Intraoperative Findings In Patients Research Articles

Evaluation of Accuracy of Clinical and Preoperative HRCT Diagnostic Findings with Intraoperative Findings in Patients of Cholesteatoma

Evaluation of Accuracy of Clinical and Preoperative HRCT Diagnostic Findings with Intraoperative Findings in Patients of Cholesteatoma

Telemedicine ultrasound assessment for placenta accreta spectrum: Utility and interobserver reliability of asynchronous remote imaging review.

Management of patients with placenta accreta spectrum (PAS) by trained multidisciplinary teams is associated with improved outcomes. Ultrasound can predict intraoperative risks, but expert ultrasound imaging of PAS is often limited. Telemedicine is used increasingly in obstetrics, permitting expert consultation when essential resources are not available locally. Our objective was to evaluate the feasibility of teleconsultation using standardized ultrasound image acquisition and reporting, and to correlate prognosis with intraoperative findings in patients at risk for PAS. A total of 12 PAS imaging experts (teleconsultants) were selected to asynchronously review deidentified standardized grayscale and color Doppler ultrasound images for five patients who had completed treatment for PAS, resulting in 60 individual teleconsultations. All patients were managed at a center using standardized imaging acquisition and intraoperative topographic classification to individualize surgical management. Teleconsultants reported the predicted topographic classification and recommended a surgical approach based on the topographic classification algorithm. Prognoses were compared with that reported by the local sonologist and with intraoperative findings. In all five patients, local sonologist prognosis and antenatal topographic classification was confirmed during surgery and the final surgical approach matched that which was recommended preoperatively. Teleconsultant antenatal evaluation and management plans matched those of the local team in 71.7% of the cases. When reports differed, PAS severity was overestimated in nine reviews (16.9%) and was underestimated in six reviews (11.3%). Remote imaging teleconsultation provides accurate prenatal staging in most patients at risk for PAS. Teleconsultation is a feasible strategy to improve prenatal imaging, management planning, and guidance for local teams in settings with limited healthcare resources.

Comparison of Ossicular Chain Status by Pre-Operative Cone Beam Computed Tomography (CBCT) with Intra-Operative Findings in Patients with Conductive Hearing Loss

Comparison of Ossicular Chain Status by Pre-Operative Cone Beam Computed Tomography (CBCT) with Intra-Operative Findings in Patients with Conductive Hearing Loss

326TiP Prospective study to correlate peritoneal disease burden on imaging with intraoperative findings in patients with peritoneal surface malignancies

326TiP Prospective study to correlate peritoneal disease burden on imaging with intraoperative findings in patients with peritoneal surface malignancies

High-Resolution Computed Tomography in Middle Ear Cholesteatoma: How Much Do We Need It?

Background and Objectives: The diagnosis of cholesteatoma is usually clinic, and the only efficient treatment is surgical. High-resolution computed tomography (HRCT) is not considered absolutely necessary for the management of an uncomplicated cholesteatoma, but unsuspected situations from a clinical point of view can be discovered using the scans, warning the surgeon. Our objective is to compare HRCT scan information with intraoperative findings in patients with cholesteatoma and analyze the usefulness of a preoperative HRCT scan from a surgical point of view. Materials and Methods: This is a prospective descriptive study conducted in the Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Romania, from May 2021 to April 2022. It was carried out on 46 patients with a clinical diagnosis of cholesteatoma who were consequently operated on in our department. All patients received full clinical and audiological examinations. In all cases, an HRCT scan was performed preoperatively as a mandatory investigation. Preoperative HRCT scans were analyzed, and their findings were compared to the intraoperative notes. The two sets of observations were analyzed using standard statistical methods. Results: Extensive cholesteatoma was the most common type of disease, involving 46% of the patients, followed by pars flaccida cholesteatoma (35%) and pars tensa cholesteatoma (19%). Eroded scutum was the most frequent lesion involving 70% of the patients, followed by incus erosion (67%). Comparison of the HRCT and intraoperative findings revealed a very good correlation for tegmen tympani erosion, sigmoid plate erosion, scutum and malleus erosion, and a moderate-to-good correlation for lateral semicircular canal erosion, incus and stapes erosion, and fallopian canal erosion. Conclusions: HRCT is a valuable tool in the preoperative assessment of cholesteatoma, helping in making surgical decisions. It can accurately predict the extent of disease and is helpful for detecting unapparent dangerous situations. However, it is not very accurate in detecting fallopian canal and stapes erosion.

