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Background/aim: This study aimed to retrospectively analyse patients with foreign body (FB) injuries in our hospital and to present a patient with missed penetrating sponge FB injury. Materials and methods: This study lasted 12 years (2008-2020) and reviewed all patients with FB injuries who were admitted to the emergency department (ED) of our hospital. Along with our overall results, we present a case with missed penetrating sponge FB injury in detail. Results: Approximately 377 patients were included in the study (age: 28.3 +/- 18.3 years, m/f: 229/148). The foot (n = 148, 39.3%) and the hand (n = 143, 37.9%) were the most frequently injured body parts. Regarding FB types, sewing needles (n = 140, 37.1%), metal pieces (n = 91, 24.1%), and glass (n = 80, 21.2%) were the most frequently observed objects. Most of the patients were injured at home, often by needles or glass. The injury-admission mean time was 7.38 +/- 2.5 days. FBs were frequently removed in the ED (n = 176, 46.7%). Plain radiography is the first line in identifying FBs. Soft tissue infection was the most common complication. MRIs were much useful than USGs in detecting the missed penetrating sponge injury of the single patient in the study. Conclusion: For diagnosis of FBs, besides recording the patient's history, obtaining a two-sided radiogram is of great importance. For nonradiolucent or deeply located FBs, further clinical or radiological investigation must be considered to avoid complications. Although most of the FBs can be removed in the ED, patients may require hospitalisation and operation for FB removal, depending upon FB location and age.

Introduction: Today film-based technologies are largely abandoned in dental radiology. New technologies based on digital detectors are being adopted. This change is part of the global digitalization of radiological procedures. A person operating the radiological device needs to be educated and well informed about radiological procedures and technologies, as well as to know how the system operates and to be sure about the dose required for the adequate image quality. The awareness of radiation doses received by patients is necessary for the estimation of risk from ionizing radiation.Material and methods: The aim of this study was to evaluate whether patient doses in intraoral dental radiology affect image quality. The study included subjective analysis of radiological image quality for an intraoral x-ray device with possibility to use both digital and film detector. Subjective assessment of image quality is performed according to criteria taken from the literature and is expressed using the Likert scale, grade 1–5. In order to improve the quality of inferential statistics related ratings to detector quality and image quality were collected, thus introducing two variables: the detector quality index and the technique quality index.Results: Z-test proportions column shows that the number of grades four given as a contrast score is significantly higher in the RVG detector (65%) compared to the film (40%). There is also a significant difference in the number of given grades five as a rating of the apex preview. The share of grades five in film is 19%, while in RVG it is 42%. It is similar in the evaluation of the preview of the dental canal, where there is also a significant difference in the number of given grades five, so that the share in the film is 11% and in RVG 35%.Conclusion: Analysis of the subjective quality of the radiological image in devices for intraoral radiography with the possibility of recording using digital and film detectors indicates that the digital detector is superior to film in low contrast resolution, apex and dental canal preview.

Surgical resection is usually indicated for symptomatic mediastinal tumors. However, surgery potentially increases postoperative complications and hospitalization length in patients who are elderly, in poor general condition, or have tumors located in the thoracic inlet. We present an 84-year-old female with progressive cough and dyspnea for 1 week. Simple radiogram and computed tomography scan showed a large superior mediastinal cyst, sized 8.3 × 6.1 × 4.6 cm, narrowing the trachea. Ultrasonography- and fluoroscopy-guided percutaneous sclerotherapy using alcohol and bleomycin was applied a single time. The patient was discharged 2 days later without complication, and she did not develop symptoms over a 6-year period. Percutaneous sclerotherapy, especially in patients who are elderly or in poor general condition, could be an effective and reliable tool for cyst management.

