Zeitschriftenartikel zum Thema „Supine radiographic examinations“

Objectives: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. Methods: 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose–area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). Results: Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. Conclusion: Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.

The initial reports on radiologic examinations in 618 consecutive patients with midfacial injuries were compared with the final clinical diagnoses. Alcohol had to some degree been imbibed by 31 per cent of the patients. Influence of alcohol was 3 times more common outside than within office hours. Radiographic analysis included estimation of blurring, errors in straightness, angulation, beam centering and limitation. Image quality was scored as visibility of ‘the imaginary lines of bony continuity’. There was no statistically significant correlation between the degree of inebriety and image quality or diagnostic performance with the radiographic technique used, with the patient supine. There is no need to postpone midfacial radiography in inebriate patients.

Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18–87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.

ABSTRACT Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.

From a series of patients undergoing routine radiographic examination, 112 temporal bones with a high jugular fossa were selected. Among these, 43 jugular bulb diverticula were found. The structures affected by a high fossa or diverticulum were recorded and correlated to the clinical symptoms of the patient. The vestibule was suspected to be affected in five patients. Two of these patients had tinnitus and vertigo, and three had hearing loss. In one of the latter the hearing loss was most marked in the supine position. The cochlea was close to the fossa in three patients, all of whom had tinnitus. Four patients had a defect of the posterior semicircular canal. One of them lost his hearing after a severe fit of coughing, became unsteady and showed signs of a fistula. The internal acoustic meatus and the mastoid portion of the facial canal were affected in two and four patients, respectively, who had no recorded symptoms. Twelve of 34 patients with Menière's disease and a high jugular fossa on the side of the diseased ear had a dehiscence of the vestibular aqueduct caused by the fossa or diverticulum, compared with nine of 58 patients in the unselected material. For comparison and demonstration of topographic relationships, 58 casts of unselected radiographed temporal bone specimens with high jugular fossae or diverticula were investigated. In patients with a high jugular fossa or jugular bulb diverticulum, tomographic assessment may be of value.

INTRODUCTION Acute osteoporotic vertebral compression fractures are common and usually managed conservatively. However, a significant number will remain symptomatic, causing significant pain with considerable associated morbidity and mortality. These fractures can be effectively treated with cement augmentation. However, it is impossible to distinguish between an acute and a chronic healed fracture on plain radiographs. The definitive investigation is a magnetic resonance scan. The aim of this paper is to describe and evaluate two new clinical signs to help in the diagnosis of symptomatic fractures. A prospective study of 83 patients with suspected acute osteoporotic vertebral compression fractures was carried out. All patients had a full clinical assessment, which included closed-fist percussion of their spine and asking the patient to lie supine on the examination couch. All patients had a MRI scan. RESULTS The closed-fist percussion sign had a sensitivity of 87.5% and a specificity of 90%. The supine sign had a sensitivi-’ of 81.25% and a specificity of 93.33%. CONCLUSIONS These tests will enable the practitioner to predict more accurately which patients have an acute fracture, guiding referral for further imaging.

A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications. References

AbstractThis study was aimed to investigate the role of anatomic variations in patellofemoral alignment in patients with or without Osgood-Schlatter disease (OSD) and to determine the potential anatomic risk factors that may play role in the etiology. This prospective observational case-control study was conducted on two groups of adolescent patients. Group 1 comprised patients who were diagnosed as having OSD and group 2 consisted of an equal number of age-matched patients who presented to the outpatient clinic with traumatic knee injury and underwent knee radiographic examination but without a diagnosis of OSD. Age, height, weight, body mass index (BMI), dominant side, and level of sporting activity were recorded. Quadriceps (Q) angles were measured using a long-arm goniometer with patients lying in the supine position with their knees in full extension and contracting the Q muscles. On anteroposterior, lateral knee, and tangential patella (Merchant and Laurin views) radiographs, the following measurements were performed: Insall–Salvati (IS), Caton–Deschamps (CD), and Blackburne–Peel (BP) indexes, congruence angles, lateral patellofemoral angles, sulcus angles, and patella type according to Grelsamer's morphology classification. Both groups were similar in respect of age (p = 0.160), sex (p = 0.311), height (p = 0.326), weight (p = 0.596), BMI (p = 0.153), and dominancy (p = 0.500). The rate of patients engaged in sports activities was significantly greater in the OSD group (p = 0.003). No significant difference was determined between the groups in respect to IS index, CD index, BP index, sulcus angle, lateral patellofemoral angle, and congruence angle (p–values: 0.358, 0.995, 0.912, 0.802, 1.000, and 0.907, respectively). The mean Q angle was measured as 15.6 ± 2.2 degrees in the OSD group and 14.3 ± 2.5 degrees in the control group (p = 0.014). Despite the difference being statistically significant, it was clinically insignificant because the difference was only 1.3 degrees. The principle etiologic factor seems to be increased physical activity rather than subtle variations is patellofemoral anatomy and alignment of extensor mechanism.

