Aim. Our aim is to assess the diagnostic potential of multiphasic contrast enhanced computed tomography for differentiation of the histological subtypes of renal cell carcinoma.Patients and Methods: We prospectively evaluated 50 patients with renal masses previously detected by ultrasound. Multiphasic CT of the kidneys and urinary tract was done. The degree of enhancement was measured by calculating the difference in the HU between the corticomedullary and unenhanced phase scans and between the excretory and unenhanced phase scans. We assessed other parameters as size of the lesion, presence of hemorrhage and calcifications, pattern of enhancement, and lymphadenopathy. CT findings were compared with the histopathological results.Results. In corticomedullary phase clear RCC had significantly higher CT HU measurement than papillary (107HU vs 41HU, p value=0.001) and chromophobe (107HU vs 71HU, p value=0.003), papillary RCC had significantly lower CT attenuation value than chromophobe (41HU vs 71HU, p value=0.022). In nephrograhic phase clear RCC had significantly higher CT HU measurement than papillary (94HU vs 51HU, p value=0.001) and chromophobe (94HU vs 74HU, p value=0.031), papillary RCC had significantly lower CT HU measurement than chromophobe (51HU vs 74HU, p value=0.015). In corticomedullary phase, a cut-off value of ≥ 76 showed 87% sensitivity and 74% specificity for the discrimination between clear and non-clear RCC.Conclusion. Multiphasic CT is capable of differentiating clear-cell RCC from papillary and chromophobe subtypes for preoperative assessment in patients with renal masses. It is considered a safe and confident method for local staging and prediction of the histological grade of RCC.
Background: Limited knowledge about anatomical variations is one of the causes of unexplained symptoms and under or maltreated conditions. Suprascapular nerve entrapment in the suprascapular notch is not an uncommon event causing a disabled limb. Studying the anatomical variations of suprascapular notch is important for clinical practice regarding diagnosis and management of the suprascapular nerve injuries. Aim: Determination of the variation in the morphology of the suprascapular notch in Egyptian dry scapulae.Material and Methods: The study was carried out on 55 dried adult scapulae of unknown sex. Suprascapular notch measurements and scapular dimensions morphometry were carried out.Results: Type II is the most prevalent type (47.3%) among the examined Egyptian scapulae, followed by type III (29.1%).Conclusion: The present study delivers data about the morphology, type and dimensions of the suprascapular notch in Egyptian dry scapulae along with the safe zone and the scapular dimensions.Keywords: Suprascapular notch, SSN safe zone, SSN measurements, Scapular measurements.
Aims: to assess the value of ciprofloxacin/dexamethasone ear drops after tympanostomy tube insertion in children.Settings and Design: This prospective randomized controlled trial was conducted on children who had persistent bilateral otitis media with effusion for > three months, scheduled for bilateral myringotomy and Grommet tube insertion. Methods and Material: Myringotomy was performed using a standardized technique under general anesthesia then ciprofloxacin/dexamethasone drops were applied in three different manners, then patient were following up for three months.Statistical analysis used: Parametric data was analyzed using the unpaired t-test, while the Mann-Whitney U test was used for non-parametric data analysis. For categorical data analysis, the Chi square test or Fisher's exact test was used as appropriate. P value of <0.05 was considered statistically significant.Results: Within included 56 patients (112 ears); 19 with unilateral intraoperative drops application, 19 with unilateral intraoperative and postoperative drops application, and 18 with intraoperative drops application in both ears and postoperative application in one side. The incidence of otorrhea were lower in the ears that had only intraoperative ear drops than those with no ear drops, and the incidence of otomycosis were lower in the ears that had only intraoperative ear drops than those had both intraoperative and postoperative ear drops. But those differences were non-significant. Conclusion: Application of ciprofloxacin and dexamethasone intraoperative after grommet tube insertion for persistent otitis media with effusion reduces the complication rate but this was not found statistically significant.
Given the substantial evidence and growing concern for the potential carcinogenic effects of children's exposure to ionizing radiation during computed tomography (CT) examinations, appropriate use of acquisition parameters is essential to attain diagnostic image quality at the lowest possible radiation dose. The objective of this article is to provide a systematic review to the pediatric imaging team members on how to manage pediatric CT doses and control the essential scanning parameters. The article also highlights other key factors that can be easily used to ensure safe imaging. Some practical tips and technical considerations are provided to be simply incorporated into clinical practice. Optimization of CT imaging is a dynamic process and needs understanding and engagement of all pediatric imaging team members, as keeping our children safe should be the ultimate goal in CT imaging.
Introduction The use of radial-artery access for percutaneous coronary angiography and interventions is recently adopted by many interventional cardiologists as their default access in coronary procedures. In some patients who have a weak radial pulse, or those who have used the radial artery as a bypass graft during coronary-artery bypass surgery, ulnar access may be a safe and convenient alternative to radial access that allows the operator to use forearm access and avoid crossing over to the femoral approach Aim In this study, we compared the safety and efficacy of ulnar access versus radial access for coronary angiography and interventions. Patients and methods This study was conducted on 100 patients who presented with chronic coronary syndromes and were referred for coronary angiography and percutaneous coronary intervention if needed. They were divided into two groups, group A consisted of 50 patients for which coronary angiography was done through transradial access, and group B consisted of 50 patients for which coronary angiography was done through transulnar access. The complication rate, crossover rate, and patient discomfort were compared in both groups. Results We found that hematoma formation and patient discomfort were found more significantly in the ulnar-access group. Access-artery occlusion was found more significantly in the radial-access group. There was no significant difference between both groups regarding access-artery spasm and crossover. Conclusion The transulnar approach proved to be noninferior to the transradial approach for coronary procedures.
Background Fatigue and cognitive dysfunctions in multiple sclerosis (MS) are well-established complications that considerably impact patients’ independence, yet lack proper medical management. Purpose To test the efficacy of low-level laser therapy (LLLT) and broadband ultraviolet B-radiation (BB-UVBR) combination on modulating fatigue and cognitive functions for patients with MS. Patients and methods Pretest–post-test nonrandomized clinical trial study. Forty participants were included, nevertheless, 32 completed the study, age 20–45 years old with definite relapsing–remitting MS on monthly cortisone therapy. Then, they were assigned into two groups, control group (n=14) received pulsed LLLT, and study group (n=18) received the same LLLT program in addition to BB-UVBR for 12 sessions. Primary measures were fatigue, Fatigue Severity Scale (FSS) and cognition, a computerized reactive stress tolerance, and percentile ratio for correct answers (PRC). Besides, Expanded Disability Status Scale (EDSS) as a secondary measure. Results The two groups were comparable at baseline in FSS, PRC, and EDSS (P≥0.05). Patients on LLLT group showed post-test highly significant improvement of PRC, FSS (P<0.001), and EDSS (P=0.023). Similarly, UVBR and LLLT group showed highly significant improvements of PRC, FSS, and EDSS (P<0.001). However, no significant differences (P≥0.05) of PRC, FSS, or EDSS were found between the two groups posttreatment. Conclusion The study suggests that there was no added value of UVBR to LLLT. That LLLT program alone has a potent beneficial short-term effect, on modulating fatigue, cognitive functions, and disability status for patients with relapsing–remitting MS.
