scholarly journals Assessment of venous Doppler ultrasound findings of acute unilateral lower limb swelling in a tertiary facility in central Ghana: a retrospective analytical study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Emmanuel Kobina Mesi Edzie ◽  
Klenam Dzefi-Tettey ◽  
Edmund Kwakye Brakohiapa ◽  
Philip Narteh Gorleku ◽  
Frank Naku Ghartey ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Lower Limb ◽  
Vascular System ◽  
Statistical Significance ◽  
Accurate Diagnosis ◽  
Main Diagnosis ◽  
Treatment Plans ◽  
Inguinal Lymphadenopathy ◽  
The Look ◽  
Ultrasound Features

Abstract Background Unilateral lower limb swelling has wide differential diagnoses with varying treatment plans, requiring an early and accurate diagnosis. Doppler ultrasound offers an extensive examination of the vascular system providing a platform for diagnosis and avoidance of unnecessary invasive procedures. Thus, it becomes pertinent to ensure that all the sonographic information required for the accurate diagnosis of a swollen lower limb is documented and critically analyzed in our setting, hence this study. Results The records of a total of 151 patients with acute unilateral lower limb swelling were retrieved, females constituted the majority (51.7%). The overall mean age was 58.70 ± 16.71 years. Statistical significance was specified at p ≤ 0.05 for this study. The males were on the average 1.86 years younger than the female, but this difference was not statistically significant (p = 0.495). Patients older than 60 years constituted the majority 72 (47.7%) followed by the 40–60-year age category 61 (40.4%), and the left lower limb was affected more often 82 (54.3%). Multiple inguinal lymphadenopathy 82 (35.7%) and edema with thickened skin and subcutaneous layers 67 (29.1%) were the two most recurrent ultrasound features. There was no significant association between the sonographic features and the diagnoses made for acute unilateral lower limb swelling, except for the feature of edema with thickened skin and subcutaneous layers (p = 0.004) and the diagnosis of cellulitis (p = 0.047) that increased significantly with age. Conclusion Multiple inguinal lymphadenopathy and edema of the skin and subcutaneous layers were the most recurrent ultrasound features with cellulitis as the main diagnosis for acute unilateral lower limb swelling in our setting. Edema with thickened skin and subcutaneous layers and cellulitis both increased significantly with age. Sonographers, sonologists, and radiologists must be on the look-out for these in their practices.

The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

The Role of Doppler Ultrasound, CT Angiography, and Conventional Angiography in Detection of Peripheral Arterial Disease

2021 ◽  
pp. 154431672110303
Author(s):  
Sayan Sarkar ◽  
Shyam Mohan ◽  
Shakthi Parvathy
Keyword(s):  
Computed Tomography ◽  
Peripheral Arterial Disease ◽  
Ct Angiography ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Color Doppler ◽  
Statistical Significance ◽  
Arterial Disease ◽  
P Value ◽  
Peripheral Arterial

The purpose of this study is to analyze how accurate duplex ultrasonography using color Doppler and computed tomography (CT) angiography are in detection of peripheral arterial disease (PAD) in comparison with the Gold Standard of digital subtraction angiography (DSA). This is a single-center prospective, analytical study done on patients with symptoms of PAD referred to the Department of Radiodiagnosis of Medical Trust Hospital (n = 53). All patients were imaged with color Doppler, CT angiography, and DSA. The peak systolic velocity (PSV) ratio was calculated by Doppler ultrasound, and the percentage stenosis for the same vascular segments was calculated using CT angiography and DSA. To test the statistical significance between the results, chi-square test was used. A P value <.05 indicates statistical significance. The PSV ratio for each grade—normal (<1.5), mild (1.5-2.8), moderate (2.9-4.9), and severe (≥5)—and the percentage of stenosis for each grade observed on CT angiography—normal (<20% stenosis), mild (20%-49% stenosis), moderate (50%-74% stenosis), severe (75%-99% stenosis), and total occlusion (100% stenosis)—were found to be highly sensitive and specific with good positive predictive value, negative predictive value, and accuracy level when compared with DSA with narrow confidence intervals for each range. The P value was <.001 for both color Doppler and CT angiography. Computed tomography angiography can be an effective tool as an alternative to DSA for gradation of stenosis if the artifacts resulting from vascular calcification can be avoided. Duplex ultrasonography can be utilized for gradation of stenosis by using the value of PSV ratio and spectral pattern together. However, it can only act as an adjunct to CT angiography because it is incapable of imaging the full length of the arterial segments in 1 frame.

scholarly journals Imaging of metastatic cervical nodes: is CT helpful in differentiation of squamous cell carcinoma (SCC) from non-SCC groups?

