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Jenko N, Ariyaratne S, Azzopardi C, Iyengar KP, Prem H, Nischal N, Budair B, Botchu R. Radiological angle assessment of Haglund's deformity: validation on Magnetic Resonance Imaging. Foot (Edinb) 2024; 59:102096. [PMID: 38626577 DOI: 10.1016/j.foot.2024.102096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Haglund's deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have been assessed on plain radiographs. The aim of this study was to identify measurements which can be applied to Magnetic Resonance Imaging (MRI) studies of the ankle. METHODS A retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund's deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices. RESULTS There was a statistically significant difference (p < 0.0001) in the angle of BRINK between the Haglund's and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund's group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p = 0.02), calcaneal oedema was more likely to be present (p < 0.001) and non-insertional tendinopathy was more likely to be present (p < 0.001). The presence of a retrocalcaneal bursa is non-specific (p = 0.602). CONCLUSION The angle of BRINK demonstrates good discrimination between normal and Haglund's cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.
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Affiliation(s)
- N Jenko
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - S Ariyaratne
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - C Azzopardi
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - K P Iyengar
- Department of Orthopaedic Surgery, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - H Prem
- Department of Orthopaedic Surgery, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - N Nischal
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - B Budair
- Department of Orthopaedic Surgery, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - R Botchu
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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2
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Adlan A, Azzopardi C, Davies AM, Botchu R. 609 Metachronous Osteoid Osteoma of the Mid-Diaphysis of the Fibula and Distal Humerus: A Case Report. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
A 7-year-old boy presented with a 4-week history of pain and swelling of the right leg. He had a history of mucoepidermoid carcinoma of the parotid gland, treated by surgical resection without any complication. There was no other significant past medical history. A radiograph of the right leg showed a lytic lesion of the right diaphysis of the fibula with periosteal reaction. An MRI of the right leg showed osteoid osteoma of the fibula with marked cortical thickening with osseous and soft tissue oedema. The patient subsequently had a Jamshidi biopsy and curettage of the lesion, with the histopathological results of the biopsy showing fragments of a typical osteoid osteoma nidus with irregular calcified bony lamellae. His symptoms had significantly improved after the procedure, and he was ambulating without any discomfort or pain. The patient remained asymptomatic until he returned seven years later with right elbow swelling, pain and reduced range of movement over 2–3 months. A radiograph of the elbow joint had shown a large effusion with a sclerotic lesion on the coronoid fossa of the distal humerus in keeping with an osteoid osteoma. The patient had a confirmational biopsy and subsequently radiofrequency ablation of the lesion with complete resolution of pain. To our knowledge, our case is an atypical presentation of osteoid osteoma in two widely separate bones, between the lower and the upper limb separated by seven years disease-free interval.
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Affiliation(s)
- A Adlan
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - C Azzopardi
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - AM Davies
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - R Botchu
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
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3
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Davies A, Patel A, Azzopardi C, James S, Botchu R, Jeys L. The influence of site on the incidence and diagnosis of solitary central cartilage tumours of the femur. A 21 st century perspective. J Clin Orthop Trauma 2022; 32:101953. [PMID: 35959501 PMCID: PMC9358228 DOI: 10.1016/j.jcot.2022.101953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the incidence of central cartilage tumours (CCTs) in the femur and the impact of site (proximal, mid and distal thirds) on tumour grade. To compare study results with historically published data. MATERIALS AND METHODS Retrospective review of solitary CCTs arising in the femur over the past 13 years. Data collected included location (proximal, mid and distal thirds) and final diagnosis in terms of tumour grade based on imaging features ± histology. Case material collected from three bone tumour textbooks provided historical data. RESULTS 430 solitary CCTs were included in the femur. 73% cases arose in the distal, 3.7% in the mid and 23% in the proximal femur. The ratio of "benign" (combining enchondroma and atypical cartilaginous tumour (ACT)) to higher grade chondrosarcoma (CS) was 11:1 in the distal, 1:1 in the mid and 1:1.5 in the proximal femur, the distribution of benign to malignant tumours being significantly different between the regions (F test, p < 0.05). Comparison with historical data showed a reversal of the benign (enchondroma) to malignant (ACT and higher grade CS) of 30%:70%-84%:16% in the current series. CONCLUSIONS The site of origin of a CCT in the femur has an impact on final diagnosis with CS uncommon in the distal as compared with the mid and proximal femur. This is in contradistinction to historical data where the incidence of CS exceeded that of enchondroma at all sites.