Background: Have been done research on inspection procedures examination in the case of abdominal CT Scan cholecystitis at Radiology installationProf. Dr. Margono Soekarjo Purwokerto Hospital. This study aims to determine the inspection procedure examination in the case of abdominal CT Scan cholecystitis not using the biphase technique diagnosis and to find out information on examination in the case of abdominal CT Scan cholecystitis with monophase technique at Radiology installationProf. Dr. Margono Soekarjo Purwokerto Hospital.Methods:This type of research is aqualitaive research case study approach. The data collection methods with unstructured observation , depth interview with 3 radiographers, 1 radiologist, a sending doctor and a patient, and the documentation of the results of reading radiographs and photographs. The data obtained then reduced, classified, dried and then interpreted in the form then concluded kuotasi and suggestions.Results: The result showed that the procedure examination abdomen ct scan in case of colecystitis at radiology installation Prof. Dr. Margono Soekarjo Purwokerto Hospital before the hearing preparation charge informed consent of patients, perform laboratory checks urium creatinin, fasting from the night and drank appoxcimately 1000 ml of Water the morning before the examination. While the position of the patient supine feet first and the administration of contrast media intra vena with a volume of 80 ml plus 20 ml Na Cl and arrangements flow rate 2,0 ml/sec with a scan delay of 40 seconds. Reason not to do engenering biphase technique examination in the case of abdominal CT Scan cholecystitis because only monophase technique, arterial phase alone can establish the diagnosis of cholecystitis.Conclusion: Information on CT Scan diagnosis in Radiology Installation Prof. Dr. Margono Soekarjo Purwokerto Hospital was able to show in indication of cholecystitis but have not been able to show the mass and metastase to the surrounding organs lake the liver gallbladder and pancreas, intrahhepatic and extrahepatic tract.

Introduction: Acute abdomen might indicate a progressive intra-abdominal condition that is threatening to life or capable of causing severe morbidity. A good history, thorough clinical examination, laboratory investigations and imaging studies is necessary in order to arrive at a correct diagnosis. The aim of our study was to compare the diagnostic yield of traditional three-view abdominal x-ray series (upright chest x-ray, supine and upright abdominal x-rays) with that of ultrasound in patients presenting with non traumatic acute abdominal surgical pain. Methods: This prospective study was conducted between February and July 2010 on 65 consecutive patients. Critically ill patients, pregnant ladies, patient with trauma abdomen, acute abdomen due to gynaecological pathologies were excluded from our study. Detail abdominal ultrasound was done. After ultrasound traditional three-views acute abdominal x-ray series (AAS) were taken. Final diagnosis was made on the basis of operative findings/therapeutic response/ histopathological/ laboratory findings. Finally, accuracy of clinical diagnosis, plain film and ultrasound in evaluation of acute abdomen was determined. Results: Ultrasound yielded an overall sensitivity and specificity of 78.7% and 84.6.6% respectively. The AAS interpretations yielded an overall sensitivity and specificity of 23.4% and 38.40% respectively. Conclusion: Plain x ray is less sensitive in the evaluation of nontraumatic acute abdomen so it should be used together with ultrasound abdomen in order to arrive at a correct diagnosis. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 20-27 DOI: http://dx.doi.org/10.3126/njr.v2i2.7681

Background. Traumatic Pneumothorax (PTX) is a potentially life-threatening injury. It requires a fast and accurate diagnosis and treatment, but diagnostic tools are limited. A new point-of-care device (PneumoScan) based on micropower impulse radar (MIR) promises to diagnose a PTX within seconds. In this study, we compare standard diagnostics with PneumoScan during shock-trauma-room management. Patients and Methods. Patients with blunt or penetrating chest trauma were consecutively included in the study. All patients were examined including clinical examination with auscultation (CE) and supine chest radiography (CXR). In addition, PneumoScan-readings and thoracic ultrasound scan (US) were performed. Computed tomography (CT) served as gold standard. Results. CT scan revealed PTX in 11 patients. PneumoScan detected two PTX correctly but missed nine. 15 false-positive results were found by PneumoScan, leading to a sensitivity of 20% and specificity of 80%. Six PTX were detected through CE (sensitivity: 54,5%). CXR detected four (sensitivity: 27,3%) and thoracic US two PTX correctly (sensitivity: 25%). Conclusion. The unblinded PneumoScan prototype did not confirm the promising results of previous studies. The examined standard diagnostics and thoracic US showed rather weak sensitivity as well. Until now, there is no appropriate point-of-care tool to rule out PTX.

Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication.

Dislocation of the intermediate cuneiform is a rare injury, and only a few cases have been reported .Cuneiforms dislocations have been treated in a variety of methods, ranging from open or closed reduction, without or with fixation such as Krischner wires or screws. Methods: A 24 years old female presented with right foot pain following fall from motorbike after got hit by a car from back. She related a history that her right foot was forced into torsion and plantarflexion at impact . On examination there was a bony protuberance on the dorsal surface, at cuneiform area . Radiograph showed dorsal dislocation of intermediate cuneiform. CT scan was performed and supported the radiographical findings. Manipulation under sedation was attempted, but was unsuccessful. Results: Patient was placed supine under spinal anesthesia . A dorsal incision was made centering over the protuberance proceeded distally up to the base of the second-metatarsal. The dislocated middle cuneiform was identified. There was proximal soft tissue attachment to the middle cuneiform which was carefully preserved. It temporarily reduced with Krishner wires and a 2.7 mm variable angle locking plate was fixed dorsally to butress the bone dislocation . The foot was immobilized with a boot slab for 6 weeks and subsequently physiotherapy was instituted and gradual weight-bearing started. Postoperative follow-up was uneventful. Discussion: Intermediate cuneiform is a part of the transverse and medial longitudinal arches of the foot and the stability is achieved by the deep transverse, dorsal, and plantar ligaments. It’s shaped like a wedge, the thin end pointing downwards, situated between medial and lateral cuneiforms, and articulates with the navicular posteriorly, the second metatarsal anteriorly and with the other cuneiforms on either side. Because it is wedge shaped and positioned dorsally, it has a tendency to dislocate dorsally, particularly when a plantar flexion force is applied to the midfoot. Immediate reduction and maintaining in reduced position is needed for good ligamentous healing. Conclusion: Intermediate cuneiform dislocation is a rare injury to encounter due to stable articulation of joints and ligament. Significant trauma is required for these injuries to take place. Open reduction is the gold standard treatment for these injuries. References: Kumaravel S et al An isolated middle cuneiform dislocation with a rare violence Journal of clinical orthopaedic and trauma 5 (2014) 161-171 Name

