Studies on the wrist joint have shown two types of the carpal bone lunate. In type II lunate there is a facet on the medial side of the lunate for articulation with the proximal pole of the hamate; such a facet is absent in type I lunate. Type II lunates have different kinematics, are more prone to clinically relevant degenerative changes in the hamato-lunate joint and are an uncommon cause of ulnar-sided wrist pain. Ninety plain radiographs showing postero-anterior views of the wrist (52 right and 38 left wrists) were studied in a population of Malays from Malaysia (mean age 48 years; age range 23 to 67 years) to determine the incidence of type I and type II lunates. Our findings were compared with those in other reports in the literature. In Malays, only 24 wrists (26.7%) showed a type II lunate compared to a reported incidence of 50% or more in populations from the Western world. Such a low incidence of type II lunate has not been reported before and may represent a genetic variation in Malays. Consequently, osteoarthritis of the hamate or lunate may play a less significant role in causing ulnar-sided wrist pain in Malays. In conclusion, the prevalence of type II lunate might vary in different population groups and further studies could be necessary to confirm this observation.
We report a case of a young man who presented with a left-sided pneumothorax after suffering an accidental penetrating injury by a sewing needle to the anterior chest wall. Chest radiograph and the computed tomography of the thorax revealed that the needle was in the pleural cavity and there was an associated pneumothorax. An attempt at retrieval by direct incision failed. The sewing needle was successfully retrieved by a medical pleuroscopy. The patient recovered without any consequences and was discharged home after 24 hours of observation.
We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.
X-ray microradiography of surgically excised breast specimens offers the possibility of morphological characterization of calcifications. When combined with digital imaging techniques there exists added potential for obtaining valuable basic quantitative morphometric information regarding differences between microcalcifications in tissues exhibiting evidence of fibrocystic change, benign and malignant tumours. A total of 157 excised breast specimens from 84 patients were microradiographed using a Softex Super Soft X-ray unit and Kodak AA high resolution industrial film. A Quantimet 570C image analysis system was used to digitize and analyse the microradiographs. Of the 157 microradiographs, 51 (from 30 patients) revealed microcalcification clusters. The existence of significant differences between the three identified categories of tissue were indicated by clustering parameters. These included the number of particles per cluster, area of clusters, maximum distance to nearest neighbour, and geometric mean distance to nearest neighbour. The distribution pattern index (DPI), another of the clustering parameters used in this study, has been observed to be a particularly powerful discriminator. The value for fibrocystic change was found to be significantly smaller (0.514) than that for benign tumour (0.796) whilst that for benign tumour was observed to be significantly larger than that for malignant tumour (0.604) at a p-value of less than 0.05 (Kruskal-Wallis one-way analysis of variance).
Matched MeSH terms: Breast Diseases/radiography*; Breast Neoplasms/radiography*; Calcinosis/radiography*; Fibrocystic Breast Disease/radiography*; Microradiography
An unusual case of proximal migration of a Hakim's valve intracranially into a porencephalic cyst two years after insertion of the ventriculo-peritoneal shunt in a neonate is reported. The underlying cause is discussed. It is recommended that all shunt should be anchored with nonabsorbable suture material properly on to the pericranium.
Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.
Susuk or charm needles are a facial cum body art widely practiced among women of Malaysia, Brunei, Singapore, Thailand and Indonesia. These are small, needle-shaped metallic talismans inserted subcutaneously in different parts of the body. The concealed art of susuk was "exposed" by routine radiographic examination in the oral and maxillofacial region. This paper reports two such cases of unusual incidental radiographic finding in dental radiographs which were taken on a routine basis as part of the diagnostic work up. This article will also primarily enlighten the importance of radiographs in detecting such charm needles as the wearer keeps the body art a "hidden secret" thereby avoiding misdiagnosis.
The identification and segmentation of inhomogeneous image regions is one of the most challenging issues nowadays. The surface vessels of the human heart are important for the surgeons to locate the region where to perform the surgery and to avoid surgical injuries. In addition, such identification, segmentation, and visualisation helps novice surgeons in the training phase of cardiac surgery.
During extensive osteological study of 150 dry skulls in the Department of Anatomy, Vardhman Mahavir Medical college, an unusual Paramedian Occipital (POC) condyle was detected in the occipital bone of a cadaveric skull. The anatomical details of this unusual occipital condyle were carefully studied and its morphometric measurements taken. A coronal multiplanner reformatted image and a volume rendered image were taken to study radiological details and establish significant clinical correlation. Precise understanding of anatomy of craniovertebral junction and its anomalies have become immensely important for the present day surgeon during orthopaedic and neurosurgical procedures of this region . Technical advancements in imaging modalities such as CT and MRI scans further signify the importance of these anatomical variations ,which are often missed in routine examination. Osteological study combined with radiological details of the paramedian occipital condyle in the present case aims to emphasize the importance of bony anomalies in the craniovertebral region and their role in diagnosis and appropriate treatment of neurovascular compression syndromes of craniovertebral junction. The present study highlights anatomical details, clinical relevance and embryological basis of such a rare unusual paramedian occipital condyle.