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Affiliation(s)
- A.M. Davies
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Patel
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - C. Azzopardi
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - S.L. James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| | - L. Jeys
- Departments of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
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4
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Saad A, Iyengar KP, Fitzpatrick J, Azzopardi C, Panchal H, Botchu R. The Linear Hallux Valgus Offset- A novel way to measure Hallux Valgus. J Clin Orthop Trauma 2022; 30:101898. [PMID: 35619938 PMCID: PMC9126759 DOI: 10.1016/j.jcot.2022.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Hallux Valgus (HV) is a complex deformity involving the first ray of the forefoot and a common cause of forefoot pain. Several radiological measurements such as Hallux Valgus Angle (HVA), First Metatarsophalangeal Angle (IMA) and Distal metatarsal articular angle (DMAA) exist to calculate the severity of HV and direct patient management. However, these are angular measurements are prone to error with variable intra- and inter-observer reliability. PURPOSE To describe a new radiological linear hallux valgus offset (LHVO) to measure HV deformity. PATIENT AND METHODS We performed a retrospective cohort study looking at Antero-posterior, weight-bearing foot radiographs of 100 consecutive patients with forefoot pain referred to our foot and ankle clinic. Demographic details, clinical indication, HVA (hallux valgus angle) and LHVO were measured for each patient and data were analyzed using the student t-test. Intraclass Correlation Coefficient (ICC) analysis was evaluated to assess the intra-class reliability between observers. RESULTS There was a female predominance of approximately 2:1, with 51.3 years (range 13-86 years). There was a statistically significant difference of LHVO between normal and hallux valgus cohorts with a p-value of 0.0001. The LHVO gave moderate intra-observer and inter-observer reliability on ICC analysis of 0.7. CONCLUSION The LHVO can be an additional measure of assessing severity of hallux valgus. In contrary to the traditional angular measurements, this linear measure is easier to calculate and reproducible on plain, weight bearing radiographs. LHVO measurement has shown a moderate inter-observer reliability in the study to complement traditional radiological evaluation of hallux valgus alignment.
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Affiliation(s)
- A. Saad
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - John Fitzpatrick
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H. Panchal
- Sanyapixel Diagnostics, Ahmedabad, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Royal Orthopaedic Hospital, Bristol Road South Northfield, Birmingham, UK.
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Doherty E, Kingsland M, Elliott EJ, Tully B, Wolfenden L, Dunlop A, Symonds I, Attia J, Ward S, Hunter M, Azzopardi C, Rissel C, Gillham K, Tsang TW, Reeves P, Wiggers J. Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial. BMC Pregnancy Childbirth 2022; 22:345. [PMID: 35448996 PMCID: PMC9027411 DOI: 10.1186/s12884-022-04646-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Background Clinical guideline recommendations for addressing alcohol consumption during pregnancy are sub-optimally implemented and limited evidence exists to inform practice improvements. The aim of this study was to estimate the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Methods A randomised stepped-wedge controlled trial was undertaken with all public maternity services in three sectors (one urban, two regional/rural) of a single local health district in New South Wales, Australia. All antenatal care providers were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care. For 35 months (July 2017 – May 2020) outcome data were collected from randomly selected women post an initial, 27–28 weeks and 35–36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness. Results Five thousand six hundred ninety-four interviews/online questionnaires were completed by pregnant women. The intervention was effective in increasing women’s reported receipt of: assessment of alcohol consumption (OR: 2.63; 95% CI: 2.26–3.05; p < 0.001), advice not to consume alcohol during pregnancy and of potential risks (OR: 2.07; 95% CI: 1.78–2.41; p < 0.001), complete care relevant to alcohol risk level (advice and referral) (OR: 2.10; 95% CI: 1.80–2.44; p < 0.001) and all guideline elements relevant to alcohol risk level (assessment, advice and referral) (OR: 2.32; 95% CI: 1.94–2.76; p < 0.001). Greater intervention effects were found at the 27–28 and 35–36 weeks gestation visits compared with the initial antenatal visit. No differences by sector were found. Almost all women (98.8%) reported that the model of care was acceptable. Conclusions The practice change intervention improved the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Future research could explore the characteristics of pregnant women and maternity services associated with intervention effectiveness as well as the sustainment of care practices over time to inform the need for, and development of, further tailored practice change support. Trial registration Australian and New Zealand Clinical Trials Registry (Registration number: ACTRN12617000882325; Registration date: 16/06/2017) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372985&isReview=true
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, 2600, Australia
| | - Mandy Hunter
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory, 0909, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
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Davies AM, Patel A, Azzopardi C, James SL, Botchu R. Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis. Indian J Radiol Imaging 2021; 31:582-585. [PMID: 34790301 PMCID: PMC8590542 DOI: 10.1055/s-0041-1735915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To determine the prevalence of enchondroma in adults as an incidental finding in the proximal femur on magnetic resonance imaging (MRI). Materials and Methods A retrospective review of the MRI scans of the pelvis in a series of adult patients was conducted. All presented with nononcological musculoskeletal complaints. The site, size, and appearances of the enchondromas were identified according to criteria from previous studies. Results A total of 1,209 proximal femora in 610 patients were reviewed and a total of 9 enchondromas were identified. These ranged from 0.6 to 2.5 cm in length (mean 1.3 cm). None showed aggressive features suggestive of malignancy. Three cases (33%) underwent follow-up MRI scans which showed no change in size or morphology. Conclusion The prevalence on MRI of incidental enchondromas arising in the proximal femur is 0.7%. This is three to four times less common than seen in the proximal humerus and around the knee.
