RESUMEN
OBJECTIVE: To evaluate the diagnostic efficacy of thin-slice (1 mm) axial proton density-weighted (PDW) MRI of the knee for meniscal tear detection and classification. METHODS: We prospectively assessed pre-operative MR images of 58 patients (41 males, 17 females; age range 18-62 years) with arthroscopically confirmed meniscal tear. First, we evaluated the performance of the sagittal and thin-slice axial MR images for the diagnosis of meniscal tears. Second, we compared the correlation of tear types presumed from sagittal and axial MRI with arthroscopy and tear classification from axial MRI. Tears were classified on the sagittal plane and the axial plane separately. The diagnostic performance and tear classification were compared statistically with arthroscopy results, which is accepted as the standard of reference. RESULTS: 8 of 58 patients were removed from the study group because they had complex or degenerative tears. A total of 62 tears were detected with arthroscopy in 50 patients. On the sagittal images, sensitivity and specificity values were 90.62% and 70.37%, respectively, for medial meniscus tears and 72.73% and 77.14%, respectively, for lateral meniscus tears. The corresponding values for axial images were 97.30% and 84.00%, respectively, for medial meniscus tears and 95.65% and 80.50%, respectively, for lateral meniscus tears. There was no significant difference in tear classification between the arthroscopy results and the thin-slice axial PDW MRI results (p>0.05). CONCLUSION: thin-slice axial PDW MRI increases the sensitivity and specificity of meniscal tear detection and especially classification, which is important for surgical procedure decisions.
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Imagen por Resonancia Magnética/métodos , Lesiones de Menisco Tibial , Adolescente , Adulto , Artralgia/etiología , Femenino , Humanos , Traumatismos de la Rodilla/clasificación , Traumatismos de la Rodilla/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Rotura/clasificación , Rotura/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: This study investigated whether addition of 15 microg epinephrine plus 25 microg fentanyl to lidocaine spinal anesthesia for outpatient knee arthroscopy makes it possible to use a subanesthetic lidocaine dose. The aim was to assess the quality of anesthesia and the suitability of this protocol for outpatient knee arthroscopy. METHODS: Seventy-five outpatients scheduled for knee arthroscopy were randomly assigned to one of three spinal anesthetic protocols: Group L10F25 received 10 mg of lidocaine plus 25 micro g fentanyl; Group L10F25E15 received 10 mg of lidocaine plus 25 microg fentanyl plus 15 microg epinephrine; and Group L20F25 received 20 microg lidocaine plus 25 microg fentanyl. Tourniquet pain and surgical pain were assessed using a visual analog scale. If spinal anesthesia was inadequate despite supplementary intravenous analgesia and sedation, the patient was converted to general anesthesia. Recovery times and side-effects in the early postoperative period were recorded. RESULTS: The highest level of sensory block was above the T12 dermatome in all patients. Compared with the other groups, significantly more patients in Group L10F25 converted to general anesthesia. Group L10F25 had a significantly higher mean surgical pain score than the other groups. The mean tourniquet pain score was significantly higher in Group L20F25 than Group L10F25E15. Group L10F25E15 had a significantly shorter time to discharge than the other groups. Post-operative nausea and vomiting and drowsiness were more frequent in Group L10F25 than in the other groups. CONCLUSION: The combination of 10 mg lidocaine and 25 microg fentanyl plus 15 microg epinephrine provides adequate spinal anesthesia and has favorable recovery characteristics for outpatient knee arthroscopy.
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Anestesia Raquidea , Epinefrina/administración & dosificación , Fentanilo/administración & dosificación , Lidocaína/administración & dosificación , Adulto , Procedimientos Quirúrgicos Ambulatorios , Anestesia Raquidea/efectos adversos , Artroscopía , Método Doble Ciego , Epinefrina/efectos adversos , Femenino , Fentanilo/efectos adversos , Humanos , Rodilla/cirugía , Lidocaína/efectos adversos , Masculino , Persona de Mediana Edad , Náusea y Vómito Posoperatorios/inducido químicamente , Estudios Prospectivos , Médula Espinal/efectos de los fármacosRESUMEN
Meningitis due to Acinetobacter calcoaceticus is rare. These rare bacteria were isolated from culture fluid in patient resembling to Neisseria meningitis with clinical and laboratory findings. The patient was treated with sensitive antibiotic.