METHODS: Computed tomography scans of 102 wrists from 51 healthy individuals were analyzed using a virtualization software. Four anatomical parameters at the distal radius sigmoid notch, namely, the radius of curvature, depth, version angle, and sagittal slope were measured. Morphological patterns of the sigmoid notch surface were identified. The results were statistically analyzed to assess the reliability of the technique and were compared with previously published literature.
RESULTS: Comparing our findings with previously published values, our study revealed a slightly larger radius of curvature and sagittal slope, while revealing a smaller depth and version. We identified the S-type, C-type, and ski-slope morphological variants. The flat-face morphological variant, however, was not identified. The sigmoid notch at the left and right wrists were similar, except for the radius of curvature.
CONCLUSION: This study demonstrates a noninvasive, fast, reliable, and reproducible technique for analyzing the sigmoid notch of the distal radius. In wrist injuries with intact distal radius sigmoid notch but involving comminuted fractures of the ulnar head, ulnar head replacement may be indicated. In such cases, analysis of the ipsilateral intact sigmoid notch would allow us to prepare an ulnar head prosthesis of appropriate size.
CASE PRESENTATION: A 14-year-old boy presented to our institution with peri-umbilical swelling and purulent discharge from his umbilicus for 2 weeks duration. There were no radiological, microbiological or clinical evidences of TB in the initial presentation, though he had close social contact with someone who had TB. A computed tomography scan of the abdomen confirmed the diagnosis of an urachal abscess. An incision and drainage procedure was performed followed by a course of antibiotics. A scheduled laparoscopic approach later showed that the peritoneum and serosal surface of the small and large intestines were studded with nodules of variable sizes, in addition to the urachal sinus. The histology of the resected tissues (urachal sinus and nodules) was consistent of TB infection. He recovered fully after completing 6 months of anti-tuberculous therapy.
CONCLUSION: This report highlights a rare case of TB urachal abscess in an adolescent boy, the difficulties in the diagnosis of abdominal tuberculosis, the need to consider TB as a cause of urachal infection in endemic areas and the use of laparoscopy in both diagnosis and treatment.
Methods: A cross-sectional study on 50 patients of age 50 and above with contrast-enhanced CT (CECT) and dual-energy X-ray absorptiometry (DXA) was conducted from November 2018 to November 2019. Single region of interest (ROI) was placed at the anterior trabecular part of L1 vertebra on CECT to obtain HU value. Correlation of CT HU value of L1 vertebra and DXA T-score, interrater reliability agreement between HU value of L1 vertebra and T-score in determining groups of with and without osteoporosis, ROC curve analysis for diagnostic accuracy and cut-off value of CT for detection of osteoporosis were identified.
Results: Significant correlation between HU value of L1 vertebra and L1 T-score (r = 0.683)/lowest skeletal T-score (r = 0.703) (P < 0.001). Substantial agreement between HU value of L1 vertebra and DXA in determining the groups with and without osteoporosis (k = 0.8; P < 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.93 (95% CI: 0.86, 1.00) using HU value (P < 0.001). Cut-off value for osteoporosis was 149 HU.
Conclusion: HU value of lumbar vertebra is an effective alternative for the detection of osteoporosis with high diagnostic accuracy in hospitals without DXA facility.
METHODS: 104 AIS patients with 1524 pedicle screws were evaluated using CT scan. 302 screws were inserted in dysplastic pedicles using fluoroscopic guidance technique. 155 screws were inserted using a cannulated system (Group 1), whereas 147 screws were inserted using standard screws (Group 2). The pedicle perforations were assessed using a classification by Rao et al.; G0: no violation; G1: <2 mm perforation; G2: 2-4 mm perforation; and G3: >4 mm perforation). For anterior perforations, the pedicle perforations were assessed using a modified grading system (Grade 0: no violation, Grade 1: less than 4 mm perforation; Grade 2: 4 mm to 6 mm perforation; and Grade 3: more than 6 mm perforation).
RESULTS: The perforation rate in Group 1 was 4.5% and in Group 2 was 15.6% (p = 0.001). Most of the perforations were anterior perforations (53.3%). The anterior perforation rate in Group 1 was 1.9% compared to 8.8% in Group 2 (p = 0.009). Group 1 has a medial perforation rate of 1.3% compared to Group 2, 6.1% (p = 0.031). The rate of critical pedicle perforation in Group 1 was 2.6% and in Group 2 was 6.8% (p = 0.102). In Group 1, there were no critical medial perforation but there was one G2 lateral perforation, one G2 superior perforation and two G3 anterior perforations. In Group 2, there were three G2 medial perforations, one G2 lateral perforation, one G2 anterior perforation and five G3 anterior perforations.
CONCLUSION: Usage of cannulated screw system significantly increases the accuracy of pedicle screw insertion in dysplastic pedicles in AIS.