The iASSIST system is a portable, accelerometer base with electronic navigation used for total knee arthroplasty (TKA) which guides the surgeon to align and validate bone resection during the surgical procedure. The purpose of this study was to compare the radiological outcome between accelerometer base iASSIST system and the conventional system. Method: A prospective study between two group of 36 patients (50 TKA) of primary osteoarthritis of the knee who underwent TKA using iASSIST ™ or conventional method (25 TKA in each group) from January 2018 to December 2019. A single surgeon performs all operations with the same instrumentation and same surgical approach. Pre-operative and postoperative management protocol are same for both groups. All patients had standardized scanogram (full leg radiogram) performed post operatively to determine mechanical axis of lower limb, femoral and tibial component alignment. Result: There was no significant difference between the 2 groups for Age, Gender, Body mass index, Laterality and Preoperative mechanical axis(p>0.05).There was no difference in proportion of outliers for mechanical axis (p=0.91),Coronal femoral component alignment angle (p=0.08),Coronal tibial component alignment angle (p=1.0).The mean duration of surgery, postoperative drop in Hb, number of blood transfusion didn’t show significant difference between 2 groups (p>0.05). Conclusion: Our study concludes that despite being a useful guidance tool during TKA, iASSIST does not show any difference in limb alignment (mechanical axis), Tibial and femoral component alignment when compared with the conventional method.

Contains fulltext : 225948.pdf (Publisher’s version ) (Open Access) Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: >500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or >100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air-fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have 'quite a bit' or 'very much' of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: 'not at all', 'a little', 'quite a bit', or 'very much', generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process.

Background Pneumothorax can present as a respiratory emergency and has varied etiology. However, literature available on assessment and management of primary spontaneous pneumothorax (PSP) based on radiological quantitation is scarce. This study was undertaken to compare two different methods of quantitating pneumothorax size with that recommended in American Thoracic Society (ATS) guideline on chest radiogram with respect to possible change in management practices. Patients and methods A prospective cohort of adults presenting with spontaneous pneumothorax (SP) over 3 years to Emergency and Pulmonology Department, St John’s Medical College Hospital, Bangalore, was included. Demographic characteristics and clinical presentation were compiled. Management of SP was based on ATS guidelines. PSP size on chest radiogram was requantitated in the included patients using Light’s index and Collin’s method and was compared with that proposed by the ATS guideline. Results Seventy-six participants with SP were studied; their mean age was 43.7 years, with a preponderance of male patients (84.2%). Twenty-four (31.6%) patients had PSP and 52 (68.4%) patients had secondary spontaneous pneumothorax. In PSP, there was poor agreement between various methods of estimating size of pneumothorax on chest radiogram (Kappa statistic=0.23; ICC of 0.263). Three (12.5%) of the 24 incidences of PSP, which were treated conservatively as per ATS guidelines, would have required invasive intervention if Light’s index or the Collin’s formula were taken into consideration. Conclusion There was poor agreement of radiological pneumothorax size estimation by Collin’s, Light’s, and that proposed in the ATS guidelines. Thus, a unified, standardized method of radiological assessment of PSP is required.

A 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable. His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes. His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax. He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.

Cervical spondylotic myelopathy (CSM) is a common age-related disease, but little is known concerning the impact of cervical facet degeneration in patients suffering from CSM without degenerative cervical spondylolisthesis or cervical instability. We report an instructive case of CSM with rapid neurological deterioration in which unilateral degenerative facet joint pathology at the affected spinal level and impressive radiological findings were observed. A 70-year-old female progressively developed C5 segmental myelopathy without any trauma within a two-week period. Radiological findings revealed C3-4 spinal canal stenosis with the emergence of increased intramedullary signal intensity on T2-weighted magnetic resonance imaging, articular surface damage at the left C3-4 facet joint on computed tomography, and unilateral "facet joint gap" on cervical radiogram, but did not meet the criteria of cervical instability or spondylolisthesis. This case suggests that some types of severe degenerative changes in cervical facet joints may contribute to cervical myelopathy, especially in cases with progressive neurological deterioration.

The segmentation of implants on orthopedic radiographs is a difficult task. Due to different acquisition conditions, some photos have reduced quality and contrast. The use of cement in alloplastics particularly hinders this process. This article presents considerations on how to increase the effectiveness of the active contour method when segmenting these implants using adaptive histogram equalization. Radiogram analyses are presented and a binarization method is proposed. Segmentation accuracy is experimentally estimated in relation to the parameter space of the algorithms used.