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Affiliation(s)
- A M Davies
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - A Patel
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - C Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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7
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Al-Assam H, Azzopardi C, McGarry S, Botchu R. Vasovagal reactions in ultrasound guided musculoskeletal injections: A study of 2,462 procedures. J Clin Orthop Trauma 2021; 24:101706. [PMID: 34840948 PMCID: PMC8605334 DOI: 10.1016/j.jcot.2021.101706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE to determine the rate of the vasovagal reaction (VVR) in ultrasound guided musculoskeletal injections (USGIs) and to investigate effect of injection site, age, and gender on this rate. MATERIAL AND METHODS Retrospective analysis of all USGIs performed from the 1st of January 2019 to the 31st of December 2019 in single tertiary orthopaedic hospital. Two thousand four hundred and sixty two consecutive subjects undergoing USGIs were included. Statistical analysis used to determine the rate of the overall VVR in USGIs and to determine if site of the injection or joint injected has an effect on this rate as well as age and gender effect. RESULTS Overall rate of VVR was 2.3% with shoulder and small joints of the hands and feet are more commonly affected than other sites. Females and patients aged younger than 65 years may be subjected to higher rate of VVR. CONCLUSIONS VVR has an overall low occurrence in USGI. The higher rate of VVR for shoulder and small joints of hands and feet procedures. Care should be taken when positioning a patient prior to the procedure to allow for a VVR in case it happens. VVR are more likely to occur in females and less likely in age more than 65 years.
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Affiliation(s)
| | | | | | - R. Botchu
- Corresponding author. Department of Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.
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Vallejo-Vaz AJ, Stevens CA, Lyons AR, Dharmayat KI, Freiberger T, Hovingh GK, Mata P, Raal FJ, Santos RD, Soran H, Watts GF, Abifadel M, Aguilar-Salinas CA, Alhabib KF, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Al-Sarraf A, Al-Sayed N, Araujo F, Ashavaid TF, Banach M, Béliard S, Benn M, Binder CJ, Bogsrud MP, Bourbon M, Chlebus K, Corral P, Davletov K, Descamps OS, Durst R, Ezhov M, Gaita D, Genest J, Groselj U, Harada-Shiba M, Holven KB, Kayikcioglu M, Khovidhunkit W, Lalic K, Latkovskis G, Laufs U, Liberopoulos E, Lima-Martinez MM, Lin J, Maher V, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nordestgaard BG, Panayiotou AG, Paragh G, Petrulioniene Z, Pojskic B, Postadzhiyan A, Raslova K, Reda A, Reiner Ž, Sadiq F, Sadoh WE, Schunkert H, Shek AB, Stoll M, Stroes E, Su TC, Subramaniam T, Susekov AV, Tilney M, Tomlinson B, Truong TH, Tselepis AD, Tybjærg-Hansen A, Vázquez Cárdenas A, Viigimaa M, Wang L, Yamashita S, Kastelein JJ, Bruckert E, Vohnout B, Schreier L, Pang J, Ebenbichler C, Dieplinger H, Innerhofer R, Winhofer-Stöckl Y, Greber-Platzer S, Krychtiuk K, Speidl W, Toplak H, Widhalm K, Stulnig T, Huber K, Höllerl F, Rega-Kaun G, Kleemann L, Mäser M, Scholl-Bürgi S, Säly C, Mayer FJ, Sablon G, Tarantino E, Nzeyimana C, Pojskic L, Sisic I, Nalbantic AD, Jannes CE, Pereira AC, Krieger JE, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Baass A, Bergeron J, Bernard S, Brisson D, Brunham LR, Cermakova L, Couture P, Francis GA, Gaudet D, Hegele RA, Khoury E, Mancini GJ, McCrindle BW, Paquette M, Ruel I, Cuevas A, Asenjo S, Wang X, Meng K, Song X, Yong Q, Jiang T, Liu Z, Duan Y, Hong J, Ye P, Chen Y, Qi J, Liu Z, Li Y, Zhang C, Peng J, Yang Y, Yu W, Wang Q, Yuan H, Cheng S, Jiang L, Chong M, Jiao J, Wu Y, Wen W, Xu L, Zhang R, Qu Y, He J, Fan X, Wang Z, Chow E, Pećin I, Perica D, Symeonides P, Vrablik M, Ceska R, Soska V, Tichy L, Adamkova V, Franekova J, Cifkova R, Kraml P, Vonaskova K, Cepova J, Dusejovska M, Pavlickova L, Blaha V, Rosolova H, Nussbaumerova B, Cibulka R, Vaverkova H, Cibickova L, Krejsova Z, Rehouskova K, Malina P, Budikova M, Palanova V, Solcova L, Lubasova A, Podzimkova H, Bujdak J, Vesely J, Jordanova M, Salek T, Urbanek R, Zemek S, Lacko J, Halamkova H, Machacova S, Mala S, Cubova E, Valoskova K, Burda L, Bendary A, Daoud I, Emil S, Elbahry A, Rafla S, Sanad O, Kazamel G, Ashraf M, Sobhy M, El-Hadidy A, Shafy MA, Kamal S, Bendary M, Talviste G, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrie A, Charrieres S, Cottin Y, Di-Fillipo M, Ducluzeau PH, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, hankard R, Inamo J, Lemale J, Moulin P, Paillard F, Peretti N, Perrin A, Pradignac A, Rabes JP, Rigalleau V, Sultan A, Schiele F, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O, Haack IA, Schmidt N, Dressel A, Klein I, Christmann J, Sonntag A, Stumpp C, Boger D, Biedermann D, Usme MM, Beil FU, Klose G, König C, Gouni-Berthold I, Otte B, Böll G, Kirschbaum A, Merke J, Scholl J, Segiet T, Gebauer M, Predica F, Mayer M, Leistikow F, Füllgraf-Horst S, Müller C, Schüler M, Wiener J, Hein K, Baumgartner P, Kopf S, Busch R, Schömig M, Matthias S, Allendorf-Ostwald N, Fink B, Böhm D, Jäkel A, Koschker AC, Schweizer R, Vogt A, Parhofer K, König W, Reinhard W, Bäßler A, Stadelmann A, Schrader V, Katzmann J, Tarr A, Steinhagen-Thiessen E, Kassner U, Paulsen G, Homberger J, Zemmrich C, Seeger