Femoroacetabular Impingement (FAI) Syndrome : the medical imaging perspective

Introduction: Sports persons, physicians, orthopods and radiologists have become increasingly aware of the extra stress that is imposed on the hip joints with excessive activity particularly when superadded weight bearing and asymmetrical variations from the normal hip joint anatomy are present leading to Femoroacetabular Impingement. Subject: Presentation of the abnormalities within the ball and socket areas of the hip joint and the resultant types of impingements, the predominant cam, the predominant pincer or mixed types femoroacetabular impingement (FAI) are discussed and illustrated. The different kind of sportspersons that are prone to FAI and the risk factors involved are discussed. Method: The main methods of investigation: The radiological techniques and radiological signs of the disease entity utilizing plain radiography and computerised transverse scanning techniques are elaborated and graphically depicted. Within the ball part of the hip joint, measurements for femoral head asphericity, that is, the Alpha (?) angle and the offset distance between the femoral head and neck are presented. With regard to pincer type FAI affecting the socket part of the hip joint, the acetabular version angle and the depth (or shallowness) of the acetabulum with their methods of quantification are discussed. Conclusion: Femoroacetabular Impingement is a syndrome which is currently more appreciated within the sports medicine field and various approaches to assessment have been devised regarding how to diagnose and quantify congenital anomalies and developmental abnormalities within both the ball and the socket regions of the hip joint.peer-reviewe

Apprehending narcotic smugglers in Malta

This is an account of the experience of the radiological department in identifying heroin smugglers coming from the African continent in transit through Malta. The method of preparation and ways of concealment of drugs in the alimentary tract are described and their radiological appearances illustrated. Conventional and alternative methods of investigation are discussed.peer-reviewe

Depressive illness in institutionalised older people in Malta

Depression in older persons is associated with being placed in a nursing home. Depression is linked to increased medical morbidity in nursing home residents. 150 patients living in two nursing homes in Malta were included in the study. The geriatric depression scale was used to identify depression. Data for risk factors for depression and management of residents for this pathology was also collected. 67.3% (p value <0.01) were found to be depressed. 12% of the total population had major depression while 55.3% had minor depression. Only 40% of those diagnosed with depression in this study had been so diagnosed prior to the study. Significant associations included low Barthel scores, loneliness, being currently in pain, taking several medications, being widowed and having osteoarthritis. The study also showed that those residents already diagnosed with depression were being treated inappropriately with low prescription levels of antidepressants (40.6%). : Results show that depression in nursing home residents is highly prevalent and under diagnosed. There is also a lack of proper treatment in those identified with depression. There is a need for further research to develop intervention and management strategies for depression that is specifically tailored to meet the needs of the frail nursing home population.peer-reviewe

Carotid artery disease screening : assessment of criteria

The Department of Radiology at St. Luke’s Hospital has provided a screening service for stroke related disease since April 1991. This consisted of Duplex Ultrasound screening (DUS) for Extracranial Carotid Artery Disease (ECAD) followed by angiography or intra-arterial digital subtraction angiography (lADSA) or digital intravenous angiography (DIVA) if ultrasound screening was positive for significant disease. The aim of this study was to evaluate in the local context, the various criteria for assessment already established overseas and to devise the best combination of these criteria to improve the detection of disease, thus improving the quality of the•local screening service. 504 patients have been screened for stroke related disease. Twelve patients (6M : 6F) with significant disease, who were considered for surgery, were referred for angiography, IADSA or DIVA. Comparison of these two modalities, DUS and vascular study, were made on 22 sides for the Multicentre Criteria (MCC), the Modified Seattle Criteria (MSC) and the Modified Washington Criteria (MWC). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for the MCC, the MSC and the MWC for peak systolic velocity. For the MCC the end diastolic velocity, the systolic velocity ratio and the diastolic velocity ratio were also compiled. The highest precision for extra cranial carotid artery disease screening can be achieved by a combination of the MCC or MSC for peak systolic velocity and with the systolic velocity ratio for the MCC.peer-reviewe

High order multiple births in the Maltese population

Triplets are a relatively rare occurrence being encountered in the Maltese Islands with an overall incidence of about 0.1 per 1000 maternities. The incidence appears to be on the increase over the last twenty years rising from the 0.08 per 1000 maternities in the decade 1960-69 to 0.11 per 1000 maternities in the following two decades. This increase has been correlated with the increasing use of ovulation induction agents, as has the occurrence of two quadruplets and one octuplet pregnancies in 1988-90. Triplets are shown to occur more frequently in elderly mothers, but no relationship to parity could be identified. Higher order births are shown to have a high incidence of antenatal and intrapartum problems, and are associated with a higher fetal loss than singleton pregnancies.peer-reviewe

Five years of peripheral percutaneous transluminal angioplasty : the St Luke’s Hospital experience

This article reviews the first series of 54 cases of Percutaneous Transluminal Angioplasty on the peripheral vasculature performed at the Radiological/Surgical Department at St. Luke’s Hospital, Malta, over a five year period. After describing in detail the technique used, the indications and the objective criteria utilised for assessment are reviewed and analysed. The two year patency rate for femoro-popliteal and iliac stenoses was 93% and 86% respectively, while for corresponding occlusions, the figures were 42% and 0% respectively. Thus, while the results were very encouraging for femoro-popliteal stenoses and occlusions, they were unacceptable for iliac occlusions. As expected the major risk factors were smoking, diabetes mellitus and associated ischaemic heart or cerebrovascular disease. This series had no mortality and there was minimal morbidity, mainly at the site of arterial access. Elective surgery for iliac re-stenosis was only required in one patient.peer-reviewe

Chronic venous insufficiency

Chronic Venous insufficiency (CVI) is a common disease with significant morbidity that results from venous hypertension of the extremities. Increased perfusion pressure probably traps excessive numbers of white blood cells in the capillaries.peer-reviewe

Out-patient percutaneous antegrade balloon dilation pyeloplasty for pelvi-ureteric junction stenosis, an alternative to surgery

A case is described in which an obviously hydronephrotic kidney due to congenital pelvi-ureteric junction stenosis was dilated with Gruntzig balloon catheter percutaneously and antegradely with resulting correction of the stenosis and urodynamic confirmation of relief of the obstruction following the procedure. The technique is illustrated. The procedure is a new less invasive approach to Pyeloplasty and was performed under local anaesthetic and on an outpatient basis.peer-reviewe

Percutaneous Ureteric Stricture Dilation (PCUSD)

Ureteric stricture dilation as an interventional uroradiological technique was initiated locally in March 1991. In ureteric dilation two approaches are feasible. The retrograde cystoscopic route is undertaken by a uroradiology team in theatre, and the renal antegrade percutaneous route is undertaken in the radiology interventional suite. This study reviewed the results of percutaneous ureteric stricture dilation undertaken over the last five years. Eighteen dilations in 16 patients (10 males : 6 females) were analysed. There was an overall success rate of 61 %. We found the procedure to be safe and effective with minimal complications. No mortality resulted from the procedure. The indications for its use are fully discussed.peer-reviewe

An integrated coastal map for the Maltese Islands

The Maltese coastal area, comprising its associated resources and services, is of substantial importance to the Maltese economy. An innovative web interface has been developed to combine information from different sources, including coastal properties, physical features, resources and amenities, into an innovative comprehensive interactive map of the Maltese coastline. It serves as a general informative tool for users in the public domain, bringing different layers of data together, and targeting a delivery over smart media like mobile phones and tablets.peer-reviewe