ABSTRACT
OBJECTIVES: To determine the value of grayscale and power Doppler ultrasound (PDUS) in the evaluation of carpal tunnel syndrome (CTS) in clinically suspected patients. METHODS: Eighty-seven wrists of 61 patients with clinically suspected CTS and 57 wrists of 30 healthy control participants were included in our study. Median nerve (MN) cross-sectional area (CSA) measurements were performed at the tunnel inlet level (wCSA) and proximal pronator quadratus muscle level (fCSA). Two parameters were calculated: CSA absolute difference (ΔCSA), which was the difference between the two measurements; and CSA ratio (RCSA), calculated by dividing wCSA over fCSA. The MN at the wrist level was evaluated for hypervascularity with PDUS. RESULTS: The mean wCSA, R-CSA, and ΔCSA values were significantly higher in patients (17 mm2 , 2.45, and 9.9 mm2 , respectively) than in control participants (8 mm2 , 1.29, and 1.65 mm2 ; (P < .0001). At their corresponding cutoff values, the wCSA yielded higher sensitivity (95%) and lower specificity (88%) compared to the RCSA and ΔCSA (89% and 93% sensitivity and 93% and 89% specificity). Power Doppler US was the most specific US parameter (100%) but the least sensitive (76%). A multivariate logistic regression model including the wCSA, RCSA, and PDUS yielded 97% diagnostic accuracy at their optimal cutoffs, which increased to 99% after eliminating age and body mass index confounding effects. CONCLUSIONS: The combination of MN swelling measurements and PDUS increases the diagnostic accuracy of US in patients with clinically suspected CTS.
Subject(s)
Carpal Tunnel Syndrome/diagnostic imaging , Median Nerve/diagnostic imaging , Ultrasonography/methods , Adolescent , Adult , Aged , Case-Control Studies , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Ultrasonography, Doppler , Wrist Joint/diagnostic imaging , Young AdultABSTRACT
PURPOSE: Cochlear implantation (CI) has been extended to involve younger age group with higher incidence of residual hearing which increases the need of minimizing surgical inner ear trauma. Radiological evaluation for electrode position has been studied yet without assessment of inner ear trauma, our objective is radiological evaluation of post cochlear implantation inner ear trauma MATERIAL AND METHODS: 20 patients with CI for pre lingual SNHL were included in this study. Cone beam CT (CBCT) was used for evaluation of electrode position and assessment of inner ear trauma. A Neuroradiologist and an implant surgeon analyzed the relation of inserted electrode to the intra-cochlear structures, with introduction of novel radiological grading for inner ear trauma. RESULTS: The mean major cochlear diameter was 8.9 mm, the mean angular depth of insertion was 406.9944 (SD = 165.0559). Ten patients were with no cochlear trauma (grade 0), three patients were grade 1, two patients were grade 2 and five patients were grade 3 inner ear trauma. CONCLUSION: Radiological evaluation for electrode position should extend to involve assessment of inner ear trauma using relation of the implant to cochlear internal structures which could be performed by CBCT with high resolution and least metallic artifacts.
Subject(s)
Cochlear Implantation/adverse effects , Cochlear Implants , Ear, Inner , Intraoperative Complications , Prosthesis Fitting , Spiral Cone-Beam Computed Tomography/methods , Child , Child, Preschool , Cochlear Implantation/methods , Ear, Inner/diagnostic imaging , Ear, Inner/injuries , Female , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Male , Outcome Assessment, Health Care , Prosthesis Design , Prosthesis Fitting/adverse effects , Prosthesis Fitting/methodsABSTRACT
Many risk factors may contribute to renal disease in patients with hemophilia A. AIM: We aimed to evaluate functional and structural renal abnormalities among a group of Egyptian children with severe and moderate hemophilia A using technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA) and technetium-99 m dimercaptusuccinic acid (99mTc-DMSA) scan. We also aimed to determine the relation between these abnormalities and different risk factors and disease severity. PATIENTS AND METHODS: Forty male patients, 16 with severe and 24 with moderate hemophilia A, were enrolled in this study. Their mean age was 10.2 ± 4.3 years (range, 5-17 years). Full history taking, clinical examination, laboratory, and radionuclide investigations including serum creatinine, blood urea nitrogen (BUN), urine analysis, creatinine clearance, 24-hour urinary protein, 99mTc-DTPA scan, and 99mTc-DMSA scan were performed to all enrolled patients. RESULTS: Serum creatinine and BUN were normal in all patients, and corrected creatinine clearance was diminished in 2 patients. However, 99mTc-DTPA results yielded 19 (47.5%) patients with diminished glomerular filtration rate (GFR). Moreover, it showed that 14 (35%) had obstructive uropathy, 15 (37.5%) had obstructive nephropathy, while 11 (27.5%) patients showed normal scan. One patient had atrophy of 1 kidney on 99mTc-DMSA scan. Among our cohort, 5 (12.5%) patients were hypertensive. Microscopic hematuria was detected in 14 (35%) patients while 72.5% had proteinuria. We found an association between hematuria and hypertension with diminished GFR. CONCLUSION: Despite normal kidney functions (serum creatinine and BUN), we found a high rate of diminished GFR and obstructive uropathy and nephropathy as detected by 99mTc-DTPA scan among children with hemophilia A.