W, Biolik K, Deiss D, Richter C, Pantchechnikova E, Dorn E, Schatz U, Julius U, Spens A, Wiesner T, Scholl M, Rizos CV, Sakkas N, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Athyros V, Skalidis E, Kolovou G, Garoufi A, Bilianou E, Koutagiar I, Agapakis D, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Koutsogianni AD, Karányi Z, Harangi M, Bajnok L, Audikovszky M, Márk L, Benczúr B, Reiber I, Nagy G, Nagy A, Reddy LL, Shah SA, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Altaey M, Al-Jumaily K, Rasul D, Abdalsahib AF, Jabbar AA, Al-ageedi M, Agar R, Cohen H, Ellis A, Gavishv D, Harats D, Henkin Y, Knobler H, Leavit L, Leitersdorf E, Rubinstein A, Schurr D, Shpitzen S, Szalat A, Casula M, Zampoleri V, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Sabbà C, Bossi AC, Borghi C, Muntoni S, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Iannuzzi A, Iannuzzo G, Calabrò P, Averna M, Biasucci G, Zambon S, Roscini AR, Trenti C, Arca M, Federici M, Del Ben M, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Bonomo K, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Khodzhiboboev E, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Upena-RozeMicena A, Terauda E, Jambart S, Khoury PE, Elbitar S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Kasim NA, Nor NS, Ramli AS, Razak SA, Al-Khateeb A, Kadir SH, Muid SA, Rahman TA, Kasim SS, Radzi AB, Ibrahim KS, Razali S, Ismail Z, Ghani RA, Hafidz MI, Chua AL, Rosli MM, Annamalai M, Teh LK, Razali R, Chua YA, Rosman A, Sanusi AR, Murad NA, Jamal ARA, Nazli SA, Razman AZ, Rosman N, Rahmat R, Hamzan NS, Azzopardi C, Mehta R, Martagon AJ, Ramirez GA, Villa NE, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJ, Zazueta AR, Alvarado RM, Portano JD, Lopez HA, Sauque-Reyna L, Herrera LG, Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PA, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AY, Cazares HE, Gonzalez JR, Valencia CV, Padilla FG, Prado RM, De los Rios Ibarra MO, Villicaña RD, Rivera KJ, Carrera RA, Alvarez JA, Martinez JC, de los Reyes Barrera Bustillo M, Vargas GC, Chacon RC, Andrade MH, Ortega AF, Alcala HG, de Leon LE, Guzman BG, Garcia JJ, Cuellar JC, Cruz JR, Garcia AH, Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez AB, Oyervides JC, Vazquez DI, Rodriguez EA, Osorio ML, Saucedo JR, Tamayo MT, Talavera LA, Arroyo LE, Carrillo EA, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LS, Starostecka E, Konopka A, Lewek J, Bartłomiejczyk M, Gąsior M, Dyrbuś K, Jóźwiak J, Gruchała M, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Woś M, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Safarova M, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AH, Awan Z, Elamin OA, Altaradi H, Rajkovic N, Popovic L, Singh S, Stosic L, Rasulic I, Lalic NM, Lam C, Le TJ, Siang EL, Dissanayake S, I-Shing JT, Shyong TE, Jin TC, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Kovac J, Mlinaric M, Sustar U, Podkrajsek KT, Fras Z, Jug B, Cevc M, Pilcher GJ, Blom D, Wolmarans K, Brice B, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Lux A, Chang NT, Ganokroj P, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural IE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Hay DA, Luqman N, Elfatih A, Abdulrasheed A, Kwok S, Oca ND, Reyes X, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV, Abdullaeva GJ, Do DL, Nguyen MN, Kim NT, Le TT, Le HA, Tokgozoglu L, Catapano AL, Ray KK. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Lancet 2021; 398:1713-1725. [PMID: 34506743 DOI: 10.1016/s0140-6736(21)01122-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Haleem S, Malik M, Azzopardi C, Botchu R, Marks DS. The Haleem-Marks-Botchu classification: a novel CT-based classification for intracanal rib head penetration. Spine Deform 2021; 9:1651-1657. [PMID: 34228311 DOI: 10.1007/s43390-021-00376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Intracanal rib head penetration is a well-known entity in dystrophic scoliotic curves in neurofibromatosis type 1. There is potential for spinal cord injury if this is not recognised and managed appropriately. No current CT-based classification system is currently in use to quantify rib head penetration. This article aims to propose and evaluate a novel CT-based classification for rib head penetration primarily for neurofibromatosis but which can also be utilised in other conditions of rib head penetration. MATERIALS AND METHODS The grading was developed as four grades: normal rib head (RH) position-Grade 0, subluxed extracanal RH position-Grade 1, RH at pedicle-Grade 2, intracanal RH-Grade 3. Grade 3 was further classified depending on the head position in the canal divided into thirds. Rib head penetration into proximal third (from ipsilateral side)-Grade 3A, into the middle third-Grade 3B and into the distal third-Grade 3C. Seventy-five axial CT images of Neurofibromatosis Type 1 patients in the paediatric age group were reviewed by a radiologist and a spinal surgeon independently to assess interobserver and intraobserver agreement of the novel CT classification. Agreement analysis was performed using the weighted Kappa statistic. RESULTS There was substantial interobserver correlation with mean Kappa score (k = 0.8, 95% CI 0.7-0.9) and near perfect intraobserver Kappa of 1.0 (95% CI 0.9-1.0) and 0.9 (95% CI 0.9-1.0) for the two readers. CONCLUSION The novel CT-based classification quantifies rib head penetration which aids in management planning.
