Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips.

BACKGROUND: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears. PURPOSE: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints. MATERIAL AND METHODS: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints. RESULTS: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%. CONCLUSION: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.

Ultrasound for diagnosis of scaphoid fractures.

We investigated the diagnostic value of two different ultrasound scanning methods for the early diagnosis of acute scaphoid fractures. Fifty-seven patients with ten scaphoid fractures were assessed within a week of injury. The accuracy of the ultrasound assessment was 84% and its specificity was 91%. However, its sensitivity was only 50%. We conclude that ultrasound examination is unreliable for the diagnosis of acute scaphoid fractures.

Jumper's knee. Review of the literature.

Jumper's knee is an overuse disease. The initial subjective complaints are well-localized pain, usually occurring after physical activities and often at the lower pole of the patella. The diagnosis of jumper's knee is usually easily established after acquiring a detailed history and a carefully performed physical examination, but the lesion can be mistaken for other disorders or injuries, such as bursitis, meniscal injuries or chondromalacia (1) or other causes of the patellofemoral pain syndrome. Today ultrasonography is the method of choice for the evaluation of jumper's knee as it is both time and cost saving, non-invasive, repeatable, accurate and allows a dynamic image of the tendon, guided injections and control of treatment. Conservative therapy is the treatment of choice in the early stages and includes adequate warm-up, stretching of the quadriceps muscle and physical activity with respect to the pain, and ice pack application after activity. When the pain disappears, the training intensity can be increased. NSAID (Non-Steroidal Anti-Inflammatory Drugs) and local peritendinous injections with long-acting steroids can be a helpful and safe adjuvant to the conservative treatment and should be tried before surgery. Surgical treatment is indicated only if a prolonged and well-supervised conservative treatment program fails in chronic jumper's knee (including local injection with steroid) or in acute total rupture. Review papers concerning jumper's knee are already published (2-5), but in this review the importance of ultrasonography to make the diagnosis, to plan therapy and control the treatment and the safety of peritendinous injection with steroid is pointed out. The scientific documentation for the recommanded treatment (conservative, steroid injection and operation) is, however, insufficient. Many more controlled studies are needed. Ultrasonography and placebo-controlled, double-blinded, cross-over studies for treatment with local injection of steroid are ongoing (6, 7).

Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus anterior cruciate ligament and cartilage lesions.

We compared the diagnostic and predictive value of magnetic resonance imaging (MRI) and clinical findings with arthroscopy in 61 knees in a prospective study. In meniscal tears, the accuracy and positive predictive value of MRI was found to be nearly twice that of clinical examination. The sensitivity, specificity, and negative predictive value of MRI were comparable to the figures found in other studies. We recommend MRI as a clarifying diagnostic tool when a clinical examination indicates a lesion of the meniscus. In our study, the clinical relevance of MRI in anterior cruciate ligament lesions and especially in cartilage lesions was more doubtful. The combination of clinical and MRI findings would reduce the number of blank arthroscopies to 5%. MRI is a valuable diagnostic tool in planning the type of anesthesia and treatment, and could significantly reduce the need for a second arthroscopy.

Treatment of acute colonic pseudo-obstruction with ultrasonography-guided percutaneous drainage. Case report.

In an 81-year-old woman acute colonic pseudo-obstruction occurred 3 days after operation for right femoral neck fracture. When conservative treatment failed, ultrasonographically guided percutaneous drainage of the caecum was performed to relieve progressive caecal dilatation. Bowel function was thereafter restored. The method may be a therapeutic option for acute colonic pseudo-obstruction in selected cases.

Radiological evaluation of early pleural and pulmonary changes in light asbestos exposure.

In a case-control study of 209 workers from a local railway maintenance and repair workshop, pleuropulmonary lesions were studied on chest radiographs. All workers were known to have been exposed to asbestos fibers of all kinds for a long period of time, but the exposure was light. A "dose index" of every worker was calculated based upon the type of working process and cumulated time spent in the working process. We found a certain dose-effect relationship between asbestos exposure and pleural thickening.

Haemoptysis associated with traumatic rupture of the thoracic aorta.

A case with severe haemoptysis nearly three weeks after a chest trauma is presented. Aortography revealed rupture of the aorta below the origin of the left subclavian artery. The rupture was caused by a fractured rib which also caused a tear in the lower lobe of the left lung. Aortic haemorrhage had dissected into the lung, causing a haematoma and finally resulting in a severe haemoptysis.