Comparison of Preoperative Computerized Tomograghic Scan of Temporal Bone Findings with Intra Operative Findings in Patients with Chronic Otitis Media Undergoing Tympanomastoidectomy: A Descriptive Study

Background: Since ancient times, chronic suppurative otitis media (CSOM) has been a significant contributor to middle ear illness. Antibiotics have been extremely helpful, but (CSOM) is still a frequent condition, and its consequences present a challenge to both otologists and radiologists. Due to the intricate anatomical nature of the middle ear and inner ear, radiological assessment of the temporal bone is challenging.
 Aim of the Study: To compare between preoperative CT scan findings of the temporal bone with the operative findings in patients with CSOM undergoing tympanomastoidectomy.
 Methodology: A Descriptive cross-sectional prospective has been adopted and 35 patients with Chronic Suppurative Otitis Media were admitted at the Department of Otolaryngology/ Alsulaymaniyah Teaching Hospital of Otolaryngology, Head and Neck Surgery, and Zhian Hospital during the period from February to December 2015. A detailed history and careful physical examination, clinical tests revealed that all of the patients had Chronic Suppurative Otitis Media, typically with discharge from the ear and hearing loss. Each patient had their clinical history collected, and they all underwent a thorough ear, nose, and throat examination as well as an attentive otoscopic and microscopic ear examination. Additionally, all patients underwent an audiological evaluation that included pure tone audiometry, tympanometry, and HRCT.
 Results: Thirty -five patients were included in this study. The mean age of the patients was 33 years; 51.4% were males and 48.6% were females. The most common presenting symptom was aural discharge in 71.4%; the second one was hearing loss in 28.6%. Mastoid pneumatization was found in 82.9% by CT while by surgery, it was found in 17.1%. CT findings showed that middle ear involvement in 11.4%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 54.3%, and EAC, mastoid, and middle ear involvement in 17.1%. While the surgical findings showed middle ear disease in 20%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 57.1%, and EAC, mastoid and middle ear involvement in 11.4%. The CT findings for eroded Malleus, Incus integrity, and stapes in 31.4%, 37.1%, not visualized while surgical findings showed eroded Malleus, Incus, and stapes integrity that 28.6%, 54.3%, and 28.6% respectively. The CT findings for an eroded facial canal, the lateral semicircular canal, the posterior external auditory canal wall, and sigmoid sinus plate integrity were 12.4%, 8.6%, 22.9%, and 11.4% in that order, while the surgical findings of the eroded facial canal, the lateral semicircular canal, and the posterior external auditory canal wall were found in 20.0%, 5.7%, 17.1%, and 14.2% respectively. Both CT and surgical findings of Integrity of the tegmen showed that 32 patients (91.4%) were found to have intact tegmen, and 3 patients (8.6%) had eroded tegmen and both showed that the eroded scutum found in 25.7%.
 Conclusions: The current study concluded a positive correlation between CT and surgical findings that has many advantages in preoperative planning for the eradication of the disease, choosing the best approach & has a very important role in the orientation of the surgeon during the surgery to avoid any possible complications.

Diagnostic Accuracy of Clinical Features, Laboratory Features, and Ultrasound Imaging Compared to Intraoperative Findings in Patients with Obstructive Jaundice

Highlights:1. Patients with obstructive jaundice have either benign or malignant underlying etiologies.2. Ultrasound imaging had the highest accuracy in diagnosing the etiology of obstructive jaundice among other examinations, such as clinical signs and laboratory tests. AbstractIntroduction: Jaundice due to biliary obstruction can be caused by a diverse group of diseases, including both benign and malignant etiologies. This study aimed to evaluate the accuracy of clinical features, laboratory features, and ultrasound imaging in diagnosing the etiology of obstructive jaundice with intraoperative findings as the gold standard.Methods: This was an observational cross-sectional analytic study conducted on 49 subjects by obtaining patients’ data from medical records in the Medical Record Center Dr. Soetomo General Academic Hospital, Surabaya. Collected data were statistically analyzed using a diagnostic test.Results: In this study, sensitivity (Sn), specificity (Sp), and accuracy of each feature in differentiating masses and stones as the etiology of obstructive jaundice were obtained. Progressive jaundice had Sn 88.2%, Sp 37%, and accuracy 56.8%. Complaints of fever had Sn 73.9%, Sp 90.9%, and accuracy 79.4%. Courvoisier’s law had Sn 61.5%, Sp 61.5%, and accuracy 61.5%. Serum CA 19-9 had Sn 75%, Sp 58.3%, and accuracy 67.9%. Ultrasound imaging had Sn 81.8%, Sp 100%, and accuracy 93.3%.Conclusion: Ultrasound imaging had the highest accuracy in diagnosing the etiology of obstructive jaundice, followed by complaints of fever, serum CA 19-9, Courvoisier’s law, and progressive jaundice, respectively.