Introduction: Cervical ossification of the anterior longitudinal ligament (OALL) occasionally leads to dysphagia by the anterior osteophyte. A recent report explained that the dysphagia after an occipito-cervical fusion is caused by the narrowing of pharyngeal space due to the cranio-cervical malalignment. The purpose of this study was to evaluate the cranio-cervical alignment in patients with OALL complaining of the dysphagia. Subjects and methods: The subjects were 11 cases with complaining of dysphagia due to cervical OALL who underwent anterior cervical OALL resection and as control, age-matched 12 cases without dysphagia who have diffuse idiopathic skeletal hyperostosis in cervical spine. All subjects were male, and the mean age was 59.5 ± 9.1 years. The subjects were divided into two groups according to the symptoms of dysphagia (dysphagia, group A; control, group B). The O–C2 angle, C2–C7 angle, and the maximum thickness of OALL and the cranio-cervical alignment (pharyngeal inlet angle; PIA) and swallowing line (S-line) were measured before and after the operation on the lateral cervical radiogram at the sitting position. Results: Group A showed significantly large maximum thickness of OALL, small cervical range of motion, small O–C2 angle, large C2–C7 angle, and small PIA. The S-line crossed the anterior apex of cervical osteophyte in group A. After OALL resection, dysphagia had improved, PIA had increased, and the S-line uncrossed the apex of cervical vertebrae in all cases. Conclusion: The prevalence of dysphagia in patients with cervical OALL was influenced by the thickness of osteophyte, cervical mobility, and cranio-cervical alignment.

Introduction. Functional treatment is the type of treatment preferred in young patients with lateral bite because it leads to simultaneous improvement of occlusion and facial profile. Objective. The aim of this study is to assess bone changes within the condylar process of the mandible and to associate them with the changes observed in the analysis of lateral cephalograms and in the patient’s occlusion. Materials and Methods. Cone beam tomography of the temporomandibular joint, lateral radiogram of the skull, was performed at the beginning of treatment and after one year of therapy. Changes in cephalometric radiograms were evaluated by analyzing them and shown by making superimposition and staining layers. For the purpose of assessing bone changes within the condylar process, digital 3D solids of these processes were generated using data from computed tomography. Results. Correction towards Angle’s dental class I, overjet reduction from 8 mm to 3 mm, and improvement of the patient’s profile were obtained. A rotation of the occlusal plane and improvement in an ANB by 1° and in the WITS measurement by 2.7 mm were observed. A growth of the condylar processes “backwards” and “upwards” was also observed, as well as a change of their shape and volume. Conclusions. The obtained results suggest that the patient’s significant improvement in occlusal conditions is due to posterior growth stimulation of the condylar processes of the mandible. The results confirm the validity of using this treatment technique in the case of growing children with complete posterior occlusion.

Introduction Lumbar spondylolysis is usually single level, and only a few multiple-level cases have been reported. We investigated the frequency of multiple-level spondylolysis and the bone union rates among growth-stage children with lower back pain (LBP). Methods The subjects were growth-stage children examined for LBP between April 2013 and December 2018. All patients with LBP persisting for at least 2 weeks and severe enough to make playing sports difficult underwent lumbar plain radiogram, computed tomography, and magnetic resonance imaging. The cases diagnosed as multiple-level spondylolysis and classified as early or progressive stage received conservative treatment to achieve bone union. Results A total of 782 growth-stage children were examined for LBP. Of them, 243 children (31.1%) were diagnosed with lumbar spondylolysis. Of these 243 children, 23 (9.5%) children had multiple-level spondylolysis. Of the children diagnosed with multiple-level spondylolysis, most children (87.0%) had pars defects in the early or progressive stage in which bone union could be expected. Most children (78.3%) had pars defects in the terminal stage and combined with these defects, had pars defects in the early or progressive stage at a different spinal level. Twenty children diagnosed with multiple-level spondylolysis who also had pars defects in the early or progressive stage received conservative treatment for bone union, which was achieved in 31 of 39 sites (79.5%). The bone union rate by stage was 92.9% (26 of 28 sites) in the early stage and 45.5% (5 of 11 sites) in the progressive stage. Conclusions In cases of multiple-level spondylolysis, bone union is likely to be achieved with conservative treatment when the pars defects are in the early or progressive stage. Therefore, the first choice of treatment should be conservative treatment to achieve bone union, the same for single-level spondylolysis.

Pulmonary arteriovenous malformations (PAVMs) are rare vascular structures providing direct capillary-free communications between pulmonary arteries and veins. Embolotherapy is indicated as a front-line therapy. We report an unusual long-term complication of coil embolization for a 44-year-old woman with hereditary hemorrhagic telangiectasia (HHT) who had repeatedly undergone the procedures for her PAVMs. She expectorated the coil which had been placed 12 years earlier and migrated to the bronchus according to the chest radiogram and bronchoscopy. Histology of the resected lung segment suggested the cavity communicating with the bronchus was the consequence of abscess formation around the coils. Even after technically successful embolization to PAVMs, long term follow-up should be necessary paying attention to the symptoms and imaging to avoid massive hemoptysis and subsequent emergency surgery.