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Lamya A. Eissa ◽  
Ahmed Mohamed Mehanna
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Statistical Significance ◽  
Imaging Parameters ◽  
Node Metastasis ◽  
Nodal Size ◽  
Choice Of Treatment ◽  
Treatment Plans ◽  
Comparative Statistical Analysis

Abstract Background Cervical node metastasis is frequently encountered in CT neck of patients with squamous cell carcinoma (SCC) and non-(SCC). Differentiation between both entities carries its value on prognosis and choice of treatment plans. The purpose of the study was to compare between the SCC and non-SCC metastatic cervical adenopathies according to different imaging parameters with the use of comparative statistical analysis of any of these criteria. This was made by retrospectively studying 157 patients. Imaging analyzed the following parameters: nodal size, laterality, nodal levels, “grouping” of nodes, nodal shape, and “periphery,” as well as the presence or absence of nodal “necrosis.” Statistics are made to show significant differences between both groups. Results The criterion of necrosis had statistical significance, being more prevalent among the SCC groups. Involvement of levels I, II, and supra clavicular was more prevalent among SCC patients. Age and sex had also some statistical significance. Conclusions The combination of different imaging parameters could distinguish SCC from non-SCC. Nodal “necrosis”—(excluding “cystic”)—combined with involvement of nodal levels II and being in older-aged men were statistically significant in the SCC compared to non-SCC.

Image-directed Doppler ultrasound in the diagnosis of lower-limb venous insufficiency

1994 ◽  
Vol 22 (5) ◽  
pp. 291-297 ◽  
Author(s):  
Diana Gaitini ◽  
Shlomo Torem ◽  
Menucha Pery ◽  
Joseph K. Kaftori
Keyword(s):  
Doppler Ultrasound ◽  
Lower Limb ◽  
Venous Insufficiency

Torsional Problems in Cerebral Palsy

Foot & Ankle ◽  
1984 ◽  
Vol 4 (4) ◽  
pp. 180-184 ◽  
Author(s):  
Howard A. King ◽  
Lynn T. Staheli
Keyword(s):  
Cerebral Palsy ◽  
Literature Review ◽  
Lower Limb ◽  
Muscle Tone ◽  
Therapeutic Challenge ◽  
Treatment Plans

Lower limb rotational problems in the patient with cerebral palsy represent a diagnostic and therapeutic challenge to the clinician. A literature review suggests that increased muscle tone may be the cause of these problems. This article proposes a simple diagnostic plan and discusses the various treatment plans and options.

scholarly journals Correlation between Innercanthal Distance and Mesiodistal Width of Maxillary Anterior Teeth in a Thrissur, Kerala, India, Population

2016 ◽  
Vol 17 (5) ◽  
pp. 382-387 ◽  
Author(s):  
Kamalakanth Shenoy ◽  
George Attokaran
Keyword(s):  
Statistical Significance ◽  
Age Group ◽  
Dynamic Changes ◽  
Anterior Teeth ◽  
High Statistical Significance ◽  
Treatment Plans ◽  
Facial Proportions ◽  
Males And Females ◽  
The Difference ◽  
Changes Over Time

ABSTRACT Background Selecting and replacing missing teeth to natural proportions and esthetic preference of a patient in the absence of pre-extraction records is a very challenging task. Although facial analysis and proportions are well discussed in many populations, none exists for the Thrissur, Kerala, population. A prosthodontic rehabilitation for Kerala patients relying on other racial norms may result in dissonant facial proportions. Therefore, the purpose of this study was (1) to evaluate the validity of innercanthal distance as a guide in determining the mesiodistal dimension of six maxillary anterior teeth in a selected Malayalee population in the Thrissur Municipal Corporation area; (2) to check whether innercanthal distance undergoes dynamic changes over time as a result of aging; and (3) to evaluate whether there is a gender difference in the analyzed mean facial and dental proportions in this population. Materials and methods The study was conducted on 1,200 subjects in the Thrissur Municipal Corporation area. From five wards, 240 subjects were selected, out of which 120 were from the 18 to 25 years age group and 120 from the 40 to 50 years age group. Sixty males and females were selected from each group. The innercanthal distance was measured using a Digital Vernier Caliper, and alginate impressions were made to evaluate the size of maxillary anteriors. The data was analyzed statistically. Results The study showed that there is a high statistical significance between the innercanthal distance and the mesiodistal width of six maxillary anterior teeth in females (p < 0.01) and no significance in males. There was also dynamic changes in the innercanthal dimension and the mesiodistal width of maxillary anteriors with increase in age (p < 0.001). The difference in the mean of innercanthal distance between the genders was highly statistically significant, but no significance was found between the genders in the mesiodistal width of maxillary anteriors. Conclusion Within the population evaluated, there was a high statistical significance in females between the innercanthal distance and the mesiodistal width of six maxillary anterior teeth, but not for males. Innercanthal dimension was found to undergo dynamic changes as age increases in both males and females, and it was much higher in males than in females. There was no statistical significance in the comparative evaluation of mesiodistal width of maxillary anteriors of males and females in the study. Clinical significance Teeth selection is a critical step in determining the outcome of successful prosthodontic treatment. No definite guidelines for the selection of maxillary anterior teeth pertaining to the Thrissur, Kerala, population exist. A prosthodontic rehabilitation of Thrissur, Kerala, patients relying on other racial norms will result in dissonant facial proportions. In selecting maxillary anterior teeth, the knowledge of racial norms will help specify certain esthetic and functional modifications in treatment plans, which might be specific to each group. Therefore, there remains an unquestionable need for a scientific and reliable method for maxillary anterior teeth selection, which can be applied on this group of Indian population. How to cite this article Attokaran G, Shenoy K. Correlation between Innercanthal Distance and Mesiodistal Width of Maxillary Anterior Teeth in a Thrissur, Kerala, India, Population. J Contemp Dent Pract 2016;17(5):382-387.

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