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Affiliation(s)
- S Haleem
- Spinal House, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK.
| | - M Malik
- Division of Medical Education, University of Brighton, Brighton, UK
| | - C Azzopardi
- Spinal House, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - R Botchu
- Spinal House, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - D S Marks
- Spinal House, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
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Rajakulasingam R, Kho J, Almeer G, Azzopardi C, James SL, Botchu R. Birmingham Intervention Tent Technique (BITT): A Technical Note. Indian J Radiol Imaging 2021; 31:521-523. [PMID: 34556944 PMCID: PMC8448233 DOI: 10.1055/s-0041-1733467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective
We describe a novel and safe CT biopsy technique that we have termed the “Birmingham intervention tent technique (BITT).” This technique is ideal for biopsying osseous lesions where a direct approach is not possible due to difficult positioning.
Methods
The BITT uses a plastic surgical forceps clamp attached at an angle to the biopsy needle, creating a tent shape. The finger rings of the forceps is stabilized on the table.
Results
In our institution, we have already used the BITT successfully in over 10 cases.
Conclusion
The BITT is an inexpensive and reproducible technique.
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Affiliation(s)
- R Rajakulasingam
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - G Almeer
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
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11
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Iyengar K, Jain V, Gupta H, Azzopardi C, Botchu R. Iyengar-Botchu (IB) confluence of the medial knee- anatomy and clinico-radiological review. J Clin Orthop Trauma 2021; 22:101591. [PMID: 34567973 PMCID: PMC8447233 DOI: 10.1016/j.jcot.2021.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
The Iyengar-Botchu confluence is a quadrilateral space on the medial side of the knee. Due to the presence of unique anatomical structures, this region is prone to injuries. The aim of this pictorial review is to illustrate an anatomical description of the structures, which form the IB complex confluence. Clinico-pathological correlation of common conditions associated with these structures will increase awareness of injuries in this area. A complementary imaging guidance will support clinical diagnosis and appropriate patient management.
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Affiliation(s)
- K.P. Iyengar
- Department of Orthopedics, Southport &Ormskirk NHS Trust, Southport, UK
| | - V.K. Jain
- Department of Orthopedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - H. Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Saad A, Azzopardi C, Patel A, Davies A, Botchu R. Myositis ossificans revisited - The largest reported case series. J Clin Orthop Trauma 2021; 17:123-127. [PMID: 33816108 PMCID: PMC7995649 DOI: 10.1016/j.jcot.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Myositis ossificans (MO) is a condition characterised by the formation of non-neoplastic heterotropic ossification in extraskeletal soft tissues. MATERIAL AND METHODS We performed a retrospective study of our radiology databases within our tertiary orthopaedic centre to identify all cases of MO, reported on X ray, Magnetic resonance imaging (MRI) and Computed tomography (CT) over the past 13 years (2007-2020). RESULTS We identified 68 cases of MO, which were included into our cohort. The average age of our patients was 36 years (range 4-84 years). 73% of cases (n = 50) were found to affect the lower limb muscles with the majority in the quadriceps. CONCLUSION We report the largest case series of MO and discuss the demographics, diagnoses and management.
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Affiliation(s)
- A. Saad
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A.M. Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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13
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Hegde G, Azzopardi C, Davies A, Patel A, James S, Botchu R. Spinal collision lesions. J Clin Orthop Trauma 2021; 19:21-25. [PMID: 34046296 PMCID: PMC8141933 DOI: 10.1016/j.jcot.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/03/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED Collision lesions are rare neoplasms often described in the hepatobiliary system, genitourinary system and adrenal glands. Vertebral haemangiomas (VH) are the most common lesions involving the vertebral bodies. VHs are usually asymptomatic and considered as "Do not touch" lesions. Rarely they can be symptomatic. Imaging findings of typical and atypical haemangiomas, variant forms of haemangioma such as aggressive haemangiomas are well known. Collision lesions involving VHs are extremely rare. This article presents a series of cases with collision lesions of the vertebral body involving VHs. ADVANCES IN KNOWLEDGE This Case series demonstrates the various collision lesions in spinal haemangioma.