Rigid bronchoscopy is a procedure that is performed in order to directly visualize the upper and lower airway, and is carried out for either a diagnostic or therapeutic purpose. Suspected foreign body (FB) aspiration is the most common indication for performing this procedure in the pediatric age group at the Philippine Children’s Medical Center where a recent census (May 2008 to April 2009) showed that of 21 cases where rigid bronchoscopy was performed, 10 were for suspected FB aspiration. A review of 101 cases in the same institution showed that the average age of patients with FB aspiration was 2 years and the most common item aspirated was a peanut followed by the atis (sweetsop) seed and chicken bone chips. The most common inorganic foreign body was an earring and “whistle” (which broke off from a toy).1 It is more common in males probably because of their usually more active nature and is frequently found in the right mainstem bronchus, where the FB more easily lodges - being straighter, shorter and wider in diameter. FBs are life-threatening events in children that require early diagnosis and prompt successful management.2 A good history, physical examination and analysis of diagnostic tests are vital in every situation. In most cases, the child’s aspiration of the foreign object is a witnessed event 3 and this history of aspiration is the most sensitive diagnostic tool. The main symptoms include choking, prolonged cough, and dyspnea. Abnormal physical examination findings are found in 67% to 80% of cases and include unilaterally decreased breath sounds, wheezing and stridor.2, 4 Radiographic procedures may show abnormal findings in only about 68-86% of cases.4 5 The most useful radiographs requested are the chest posteroanterior (anteroposterior in infants and small children) and lateral views which may help localize the impaction site when the object aspirated is radiopaque.3 However, most inhaled FBs are radiolucent, and their presence can be suspected by obtaining inspiration and expiration views to demonstrate unilateral hyperinflation. Other suggestive features include atelectasis, pneumothorax and pneumonia. These indirect radiologic features of FB inhalation are present in 76% of cases.2, Where inspiration and expiration views cannot be obtained, as in very young children, left and right decubitus views may be helpful. 6 Fluoroscopic studies may also be obtained along with the plain radiographs, however, specificity and sensitivity are not very high.4 Virtual bronchoscopy may also be used in patients with suspected FB aspiration. Virtual bronchoscopy which uses multislice computerized tomography (MDCT) with realistic 3-dimensional reconstruction may be helpful in detecting and localizing the FB prior to any surgical procedure and thus decreasing the number of patients needing diagnostic bronchoscopies.7 Flexible fiberoptic bronchoscopy under local anesthesia and premedication may also be performed in cases of suspected FB aspiration wherein clinical and radiologic findings are not consistent with FB aspiration. When no FB is visualized, the patient is saved a rigid bronchoscopic procedure under general anesthesia.8 Flexible fiberoptic bronchoscopy is also used therapeutically to remove FBs in the bronchus, however, successful removal is more common with rigid bronchoscopy. All the necessary instruments needed for the procedure must be prepared. As much as possible 2 of each instrument are prepared: 2 bronchoscopes (one estimated from the age and size of the child and one smaller than that – just in case!), 2 suction devices (if one gets clogged up, the other one is ready) and 2 forceps. The peanut forceps is ideal, not only for peanuts but usually for other nuts as well; the alligator forceps is useful for relatively flat foreign bodies; while the “jaw type” forceps appears to be useful for everything else.9 The instruments are then tried, to check if they are in working order before commencement of anesthesia. This involves checking the transparency of the glass window plug, ensuring that the light source and the proximal prismatic light deflector are both illuminating, and trying out all the forceps and suction tips. It is best to try the instruments on an object similar to what the child aspirated.3 The surgical assistant, nurse and instruments are usually on the right (if the surgeon is right-handed) and anesthesiologist on the left. The suction and bronchoscope are then made ready. Knowledge of the anatomy of the tracheobronchial tree is imperative to be able to navigate through this area while looking for the FB. The use of optical forceps with mounted rod-lens telescopes has made the removal of airway FBs simpler, quicker and safer. These new devices have led to decreased complication rates and fewer missed or incomplete FB removals. While access to FBs located in the distal small segmental bronchi especially in very young children may be limited with the use of optical forceps,10 this can be overcome by removal of the connecting bridge to allow the optical forceps to be passed distal to the tip of the bronchoscope. An anesthesiologist familiar with the procedure must be called in. It is very important to have discussed the case and the procedure with the anesthesiologist prior to the operation to minimize confusion and promote harmony. Most anesthesiologists have become at ease with giving intravenous general anesthesia which circumvents the use of potentially noxious gases. Assisted spontaneous ventilation can avoid the need for muscle relaxation and paralysis so that the wake-up time is shortened. Intravenous general anesthesia with propofol and assisted spontaneous ventilation is currently the frequently used anesthetic technique for rigid bronchoscopy although volatile agents and gases are still used.11,12 The patient is placed supine on the operating table. A shoulder roll is not required. After induction of anesthesia, the patient is hyperventilated to 100% oxygen saturation to take full advantage of operating time.3 A topical anesthetic (lidocaine or tetracaine) is sprayed into the laryngeal area and distally into the trachea to lessen stimulus and pain, thus lowering the level of the anesthetic agent used and minimizing the possible occurrence of laryngospasm after the procedure.12 The state of dentition is inspected and a tooth guard placed over the upper teeth. Although it is possible to do bronchoscopy directly without using a laryngoscope, it is more expedient to use the laryngoscope (with the left hand) to visualize the larynx. The assistant (most likely the ORL resident but occasionally, a nurse) hands over the bronchoscope (to the right hand) without the glass window plug initially (because it may fog up or fall off) and the bronchoscope is inserted by looking through the bronchoscope as it passes through the larynx. Rotating the bronchoscope by 900 (with the axis of the lip in the anteroposterior axis of the glottis chink) is often useful for easier bronchoscopic insertion.2 Never force the bronchoscope into the larynx – if there is difficulty, reposition the laryngoscope to better visualize the larynx. Where exposure of the larynx is adequate, inability to pass the bronchoscope may be due to the bronchoscope lip hitting a vocal fold instead of entering the glottic chink. Another possibility is that the bronchoscope is too large to fit through a narrowed subglottis. The laryngoscope is removed once the bronchoscope has been inserted and the anesthesiologist connects the anesthetic tube to the standard 15-mm adapter of the bronchoscope and the glass window plug is inserted (this is again removed when the forceps is introduced or suctioning needed). A 0o telescope of the appropriate size may be inserted at this time or even during the initial insertion of the bronchoscope. The left hand is placed over the tooth guard and the thumb and index finger are used to support the bronchoscope being held in the right hand, much like a billiard cue. The left thumb lifts the bronchoscope off the tooth guard to enable the bronchoscope to be advanced without resistance. The bronchoscope is advanced slowly, always ensuring that the lumen is clearly in view, and suctioning whenever needed. Once the carina is seen, the main bronchus, where the FB is likely to be located, is then entered. Turn the head to the left to enable passage into the right main bronchus, and then to the right to enter the left main bronchus. Some degree of neck flexion can also be helpful in aligning the main bronchus. The bronchoscope is advanced until it is as near as possible to the FB to allow accurate suction of secretions so that the surgeon can determine how best to orient the forceps during application. The bronchoscope is then slightly withdrawn to allow the forceps to be freely inserted beyond the bronchoscope. The forceps are opened as widely as possible as this stretches the airway walls and allows the foreign body to fall into the jaws of the forceps which is then firmly grasped. Care must be taken not to push the FB further down the airway. If the FB fits through the bronchoscope, then it is pulled right through without removing the bronchoscope. However, if the FB does not fit through the bronchoscope, then the bronchoscope has to be withdrawn with the FB trailing behind held by the forceps. It is important to keep your eyes (and hands) on the bronchoscope and forceps at all times. The FB may become caught in the larynx or dropped into the trachea, causing complete airway obstruction. This possibility should always be anticipated and equipment be able to deal with this needs to be readily at hand. To prevent the FB being lost at the laryngeal inlet, the bevel of the bronchoscope is moved around over the FB by rotating the bronchoscope 900 and the bronchoscope is slightly tilted down at this area. A firm grip on the forceps with the FB must be maintained and hopefully, it is still there when the forceps is removed from the oral cavity. If the FB has been removed from the tracheo-broncial tree, but is not found in the forceps, the naso-oro-hypo pharynx should be checked in addition to a repeat bronchoscopy. All throughout the procedure, it is imperative to listen to the sound of the oxygen saturation monitor for signs of desaturation and to inquire from the anesthesiologist regarding the condition of the patient. If desaturation occurs, the bronchoscope is moved back out of the bronchus and into the trachea to allow the anestheshiologist to ventilate the patient through the bronchoscope adaptor. If this is due to a large FB that slipped while in the trachea, then, the FB must be removed right away or pushed back into the bronchus to regain the airway. Once the FB is removed , a second bronchoscopic examination is done to check for any pooling of secretions or blood that may need to be suctioned or for any remnant of the FB- which may have accidentally separated from the bigger piece- that has to be retrieved. Small pieces can often be removed by suctioning. Rarely, a tracheostomy may have to be performed for a FB that, during extraction, will not fit through the laryngeal inlet. Tracheotomy is performed while the bronchoscope is in place and with the forceps grasping the FB. The FB is extracted through the tracheostoma. Afterwards, tracheostoma is closed with sutures and regular wound care is initiated. If the procedure took less that an hour with minimal trauma, then the child is assisted with ventilation until he/she recovers full spontaneous respiration. A dose ofteroids may also be given (I.V. Dexamethasone, 1.0 to 1.5 mg/kg; maximum, 20 mg). The patient is brought to the post-anesthesia room and observed. Delayed diagnosis and intervention (24 hours or more) were found to be related to higher complication rates such as recurrent or chronic pulmonary infections and prolonged hospital stay. 13 Thus the need for early diagnosis and treatment of cases with suspected FB aspiration.