Surgical indication of posterior decompression and fusion (PDF) for cervical OPLL in mainly based on K-line, which is defined as that which connects the midpoints of the spinal canal at C2 and C7 in a plain lateral radiogram of the cervical spine. We defined K-line (+) as cases where the peak of ossification foci does not exceed the K-line and K-line (−) as cases where the peak of ossification foci exceeds the K-line. Previous reports revealed that laminoplasty produces a poor outcome in K-line (−) OPLL. One of the surgical options is PDF.

Aim Respiratory syncytial virus is the main pathogen responsible for bronchiolitis. Usually, there is no indication to perform diagnostic imaging or run laboratory tests in patients with bronchiolitis since the diagnosis is based on the clinical presentation. Chest radiogram can be useful in severe cases. So far, lung ultrasound has not been considered as an alternative in guidelines for imaging diagnosis of bronchiolitis. The aim of the study was to compare lung ultrasound and chest X-ray findings in children with bronchiolitis. Material and methods In our study we retrospectively compared diagnostic imaging findings in children with confirmed respiratory syncytial virus infection. The study included 23 children aged 2 weeks to 24 months and 3 children older than 24 months. Results Chest X-ray showed lesions in only 4 cases, whereas ultrasound abnormalities were found in 21 patients. Pathologies revealed by chest X-ray were the same for all 4 cases and consisted of an enlarged hilus and peribronchial cuffing. Sonographic lesions included inflammatory consolidations larger than 10 mm in 11 patients, small consolidations (

We report an extremely rare case of inner head displacement from the stem of a bipolar hip prosthesis (BHP). An 88-year-old woman underwent BHP implantation for right femoral neck fracture. However, severe right hip joint pain occurred 12 days after surgery. A plain radiogram film revealed displacement of the inner head from the neck of the stem, accompanied by sinking of the stem. At reoperation, the inner head was disassembled from the stem, and Vancouver type A1 fracture was confirmed. Disassembly may have been caused by the pumping phenomenon or micromovement of the stem due to periprosthetic fracture. To our knowledge, this is the first report about disassembly of the BHP inner head, probably due to periprosthetic fracture. Keywords: Bipolar hip prosthesis, Disassembly, Inner head displacement, Periprosthetic fracture

BACKGROUND AND OBJECTIVE Acetabular cup orientation, consisting of pelvic positioning, version and inclination, can influence short-term and long-term results after total hip arthroplasty (THA). The radiographic measurement of acetabular cup inclination represents an indicator of quality for the EndoCert certification in Germany. The purpose of this study was to determine the intrarater and interrater reliability of radiographic measurements of acetabular cup inclination after THA. MATERIAL AND METHODS In this study four independent investigators with different levels of expertise retrospectively performed measurements on radiograms (anteroposterior pelvic radiogram) from 99 patients. The intraclass correlation coefficient (ICC) and Pearson's correlation coefficient were determined and were considered statistically significant with r > 0.8 and p 0.9 and p

Background: The K-line, which is a virtual line between the midpoints of the antero-posterior canal diameter at C2 and C7, can be useful for determination of surgical procedures for cervical ossification of the posterior longitudinal ligament (OPLL). Although K-line is originally measured with plain radiogram, computed tomography multiplanar reconstruction (CT-MPR) is applied for K-line measurement by several surgeons. The purpose of the present study was to analyze whether there is a difference in K-lines obtained from radiographs of standing patients and those obtained from CT-MPR images of supine patients. Methods: The present study included 65 patients with cervical OPLL underwent surgical treatment. We investigated the K-line (+ or −) before surgery, measured from lateral cervical spine radiographs taken in standing patients in a neutral position (X-P-based K-line) and CT-MPR mid-sagittal images obtained in supine patients (CT-based K-line). The X-P-based and CT-based K-lines were compared and differences between them were assessed. Results: The-X-P-based K-line was found to be (+) in 35 patients and (−) in 30 patients. Four of 35 patients with an X-P-based K-line (11%) showed a change from K-line (+) to (−) in CT-based K-line measurements. One of 30 patients with an X-P-based K-line (3%) showed a change from (−) to (+) in CT-based measurements. Conclusions: The K-line should be measured with plain radiogram of standing patients because X-P-based K-line and CT-based K-line can be different.