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Affiliation(s)
| | | | | | | | | | - R. Botchu
- Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Hegde G, Subramanian A, Azzopardi C, Patel A, James SL, Botchu R. Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement. J Ultrasound 2021; 25:83-87. [PMID: 33591565 PMCID: PMC8964855 DOI: 10.1007/s40477-021-00565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
Iliotibial band (ITB) pathology is one of the main causes of lateral knee pain. The enthesopathy of the ITB at its insertion post total knee replacement (TKR) is a rare cause of lateral knee pain. We describe a series of cases of ITB enthesopathy with sonographic findings and management.
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Affiliation(s)
- G Hegde
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - A Subramanian
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Thaker S, Azzopardi C, Gulia A, Botchu R. Exploring Correlation between Extent of Tumour Necrosis on MRI And Histological Grade of Soft Tissue Sarcoma. An Initial Experience. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.04.2020.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Thaker
- Department of Diagnostic Imaging, Kettering General Hospital, Kettering UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Gulia
- Department of Orthopaedic Oncology, Tata Memorial Centre, Mumbai, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Haleem S, Malik M, Guduri V, Azzopardi C, James S, Botchu R. The Haleem-Botchu classification: a novel CT-based classification for lumbar foraminal stenosis. Eur Spine J 2020; 30:865-869. [PMID: 33179129 DOI: 10.1007/s00586-020-06656-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis. MATERIALS AND METHODS The grading was developed as four grades: normal foramen-Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression-Grade 1, both AP/SI compression (two planes) without distortion of nerve root-Grade 2 and Grade 2 with distortion of nerve root-Grade 3. A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic. RESULTS A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60-83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0-540, SD-108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers. CONCLUSION The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required.
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Affiliation(s)
- S Haleem
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK.
| | - M Malik
- Division of Medical Education, University of Brighton, Brighton, UK
| | - V Guduri
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - C Azzopardi
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - S James
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - R Botchu
- Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
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Azzopardi C, Almeer G, Kho J, Beale D, James S, Botchu R. Hamstring origin-anatomy, angle of origin and its possible clinical implications. J Clin Orthop Trauma 2020; 13:50-52. [PMID: 33717874 PMCID: PMC7920124 DOI: 10.1016/j.jcot.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The posterior compartment of the thigh is composed of three major muscles collectively known as the hamstring muscles. These consist of the biceps femoris short and long head, semimembranosus and semitendinosus. Excluding the short head of biceps femoris, the hamstrings contribute to the movement of the hip and the knee joints as they span across both joints. Our hypothesis is that the nature of the conjoint tendon -ischial angle predisposes to an increased risk of tearing in this hamstring component. We therefore aim to look at the anatomy of the hamstring origin at the ischial tuberosity and spatial relationship between the long head of biceps, semitendinosus and semimembranosus in the form of vector angles. MATERIAL AND METHODS 100 consecutive pelvic MRIs in patients under the age of 40 years were reviewed by musculoskeletal radiology fellow and a consultant musculoskeletal radiologist with more than 10 years' experience in musculoskeletal radiology and measured the angle of origin of conjoined tendon and semimembranosus at its ischial origin. P value using a paired t-test was less than 0.0001 confirming that the difference in the vector angle of the different hamstring components was statistically significant. RESULTS The median angle of origin of conjoined tendon was 12° and for semimembranosus was 6°. Applying the concept of Newton's second law to the angles calculated we demonstrated that an increase of 9% force applied to the conjoint tendon origin when compared to the semimembranosus tendon. CONCLUSION We hypothesis that the difference in the angle of origin of the components of hamstrings might be one of the reasons for the difference in the incidence and patterns of the injuries of the various muscles of the hamstrings.
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Affiliation(s)
- C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - G. Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - D. Beale
- Department of Radiology, Heath Lodge Clinic, Knowle, UK
| | - S.L. James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
- Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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18
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Kho J, Azzopardi C, Davies AM, James SL, Botchu R. MRI assessment of anatomy and pathology of the iliofemoral ligament. Clin Radiol 2020; 75:960.e17-960.e22. [PMID: 32718743 DOI: 10.1016/j.crad.2020.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
The iliofemoral ligament is strongest ligament of the body. We review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the disease entities that may affect this region.
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Affiliation(s)
- J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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19
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Rajakulasingam R, Da Silva EJ, Azzopardi C, Fernandez T, Botchu R, Hargunani R. Standard operating procedure of image-guided intervention during the COVID-19 pandemic: a combined tertiary musculoskeletal oncology centre experience. Clin Radiol 2020; 75:794.e19-794.e26. [PMID: 32732094 PMCID: PMC7373026 DOI: 10.1016/j.crad.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. MATERIALS AND METHODS This study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Birmingham, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. RESULTS Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, 7 CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. CONCLUSION By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes. COVID-19 has had a significant impact on CT interventional procedures. Air pressures and appropriate ventilation systems need to be considered. A pragmatic and meticulous approach is crucial in operating a functional service.
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Affiliation(s)
- R Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
| | - E J Da Silva
- Department of Anaesthetics, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK
| | - C Azzopardi
- Department of Radiology, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK
| | - T Fernandez
- Department of Anaesthetics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
| | - R Botchu
- Department of Radiology, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham B31 2AP, UK.
| | - R Hargunani
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, UK
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20
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Smith E, Azzopardi C, Thaker S, Botchu R, Gupta H. Power Doppler in musculoskeletal ultrasound: uses, pitfalls and principles to overcome its shortcomings. J Ultrasound 2020; 24:151-156. [PMID: 32683646 DOI: 10.1007/s40477-020-00489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022] Open
Abstract
Power Doppler (PD) is used widely in musculoskeletal ultrasound, especially in the assessment of structures for evidence of inflammation and in evaluating soft tissue neoplasms. We reinforce and delineate the three cardinal principles of optimising PD assessment in order to avoid false positive or false negative results; namely (1) Optimal gain settings (2) Adequate transducer pressure, and (3) Proper patient/anatomical structure-of-interest positioning with complete tissue relaxation.