Background: A lumbosacral spinal compression device has been developed by the authors (SpineMAC) to simulate normal weight-bearing by axial-loading of the lumbar spine while the patient is in the supine position. Objective: To investigate the effect of axial loading using a SpineMAC device, on lumbar spine, spinal canal, and spine curvature, in subjects with suspected spinal stenosis. Materials and Methods: The present study was prospective cross-sectional study. Forty-five (21 males and 24 females) consecutive Thai adults underwent unloaded and axial-loaded supine magnetic resonance imaging (MRI) examinations of the lumbosacral spine. Radiographic parameters included cross-sectional area of disc (DA), cross-sectional area of dural sac (DCSA), disc height (DH), anterior to posterior distance of disc (DAP), L1-L3-L5 angle (LA), and lumbar lordosis (LL). Results: During the axial-loaded MRIs, the pathologic features of the lumbar spinal stenosis such as the disc bulging, nerve root compression, narrowing of the spinal canal, and the spinal neural foramina, were frequently observed in L4-L5 and L5-S1. Radiographic parameters differences of more than 5% between unloaded and axial-loaded supine MRIs were observed in DCSA and DH. Narrowing of the dural sac due to axial compression was observed at the L4-L5 level (8.1%), while loss of DH was found at both the L5-S1 (-7.9%) and the L4-L5 (-6.8%) levels. Axial compression only slightly affected the DA and DAP of the intervertebral discs with a difference of 5% or less. Furthermore, it rarely changed the spine curvature (LL and LA) of the subjects, with a difference of 2% or less. LL decreased during axial loading and may not correlate with the findings during normal standing position. Although the authors found greater DA and DAP values in male (p<0.001) and obese (p<0.05) subjects, changes of radiographic parameters with axial loading were otherwise not correlated with sex, age, or body mass index. Conclusion: An axial-loaded MRI, using a SpineMAC device, may be superior to conventional MRI when evaluating narrowing of the dural sac and disc height of patients. Keywords: Lumbar lordosis, Spinal stenosis, Axial loading, Weight bearing, Disc herniation, Low back pain

