Ray In Patients Research Articles

Frontal Plane Rotation of the First Ray in Hallux Valgus using Standing Computerized Tomography (CT)

The purpose of the present study was to analyze the difference in frontal plane rotation of the entire first ray in patients with and without hallux valgus using standing weightbearing computed tomography (CT). Ten feet of 10 patients with hallux valgus and 36 feet of 36 patients without hallux valgus were examined. Standing weightbearing CT scans and radiographs were taken for all subjects. Frontal plane measurements of the sesamoid apparatus, first metatarsal head, first metatarsal base, and medial cuneiform were performed. Frontal plane rotation of the first tarsometatarsal joint and intrinsic first metatarsal torsion was calculated. An independent 2 sample t test was used to compare means of outcomes of interest across control and treatment groups. Statistical significance was set at an alpha level of 0.05. There was a significant increase in pronation of the sesamoid apparatus (23.49° vs 6.60°) and first metatarsal head (17.79° vs 9.81°) in patients with hallux valgus. There was a significant increase in first metatarsal torsion toward pronation in patients with hallux valgus (22.28° vs 13.52°). No significant difference was detected in the rotation at the first tarsometatarsal joint or the frontal plane orientations of the first metatarsal base and medial cuneiform. By examining the frontal plane position of the entire first ray during weightbearing using standing CT in patients with and without hallux valgus, we determined the level at which pronation originates to be within the first metatarsal bone rather than the first tarsometatarsal joint.

P.641 Anxiety and insomnia as correlates of major depressive disorder with mixed features

The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal–metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered.

Three-Dimensional Weightbearing Assessment of the First Ray in Hallux Valgus: A Case-Control Study

Category:BunionIntroduction/Purpose:Coronal plane rotational deformity of the first ray has been implicated with the developmental pathologic process of hallux valgus (HV). Weight Bearing CT (WBCT) is an imaging technology that can support the assessment of this complex three-dimensional (3D) deformity. The objective of the study was to analyze the 3D architecture of the first ray in patients with HV when compared to controls using WBCT images and a 3D biometric algorithm analyzing the deformity in all three planes. We hypothesized that WBCT would confirm the rotational deformity in HV patients, and that the 3D algorithm would demonstrate increased specificity and sensitivity for the pathology when compared to traditional two-dimensional (2D) HV measurements such as the 1-2 intermetatarsal angle.Methods:Retrospective case-control study, ethics committee approved. Twenty-one feet of patients with clinically symptomatic HV and 20 feet of asymptomatic controls were included. Exclusion criteria applied were previous trauma or surgery affecting first ray or forefoot morphology. All patients were assessed using WBCT. First ray 3D coordinates (x, y, z) were harvested including: center-points of the heads and bases of the first and second metatarsals, center-point of the medial and lateral sesamoids, distal condyles of the proximal phalanx (PP) of the first toe, as well as the medial and lateral borders of the first metatarsal head and diaphysis. The 2D measurements (dorsoplantar 1-2 intermetatarsal (IMA) and metatarsophalangeal (MPA) angles) were obtained using digitally reconstructed radiographs (DRR). The Sesamoid Rotation Angle (SRA) was measured in the coronal plane. Using these coordinates, all 2D, 3D axes, distances, angulations and 3D biometric for HV (HV-3DB) could be calculated.Results:Mean ages were respectively 62.2y in the HV group and 48.8y in the control group (p<0.05). In 2D, the mean IMA and MPA for HV/controls were respectively 14.9/9.3 (p<0.001) and 30.1/13.1 (p<0.001). The SRA were respectively 29.1/7.1 (p<0.001). We found an almost perfect positive correlation between P1 rotation and sesamoid rotation, good correlation between IMA, MPA and SRA angles. There was poor correlation between pronation angles of the 1st phalanx and the 1st metatarsal. The 3D biometric algorithm combining IMA, MPA and SRA had a sensitivity of 95% and a specificity of 95.2% for the diagnosis of HV, compared to 90%/85.6% for the IMA and 90%/90.5% for the SRA.Conclusion:This original study confirmed our hypotheses. Weight Bearing CT efficiently analyzed the 3D architecture of the 1st ray in HV patients compared to asymptomatic controls. We concur with previous findings described in the literature concerning increased pronation of the 1st ray in HV. A novel biometric for HV using a specific multidimensional algorithm which combined IMA, HVA and SRA in a single 3D measurement, demonstrated increased sensitivity and specificity compared to the conventional 2D 1-2 intermetatarsal angle for the diagnosis of HV.