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Affiliation(s)
- E Smith
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S Thaker
- Department of Radiology, Kettering General Hospital, Kettering, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| | - H Gupta
- Department of Musculoskeletal Imaging, Leeds Teaching Hospital, Leeds, UK
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21
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Davies AM, Patel A, James SL, Azzopardi C, Botchu R. An imaging protocol for the management of central cartilage tumours of the proximal fibula. Clin Radiol 2020; 75:714.e1-714.e6. [PMID: 32665062 DOI: 10.1016/j.crad.2020.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/19/2020] [Indexed: 10/23/2022]
Abstract
AIM To retrospectively review a series of solitary central cartilage tumours (CCTs) of the proximal fibula and propose an imaging protocol for their management. MATERIALS AND METHODS Over 11 years, 48 patients were identified with a CCT of the proximal fibula. The initial magnetic resonance imaging (MRI) and follow-up imaging were assessed for tumour length, endosteal scalloping, or aggressive/malignant features. Each case was categorised according to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). The final diagnosis and outcome were reviewed to establish an appropriate imaging protocol for the management of similar cases in the future. RESULTS The final diagnosis based on imaging alone or imaging and histopathology was enchondroma in 46 cases (96%) and atypical cartilage tumour (ACT)/low-grade chondrosarcoma in two (4%). Using the BACTIP classification, the majority were type IC (48%) with type IA the second commonest (24%). Of 19 that underwent follow-up MRI, only two revealed any increase in length, neither of which was shown to be malignant. No cases re-presented later with evidence of malignant transformation. CONCLUSION There has been a significant increase in the number of CCTs of the proximal fibula referred to Royal Orthopaedic Hospital, Birmingham, over the past decade. This can largely be attributed to the increased use of MRI. The majority were benign with only 4% classified as an ACT. A modified BACTIP, the Fibular Atypical Cartilage Tumour Imaging Protocol (FACTIP) is presented, indicating which cases would benefit from follow-up imaging and which require referral to a specialist orthopaedic oncology service.
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Affiliation(s)
- A M Davies
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - A Patel
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
| | - S L James
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - C Azzopardi
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - R Botchu
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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22
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Almeer G, Azzopardi C, Beale D, James SL, Botchu R. Proximal Hamstring Origin Architecture: Defining the Vector Angle. Semin Musculoskelet Radiol 2020. [DOI: 10.1055/s-0040-1722503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Facet joints are the only synovial joints in the spine and can be involved in a large number of pathological processes including arthropathy, infection, inflammation, trauma and tumour. In this review article, we present a spectrum of pathologies that arise from or involve facet joints that we have encountered in our tertiary orthopaedic and spinal centre. The objective of this review is to create an aide memoire for the general radiologist who may encounter facet joint pathology, which they may not be familiar with.
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Affiliation(s)
- G Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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24
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Boppana S, Rajakulasingam R, Azzopardi C, Botchu R. Ultrasound of glenoid labrum with MR arthrographic correlation. J Ultrasound 2020; 24:99-106. [PMID: 31983012 DOI: 10.1007/s40477-020-00428-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
Ultrasound (US) is a reliable non-invasive method to image the rotator cuff tendons. Even though glenoid labral pathology is common, it is not routinely looked at as part of the shoulder ultrasound protocol. Currently, the gold standard for labral imaging remains MR arthrography. However, given the rather long waiting list and cost implications, US may be used as a modality to quickly screen the shoulder for gross labral pathology. Whilst there is relative paucity of the literature outlining labral pathology on US, there is none correlating sonographic and corresponding MRI appearances. We present a pictorial review highlighting scanning positioning, US and corresponding MRI appearances of a normal labrum and various labral pathologies. We discuss useful scanning tips and characteristic US signs which can help the radiologist.
