Comparisons between ultrasonographic screening results and risk factors of developmental dysplasia of the hip

Amaç: Çalışmamızın amacı ultrasonografik taramanın seçilmiş hastalarda mı (risk faktörleri ya da muayene bulguları olan) ya da genel popülasyon üzerinde mi yapılması gerektiğini değerlendirmektir. Gereç ve Yöntem: Kliniğimize 2010-2012 gelişimsel kalça displazisi (GKD) taraması amacıyla başvuran 634 bebek çalışmaya dâhil edildi. Risk faktörleri olarak aile öyküsü, makat gelişi, tortikollis, ilk gebelik, oligohidramniyos, çarpık ayak, kız cinsiyet olarak belirlendi. Graf metodu ile yenidoğan kalçaları taranarak, hastalardaki risk faktörleri ve klinik muayene bulguları istatistiksel olarak duyarlılık ve özgüllük açısından karşılaştırıldı. Bulgular: Çalışmaya alınan 634 bebeğin 403'ü kız, 231'i erkekti. Hastaların ortalama yaşı 87,45±49,6 gündü. Ortalama anne yaşı 29,6±5,4 yıldı. Ultrasonografik tarama sonucunda 66 bebeğin 71 kalçası displazik bulundu. Bu kalçalardan 30'u Tip 2b, 8 kalça Tip 2c, 3 kalça Tip d, 23 kalça Tip 3, 7 kalça Tip 4 olarak tespit edildi. Sonuç: Çalışmamızda klinik bulguların GKD taraması açısından yeterli olmadığı sonucuna ulaşılmıştır. Bu nedenle de özellikle ülkemiz gibi GKD prevelansının sık görüldüğü ülkelerde seçilmiş hastalara ultrasonografik tarama yapmaktansa tüm popülasyonun ultrasonografik taramasının yapılması gerektiği düşüncesindeyiz.Objective: The aim of the study is to evaluate the efficacy of ultrasonographic screening in general population and selected patients (who had risk factors or clinical findings) for developmental dysplasia of the hip (DDH).Material and Methods: 634 babies who had been admittted to our clinic between 2010 and 2012 were included in the study. Family history, breech presentation, torticollis, first child, oligohydramnios, club foot, and female gender were accepted as risk factors. The newborns patients were evaluated with Graf method. Risk factors and clinical findings of the patients were compared with these results for sensitivity and specificity. Results: 403 patients were female and 231 patients were male. The mean age of the patients were 87.45±49.6 days and the mean maternal age was 29.6±5.4 years. In the screeening of the patients 66 babies with 71 hips were dysplasic (30 hips Type 2b, 8 hips Type 2c, 3 hips Type d, 23 hips Type 3, and 7 hips Type 4).Conclusion: According to our study, clinical examination of the patients is not sufficient for the screening of the babies for DDH. We think that the ultrasonographic screening of the babies for DDH is recommended for general population of high risk countries like Turkey

Sex Estimation From Sternal Measurements Using Multidetector Computed Tomography

We aimed to show the utility and reliability of sternal morphometric analysis for sex estimation. Sex estimation is a very important step in forensic identification. Skeletal surveys are main methods for sex estimation studies. Morphometric analysis of sternum may provide high accuracy rated data in sex discrimination. In this study, morphometric analysis of sternum was evaluated in 1mm chest computed tomography scans for sex estimation. Four hundred forty 3 subjects (202 female, 241 male, mean age: 44 +/- 8.1 [ distribution: 30-60 year old]) were included the study. Manubrium length (ML), mesosternum length (2L), Sternebra 1 (S1W), and Sternebra 3 (S3W) width were measured and also sternal index (SI) was calculated. Differences between genders were evaluated by student t-test. Predictive factors of sex were determined by discrimination analysis and receiver operating characteristic (ROC) analysis. Male sternalmeasurement values are significantly higher than females (P< 0.001) while SI is significantly low in males (P< 0.001). In discrimination analysis, MSL has high accuracy rate with 80.2% in females and 80.9% in males. MSL also has the best sensitivity (75.9%) and specificity (87.6%) values. Accuracy rates were above 80% in 3 stepwise discrimination analysis for both sexes. Stepwise 1(ML, MSL, S1W, S3W) has the highest accuracy rate in stepwise discrimination analysis with 86.1% in females and 83.8% in males. Our study showed that morphometric computed tomography analysis of sternum might provide important information for sex estimation

Comparisons Between Ultrasonographic Screening Results and Risk Factors of Developmental Dysplasia of The Hip