Role of X Ray in Patients with Acute Abdomen in a Tertiary Care Centre in Northern Western Rajasthan

Role of X Ray in Patients with Acute Abdomen in a Tertiary Care Centre in Northern Western Rajasthan

Evaluation of First-Ray Mobility in Patients with Hallux Valgus Using Weight-Bearing CT and a 3-D Analysis System

Some physicians report that patients with hallux valgus have hypermobility at the tarsometatarsal (TMT) joint of the first ray and 3-dimensional (3-D) deformity. With use of non-weight-bearing and weight-bearing computed tomography (CT), we evaluated the 3-D mobility of each joint of the first ray in feet with hallux valgus compared with normal feet. Ten feet of 10 patients with hallux valgus and 10 feet of 10 healthy volunteers with no foot disorders were examined. All participants were women. Weight-bearing (a load equivalent to body weight) and non-weight-bearing CT scans were made with use of a device that we developed. Orthogonal coordinate axes were set and a 3-D model was reconstructed. Each joint of the first ray was aligned with the respective proximal bone, and 3-D displacement of the distal bone relative to the proximal bone under loading was quantified. At the talonavicular joint, significantly greater dorsiflexion of the navicular relative to the talus was observed in the hallux valgus group compared with the control group. At the medial cuneonavicular joint, the hallux valgus group showed significantly greater eversion and abduction of the medial cuneiform relative to the navicular. At the first TMT joint, the hallux valgus group showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the hallux valgus group showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal (all p < 0.05). The results of this study suggest that loading of the foot causes significant 3-D displacement not only at the TMT joint but also at the other joints of the first ray. There is increased mobility in the first ray in patients who have hallux valgus.

How to evaluate brace treatment using X ray in patients with scoliosis

How to evaluate brace treatment using X ray in patients with scoliosis

Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas.

Since the diagnostic yield of chest X-ray (CXR) is not high enough, when it is ordered for all the multiple trauma patients, this study was aimed to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients. Stable multiple blunt trauma patients referring to the ED were included. The clinical and radiographic findings of all the patients were collected and the relationships between these variables analysed. Finally, based on the regression coefficients (β) of the variables, the Thoracic Injury Rule-out Criteria (TIRC) were designed. A total of 2607 patients were included (males: 78.9%, mean age: 34.1 ± 15.0 years). Age over 60 (β = 0.8; 95% CI: 0.27-1.34; P = 0.003), crepitation (β = 4.33; 95% CI: 1.65-7.0; P < 0.001), loss of consciousness (β = 3.16; 95% CI: 2.44-3.88; P < 0.001), decrease in pulmonary sounds (β = 2.67; 95% CI: 1.73-3.6; P < 0.001), chest wall pain (β = 2.12; 95% CI: 1.63-2.61; P < 0.001) and tenderness (β = 1.78; 95% CI: 1.26-2.27; P < 0.001), dyspnea (β = 1.3; 95% CI: 0.41-2.18; P = 0.004) and abrasion (β = 0.5; 95% CI: 0.22-0.83; P = 0.03) were independent factors predicting thoracic injury. CXR in stable conscious multiple blunt trauma patients under 60 years, without chest wall pain and tenderness, decrease in pulmonary sounds, crepitation, skin abrasion, and dyspnea did not provide any additional findings. Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.

