Chronic painpatients who show aberrant drug-related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain. The purpose of this study was...Full Text Available
Two experiments used the McGill Pain Questionnaire (MPQ) to examine the affective dimension of pain in patients whose pain was secondary to malignancy. In experiment I, segregating groups of cancer patients on the basis of extreme scores (high versus low) on the MPQ failed to produce segregation on independent measures of affect and infirmity. This outcome contrasts with earlier work with chronic benign painpatients. Experiment II compared cancer painpatients matched with benign painpatients on intensity of pain report on the affective dimension of the MPQ. Cancer painpatients reported a reliably higher affective loading to their pain. These data suggest that cancer ...
Despite the existence of effective analgesic drugs, many cancer patients live and die with ineffective pain control. The control of cancer pain is largely achievable with the appropriate use of available...Full Text Available
Although previous research suggests that preamputation pain is a risk factor for pain after amputation, little is known about the association between acute postsurgical pain and chronic amputation-related pain. The current prospective study examined the associations of preamputation pain and acute postamputation pain with chronic amputation-related pain. The sample consisted of patients with lower limb amputation (N = 57) who provided both preamputation and postamputation data during a 2-year study period. Preamputation pain intensity and duration were assessed before amputation; acute phantom limb pain (PLP) and residual limb pain (RLP) intensity were assessed on postsurgical days 4 and 5. Acute PLP intensity was the only significant independent predictor of ...
Psychological illness influences the experience and expression of pain and disability. We tested three null hypotheses: (1) patients with nonspecific pain (medically unexplained and idiopathic) and...Full Text Available
Five methods of personality assessment are evaluated to provide guidance for the psychological treatment of patients with chronic back pain. Patientpain drawings, pentothal pain studies, stress score...Full Text Available
Pain is necessary for survival but chronic pain is disabling and causes significant health and economic problems. This study provides an understanding of the future for spinal cord stimulation. Stimulation by means of chronically implanted electrodes, was carried out in 200 patients with pain of varied benign organic etiology. In 177 of them, pain was confined to the failed back syndrome. Most patients were referred by a Pain Management Service. 226 epidural implants were used: 80 unipolar, 59 Resume, 12 bipolar, and 75 quadripolar. Patients were followed for periods of 6 months to 12 years, with a mean follow-up of 44 months. 84 patients (42%) were able to control their pain by stimulation alone, 22 patients (11%) needed occasional analgesic supplements ...
The family physician dealing with gynecologic pelvic pain (acute or chronic) enters at the beginning of the problem as diagnostician, refers the patient to a specialist in the interim, and resumes...Full Text Available
Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through...Full Text Available
Forty-one patients were treated with epidural neurolysis using 50 % ethyl alcohol 2 ml. Thirty eight patients were suffering from cancer pain and three patients were complaining of chronic benign pain. Alcohol block was repeated 2.3 times (mean) in the same patient. Thirty patients were followed after the treatment. Forty-seven percent of the patients reported 70 % or greater pain relief and 20 % of the patients reported about 50 % pain relief. Duration of pain relief was from 9 days to 203 days with a mean duration of 54 days. Adverse effects were reported 43 % of the patients. There is no miserable adverse effect. Adverse effect reported most was pain with epidural injection of drugs after the ...
While research has shown that patients’ beliefs about their pain are related to pain adjustment and treatment outcomes, little is known about the beliefs of their significant others....Full Text Available
Even clinicians who keep up with the research literature on pain mechanisms may find themselves uncertain when trying to bring these new theories down to practical application for a patient with pain....Full Text Available
Objective:To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP).Materials...Full Text Available
Post amputation pain can be debilitating for patients and families. Chronic pain is a common phenomenon after lower extremity amputation, occurring in up to 80% of this population. The purpose of this...Full Text Available
Over the years, nurses, doctors and scientists have sought ways of assessing the impact of pain on patients. While many of the instruments devised have been extremely useful in identifying the nature and intensity of pain, defining the effect it has on people's lives and perceptions has proved much more problematic. Based on the work she carried out with patients suffering from chronic benign pain, Karen Rose explores one aspect of these effects--the feeling of isolation. By using a four-step anthropological approach to identify the impact of pain, she argues, nurses can arrive at a realistic and accurate assessment of how patients are coping. PMID:7947167
The treatment of chronic pain conditions continue to present a challenge to the medical field. Physical therapy treatment needs to approach the management of chronic pain differently than the approach used to resolve acute pain. Patients with chronic pain often have many factors that have perpetuated the pain condition. These factors, as well as pain itself, influence their ability to reactivate and perform functional daily activities. Physical therapists can begin to address some of the factors, including fear and deconditioning, by building confidence and body awareness in a self-care model including a slow graduated reactivation program. There is evidence that patients with chronic pain conditions have altered motor control that may be influencing reoccurrences and possible flares of pa...