Acute shock in severe dengue haemorrhagic fever (DHF) may occur concurrently with accumulation of fluid in serous body spaces such as pleural, peritoneal and pericardia/ cavities.Echocardiography is a non-invasive diagnostic procedure which is sensitive to detect even a small quantity of pericardia/ effusion.The chest radiogram in two reported cases of DHF associated with severe shock revealed that almost half of the pleural cavity was filled with fluid. Although no signs of pericardia/ effusion could be determined on physical examination, ECG and radiological procedures, a small amount of fluid was clearly seen on echocardiogram.

Cystic echinococcosis is a common parasitic disease in some areas and involves different organs with different presentations. Rural areas in our country are endemic with this disease. We present a case of echinococcal aortic involvement that was diagnosed incidentally by a routine chest radiogram as a mediastinal mass. Cystic echinococcosis was established as final diagnosis after magnetic resonance imaging (MRI) and ELISA studies. The patient was treated surgically through a thoracotomy and her aortic defect was repaired during the operation. She has been asymptomatic and complication free in physical examination and imaging study in follow up periods after two years. Awareness of various presentations of the disease is necessary for physicians who are occupied in endemic areas. It is rational to treat echinococcal cysts adjacent to the great vessels with the cooperation of a vascular surgeon.

Morgagni hernia is a rare disorder in adulthood, and most of the cases are asymptomatic. Symptomatic cases are extremely rare and present with life-threatening complications. Early diagnosis and surgery are lifesaving. We hereby present an adult case of symptomatic Morgagni hernia. Diaphragmatic herniation of the stomach and mesenteroaxial rotation led to intrathoracic gastric volvulus in this case. A right-sided air bubble on a chest radiogram was the only finding leading to the suspicion of diaphragmatic hernia. Computed tomography in the diagnosis of diaphragmatic hernias is of great importance.

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. Results: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p=0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa=0.41, p&nbsp

A 10-months-old cross long hair cat named Casper with clinical symptom of vomiting mixed with slimy cat feed was referred to Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Bogor Agricultural University to endoscopy examination and therapy. The owner believed that Casper ate a 5 cm long sewing needle a few days earlier. The history and physical examination were examined at DNA Clinic with symptoms of lack of appetite and becoming quieter and calmer. Radiogram showed the needle was in thorax area with a vertical needle penetrating the esophageal wall. Removal of the needle and observation of the esophagus area were done using endoscopy under general anesthesia. Using endoscopy, it was known that the needle was swallowed along with the sewing thread with position of all needles penetrating the esophagus wall and leaving a small amount of thread on the lumen. The needle was pulled back to the esophageal lumen by pulling the remaining thread and then both needle and the thread were pulled back out using an alligator grasping forceps that used through working channel. Therapy given after endoscopy was antibiotics and anti-emetics.

Study design Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS). Objectives The aims of this study were to analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF. Summary of background data Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches. Methods Each four patients with or without postoperative dysphagia (group D and N, respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-mL diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution was analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment. Results O-C2A in group D was -7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P = 0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical ocurvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing. Conclusion This study presented that postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space towing to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as craniocervical junction during OSF. Level of evidence 4.

We herein report a case of breast cancer in a 74-year-old woman treated with exemestane as fourth-line hormonal therapy and bone-modifying agents for long time. She suddenly developed a right femoral shaft fracture during treatment. Her femoral fracture had a beaking sign on radiogram. Given this finding, her fracture was ultimately diagnosed as atypical femoral fracture (AFF). In this case, it was difficult to recognize the difference between groin pain as a prodromal symptom of AFF and that due to an adverse reaction to hormonal therapy. Therefore, clinicians should recognize the difficulty of this differentiation and consider the situation with caution.

