Background: Injuries to the posterolateral corner of the knee (PLC) can be difficult to diagnose and are often missed. The prone dial test can be difficult to perform in the acute setting and the supine dial test requ...Background: Injuries to the posterolateral corner of the knee (PLC) can be difficult to diagnose and are often missed. The prone dial test can be difficult to perform in the acute setting and the supine dial test requires an assistant. Purpose: We present a simple single person seated dial test that can easily be performed in all patients with a suspected diagnosis of PLC injury. Study Design: Case Series. Method: The patient is seated on the edge of the examination couch with their knees flexed over the side and their calves pressed against the couch to reduce any posterior tibial subluxation. The patients’ knees are placed together ensuring the pelvis is square;the knees are at the same level, and the patellae are facing anteriorly. The patients place their hands against the side of their knees and hold their knees together in this position. The examiner then grasps the patient’s feet, approximates the medial malleoli and exerts a lateral rotational force at 30 and 90 degrees of knee flexion. Results: This test has 100% accuracy for diagnosing PLC injury in our institution. Conclusion: We present a sample to use alternative to traditional dial testing that does not require an assistant and also does not require the patient to be prone, thus limiting discomfort in the acute setting.展开更多
Dear Sir,We write to report a case of new onset atrial fibrillation following sub-Tenon’s block.Cataract surgery is nowadays mostly performed as a day case procedure with 95.5%of surgery performed under local anaesth...Dear Sir,We write to report a case of new onset atrial fibrillation following sub-Tenon’s block.Cataract surgery is nowadays mostly performed as a day case procedure with 95.5%of surgery performed under local anaesthesia.This can be done with sub-Tenon’s,retrobulbar,peribulbar,intracameral or topical anaesthesia[1].Sub-Tenon’s anaesthesia involves opening the conjunctiva and tenon’s展开更多
Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitiv...Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.展开更多
文摘Background: Injuries to the posterolateral corner of the knee (PLC) can be difficult to diagnose and are often missed. The prone dial test can be difficult to perform in the acute setting and the supine dial test requires an assistant. Purpose: We present a simple single person seated dial test that can easily be performed in all patients with a suspected diagnosis of PLC injury. Study Design: Case Series. Method: The patient is seated on the edge of the examination couch with their knees flexed over the side and their calves pressed against the couch to reduce any posterior tibial subluxation. The patients’ knees are placed together ensuring the pelvis is square;the knees are at the same level, and the patellae are facing anteriorly. The patients place their hands against the side of their knees and hold their knees together in this position. The examiner then grasps the patient’s feet, approximates the medial malleoli and exerts a lateral rotational force at 30 and 90 degrees of knee flexion. Results: This test has 100% accuracy for diagnosing PLC injury in our institution. Conclusion: We present a sample to use alternative to traditional dial testing that does not require an assistant and also does not require the patient to be prone, thus limiting discomfort in the acute setting.
文摘Dear Sir,We write to report a case of new onset atrial fibrillation following sub-Tenon’s block.Cataract surgery is nowadays mostly performed as a day case procedure with 95.5%of surgery performed under local anaesthesia.This can be done with sub-Tenon’s,retrobulbar,peribulbar,intracameral or topical anaesthesia[1].Sub-Tenon’s anaesthesia involves opening the conjunctiva and tenon’s
文摘Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.
