Objectives The Radiographic Union Score for Tibia (RUST) scoring system has been validated in multiple studies assessing the healing of tibial fractures. Our objective was to assess the inter and intraobserver reliability for the RUST in diaphyseal femoral fractures treated with intramedullary (IM) nailing. Patients and Methods A total of 60 sets of anteroposterior (AP) and lateral radiographs of diaphyseal femoral fractures treated by reamed IM nailing were randomly selected from a prospectively collected database. The 60 sets of radiographs were then scored by three reviewers using the RUST system. Interobserver reliability was measured at initial scoring. The 60 sets of radiographs were scored again by the three reviewers to calculate the intraobserver reliability. Results The RUST scores ranged from 4 to 12 with a mean score of 11.3 ± 1.3. The interobserver intraclass correlation coefficient (ICC) was 0.87 (95% CI, 0.81-0.92) and the intraobserver ICC was 0.91 (95% CI, 0.88-0.94), which indicated excellent agreement. Conclusion This study demonstrated that the RUST system can be used reliably in the assessment of healing in diaphyseal femur fractures treated by reamed intramedullary nailing, with excellent interobserver and intraobserver reliability.

Ultraljud är en metod som kan användas för att bedöma hjärtfunktionen, en så kallad ekokardiografi undersökning. Ekokardiografi är en svårbemästrad metod som är mycket beroende av handhavaren. Tvådimensionell ekokardiografi är en etablerad metod som används inom klinisk diagnostik. Idag är även tredimensionella registreringar möjliga att utföra, men bör endast utföras av en erfaren handhavare och på patienter med adekvat bildkvalitet. Syftet med studien var att jämföra vänsterkammarvolym och ejektionsfraktion mellan tvådimensionell och tredimensionell ekokardiografi. Även intraobservatörsvariation hos två oerfarna handhavare har granskats.  I studien inkluderades 46 försökspersoner med normal sinusrytm och inga kända hjärt- och kärlsjukdomar. Vänsterkammarvolym och ejektionsfraktion beräknades med hjälp av Siemens automatiska funktioner eSie Left Heart och eSie LVA. Studiens resultat visade att det föreligger det en signifikant skillnad mellan tvådimensionell- och tredimensionell ekokardiografi för både vänsterkammarvolym och ejektionsfraktion. De tredimensionella mätningarna gav en större vänsterkammarvolym men mindre ejektionsfraktion jämfört med de tvådimensionella mätningarna. Intraobservatörsvariationen för tredimensionell ekokardiografi gav en större standardavvikelse för vänsterkammarvolym hos båda handhavarna jämfört med tvådimensionell ekokardiografi. För ejektionsfraktionen fick handhavare 1 samma standardavvikelse mellan metoderna medan handhavare 2 fick en större standardavvikelse i tredimensionell ekokardiografi. / Ultrasound is a method that can be used to assess heart function, so-called echocardiography. The method is difficult and highly operator dependent. Two-dimensional echocardiography is an established method in clinical diagnostics. Three-dimensional registrations are possible to perform, but should only be performed by an experienced operator and on patients with adequate image quality. The aim of this study was to compare left ventricular volume and ejection fraction between two-dimensional and three-dimensional echocardiography. Intraobserver variation in two inexperienced operators has also been studied. The study included 46 subjects with normal sinus rhythm and no known cardiovascular diseases. Left ventricular volume and ejection fraction were calculated using Siemens automatic functions, eSie Left Heart and eSie LVA. Based on the result, there is a significant difference between two-dimensional and three-dimensional echocardiography for both left ventricular volume and ejection fraction. The three-dimensional measurements yielded a greater left ventricular volume but a smaller ejection fraction compared to the two-dimensional measurements. The intraobserver variation for three-dimensional echocardiography yielded a greater standard deviation for left ventricular volume in both operators compared to two-dimensional echocardiography. For ejection fraction, operator 1 obtained the same standard deviation between methods, while operator 2 obtained a greater standard deviation in three-dimensional echocardiography.