We investigated the correlation between abdominal trunk muscle strength and spinal deformities in middle-aged and older women. The results indicated that abdominal trunk muscle weakness, older age, and low lumbar bone mineral density were significant risk factors associated with the presence of OVFs in the lower thoracic and lumbar spine. We developed an innovative exercise device for the abdominal trunk muscles that also measures muscle strength. We investigated the correlation between the strength and thoracolumbar spinal deformity in middle-aged and older women. This study included 206 consecutive female patients who were 50 years or older and scheduled to undergo surgery for degenerative diseases of the lower extremities. Patients with a history of symptomatic osteoporotic vertebral fractures (OVFs) requiring treatments were excluded. Before surgery, patients underwent physical measurements including abdominal trunk muscle strength using our device, full-spine standing radiography, and bone mineral density measurement of the lumbar spine (L-BMD). According to radiographic findings of the radiogram, patients were divided into four groups: control group (n = 134), listhesis group (n = 29), scoliosis group (n = 19), and fracture group (n = 24). The Tukey-Kramer honestly significant difference test was used to compare all measurements among the four groups. To identify factors associated with the presence of OVFs, a multivariate logistic regression analysis was performed. The average abdominal trunk muscle strength in the fracture group was significantly lower than that of the control group. The multivariate analysis revealed that abdominal trunk muscle weakness, older age, and a low L-BMD were associated with OVF findings. Abdominal trunk muscle weakness in middle-aged and older women was associated with OVF. The strength measurement can be a risk assessment of OVF.

Dijagnostički ultrazvuk (UZ) ima iznimno važno i često nezamjenjivo mjesto u suvremenoj medicini. Gotovo da ne postoji grana medicine koja ne rabi ultrazvuk pri dijagnostici. Najkasnije se pozicionirao u reumatologiji tako da 90-e godine postaju prekretnica u služenju ultrazvukom u bolesnika s upalnim reumatskim bolestima. Stvaraju se uvjeti za praćenje ranih promjena na hrskavici, tetivama, kostima. Tomu je pridonio tehnički napredak u proizvodnji sonda viših frekvencija. Muskuloskeletni ultrazvuk (MSUS) dijagnostička je pretraga velikih mogućnosti. Cilj primjene dijagnostičkog UZ-a jest uočavanje ranih promjena na tkivu zahvaćenom upalom, posebice onih koje govore u prilog agresivnom tijeku bolesti. Zahvaljujući ultrazvuku, možemo rano, puno prije nego radiogramom ili samo kliničkim pregledom, otkriti promjene koje mogu dovesti do oštećenja zgloba i struktura vezanih uza zglob. Diagnostic ultrasound plays an extremely important and frequently invaluable role in modern medicine. There is hardly any field of medicine that does not use ultrasound for diagnostic purposes. Its latest application was in rheumatology, where the 90s marked the beginning of its use in patients with inflammatory rheumatic diseases. Ultrasound has enabled the monitoring of early changes in cartilage, tendons, and bones, owing to technological progress which enabled the development of high-frequency probes. Musculoskeletal ultrasound (MSUS) is a diagnostic procedure with high possibilities. Its aim is the detection of early changes in the inflamed tissue, especially those that have a more aggressive potential. Thanks to ultrasound, changes that can lead to the damage of joints and joint-related structures can be detected much earlier than by radiogram or clinical examination alone.

Breech foetuses are commonly delivered via caesarean section to prevent trauma and decrease the risk of head entrapment, though extraction by abdominal route can very rarely lead to traumatic femur fracture. Typical site of fracture is femoral diaphysis. Although femur fracture is a relatively rare complication, it represents one of the most common fractures of the lower extremity presenting in newborns. A 3900 g female child born at 39 weeks of gestation by caesarean section, presented swelling and tenderness of the left lower extremity in the second day of life. There was no apparent bone disorder predisposing to femur fracture. Fracture of left diaphysis was successfully treated by immobilization with Pavlik harness, healing in a good position for 23 days. Three months after birth, radiogram revealed regular bone consolidation and fracture fully welded. One year after birth, both lower limbs showed a proper mobility with no dysmetria. Caesarean delivery reduces increasingly traumatic complications, especially in breech delivery compared with vaginal delivery, but does not eliminate possible accidental injuries of the newborn. Predisposing factors are many, especially breech presentation and foetuses with malpresentation. Clinicians must be aware that abdominal delivery does not preclude the occurrence of femur fractures.