Amaç: Çalışmamızın amacı ultrasonografik taramanın seçilmiş hastalarda mı (risk faktörleri ya da muayene bulguları olan) ya da genel popülasyon üzerinde mi yapılması gerektiğini değerlendirmektir. Gereç ve Yöntem: Kliniğimize 2010-2012 gelişimsel kalça displazisi (GKD) taraması amacıyla başvuran 634 bebek çalışmaya dâhil edildi. Risk faktörleri olarak aile öyküsü, makat gelişi, tortikollis, ilk gebelik, oligohidramniyos, çarpık ayak, kız cinsiyet olarak belirlendi. Graf metodu ile yenidoğan kalçaları taranarak, hastalardaki risk faktörleri ve klinik muayene bulguları istatistiksel olarak duyarlılık ve özgüllük açısından karşılaştırıldı. Bulgular: Çalışmaya alınan 634 bebeğin 403'ü kız, 231'i erkekti. Hastaların ortalama yaşı 87,45±49,6 gündü. Ortalama anne yaşı 29,6±5,4 yıldı. Ultrasonografik tarama sonucunda 66 bebeğin 71 kalçası displazik bulundu. Bu kalçalardan 30'u Tip 2b, 8 kalça Tip 2c, 3 kalça Tip d, 23 kalça Tip 3, 7 kalça Tip 4 olarak tespit edildi. Sonuç: Çalışmamızda klinik bulguların GKD taraması açısından yeterli olmadığı sonucuna ulaşılmıştır. Bu nedenle de özellikle ülkemiz gibi GKD prevelansının sık görüldüğü ülkelerde seçilmiş hastalara ultrasonografik tarama yapmaktansa tüm popülasyonun ultrasonografik taramasının yapılması gerektiği düşüncesindeyiz.Objective: The aim of the study is to evaluate the efficacy of ultrasonographic screening in general population and selected patients (who had risk factors or clinical findings) for developmental dysplasia of the hip (DDH).Material and Methods: 634 babies who had been admittted to our clinic between 2010 and 2012 were included in the study. Family history, breech presentation, torticollis, first child, oligohydramnios, club foot, and female gender were accepted as risk factors. The newborns patients were evaluated with Graf method. Risk factors and clinical findings of the patients were compared with these results for sensitivity and specificity. Results: 403 patients were female and 231 patients were male. The mean age of the patients were 87.45&plusmn;49.6 days and the mean maternal age was 29.6&plusmn;5.4 years. In the screeening of the patients 66 babies with 71 hips were dysplasic (30 hips Type 2b, 8 hips Type 2c, 3 hips Type d, 23 hips Type 3, and 7 hips Type 4).Conclusion: According to our study, clinical examination of the patients is not sufficient for the screening of the babies for DDH. We think that the ultrasonographic screening of the babies for DDH is recommended for general population of high risk countries like Turkey

Vliv nesprávné polohy nohy na presnost radiologického merení deformity a intermetatarzálních úhlu pri lécení hallux valgus

PURPOSE OF THE STUDY Accurate radiographic measurements are crucial in treating hallux valgus (HV). This three-dimensional deformity should not be evaluated from one joint on one plane. However, in practice, surgeons measure the deformity only on transverse dorsoplantar radiographs. We determined the amount of error associated with positioning the foot incorrectly on radiographs. MATERIAL AND METHODS To simulate incorrect positions of the foot in radiographic evaluation, we designed an angled device that can move in transverse and frontal plane. In four patients with symptomatic HV, we took weight-bearing radiographs of the involved foot in seven different positions. These 28 radiographs were given identifying but meaningless labels. On each radiograph, six surgeons blinded to the position of the radiograph measured the HV angle (HVA) and the inter-metatarsal angle (IMA) and state the treatment plan according to five treatment options were given to participants. RESULTS Inter-observer agreement was high for measurements of HVA and IMA in all positions (interclass correlation coefficients, 0.96 and 0.88, respectively). However, intra-observer agreement was poor for HVA (intra-observer agreement, 0.17) but good for IMA (intra-observer agreement, 0.64). According to the measurements in different positions, intra-observer treatment choices revealed moderate results (ICC: 0.524). Clinical Relevance Radiographic measurements are very important on the treatment decisions of hallux valgus. The foot position can influence the measurement accuracy and can cause incorrect decisions. In this study, we evaluated the impact of foot positions on measurements of hallux valgus angle and inter-metatarsal angle. Additionally, we evaluated the incorrect foot positioning on treatment decisions. Moreover, we analyzed intra-observer and inter-observer agreements of these angles in various positions. CONCLUSIONS We recommend that measurements of IMA are more reliable than those of HVA for managing hallux valgus in terms of false weight bearing radiographs taken in different positions. Positional changes during foot radiographs could lead clinicians to perform incorrect HVA and IMA measurements. This could change the treatment option. HVA measurements were more affected with foot positioning. It is important to take full weight bearing foot radiographs in correct technique

Comparison of fdg-pet/ct and mr with diffusion- weighted ımaging for assessing peritoneal ımplants in patients with gynecologic neoplasms