The sphenoid sinus, one of the posterior groups of sinuses, has long been regarded as a 'neglected sinus' due to the anatomical location, poor understanding and poor accessibility, till the advent of endoscopes and modern imaging techniques. Increasing knowledge and greater understanding of this sinus has permitted an evolution in surgical practices and boundaries. Various literatures of the past report a great variety of rates of pneumatization, rates of optic nerve protrusion and dehiscence, as well as internal carotid artery (ICA) protrusion and dehiscence. One similarity noted among these studies is that the rates vary according to the ethnicity of the patients. Recommendations have also been made along the way with regard to modified surgical techniques. This review aims to describe the pneumatization of sphenoid sinus and the topographical relation of the optic nerve and ICA in different populations.
BACKGROUND: Dengue is a common illness in the tropics. Equally common are neurological complications that stem from dengue infection. However, to date, parkinsonism following dengue has not been reported in medical literature.
CASE PRESENTATION: A previously well 18-year old man developed parkinsonism, in addition to other neurological symptoms following serologically confirmed dengue fever. Alternative etiologies were excluded by way of imaging and blood investigations.
CONCLUSIONS: The authors detail the first reported case of parkinsonism complicating dengue fever. Keeping rare presentations of common illnesses in mind, it behoves clinicians to consider parkinsonism as a complication following dengue infection. This would prevent injudicious treatment with L-dopa and dopamine agonists. Immunosuppression with steroids has been shown to be helpful in certain cases.
INTRODUCTION: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination.
PURPOSE: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination.
METHODOLOGY: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider.
FINDINGS: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34.
DISCUSSION: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.
Congenital bilateral agenesis of the tibialis anterior muscles is a rare condition. We present a case of congenital absence of bilateral tibialis anterior muscles in a 6-year-old boy who presented with an abnormal gait. He was previously diagnosed to have bilateral congenital talipes equinovarus (CTEV) deformity for which he underwent corrective surgery two times. However, he still had a residual foot problem and claimed to have difficulty in walking. On examination, he walked with a high stepping gait and muscle power of both lower limbs was 5/5 on the medical research council scale (MRCS) except for both ankle dorsiflexors and long toe extensors. The sensation was intact. Magnetic Resonance Imaging (MRI) study of both legs revealed that tibialis anterior muscles were not visualized on both sides suggestive of agenesis of the tibialis anterior muscles. The rest of the muscles appeared mildly atrophied. The electrophysiological study showed normal motor and sensory conduction in both upper and lower limbs. Electromyographic (EMG) study of the vastus medialis was within normal limit and no response could be elicited for EMG of tibialis anterior muscles suggesting possible absence of tibialis anterior muscles, bilaterally. The patient underwent split tibialis posterior tendon transfer to achieve a balanced and functional foot and was well on discharge. The present case describes the normal anatomy and embryology of tibialis anterior muscles as well as possible causes of its agenesis along with its clinical implications.
Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure.
Pseudoaneurysm of the internal iliac artery is a rare occurrence. Our patient presented with pain over the lower abdomen which also radiated to the back. An Angiogram of the aorta and the iliac arteries showed a pseudoaneurysm of the right internal iliac artery which measured about 8 x 8 cm with a proximal branch of the internal iliac artery distended. Initial efforts of trying to embolize the pseudoaneurysm revealed that there was a connection between the pseudoaneurysm and the interanal iliac vein where foam was getting dislodged into the venous system. Subsequently, we decided to use a vascular plug which has just been recently being introduced. Post procedure there was no more flow into the right internal iliac artery pseudoaneurysm.
This paper presents a statistical method for the detection of lobar pneumonia when using digitized chest X-ray films. Each region of interest was represented by a vector of wavelet texture measures which is then multiplied by the orthogonal matrix Q(2). The first two elements of the transformed vectors were shown to have a bivariate normal distribution. Misclassification probabilities were estimated using probability ellipsoids and discriminant functions. The result of this study recommends the detection of pneumonia by constructing probability ellipsoids or discriminant function using maximum energy and maximum column sum energy texture measures where misclassification probabilities were less than 0.15.
This is a case report of disseminated Penicillium marneffei infection in a patient with leprosy, responding to antifungal therapy. Radiologically there were nodules in the left lung, right pleural effusion, lymphadenopathy in neck, mediastinum and upper abdomen and abscesses in the liver and right parietal lobe. This case highlights a rare infection in a non-HIV related immunocompromised patient, and its nonspecific radiologic manifestations.
We experienced the case of a patient who had a foreign body in the maxillary sinus. The foreign body was an arrow accidentally triggered by the patient while fishing. The foreign body was removed via the Caldwell-Luc approach.
Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.