An observational study of the association of preoperative MRI findings and intraoperative findings in patients with fistula in ano

An observational study of the association of preoperative MRI findings and intraoperative findings in patients with fistula in ano

Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation

Category: Ankle Introduction/Purpose: Suspected peroneal tendinopathy, tears, and subluxation are often confirmed using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). The choice between these two imaging modalities is commonly based on surgeon preference as the accuracy of these tests for the diagnosis of peroneal tendinopathy, tears, and subluxation is not known. The purpose of this study was to compare MRI and US to the intraoperative findings in patients who underwent surgery for the treatment of suspected peroneal tendinopathy, tears, and subluxations to determine the diagnostic accuracy of each imaging modality. Methods: The operative records and diagnostic images for 21 patients who underwent surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. Two fellowship trained musculoskeletal radiologists conducted a systematic blinded review of the stored MRI and US images. The results of this review were compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. Results: For the diagnosis of peroneus brevis tears, both MRI and ultrasound were equally good at detecting tears. In the diagnosis of peroneus brevis tears, MRI was marginally better with a sensitivity and specificity of 100% versus ultrasound, which had a sensitivity of 90% and specificity of 100%. In the diagnosis of peroneal subluxation, ultrasound had a sensitivity of 100% and a specificity of 100% compared to MRI, which had a sensitivity of 33% and specificity of 100%. Conclusion: In comparing MRI and US to intraoperative findings for the diagnosis of peroneal tendinosis, tears and subluxation, we found ultrasound to be more effective at diagnosing peroneal tendinopathy and subluxation, while MRI was found to be slightly more accurate in the diagnosis of peroneus brevis tendon tears. Both MRI and ultrasound were effective for the diagnosis of peroneus longus tears.

Comparative Study between CT Findings and Intra-Operative Findings in Patients with CSOM (Attico-Antral Disease)

Comparative Study between CT Findings and Intra-Operative Findings in Patients with CSOM (Attico-Antral Disease)

Comparison of pre-operative temporal bone high resolution CT scan and intraoperative findings in patients with chronic suppurative otitis media

Background and objectives:To compare the findings of high resolution computed tomography of temporal bone with intraoperative findings of patients suffering from chronic suppurative otitis media. Methods:This is a prospective randomize case study which was conducted on 100 patients complaining from chronic ear discharge and hearing impairment. The study was conducted at otolaryngology department, Rizgary Teaching hospital, Erbil City-Iraq from January 2016 to December 2018. The surgical procedures were the same for all patients as mastoid exploration. Based on the intraoperative finding it was decided either to choose canal wall up mastoidectomy or canal wall down mastoidectomy procedure that to be appropriate for particular case with studying and comparing the radiological finding accordingly. Results:Of the 100 patients,47% were males and 53% females. Eighteen cases were diagnosed with cholesteatoma and 82 cases were without. The high resolution computed tomography of temporal bone offered very high sensitivity in detecting erosion of scutum (100%), semicircular canal (100%), ossicles erosion (94%), but it gave low sensitivity 33% regarding prediction of facial nerve canal dehiscence. However, the prediction of the dehiscence of the facial canal should be not excluded regardless of images show intact facial canal in high resolution CT scan. Nearly 100% specificity obtained for erosion of scutum, semicircular canal, dehiscence of facial canal and sigmoid sinus wall. Whereas it is relatively less specific for erosion of ossicles and differentiation between the cholestatoma and granulation tissue. Conclusion:We concluded that high resolution computed tomography scan of temporal bone is a golden investigation before surgery for cases of chronic suppurative otitis media to plan for the type of surgery accordingly

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Objective To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure. Methods Medical records of 17 patients with NVS (trigeminal neuralgia [TN] = 14 and hemifacial spasm = 3) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1–36 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded. Statistical Analysis Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages. Results The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month. Conclusion Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.

