The normal appearance of CT myelograms.

PURPOSE: CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural compression has been questioned as its normal appearances are not defined in the study. In this study, we examine a series of CT myelograms to define the normal appearances of the neural elements of the spine. METHODS: The CT myelograms of patients with unilateral symptoms were examined by four independent physicians. The lateral extent of contrast was examined and recorded. Concordance between the recorded extents was assessed using kappa scores. RESULTS: Thirty-six scans were reviewed. Kappa analysis shows that there is a fair agreement in the lateral extent of contrast at L1, L3 and L4. At L2 and L5, agreement is slight. CONCLUSION: The interpretation of CT myelography shows significant interobserver variability. As a result, the usefulness of this diagnostic tool can be questioned, and if misinterpreted, it could lead to questionable diagnoses and inadvertently erroneous management if used in isolation. These slides can be retrieved under Electronic Supplementary Material.

Predicting the underestimation of the femoral offset in anteroposterior radiographs of the pelvis using 'lesser trochanter index': a 3D CT derived simulated radiographic analysis.

We developed 'lesser trochanter index' (LTI) and estimated its accuracy in predicting the underestimation of offset in the anteroposterior (AP) pelvic radiographs. We reconstructed 320 simulated radiographs from the CT scans of 40 adult hips at different rotational projections of 10° increments from 30° internal rotation to 40° external rotation. Underestimation of femoral offset as a percentage was derived from the neck profile angle for all radiographs. Radiographs with an LTI value above 35 were 94% (95% CI, 89%-97%) likely to underestimate femoral offset by more than 5%. Radiographs with LTI between 0 and 30 demonstrated femoral offset within 5% of the true offset (predictive value 100%, CI 87%-100%). LTI could be a useful guide in preoperative templating of hip arthroplasty.

Demonstration of an occult biliary-arterial fistula using percutaneous contrast-enhanced ultrasound cholangiography in a transplanted liver.

We present a case of a biliary-arterial communication as a consequence of the placement of an internal-external biliary drainage catheter in a liver transplant patient diagnosed on contrast-enhanced ultrasound using a novel application by injecting microbubble contrast into the catheter tube. We postulate that this method may be sensitive in identifying occult communications between the biliary tree and the vascular compartment when a catheter drain is positioned, and there is hemobilia or unexplained sepsis.

Treatment of hand scalds in the paediatric age group: a novel Biobrane glove.

UNLABELLED: This article describes a technique to create a novel Biobrane glove to treat superficial circumferential paediatrics hand scalds. It includes step by step instructions and illustrations to demonstrate the application of two sheets of Biobrane to cover the entire hand. CONCLUSION: This method seems to be more cost-effective than the Biobrane glove distributed by Smith & Nephew.