Radiology
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Air enema was used for exclusion, diagnosis, initial movement, and complete reduction of intussusception in 186 pediatric patients. Average pressure needed for initial movement of intussusception was 56.5 mm Hg; average maximum pressure of 97.8 mm Hg was required for complete reduction. Average fluoroscopy time required for intussusception reduction was 94.8 seconds; an average of 41.8 seconds was required to exclude intussusception. ⋯ Of 100 consecutive patients that underwent hydrostatic reduction of intussusception at the authors' institution, reduction was successful in 55. Compared with hydrostatic enema, air enema involves shorter fluoroscopy time and lower radiation dose to the patient. Air enema is safe and effective for diagnosis and treatment of intussusception in infants and children and has replaced hydrostatic enema for such procedures at the authors' institution.
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The effect of humeral rotation on the appearance of the rotator cuff tendon in oblique coronal magnetic resonance images was evaluated in 70 such images. Internal rotation produced overlap of the supraspinatus and infraspinatus tendons with soft-tissue interposition or apparent discontinuity of the tendon in 22 cases, including 14 of 15 shoulders positioned in the first 30 degrees between extreme internal and external rotation. Imaging in internal rotation makes assessment of the tendon difficult and should be avoided.
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Open reduction and internal fixation (ORIF), the currently preferred method for treatment of unstable posterior pelvic and sacral fractures, has two significant disadvantages: the need for blind placement of the fixation screws and the occurrence of high complication rates. Advantages of computed tomographic (CT)-guided sacral fixation include direct visualization of the course of the screws and absence of significant complications. Eight patients with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions (seven unilateral and one bilateral) underwent CT-guided sacral fixation with use of the standard orthopedic A-O, 7.0-mm-diameter cannulated screw system. ⋯ After confirmation of the position of the pin with CT, the screw tract was drilled, and the cannulated screw was placed into position. Radiographic and clinical follow-up (5-9 months) showed healing with no significant complications in all eight patients. CT-guided sacral fixation is a safe alternative to ORIF in patients with reducible unstable pelvic fractures.
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In a review of the indications and uses for magnetic resonance (MR) imaging of the pediatric musculoskeletal system, MR evaluation of conditions unique to the pediatric musculoskeletal system were emphasized. Indications for MR imaging of the pediatric musculoskeletal system include evaluation of bone marrow, neoplastic processes, and periarticular disorders.
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Randomized Controlled Trial Comparative Study Clinical Trial
Therapeutic effect of hysterosalpingography: oil- versus water-soluble contrast media--a randomized prospective study.
In a prospective randomized study, the number of pregnancies after hysterosalpingography (HSG) was estimated in 398 patients who had been infertile for longer than 1 year. Iohexol was used in 101 patients, ioxaglate in 102 patients, diatrizoate meglumine in 97 patients, and ethiodized poppy-seed oil in 98 patients. Ten months after HSG, the patient, referring physician, and/or hospital department was consulted for information about pregnancies. ⋯ Significantly more patients became pregnant after HSG in the ethiodized poppy-seed oil group than in the three water-soluble contrast media groups (P less than .01). When only intrauterine pregnancies resulting in full-term births were considered, significant differences in pregnancy rates between the oil-soluble and the water-soluble contrast media groups became more obvious. In the group that received ethiodized poppy-seed oil, almost one-third of the infertile women had normal pregnancies and childbirths after HSG.