A 68-year-old female patient admitted to our clinic with right anterior thigh pain ongoing for six months and which increased in last two months. The patient had no trauma history. The patient had been followed-up for 15 years because of osteoporosis and administrated alendronate and ibandronate treatment for 10 years. Patient had three shots of zoledronate once a year during the last three years. Her pain was increasing when she was walking. Physical examination revealed pain in her right thigh. Radiogram showed thickened lateral cortex of the subtrochanteric area. Magnetic resonance imaging also showed thickening and edema of the same area. These images were correlated with atypical fracture in right femoral subthrochanteric zone. Dual energy X-ray absorptiometry revealed that T score was -3.3 in lumbar region and -2.5 in femoral neck. Zoledronate treatment was ended. Prophylactic surgical fixation was performed with titanium elastic nails.

INTRODUCTION: Pneumonia is most significant disease in today’s world. It resulted around 15 % of the total deaths of children of the same age group. OBJECTIVES: This paper proposes Depth Wise Convolution Neural Network (DW-CNN) using the SWISH Activation and Transfer Learning (VGG16) to reliably diagnose pneumonia. METHODS: The proposed model contains 10 layers of convolutional neural networks. Also, three dense layers with the Swish activation function with a dropout of 0.7 and 0.5 respectively in each layer. The model was trained on 5216 augmented with weighted contrast and brightened radiograph Images and tested on 624 radiogram images using Deep Learning and Transfer Learning (VGG16). RESULT: The model was trained on 5216 augmented radiograph Images and tested on 624 radiogram images using Deep Learning and Transfer Learning (VGG16) and the final results obtained with training accuracy of 98.5%, testing accuracy of 79.8% and validation accuracy of 75%. CONCLUSION: The model can be improved by using different transfer learning models and hyperparameter tuning parameters.

Background Physical examinations may reveal the instability of a glenohumeral joint but cannot diagnose the bony Bankart lesions. Soft tissue Bankart lesion cannot be visualized on traditional radiogram. Magnetic resonance images have high cost and availability issues. The purpose of the study was to access the diagnostic performance of the Computed Tomography (CT) in the assessment of patients with shoulder instability and to diagnose the Bankart and bony Bankart lesions. Methods A total of 145 patients with shoulder instability were included in the study. Patients were subjected to clinical examination tests, traditional radiography, and CT. Two orthopedic surgeons, two engineers (trained in musculoskeletal imaging), and two physiotherapists have analyzed the radiological images, CT scans, and the clinical examination tests respectively. The Chi-square test or one-way ANOVA/ Dunnett Multiple comparisons test was performed at 99% of confidence level. Results Sensitivity (0.972 ± 0.18 vs. 1, p = 0.11) and accuracy (0.942 ± 0.17 vs. 1, p

The aim of this study was to investigate the possibility of evaluating the relationship between dental maturation and skeletal maturation without taking a hand-wrist radiogram outside of panoramic radiogram.Panoramic and hand-wrist radiographs of 717 patients (383 girls and 334 boys), with ages ranging from 10 to 15 years, were evaluated. Dental maturity stages of the mandibular canine, first premolar, second premolar and second molar teeth were determined by Demirjian's and Nolla's methods. The skeletal maturation was determined by Fishman method and bone age was determined through the Greulich and Pyle method.All teeth showed positive and statistically significant correlations, the highest correlation was between the mandibular second premolar calcification stages and hand-wrist maturation stages. According to both dental age determination methods, mandibular second premolar was prominent in determining to the pubertal growth stages.There was a positive relationship between dental calcification stages and skeletal maturation stages, in the study population. Dental calcification stages of the second mandibular premolar showed the highest positive correlation with the skeletal maturation stages.

Highlights • An alternative for endoscopy retrograde cholangiopancreatography (ERCP). • Minimal intraoperative bleeding. • This helps reduced length-of-stay in hospital. • This procedure can be an alternative to prevent recurrence., Introduction Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the leading method to manage the patients. But ERCP has difficulties when facing the multiple and large stones Presentation of case Our first case was a 51-years-old man who was admitted to our surgery unit with a diagnosis of chronic pancreatitis. Plain abdominal radiogram, Abdominal MSCT and Magnetic Resonance Cholangiopancreatography (MRCP) showed opacity suspected as stone at the pancreatic duct and distal part of the common bile duct. The second case was a 48-years-old female with the clinical presentation of left upper quadrant pain and history of chronic pancreatitis and intermittent jaundice. Plain abdominal radiogram and MRCP revealed multiple stones in the main pancreatic duct and common bile duct stones. Our third case was female, 60-years-old, who was hospitalized with jaundice and recurrent upper abdominal pain with a history of open cholecystectomy one month previously. Radiologic examination showed multiple stones in the main pancreatic duct and common bile duct. Combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy were performed successfully in all cases. Postoperative follow-up showed good recovery of all patients. Discussion Since ERCP is not proper to be used for multiple and large pancreatic duct stones, we performed a combination of longitudinal pancreatojejunostomy Roux-en-Y and choledoco-duodenostomy to treat the patients and prevent the recurrence. Conclusion The incidence of multiple pancreatic duct stones and large choledochal stones is infrequent. Surgical treatment with combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy is safe and effective to resolve jaundice and recurrent pain caused by chronic pancreatitis.