Comparison of preoperative trans-thoracic echocardiography with intraoperative findings in patients with congenital heart disease undergoing surgery: a prospective observational study

ObjectiveTo determine the diagnostic accuracy and safety of trans-thoracic echocardiography alone for indicating surgery by correlating preoperative trans-thoracic echocardiography with intra-operative findings in patients with congenital heart disease (CHD) in a low resource, low volume center.MethodologyThe pre-operative trans-thoracic echocardiography and intra-operative findings of two hundred and fifty patients with CHD, undergoing surgery at the National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, from 2012 to 2017 were prospectively compared. Included in this prospective study, were all patients with CHD who had trans-thoracic echocardiography alone at the NCTC. Excluded were patients who were operated at the NCTC based on echocardiography done elsewhere, those who had echocardiography at the NCTC but were operated elsewhere, as well as those whose operative decision were based on cardiac catheterization or CT angiography and patients with acquired heart defects. The analysis included profiling of patients on different demographic and clinical parameters. SPSS software was used for analysis.ResultsOf the 250 patients ages ranged from 2 months to 60 years. The mean was 4 years 95 days, median 1 year 180 days. The female sex accounted for 152 (60.6%). The preoperative trans-thoracic echocardiography correlated with intra-operative findings completely in 228 (91.2%) of patients, affirming the accuracy of this imaging modality. There were however, 19 (7.6%) false negatives and 3 (1.2%) false positive. Neither the false positive nor false negative errors resulted in complications or adversely affected the surgical outcome.ConclusionBased on the results of this study, preoperative transthoracic echocardiography done by cardiologists at the National Cardiothoracic Center, Korle Bu Teaching Hospital Accra, demonstrated a high correlation with intraoperative findings. Echocardiography also proved to be sensitive, accurate and safe for indicating surgery in patients with congenital heart disease.

Surgical treatment of sagittal band injuries and classification according to operative findings

PurposeThe indications for surgery in patients with acute closed sagittal band injuries are still undetermined. The purpose of this study was to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injuries, and to present the treatment plans and surgical methods.MethodsTwenty-five patients who had undergone surgical exploration for closed sagittal band injuries between January 2011 and December 2020 were included in the study, comprising 17 patients with acute injuries (within 3 weeks), four patients with chronic injuries, and four patients who underwent surgery because symptoms did not improve in response to conservative treatment. Patients with laceration, fracture, and rheumatoid arthritis were excluded.ResultsSagittal band injuries were classified into two groups: superficial sagittal band (SSB) and proper sagittal band (PSB) injuries. SSB injuries were observed in 75.0% of spontaneous rupture cases and PSB injuries were observed in 66.7% of traumatic rupture cases. SSB injuries were observed in 83.3% of Rayan and Murray classification type II cases and PSB injuries were observed in 61.5% of type III cases (p=0.041). PSB injuries were present in all four patients who underwent surgery because conservative treatment failed.ConclusionWe successfully corrected sagittal band injuries with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injuries can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. The surgical method and treatment plan can be chosen based on this classification.

Anatomical Barriers in Congenital Canal Atresia Affecting Operative Candidacy and Patient Selection

AbstractBackground: By analyzing the temporal CT images and intraoperative findings in patients with canal atresia and comparing those with images and intraoperative findings of normal canals, we further understand ex‌ternal and middle ear development to improve surgical candida‌cy selection. In addition to the status of the ossicu-lar chain, the degree of development of the tympanic cavity and mastoid, and the course of the facial nerve, the most important information taken from CT and intraoperative findings are the dimensions of the future canal. This study will focus on the dimensions of the created canal and whether it is correctable or uncorrectable.Aim of the study: To match the C.T. scan and intraoperative findings with the surgical outcome for patients with congenital canal atresia for proper surgical candidacy considerations. Patients and methods: A prospective, study conducted from September 2017 to December 2020 on 50 congenital canal atresia patients. All patients have undergone surgical meatocanaloplasty. Intraoperative data collection was done to be matched with preoperative C.T. data and correlated later on with the final outcome. Results: Follow up of all patients recorded progressive circumferential narrowing of their canals and progressive reduction of their depth. Final outcome showed narrow short canals in all patients. Conclusion: Analysis of the C.T. data and intraoperative findings in patients of congenital canal atresia showed uncorrectable dimensions even for those patients with the highest Jahrsdoerfer score due to lack of full dimension consideration. Keywords: Congenital anatomical Barriers, Non corrected dimensions, Congenital Canal Atresia.

Development and assessment of 3-dimensional computed tomography measures of proximal humeral bone density: a comparison to established 2-dimensional measures and intraoperative findings in patients undergoing shoulder arthroplasty.