Abstract Background Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. However, the the clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum are still uncertain. Methods We evaluated consecutive patients who were diagnosed with OO of the acetabulum and who underwent hip arthroscopy at our hospital between January 2013 and March 2020. All patients underwent a preoperative physical examination. Preoperative supine anteroposterior hip radiography, cross-table lateral radiographs, computed tomography (CT), and magnetic resonance imaging were performed in all patients. The alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiography and CT were performed in all patients postoperatively. Preoperative patient-reported outcomes (PROs), including Visual Analog Scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated. Results A total of 6 patients (mean age, 18.7 years; age range, 6–31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6–90 months). Before surgery, the mean mHHS was 45.2 ± 10.5 (range, 33–56), the mean iHOT-12 was 33.3 ± 14.5 (range, 13–49), and mean VAS was 8.2 ± 1.0 (range, 7–9). At one month after surgery, mean mHHS was 78.7 ± 1.9 (range, 77–81), iHOT-12 was 71.0 ± 4.5 (range, 68–80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2 ± 2.1 (range, 86–91), iHOT-12 was 93.5 ± 5.0 (range, 88–98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery. Conclusions Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum. Further study on the mechanism of secondary femoroacetabular impingement (FAI) caused by OO of the acetabulum is needed. More cases of arthroscopic excision and longer follow-up are also needed to better prove the clinical outcomes of hip arthroscopy for OO of the acetabulum.

Abstract Background Mayfield skull clamps are widely used and indispensable in current neurosurgery. Complications such as skull fractures or intracranial hematoma from using a Mayfield skull clamp have largely been reported in the pediatric population, are likely related to the relative thinness of the skull, such as in patients with hydrocephalus, and are extremely rare in adults. Here, we report a case of skull fracture and epidural hematoma caused by a Mayfield skull clamp used for posterior decompression surgery in an adult patient with chronic hemodialysis. Case presentation A 67-year-old Asian male patient with a history of dialysis-dependent chronic renal failure over 36 years suffered from severe cervical myelopathy. Neurological examination and radiographic images revealed cervical spondylotic myelopathy due to dialysis-related spondyloarthropathy. Laminoplasty was planned on patient consent. A Mayfield skull clamp was applied with the patient supine. Torque was applied to the screws with gentle care, but there was no resistance and it was not easy to reach the standard 60 lb (267 N) to 80 lb (356 N). Because a skull fracture was suspected, we canceled the surgery. Emergency head computed tomography showed depressed skull fractures underlying the single-pin sites with an associated epidural hematoma. The fractures and epidural hematoma were treated conservatively, and spontaneous resolution of the hematoma was confirmed. Cervical laminoplasty was performed successfully using a mask-type head holder on the subsequent day. Conclusions As a precaution for fractures and epidural hematoma in neurosurgical patients with bone fragility or a thin skull, use of a mask-type fixing device or halo ring is recommended.

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.