Pattern of occurrence and treatment of impacted teeth at the Muhimbili National Hospital, Dar es Salaam, Tanzania

BackgroundImpacted teeth predispose to periodontal disease and dental caries of adjacent teeth resulting in pain, discomfort and loss of function. This study analyzed the pattern of occurrence of impacted teeth, associated symptoms, treatment and complications of treatment in patients who presented at the Muhimbili National Hospital, Tanzania.MethodThis was a crossectional descriptive study which utilized notes and x rays of patients who were treated for impacted teeth at the Oral and Maxillofacial firm in Muhimbili National Hospital over five years, from January 2005 to August 2010. These records were retrieved and examined for the major complaint of the patient at presentation to hospital, demography, impacted tooth, type of impaction (for third molars), treatment offered and complications after treatment. Similar information was collected from all patients with impacted teeth attended in the same centre from 1st September 2010 to 31st August 2011.ResultsA total of 896 patients (496 males and 400 females) treated for complaints related to impacted teeth were recorded. The male to female ratio was 1.2:1, age range of 16 to 85 years and a mean age of 28.9 years (SD = 9.5).Slightly more than 84% of the patients presented with mandibular third molar impactions. Most (44.7%) of these patients had an impacted lower right third molar followed by those presenting with a lower left third molar impaction (39.7%). In 1.3% of the patients all the four third molars were impacted. Sixty nine (7.7%) patients had impacted upper 3rd molars while 2% had impacted upper canines. Of the mandibular 3rd molar impactions 738 (76%) were mesio-angular type, 87 (8.9%) horizontal type and 69 (7.1%) disto-angular.Patients presented with a variety of complaints. About 85% of the patients presented to hospital due to varying degrees of pain. In 4.9% the detection of the impacted tooth/teeth was coincidental after presenting to hospital for other reasons not related to the impaction.Majority of the patients with impacted mandibular third molars had carious lesions on the impacted teeth, neighbouring tooth or both. Four hundred and five (45.2%) patients had a carious lesion on one of the impacted teeth while 201(22.4%) patients had a carious lesion on the adjacent second molar. In 122 (13.6%) patients both the impacted third molar and the adjacent second molar were carious. In twelve patients who presented with a main complaint of fracture of the angle of the mandible there was an associated impacted 3rd molar. Eight hundred and fifteen (91%) patients with impacted teeth were treated by surgical removal. Among these only 15 (1.8%) had complications that ranged from excessive swellings, trismus and severe pain post operatively. One patient was reported to have fracture of the angle of the mandible sustained during surgical removal of an impacted 48.ConclusionsThe majority of patients with impacted teeth were young with an almost equal sex distribution. The most commonly impacted teeth were mandibular third molars followed by the maxillary third molars. Patients with impacted teeth reported for health care predominantly because of pain due to dental caries or infection.There is a need of creating appropriate programmes that would further raise peoples’ awareness to regular dental checkups so that appropriate measures are taken before complications arise.

English

Pulmonary embolism (PE) is frequent in our country and accounts for thousands of hospitalization with significant mortality and morbidity. Diagnosing PE in our country is very difficult where there is paucity of high resolution multi-detector 64 slice CT scan along with financial limitations of patients. We can diagnose moderate to large pulmonary embolism with the help of D Dimer assay, electrocardiography, echocardiograph, Chest X ray along with symptoms which are highly suggestive of pulmonary embolism apart from the gold standard that is high resolution 64 slice multi-detector CT scan. There is a greater need to confirm and diagnose PE with the help of D- dimer assay, electrocardiography, Echocardiograph, Chest X ray in patients who present with features of PE(wells criteria) in our country because either most hospital in our country do not have multi detector CT scan or patient is not financially sound to afford it. We can still diagnose PE without CT scan and thus in turn can treat most of the patients with moderate to large pulmonary embolism without high resolution CT scan. INTRODUCTION: Pulmonary embolism accounts for millions of hospitalizations annually worldwide. Although D-Dimer testing for exclusion of PE and chest computed tomography(CT)for imaging PE have revolutionized the diagnostic approach, PE remain difficult to detect unless high index of clinical suspicion is kept during management of critically ill patients. Our understanding of the precipitants of PE has improved especially the role of hyper- coagulable states and potentially modifiable risk factors such as long-haul air travel and obesity. Doctors in critical care and cardiologist must provide expertise in the treatment of hemodynamically compromised patients with PE as well as those with right ventricular failure who maintain a stable blood pressure and heart rate. This requires rapid and accurate risk stratification, often with echocardiography, elevation of troponin, D-dimer assay, brain natriuretic peptide levels, so that those patients with adverse prognosis will be identified and treated with thrombolysis or embolectomy.