BackgroundThe purpose of this study was to develop novel three-dimensional (3D) measures of bone density from computed tomography (CT) scans and to compare them with validated two-dimensional (2D) radiographic assessments of bone density. Patient demographic data were also analyzed to see if there were any predictors of bone density (age, sex, etiology).MethodsThe study group consisted of 290 consecutive patients undergoing primary shoulder arthroplasty surgery (total anatomic, reverse, and hemiarthroplasty). All underwent preoperative CT imaging. Three 3D CT measurements (metaphysis cancellous, metaphysis cortical, and proximal diaphysis) were developed and automated into software. The developed 3D measurements were compared with validated 2D measures (Tingart and Gianotti Index). Patient demographic data were correlated with these measurements. The difference between the size of the final sounder and of the final stem was calculated as Delta.ResultsThere was moderately strong correlation between Tingart and Gianotti measures (0.674, P < .001), as well as between 3D metaphysis cancellous measurements and Tingart (0.645, P < .001). Decreased bone density was highly correlated with female sex. Tingart (area under the curve [AUC]: 0.87, 95% confidence interval [CI]: 0.82-0.91) and 3D metaphysis cancellous (AUC: 0.78, 95% CI: 0.72-0.84) had the highest correlation. These were significantly more than other measures of bone density (P < .01). Decreased bone density measured with Tingart also had moderate correlation with advanced age (AUC: 0.67, 95% CI: 0.6-0.73), but less so for etiology (AUC: 0.62, 95% CI: 0.55-0.69). The 3D metaphysis cancellous measure had lower correlation with age (AUC: 0.59, 95% CI: 0.52-0.66) and etiology (AUC: 0.59, 95% CI: 0.52-0.65). The highest correlation with Delta (the difference between the final sounder and the stem size) was with the 3D metaphysis cancellous measure (AUC: 0.67, 95% CI: 0.59-0.73), followed by Tingart (AUC: 0.647, 95% CI: 0.57-0.671). A multiple regression model to predict Delta demonstrated the stronger prediction using 3D metaphysis cancellous (analysis of variance F-ratio of 42.6, P < .001) than Tingart (35.9, P < .001).ConclusionThis study demonstrates that automated measures of bone density can be obtained from 3D CT scans. Of the three novel 3D measurements of bone density, the humeral metaphysis cancellous measurement was most correlated to the known 2D measures and most correlated to the intraoperative assessment of bone density (delta).

Lumbosacral plexus MR tractography: A novel diagnostic tool for extraspinal sciatica and pudendal neuralgia?

BackgroundDiagnosing extraspinal sciatica and pudendal neuralgia remains a clinical challenge. MRI and MR Neurography (MRN) are currently the standard techniques used to support the diagnosis of extraspinal lumbosacral plexus entrapments; however, for the intrapelvic portions of the lumbosacral plexus their accuracy is still limited. MR Tractography (MRT) feasibility to image the lumbosacral plexus has been demosntrated, but its clinical applications have yet to be determined. PurposeTo correlate MRT with intraoperative findings in patients undergoing laparoscopic treatment of intrapelvic entrapments of the lumbosacral plexus and compare its accuracy with Neuropelveological clinical assessment and MRN. Materials and methodsThis is a retrospective analysis of MRT reconstructions of diffusion tensor imaging (DTI) sequences acquired for the MRN collected from a cohort of 13 patients undergoing laparoscopic detrapment of the lumbosacral plexus. The primary outcome of this study was the correlation of MRT reconstruction with intraoperative findings. Secondary outcomes included the correlation of MRN, preoperative Neuropelveological clinical diagnoses and the diffusion-weighted imaging (DWI) fractional anisotropy (FA) and Apparent Diffusion Coefficient (ADC) in patients undergoing pelvic MRI and MRN for the investigation of intrapelvic nerve entrapments. ResultsMRT correlated with intraoperative findings in 11 of 13 patients (85%). Neuropelveological clinical assessment was able to accurately diagnose a pelvic nerve entrapment in 12/13 patients (92%) and MRN agreed with surgical findings in only 2/13 (15%) patients. MRT was significantly superior to MRN (p < 0.001). FA and ADC did not correlate with the identification of a nerve entrapment, likely due to limitations regarding the placement of the seedpoints. ConclusionsThis initial, retrospective analysis, suggests that MRT is superior to MRN at diagnosing intrapelvic entrapments of the lumbosacral plexus. A prospective, double-blinded study is underway to validate this data, but these initial findings show great potential for MRT as a diagnostic tool for extraspinal sciatica and pudendal neuralgia.Clinical Trials Registry: U1111–1261-4910 (REBEC – Brazilian Registry for Clinical Trials).