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Affiliation(s)
- S Boppana
- Department of Radiology, Kamineni Hospital, LB Nagar, Hyderabad, India
| | - R Rajakulasingam
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Kingsland M, Doherty E, Anderson A, Tully B, Crooks K, Elliott E, Wolfenden L, Dunlop A, Tsang T, Rissel C, Symonds I, Attia J, Azzopardi C, Wiggers J. Developing a practice change initiative to improve care for alcohol consumption in pregnancy. Women Birth 2019. [DOI: 10.1016/j.wombi.2019.07.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Doherty E, Wiggers J, Wolfenden L, Anderson AE, Crooks K, Tsang TW, Elliott EJ, Dunlop AJ, Attia J, Dray J, Tully B, Bennett N, Murray H, Azzopardi C, Kingsland M. Antenatal care for alcohol consumption during pregnancy: pregnant women's reported receipt of care and associated characteristics. BMC Pregnancy Childbirth 2019; 19:299. [PMID: 31419964 PMCID: PMC6698023 DOI: 10.1186/s12884-019-2436-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background Antenatal clinical guidelines recommend that during initial and subsequent antenatal visits all pregnant women: have their alcohol consumption assessed; be advised that it is safest not to consume alcohol during pregnancy and of the potential risks of consumption; and be offered referrals for further support if required. However, the extent to which pregnant women attending public antenatal services receive guideline recommended care at these visits, and the characteristics associated with its receipt, is unknown. The purpose of this study was to examine: 1) pregnant women’s reported receipt of guideline recommended care addressing alcohol consumption during pregnancy; 2) characteristics associated with the receipt of care; and 3) pregnant women’s acceptability of care. Methods From July 2017 – February 2018 a survey (telephone or online) was undertaken with 1363 pregnant women who had recently visited a public antenatal service in one health district in Australia. Receipt and acceptability of recommended care were assessed via descriptive statistics and associations via logistic regression analyses. Results At the initial antenatal visit, less than two thirds (64.3%) of pregnant women reported that they received an assessment of their alcohol consumption and just over one third (34.9%) received advice and referral appropriate to their self-reported level of alcohol consumption since pregnancy recognition. Less than 10% of women received such care at subsequent antenatal visits. Characteristics that significantly increased the odds of receiving all guideline elements at the initial antenatal visit included: less than university attainment (OR = 1.93; 95% CI:1.12, 3.34), not residing in an advantaged area (OR = 2.11; 95% CI:1.17, 3.79), first pregnancy (OR = 1.91; 95% CI:1.22, 2.99) and regional/rural service location (OR = 2.38; 95% CI:1.26, 4.48); and at subsequent visits: younger age (OR = 0.91; 95% CI:0.84, 0.99) and Aboriginal origin (OR = 3.17; 95% CI:1.22, 8.24). Each of the recommended care elements were highly acceptable to pregnant women (88.3–99.4%). Conclusions Although care for alcohol consumption is both recommended by clinical guidelines and highly acceptable to pregnant women, its receipt in public antenatal services is suboptimal. There is a need and an opportunity for interventions to support antenatal care providers to routinely and consistently provide such care to all pregnant women.
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Affiliation(s)
- Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia Dray
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Nicole Bennett
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Henry Murray
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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27
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Kingsland M, Doherty E, Anderson AE, Crooks K, Tully B, Tremain D, Tsang TW, Attia J, Wolfenden L, Dunlop AJ, Bennett N, Hunter M, Ward S, Reeves P, Symonds I, Rissel C, Azzopardi C, Searles A, Gillham K, Elliott EJ, Wiggers J. A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial. Implement Sci 2018; 13:112. [PMID: 30126437 PMCID: PMC6102816 DOI: 10.1186/s13012-018-0806-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women. Methods The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at ‘booking in’, 27–28 weeks gestation and 35–36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome. Discussion This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child. Trial registrations Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).
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Affiliation(s)
- Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Danika Tremain
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tracey W Tsang
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Nicole Bennett
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mandy Hunter
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Chris Rissel
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,New South Wales Office of Preventive Health, Liverpool, New South Wales, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Andrew Searles
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Vassallo E, Azzopardi C, Grech R. Not just another thunderclap headache: a case of isolated cortical vein thrombosis and subarachnoid haemorrhage. BMJ Case Rep 2015; 2015:bcr-2015-212273. [DOI: 10.1136/bcr-2015-212273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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29
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Azzopardi C, Attard J, Aquilina S, Grech R. When the going gets rough: a sequela of splenic trauma. Case Reports 2014; 2014:bcr-2014-205905. [DOI: 10.1136/bcr-2014-205905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The Churg-Strauss syndrome is characterised by a history of asthma and paranasal sinus disease, eosinophilia of more than 10 per cent, non-fixed pulmonary infiltrates on chest radiography and vasculitis which may affect multiple organ systems. The condition usually manifests in the 4th decade. We present a 21-year old female with a history of asthma since one year of age who developed symptoms and signs of pneumonia, a pulmonary infiltrate on chest radiography and eosinophilia. This was followed a few weeks later by vasculitis which affected the skin and myocardium and associated with a peripheral eosinophilia of more than 80%. Physical examination revealed palpable purpura and signs of left ventricular failure. Echocardiography confirmed significant diminution of left ventricular contractility. A rapid improvement was observed after steroid therapy. Echocardiography after two months showed normal left ventricular function. In this presentation we review the cardiac manifestations of the Churg-Strauss syndrome and its management.
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Affiliation(s)
- C Azzopardi
- Department of Medicine, St. Luke's Hospital, Guardamangia, Malta
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33
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Abstract
Two young women with no risk factors for cerebrovascular disease developed hyperpyrexia, rigidity, and autonomic features while taking neuroleptic agents. The first presented with increasing rigidity, profuse diaphoresis and dehydration, and a right hemiparesis, and computed tomography (CT) showed a left striato-capsular infarction. The second became unresponsive following severe hypoxia and was found to have left-sided pyramidal signs three days later. Hemoconcentration and hypoxemia predispose to cerebral ischemic injury in the neuroleptic malignant syndrome and should be avoided as much as possible.
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Affiliation(s)
- P Pullicino
- University of Malta, St. Luke's Hospital, Gwardamangia, Malta
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