This study reveals the pore-scale details of oil mobilisation and recovery from a carbonate rock upon injection of aqueous nanoparticle (NP) suspensions. X-ray computed micro-tomography (μCT), which is a non-destructive imaging technique, was used to acquire a dataset which includes: (i) 3D images of the sample collected at the end of fluid injection steps, and (ii) 2D radiogram series collected during fluid injections. The latter allows monitoring fluid flow dynamics at time resolutions down to a few seconds using a laboratory-based μCT scanner. By making this dataset publicly available we enable (i) new image reconstruction algorithms to be tested on large images, (ii) further development of image segmentation algorithms based on machine learning, and (iii) new models for multi-phase fluid displacements in porous media to be evaluated using images of a dynamic process in a naturally occurring and complex material. This dataset is comprehensive in that it offers a series of images that were captured before/during/and after the immiscible fluid injections.

Key Clinical Message Bronchial rupture following major blunt chest trauma should be suspected in every case of massive and persistent air leak through the intercostal drain tube. Chest radiogram offers indirect signs, while chest CT scan demonstrates specific signs highly suggestive for this extremely rare tracheobronchial injury. Bedside bronchoscopy confirms the diagnosis.

A 12-years-old mini pomeranian with clinical symptom of coughing was referred to Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Bogor Agricultural University for evaluation. The radiogram showed difus interstitial nodular pattern on the lungs and enlargement of the spleen. Abdominal ultrasonography and echocardiography was performed to further diagnose the dog. Abdominal ultrasonography was taken using linear probe with frequency 5-11 MHz. Echocardiography was perfomed with right parasternal and left apical views using microconvex probe, with frequency 6-8.8 MHz. Abdominal utrasonogram showed that the dog had billiary sludge, mild splenitis, nephrolithiasis, and urolithiasis. Two dimensional Brightness-mode echocardiography showed thickened and prolapsed mitral valve. Two-dimensional M-mode echocardiography showed increasing of left ventricle lumen dimension (LVID) at systole, decreasing of fractional shortening (FS), and enlargement of left atrial. Color Flow Doppler-mode revealed there was mild regurgitation at the mitral valve. These results lead diagnosis to dilated cardiomyopathy and myxomatous mitral valve disease

A 67-year-old man with a DDD pacemaker for complete atrioventricular block had dyspnea with cardiomegaly on a chest radiogram. Additionally, he had atrial fibrillation, which was well controlled with a class Ic antiarrhythmic agent. He had chronic kidney disease; therefore, uremic pericardial effusion was highly suspected, and pericardiostomy was performed. During surgery, the pacemaker mode was temporarily set to DOO to avoid electrical interference. After surgery, dyspnea was relieved, but it recurred 2 days later without aggravated pericardial effusion. An electrocardiogram showed wide QRS tachycardia at 150 beats per minute. What is the mechanism?

The aim of this study was to find out the in-vivo radiography density changes of hydroxyapatite coated porous tantalum biomaterial implant after surgical implantation in rats. Ten adult male Sprague Dawley rats were divided into two groups: hydroxyapatite-coated porous tantalum (pTa-HAp) and uncoated porous tantalum (pTa). The implants with dimension of 5 x 2 x 0.5 mm3 was inserted into flatten bone defects drilled at the femur bone on latero-medial region. The implant density from right lateral view radiogram was analyzed at day 0, 7, 14 and 30 post-implantation. The results showed that the radiodensity of both pTa and pTa-HAp groups decreased in time of implantation. The radiodensity changes of pTa-HAp showed higher decrease compared to pTa.