- 18] min in LA group and [25 +/- 12] in SA group, but in the GA group the operation time ranged from 20 to 40 min [20 +/- 10]. There was no difference between LA group, SA group and GA group regarding the personal data [age, weight, and ASA I /II/III]. The percent of female patients in the third group was more than that in the other two groups. The intraoperative pain scale in the in the LA and SA groups during the operation didn't exceed 3 form the start of operation till the end except only one patient in group LA who is shifted to general anesthesia as she was noncooperative and she asked for GA. Intraoperative pain scale more than 5 [3 and 2 patients] in the LA and SA groups during anal dilatation and early manipulations and intensity of pain decreased by time to pain scale less than 3. Five minutes after the end of operation, all patients received declofenaic sodium 75 mg IM. Twenty six patients in the GA start to complain of pain so pethidine 0.3mg /kg IV bolus dose followed by 0.7 mg / kg pethidine IM to control pain. In spite of this six patients of the GA group started to complain of pain again after 90 min of the last dose of pethidine, VAS for these patients was more than 5. 87% of patients in the LA group didn't need any analgesic in PACU for 120 min. Three patients [11%] in SA group developed urinary retention. No patient in LA or GA group developed urinary retention. No surgical complication reported in the three groups. Local anesthesia is more effective and more beneficial to the patients planned to have simple anorectal operations than general anesthesia. Local anesthesia is nearly as effective as the spinal anesthesia. It has the advantages of preemptive analgesia, early patient movements, and early return to the work, and fewer complications than GA

Remifentanil with propofol or thiopental for tracheal intubation without muscle relaxants

This study designed to evaluate the use remifentanil followed by propofol or thiopental without muscle relaxants for endotracheal intubation compared to thiopental followed by succinylcholine as a control group for obtaining clinically acceptable intubation conditions and hemodynamic changes. We studied 90 healthy children [ASA I-II], aged three to nine years presenting for elective ENT-surgery. The children were enrolled into three equal groups: Group A received remifentanil 3 micro g/kg followed by 2.5 mg/kg propofol. Group B received remifentanil 3micro/kg followed by 5 mg/kg thiopental, and Group C as a control group received 5mg thiopental followed by succinylcholine 1.5 mg/kg. The tracheal intubating conditions were considered excellent in 30[100%] of children in Group C, 27[90%] in Groups A and 24 [80%] in Group B. Mask ventilation done easily in all children and complete jaw relaxation in 93.3% of children in Group A, 86.6% in Group B and 100% in Group C [significant difference between Group B and C P<0.05]. All children intubated easily, and slight cord movement in 10% of children in Group A and in 20% in Group B [significant difference between Group A and C P<0.05 and a highly significant difference between Group B and C P<0.001]. 6.66% of children in Group A and 20% in Group B developed slight coughing at intubation [a highly significant difference between Group B and C P<0.001]. As regard the MAP changes after induction and intubation In Group C there was significant difference [P<0.05] between Group C and B and a very highly significant difference [P<0.0001] between group A and C. The heart rate decreased 14% and 2% in the remifentanil groups A and B respectively [P<0.05] arid remained lower than baseline throughout the study. The heart rate increased in group C after induction and intubation and there was significant difference [P<0.05] between Group C and B while the difference in heart rate was very highly significant difference [P<0.0001] between group A and C. In summary, the administration of 2.5 mg/kg propofol or 5mg/kg thiopental and 3.0 microg/kg remifentanil provided clinically acceptable conditions for tracheal intubation and stable hemodynamic in children pretreated with atropine. With this combination of drugs, the return of spontaneous ventilation was as rapid as after thiopental/ succinylcholine with acceptable hemodynamic changes. This technique may be advantageous in children with normal airway anatomy undergoing elective brief surgical procedures or in cases in which neuromuscular block is contraindicated

Can ultrasound guided percutaneous sclerotherapy of symptomatic simple renal cyst be considered as alternative to surgery?

Objective: To evaluate the efficacy of ultrasound [US] guided aspiration and instillation of ethanolamine oleat as sclerosing material for manage- merit of symptomatic simple renal cyst

Patients and methods: It is a prospective study performed on 26 patients with symptomatic simple renal cyst from February 2003 to February 2005. The diagnosis depends on the ultrasonic imaging. Percutaneous ultrasonographic guided-aspiration of cyst fluid was performed. Then, ethanolamine oleat was instillated into the cyst cavity which was re-aspirated back 90 minutes after instillation with keeping the 5 Fr catheter in place. The procedure was repeated in the 2[nd] day with removal of the catheter

Results: Follow up period was 6-24 months [mean +/- SD, 15 +/- 6.2]. Significant clinical improvement of symptoms was detected in 22 patients [84.6%] and the symptoms remained the same in the remaining 4 patients [15.4%]. The procedure was tolerated by all patients without major significant complications except one patient had a fever [38.5C] for one day and another patient developed pain for 2 days related to the procedure and responded to medical treatment. There was a statistically significant decrease in the diameter of cysts from a pre-procedure [mean of 9.2 +/- 2.2] to the post procedure [mean of 1.6 +/- 2.2] P=0.001

Conclusion: Percutaneous aspiration and sclerotherapy guided by ultrasound is a good option for management of simple renal cyst without significant complications if performed successfully by well-trained hands