Non-haemorrhagic uterine rupture at 28\xa0weeks of pregnancy following previous caesarean section: a case report

BackgroundThere is need to put forward more symptoms and signs that could suggest a diagnosis of uterine rupture so that clinicians’ suspicion is increased; there is also need to put forward uncommon intraoperative findings in patients with uterine rupture to correlate with the signs and symptoms of patients.Case presentationA 33 year old Gravida 5 Para 4 + 0 with 2 previous caesarean section scars at 28 weeks of amenorrhoea, presented to hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine. On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labour and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios. Decision do deliver her by emergency caesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through and vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively.ConclusionsThere is need to suspect uterine rupture in pregnant women with previous caesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are haemodynamically stable and without vaginal bleeding and remote from term.

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

AimsTo compare the diagnostic accuracy of investigators from different specialities (radiologists and orthopaedic surgeons) with varying levels of experience of 1.5 T direct magnetic resonance arthrography (dMRA) against intraoperative findings in patients with femoroacetabular impingement syndrome (FAIS).MethodsA total of 272 patients were evaluated with dMRA and subsequent hip arthroscopy. The dMRA images were evaluated independently by two non-hip-arthroscopy-trained orthopaedic surgeons, two fellowship-trained musculoskeletal radiologists, and two hip-arthroscopy-trained orthopaedic surgeons. The radiological diagnoses were compared with the intraoperative findings.ResultsHip arthroscopy revealed labral pathologies in 218 (79%) and acetabular chondral lesions in 190 (69%) hips. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for evaluating the acetabular labral pathologies were 79%, 18%, 79%, 18%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 83%, 36%, 83%, 36%, and 74% (fellowship-trained musculoskeletal radiologists), and 88%, 53%, 88%, 54% and 81% (hip-arthroscopy trained orthopaedic surgeons). The sensitivity, specificity, PPV, NPV and accuracy of dMRA for assessing the acetabular chondral damage were 81%, 36%, 71%, 50%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 84%, 38%, 75%, 52%, and 70% (fellowship-trained musculoskeletal radiologists), and 91%, 51%, 81%, 73%, and 79% (hip-arthroscopy trained orthopaedic surgeons). The hip-arthroscopy trained orthopaedic surgeons displayed the highest percentage of correctly diagnosed labral pathologies and acetabular chondral lesions, which is significantly higher than the other two investigator groups (p < 0.05).ConclusionThe accuracy of dMRA on detecting labral pathologies or acetabular chondral lesions depends on the examiner and its level of experience in hip arthroscopy. The highest values are found for the hip-arthroscopy-trained orthopaedic surgeons.Level of evidenceRetrospective cohort study; III.

Femoral cartilage damage occurs at the zone of femoral head necrosis and can be accurately detected on traction MR arthrography of the hip in patients undergoing joint preserving hip surgery.

The primary purpose was to answer the following question: What is the location and pattern of necrosis and associated chondrolabral lesions and can they be accurately detected on traction MR arthrography compared with intra-operative findings in patients undergoing hip preservation surgery for femoral head necrosis (FHN)? Retrospective, diagnostic case series on 23 patients (23 hips; mean age 29 ± 6 years) with diagnosis of FHN undergoing open/arthroscopic joint preserving surgery for FHN and pre-operative traction MR arthrography of the hip. A MR-compatible device for weight-adapted application of leg traction (15–23 kg) was used and coronal, sagittal and radial images were acquired. Location and pattern of necrosis and chondrolabral lesions was assessed by two readers and compared with intra-operative findings to calculate diagnostic accuracy of traction MR arthrography. On MRI all 23 (100%) hips showed central FHN, most frequently antero-superiorly (22/23, 96%) where a high prevalence of femoral cartilage damage was detected (18/23, 78%), with delamination being the most common (16/23, 70%) damage pattern. Intra-operative inspection showed central femoral head cartilage damage most frequently located antero-superiorly (18/23, 78%) with femoral cartilage delamination being most common (14/23, 61%). Traction MR arthrography enabled detection of femoral cartilage damage with a sensitivity/specificity of 95%/75% for reader 1 and 89%/75% for reader 2. To conclude, femoral cartilage damage occurs at the zone of necrosis and can be accurately detected using traction MR arthrography of the hip which may be helpful for surgical decision making in young patients with FHN.