Introdução- A dor pélvica crônica é patologia debilitante em mulheres em idade reprodutiva, considerada problema de saúde pública, responsável por gasto anual nos EUA acima de 5 bilhões de dólares com diagnóstico desconhecido em cerca de 60% dos casos e se associa a dispareunia em 50% dos casos. E fundamental a obtenção de métodos diagnósticos dessa patologia. A ultrassonografia tridimensional vem se mostrando método de confiabilidade para avaliação do assoalho pélvico. ObjetivoAvaliar as lesões do músculo levantador do ânus (MLA) e a confiabilidade inter e intraobservador da biometria do assoalho pélvico pela ultrassonografia 3D em mulheres com dor pélvica crônica e dispareunia. Métodos- O estudo incluiu 49 pacientes com dor pélvica crônica e dispareunia no HCFMRP-USP. A aquisição dos blocos de ultrassonografia 3D foi realizada por dois examinadores de forma independente e \"cegados\", via transperineal utilizando a sonda RIC5-9D. Foram coletados três blocos por paciente (total 147) que foram analisados pelo examinador A (estudo intraobservador) e pelos examinadores A e B (estudo interobservador). A análise das medidas intraobservador foi realizada em dois tempos com intervalo de 90 dias. Os seguintes parâmetros foram avaliados: diâmetro transverso do hiato, diâmetro ânteroposterior do hiato, área hiatal, espessura do MLA às 3 e 9 h, as distâncias entre o músculo levantador do ânus e a uretra (DMLU) direita (D) e esquerda (E) e calculados os coeficientes de correlação intraclasse (CCI) e o coeficiente de correlação de concordância (CCC). Os gráficos correlação e de Bland e Altmann com seus limites de concordância (LC) foram elaborados. Adicionalmente os examinadores avaliaram as lesões do MLA através de sistema de score. Resultados - Na análise intraobservador os melhores parâmetros foram o diâmetro ântero-posterior (CCC 0,98; CCI 0,99 e LC 4,5%), a área hiatal Omni-VCI (CCC 0,99; CCI 0,98 e LC 3,8%) e área hiatal render (CCC 0,99; CCI 0,99 e LC 5,4%). Os parâmetros menos reprodutíveis foram a espessura do MLA às 3 h (CCC 0,58, CCI 0,90 e LC 28,2%) e 9 h (CCC 0,53, CCI 0,93 e LC 29,7%). Na análise interobservador os melhores parâmetros foram o diâmetro ântero-posterior (CCC 0,96; CCI 0,97 e LC 5,4) e a área hiatal Omni-VCI (CCC 0,97; CCI 0,97 e LC 8,9%). Os piores parâmetros foram espessura do MLA às 3 h (CCC 0,30; CCI 0,34 e LC de 38,2%) e às 9 h (CCC 0,32; CCI 0,32 e LC 35,1%). Tais achados foram reforçados pelos gráficos de Bland and Altman e de correlação. As lesões do levantador do ânus foram observadas em 10,2% (5/49) com excelente concordância. Conclusão - A avaliação do assoalho pélvico pela ultrassonografia transperineal em pacientes com dor pélvica crônica e dispareunia foi reproduzível através das análises morfológicas das lesões, do estudo biométrico intra ou interobservador para o diâmetro ântero-posterior, área hiatal render e Omni-VCI. Entretanto as medidas do diâmetro transverso do hiato, a espessura do MLA, o DMLU e a distância uretra ânus não são recomendadas para uso clínico devendo estar restritos à pesquisa / Introduction: Chronic pelvic pain is a debilitating condition in women of childbearing age, considered a public health problem, responsible for annual US spending of over US $ 5 billion, with an unknown diagnosis in about 60% of the cases and is associated with dyspareunia in 50% of cases. It is fundamental to obtain diagnostic methods for this pathology. Three-dimensional ultrasonography has shown to be a reliable method for evaluation of the pelvic floor. Objective: to assess levator ani muscle (LAM) injury and intra/interobserver reliability of pelvic floor biometry by 3D ultrasound in women with chronic pelvic pain and dyspareunia. Methods: The study included 49 women with pelvic pain and dyspareunia of the HCFMRP-USP. Two examiners performed the acquisition of 3D ultrasound via transperineal using the probe RIC5-9D independently and blindly. There were collected three blocks per patient (total 147) that were analyzed by the observer A (intraobserver study) and A and B (interobserver study). The analysis of the intraobserver measurements was performed in two times with 90 days apart. The following parameters were evaluated: the hiatal transverse diameter, hiatal anteroposterior diameter, hiatal area, thickness of the LAM at the 3 h and 9 h positions and right and left levator-urethra gap (LUG) measurements and calculated the intra-class correlation coefficient (ICC) and concordance correlation coefficient (CCC). Plots of correlation and Bland and Altmann with the limits of agreement (LoA) were constructed. Additionally, the observers evaluated the LAM injury using a score system. Results: In the intraobserver analisys the best parameters were the anteroposterior diameter (CCC 0.98; ICC 0.99 and LoA 4.5%), the hiatal area Omni-VCI (CCC 0.99; ICC 0.98 and LoA 3,8%) and hiatal area render (CCC 0.99; ICC 0.99 and LC 5.4%). The least reproducible parameters were the LAM thickness at 3 h (CCC 0.58, ICC 0.90 and LC 28.2%) and 9 h (CCC 0.53, ICC 0.93 and LC 29.7%). In relation to the interobserver analysis the best parameters were the anteroposterior diameter (CCC 0.96; ICC 0.97 and LoA 5.4) and the hiatal area Omni-VCI (CCC 0.97; ICC 0.97 and LC 8.9%). The worst results were LAM thickness at 3 h (CCC 0.30; ICC 0.34 and LC de 38.2%) and at 9 h (CCC 0.32; ICC 0.32 and LC 35.1%). Such findings were enforced by Bland and Altman and correlation plots. The LAM injuries were observed in 10.2% (5/49) with excellent concordance. Conclusions: The assessment of pelvic floor by transperineal ultrasound in patients with chronic pelvic pain and dyspareunia was reproducible either by morphology of LAM injuries or by biometric study, using intra or interobserver analysis for the anteroposterior diameter, hiatal area render and Omni-VCI. However, the measurements for the hiatal transverse diameter, levator ani thickness, right and left LUG and urethra-anus distance are not recommended for clinical use and it should be restricted for research purpose

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