Urolithiasis in patients on chronic hemodialysis

Reports were conflicting with respects to the composition of calculi formed in patients who were kept on hemodialysis and also on the pathogenetic factors involved in their formation. This study was, therefore, conducted to investigate these debates. Patients and methods: renal calculi form 38 hemodialysis patients were subjected to morphological study with microscopic examination and constitutional analysis with infrared spectrophotometry. patients' calculi were mainly consisting of oxalo-protein calculi with > 30% calcium oxalate as a total stone content [18 patients, or 47%]. They could be a consequence to metabolic factors, such as high urinary oxalate and low urinary citrate concentration, and to iatrogenic factors, namely vitamin D3 and calcium salts supplementation. In 14 [37%] patients, calculi were made of sole proteins or in association with < 30% calcium oxalate, and were observed mainly in patients with primary glomerular disease. Aluminum-magnesium urate calculi, which may be related to aluminum overload were seen in the remaining 6 [16%] patients. metabolic and iatrogenic conditions come as the predominant factors incriminated in pathogenesis of most calculi formed by hemodialysis patients. The precise analysis of such calculi is therefore, higher recommended as it can offer useful information on pathogenesis, and hence a possible approach to their prophylaxis

Portal hypertensive cholycystopathy in cirrhotic patients

The affection of the gallbladdor in liver cirrhosis and its relation to portal hypertension has been a matter of research for many years. The aim of this work is to study the relationship between gallbladder function, gallbladder wall thickness, and portal hemodyanamics in patients with liver cirrhosis. Twenty three males and seven females were included in this study with well known liver cirrhosis and no gallbladder disease. Ten volunteers with matched age and sex were taken as a control group. Ultrasonographic examination revealed significant increase in portal vein diameter with significant correlation with gallbladder wall thickness. Patients in Child's class C had significant lower fractional emptying of the gallbladder than both Child A and B and the control group. The three Child classes A, B, and C had significant increased gallbladder wall thickness compared to the control group. The wall thickness correlates significantly with serum albumin, presence of ascites and dilated portal vein. There was a significant correlation between the congestion index and both gallbladder fractional emptying and postprandial volume. In conclusion, portal hypertension and associated changes can be considered one of the causes that lead lo impairment of the gallbladder contractile function in liver cirrhosis and contribute to the increased prevalence of gallstones

Helicobacter pylori in diabetics with and without neuropathy: relation to metabolic control and gastric emptying

This work was carried out on 60 diabetic patients and 20 healthy subjects as control. For each diabetic patient and for the control, the followings were done: history and clinical examination, laboratory investigations including fasting blood sugar, post-prandial blood sugar, HBA1c, lipid profile, liver and kidney function tests. Also, assessment of autonomic functions, gastroscopy and biopsy for rapid urease test, estimation of serum gastrin and gastric scintigraphy for evaluation of gastric motility. The results were as follow: patients with autonomic neuropathy demonstrated a higher prevalence of Helicobacter pylon [HP +ve] than those without and controls. Patients with motility disorder also showed a significant higher level of HP +ve than those without and controls. Diabetic patients had a significantly higher level of serum gastrin than controls. Conclusion: H. pylon prevalence was higher in diabetics and it was higher in those with autonomic neuropathy and dysmotility. Serum gastrin was significantly higher in those H. pylon positive patients. H.pylori infection tends to cause antral gastritis or pangastritis in diabetics rather than peptic ulcer especially in those with autonomic neuropathy. Non-ulcer dyspepsia is common in diabetics. Treatment of H. pylon infection may be of great benefit for metabolic control

Effect of hemodialysis on protein C and antithrombin III

The effect of hemodialysis on natural coagulation inhibitors including protein C [PC] and antithrombin III [AT III] had been studied. Plasma PC and AT III levels measured in 20 uremic patients on maintenance hemodialysis immediately before and after dialysis treatment. These values were compared with those obtained from 20 matched healthy controls. Functional activities of PC was determined by coagulometric method and functional activities of AT III was determined by amidolytic method. Both the functional activities of PC and AT III in uremic patients were significantly lower than those of controls. No significant change in the level of AT III was observed with dialysis, but a progressive increase of functional activity of PC was documented with hemodialysis. On the luisis of this study, the risk of thrombosis may increase due the decrease in AT III levels. However, this effect may be compensated by the increase in PC activity, possibly due to the removal of an inhibitory substance on PC activity

Study of some respiratory physiological parameters in patients with chronic renal failure during hemodialysis

Twenty non smoker patients with chronic renal failure on maintenance hemodialysis were studied. Forced vital capacity [FVC] and peak expiratory flow [PEF] decreased significantly after 30 minutes from the start of dialysis followed by insidious increase to levels close to predialysis values at the end of dialysis. Maximal expiratory pressure [PE max] did not show any significant change throughout the dialysis. Serum bicarbonate, base excess and arterial pH increased throughout the dialysis specially after 60 minutes from the start of dialysis till its end. Arterial PCO2 showed minimal changes. However, there was a significant increase after 30 minutes as well as throughout the dialysis. The possible roles of uremic pulmonary edema, peribronchial edema, release of bronchoconstrictor mediators secondary to bioincompatibility of the dialyser membrane, uremic myopathy as well as the possible role of hypoventilation occurring as a compensation for CO2 loss through the dialyser were discussed in explanation for the previously mentioned results