Amaç: Jinekolojik maligniteli hastalarda peritoneal imp- lant saptamada rutin abdominal MRG, diffüzyon ağırlıklı görüntüler (DAG) ve PET-BT tetkiklerinin duyarlılıklarını saptamak ve birbirleri ile karşılaştırmaktır. Gereç ve Yöntemler: Jinekolojik tümör nedeniyle takip edi- len 21 hasta çalışmamıza dâhil edildi. Hastalara PET-BT, tüm batın MRG ve b 0-500-1000 s/mm2 değeri kullanılarak batına yönelik diffüzyon ağırlıklı (DAG) çekimler yapıldı. PET-BT incelemesi nükleer tıp uzmanı tarafından, MRG ve DAG ise radyoloji uzmanı tarafından değerlendirildi. Batın içi implantlar, lezyon sayılarına göre standart referansla karşılaştırılıp değerlendirildi. Bulgular: PET-BT incelemesinde toplam 40 lezyon izle- nirken, MRG’de 49, MRG ve DAG birlikte değerlendiril- diğinde 65 lezyon raporlandı. Tüm görüntüleme metodla- rı ile toplam 8 hastada lezyon izlenmedi. İki hastamızda MRG+DAG’te lezyon izlenirken, MRG ve PET-BT’de iz- lenmedi. Bir hastada ise MRG ve MRG+DAG’de lezyon izlenirken PET-BT’de lezyon izlenmedi. MRG+DAG’de iz- lenen lezyon sayısı, PET-BT ile karşılaştırıldığında anlamlı derecede fark izlendi. Sonuç: Biz bu çalışmada kontrastlı MRG ve MRG+DAG ile PET-BT’ye göre daha fazla lezyon bulduk. PET-BT’ye alternatif olabilecek diffüzyon ağırlıklı görüntüleme, kon- vansiyonel MRG’e eklenerek peritoneal implant taramada daha duyarlı sonuçlar elde edilebilir.Objective: Our aim was to determine the sensitivity and comparison of abdominal MRI, diffusion weighted MRI (DWI), PET-CT in detecting peritoneal implants in patients with gynecologic neoplasms. Material and Methods: Twenty-one patients with gyneco- logical malignant tumors were enrolled in this retrospective study. Twenty-one oncology patients underwent abdominal and pelvic MRI, diffusion weighted MRI with a b value of 0-500-1000 s/mm2 and whole body PET-CT for follow-up. All MRI images were evaluated by a radiologists and PET- CT images were reviewed by a nuclear medicine physici- an. The results were compared with surgery or laparotomy exploratis, follow-up MRI or CT at a varying time between 2 and 12 months from the initial MRI, and moreover they were also evaluated with laboratory values and clinical outcomes at the 12 to 36th month from the initial MRI. Results: Forty lesions were identified with PET-CT, forty- nine lesions with MRI and 65 lesions with MRI+DWI. In 8 patients there were no implants with all imaging modalities. Although PET-CT and MRI were negative for two patients, MRI+DWI was positive for them. And also PET-CT was negative for one patient whereas MRI and MRI+DWI was positive. On a lesion-based analysis, overall lesion num- bers for PET-CT and MRI+DWI were significantly different (p&lt;0,05). Conclusion: In our study we found with MRI and MRI+DWI more implants than PET-CT. DWI which may be an alter- native to PET-CT with conventional MRI can improve the sensitivity in depicting peritoneal implants

Radiologic approach to bloody nipple discharge

Objective: We aimed to evaluate the radiological approach in patients with pathologic nipple discharge in the light of the results of our patients with a complaint of bloody nipple discharge

Computed tomography evaluation of the iliac crest apophysis: age estimation in living individuals

Determination of the ossification properties of the iliac apophysis is important not only in the clinical evaluation of patients undergoing orthopedic surgery but also in age estimation studies for forensic purposes. The literature includes both anthropological and radiological (conventional radiography, ultrasonography, and magnetic resonance imaging modalities) investigations of the different staging systems used for these purposes. In this study, we assessed the utility of computed tomography (CT) of the iliac crest apophysis in estimating forensic age. CT scans of the iliac crest apophysis of 380 patients (187 females, 193 males, and 10-29 years of age) were evaluated according to the four-stage system. Further subclassification did not give data properly due to the reference length measurement of the iliac wing with CT. Thus, in our series, stage 2 was first seen in 12 years of age and stage 3 in those 14 years of age in both sexes and on both sides of the pelvis. Stage 4 was first seen in 17 years of both sexes but only on the right side; on the left side, it appeared in females 18 years of age and in males 17 years of age. Present data was found consistent with previous pelvic radiographic findings. First seen ages for stage 2 and 3 are 12 and 14 years respectively which presented valuable information for legally important age thresholds. However, disadvantages of CT, including high-dose radiation exposure to gonads, the difficulty of evaluating the iliac crest, and the age boundary of 17 years, could make this method infeasible, as compared with hand wrist and pelvic radiographic methods. CT of the iliac crest has probably a greater utility where preexisting CT scans of the pelvic region are available, and it may be considered as a supportive method for age-estimation purposes