Background The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. Objective The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. Methods Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. ConclusionClinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6300 Kathmandu Univ Med J 2011;9(3):174-8
Background and purpose: When >50% of the brain supplied by middle cerebral artery (MCA) gets infracted they are often termed as malignant MCA infarction. Decompressive hemicraniectomy has became the standard treatment option in carefully selected cases with higher survival benefit (78% Vs 29%) in a pooled analysis of one year follow up; however, there was no promising outcome noted in terms of disability rating. To see the outcome following decompressive hemicraniectomy and lax duroplasty for malignant middle cerebral artery (MCA) infarction this study was pserformed. Materials and Methods: This is a retrospective analytical study, with non-probability consecutive sampling of decompressive hemicraniectomy with lax duroplasty for malignant MCA territory infarction over the last 4 years were collected and Glasgow outcome scale (GOS) at one and six month were measured. The significance was analyzed using chi square or Fisher exact test wherever applicable using SPSS-20. Results: Total 31 cases, with male predominance (74.2%), and mean age of presentation was 51.9 years. Most commonly operated side was on the left (58.1%). Overall favorable outcome at 6 month was 35.5%. When operated for the preoperative GCS of >8, favorable outcome was observed in 30.8% at one month and 76.9% at six months which was statistically significant. Conclusion: Decompressive hemicraniectomy with lax duroplasty has a significant survival benefit. The outcome is significantly better when the preoperative GCS is >8.
Cranial venous sinus anatomy is fundamental in neurosurgery and radiology, especially in surgical planning and treatment of neurological diseases. In this study, we aimed to study the morphometric relationship of the transverse sinus with sigmoid sinus groove and jugular foramen and imply if this relationship could aid in diagnosing the transverse sinus thrombosis. This is a retrospective analytical study conducted in our center among 30 patients who underwent Computed Tomography (CT) venogram during a period of 1 year. Diameter of transverse sinus and sigmoid groove at midpoint, and diameter of jugular foramen as it enters the skull base were collected. Relation of transverse sinus with sigmoid sinus groove and jugular foramen was analyzed. There were 60 transverse sinuses in the study with left and right being 50% (30 each). Mean age of patients collected was 53.20 years. There were 43.3% male and 56.7% female patients. Diameter of the Transverse sinus has statistically significantly linear relationship with the diameter of the sigmoid sinus groove and jugular foramen (p<0.001) and was positively correlated (r= 0.651 and 0.624 respectively). Diameter of the transverse sinus has significant positive linear correlation with the sigmoid sinus groove and jugular foramen.
Cranioplasty is the next major surgical procedure that the patient undergoes following the decompressive craniotomy for severe traumatic brain injury (TBI). This study was designed with the objective to evaluate the outcome of our institutional algorithm-based protocol in the management of cranioplasty. This is aretrospective analytical study conducted in National Institute of Neurological and Allied sciences, Bansbari Kathmandu among 40 patients who underwent cranioplasty during a period of 5 years. Variables viz. postoperative CT changes, cranioplasty site infection and change in the modified Rankin scale following the cranioplasty were analyzed. Among 40 patients who underwent the cranioplasty, 82.5% were male and 17.5% were female. The age of the patients ranged from 4 to 72 years with mean of 29.5±13.13. Interval between primary decompression and cranioplasty ranged from 3 to 78 weeks. Algorithm based preoperative planning was done before cranioplasty. Previous abdominal bone fl ap preservation site infection was significantly associated (p value 0.048) with cranioplasty site infection. There was no deterioration in the MRS score. The proper evaluation of the preoperative CT scan and the combined adjunctive procedure with cranioplasty in the selected patients helps to decrease the post cranioplasty related complications.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 36-40
Background: Different types of behavioral changes are seen in head injury patients, and these changes are directly or indirectly related to the daily activities of both patient and the family members. The impact of head injury has affected the relationships in the family and friendship status too. Even it has brought about divorce and other family disruption in the present modern world. This study was designed with the aim of evaluating family disruption in different grades of head injury. Materials and methods: This is a prospective analytical study that included 76 patients with non-probability consecutive sampling conducted at the National Institute of Neurological and Allied Sciences, Bansbari, Nepal over 6 months duration. All head-injured patients above the age of 16 years were included and patients with Extended Glasgow Outcome Scale of less than 3 at 6 months follow up were excluded. Their age, gender, mode of injury, GCS at presentation were collected. Extended Glasgow Outcome Scale and their family adjustment were evaluated at 6 months. The family adjustment was seen and analyzed from the GOS-E interview questionnaire. Data analysis was done using SPSS v.20. Results: The total number of patients was 76 among which 71% were below 40 years of age and the majority (87%) were males. The commonest mode of injury was a road traffic accident (35, 46%) followed by injury due to fall and physical assault. Of all, 76% (58/76) were mild head injured followed by 15% (11/76) severe head-injured patients. At 6 months, the Extended Glasgow Outcome Scale (EGOS) of 7 and 8 were obtained in 37% and 43% of the patients respectively. All the family who had severe head-injured patients and about 85% of the family with moderate head-injured patients had a significant degree of family disruption. Also, 8% of families with Mild head-injured patients had some degree of family disruption. Family disruption and its extent of severity were significantly related to the severity of the head injury. Conclusion: Family disruption and extent of disruption/ strain are also strongly associated with the severity of the head injury.
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