Hypermobility of the first ray in patients with planovalgus feet and tarsometatarsal osteoarthritis

Hypermobility in the foot is a common observation but difficult to quantify. Primary tarsometatarsal arthritis is less common and its aetiology uncertain. This study introduces a novel means of clinical measurement for range of motion of the medial column and investigates the association between hypermobility, planovalgus foot shape and tarsometatarsal arthritis. 32 planovalgus feet with symptomatic tarsometatarsal arthritis were compared with 36 controls. Radiographic angular measurements and arthritic grade were recorded from standing radiographs. Medial column flexion and extension was measured clinically using a validated electronic goniometer. There was a significant difference in medial column range of motion between the patient and control groups (17±5° compared to 9±3° [P<0.001]). Patients with planovalgus feet and tarsometatarsal osteoarthritis have greater range of motion of the medial column than controls with normal feet when measured using this technique. Recognition of this association may lead to progress in prevention and treatment.

The Woman Who Knew Too Much: Alice Stewart and the Secrets of Radiation (review)

For the past twenty years, most American and British obstetricians have avoided taking routine X rays of patients who are pregnant. In dental offices, at least in the United States, no one is X-rayed without first donning a protective apron extending from shoulders to knees. These precautions are the result, at least in part, of research performed by the British physician and epidemiologist Alice Stewart (b. 1906). Gayle Green's lively biography traces the life of Dr. Stewart, principal discoverer of the link between in utero X-ray exposure and the development of childhood leukemia.

Increased Thromboxane B&lt;sub&gt;2&lt;/sub&gt; and Prostaglandin E&lt;sub&gt;2&lt;/sub&gt; Levels Precede Clinical Acute Respiratory Distress Syndrome after Esophageal Resection

The acute respiratory distress syndrome (ARDS) is a frequent, nonsurgical complication after esophageal resection, and requires immediate counter measures. We recently described the time course of ARDS after esophageal resection as being clinically very consistent, with a peak of pulmonary edema on postoperative day 5. In the present study, we investigated the time course of ARDS mediators such as thromboxane B2 (TxB2), prostaglandin E2 (PGE2) and endotoxin in the central venous and arterial blood of patients who had undergone esophagectomy and subsequently developed ARDS. Serum PGE2 levels in control patients were 3.2 ± 5.9 ng/ml, and 10.5 ± 6.3 ng/ml in patients who developed ARDS, with a trend towards higher PGE2 levels in ARDS patients early postoperatively. TxB2 levels ranged between 0.9 and 1.4 ng/ml in ARDS as well as control patients during the intraoperative course and the first 2 postoperative days, with a trend towards higher peripheral TxB2 levels in ARDS patients. This study provides evidence that PGE2 and TxB2 start to increase in parallel with the rise in pulmonary effusions seen on the chest X rays of patients who develop the clinical picture of ARDS.

Jejunal interposition operation; analysis of thirty-three clinical cases.

It is now possible to excise the esophagogastric junction for such conditions as reflux esophagitis with stricture with restoration of continuity and without fear of recurrent esophagitis. The operation here described involves the interposition of a segment of jejunum, from 15 to 48 cm. in length, with certain precautions taken to make sure of a good blood supply. Four anastomoses have to be made, the most crucial being that between the esophagus and the jejunal segment. In a period of six years this interposition operation has been carried out in 33 patients. Four postoperative deaths occurred, and analysis of the case histories indicates that improvements in technique would reduce the mortality significantly. Among the other 29 patients there has been no dysphagia, and the functioning of the interposed segment of jejunum has been studied by roentgen ray in patients up to six years after operation. All patients, including some with cardiospasm, esophageal varices, and lye stricture, were relieved to be able to swallow normally again, and the majority ate three meals a day, but 6 established a pattern of eating five or six times a day, and 12 were apparently unable to vomit. The substitution of a segment of jejunum for the esophagogastric sphincter is a sound physiological procedure.