BackgroundControversy exists about how to effectively measure patient reported outcomes in IBS clinical trials. Pain numeric rating scales (NRS) are widely used in...Full Text Available
Inclusion of family members in the assessment of patients with chronic pain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy....Full Text Available
BackgroundThe purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA).MethodsTwenty-three...Full Text Available
Approximately 20% to 30% of patients who undergo coronary arteriography for the evaluation of chest pain are found to have normal coronary arteries. These patients have a survival rate comparable to...Full Text Available
Spinal cord stimulation (SCS) is frequently used for relief of chronic benign pain resistant to conservative therapies. Clinical practice suggests, at least in patients with failed back surgery syndrome (FBSS), the possibility that SCS significantly improves motor performances. We present here the case of a 41-years-old female patient with FBSS, who showed a clear improvement in muscle strength after SCS, persisting at 6-months follow-up. We speculate that the electrical stimulation of posterior columns could potentiate the caudal, segmental spinal reflexes resulting in a facilitation of motoneurons activation. PMID:16175150
This study evaluated the clinical efficacy of treatment with oral risedronate (17.5?mg once daily) for 8?weeks in 11 Japanese patients with Paget?s disease of bone (PDB). Risedronate suppressed the excessive bone turnover associated with PDB and improved several biochemical markers, including serum alkaline phosphatase (ALP), serum bone-specific ALP (BALP), urinary deoxypyridinoline (DPD), and urinary cross-linked N-telopeptide of type 1 collagen (NTX). These markers began to decrease within about 2?weeks after the initiation of treatment in most patients, and the response persisted for up to 40?weeks after the cessation of treatment. Risedronate reduced pain by week 24 in most patients. According to quantitative bone scintigraphy, the lesion with the highest radioisotope (RI) uptake showe...
Abstract Introduction: Transduodenal ampullectomy (TDA) can be performed for benign and premalignant tumors of the ampulla of Vater (AOV) as an alternative to pancreaticoduodenectomy. However, the laparoscopic approach has rarely been attempted. In this report 2 cases of benign ampullary tumor that were treated by totally laparoscopic TDA. Patients and Methods: Case 1 was of a 75-year-old female who was admitted with left knee pain and underwent arthroscopic debridement. On postoperative day 6, she showed elevated levels of alkaline phosphatase, aspirate aminotransferase, alanine transaminase, and gamma-glutamyl transpeptidase, without any other laboratory test abnormality. She had no complaint of abdominal pain, and physical examinations were unremarkable. Computed tomography (CT), magnet...
The language used by chronic benign painpatients to characterize their pain complaint was analyzed to determine the best predictor of psychiatric disturbance. Using the 78 adjectives provided by the McGill Pain Questionnaire, the number of affective descriptors used was the best predictor of psychiatric disturbance. Addition of sensory descriptors either to augment the total number of descriptors used (magnitude) or as a pattern of sensory greater than affective or sensory less than affective failed to increase predictive strength. PMID:6877847
BackgroundPatients’ general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain...Full Text Available
This article reports on an exploratory study of hospice social workers’ assessment and collaborative practices related to pain management; especially caregiver concerns about patient...Full Text Available
The development of central neuropathic pain varies among patients with spinal cord injury (SCI). The factors contributing to the development and perpetuation of segmental pain (at-level allodynia)...Full Text Available
The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational,...Full Text Available
The frozen shoulder is a common cause of shoulder pain and disability. Most patients slowly improve over 12 to 24 months. Some have prolonged loss of movement, pain, and associated disability. Treatments...Full Text Available
Patients with adhesive capsulitis were clinically evaluated to establish whether pain elicited by pressure on the coracoid area may be considered a pathognomonic sign of this condition. The study group...Full Text Available
ObjectivePersons with chronic or recurrent pain frequently visit the emergency department (ED), yet little research examines this experience. We conducted this national survey to...Full Text Available
"Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this c...
In the last 40 years, significant advances have been made in the understanding of the neurophysiologic processes involved in the experience of trauma and pain. This knowledge, together with the rapid growth and understanding in the behavioral health sciences, has expanded to include a much better appreciation of how these fields are converging and contribute to a process called neuroplasticity. These basic mechanisms common to all patients have important implications for clinical outcome and for improving clinical practice. This article is written for clinicians who manage patients with sacroiliac joint dysfunction, a specific type of nonspecific low back pain.
This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by /sup 99m/Tc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative /sup 99m/Tc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier ...
Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring...Full Text Available
A large proportion of patients may develop chronic pain following cancer treatments such as surgery, radiotherapy, or chemotherapy. These patients can experience significant levels of physical and psychological morbidity. Our aim was to investigate a cognitive-behavioral pain management program (PMP) for cancer patients with chronic treatment-related pain. Thirteen patients (1 man, 12 women; mean age 52 yrs) completed the study, 9 of whom had a history of breast cancer and had received extensive medical treatment, including surgery. A combination of physical and psychological techniques were adapted from previous work in chronic benign pain and implemented by two therapists. Interventions included education, relaxation, exercise training, and goal setting. A variety of outcomes were examined to assess general fitness, ...
Two cases of tetracycline ulcers of the oesophagus are reported and compared with thirteen other cases from the literature. In most cases, the patients had taken their capsules with little or no fluid just before going to bed. Some hours later they developed retrosternal pain that was intensified by swallowing. Endoscopy showed sharply demarcated greyish-white areas of mucosal damage which represented layers of stratified squamous cells, separated by oedema, and a dense neutrophilic infiltration of the lamina propria and the muscularis mucosa. Roentgenology was unsuitable to detect the lesions. They healed without complications within one to six weeks. Prolonged retention of the capsules in the oesophagus is thought to cause the mucosal damage. Patients on oral tetracycline or doxycycline treatment should therefore be instructed to take their capsules with a meal or with copious water and not just ...
Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the ...
Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the ...
In 15 patients (16 hip joints) we found the clinical and radiological signs of BMOS. On T1-weighted MRI images areas of low signal intensity could be observed in the head, neck and the intertrochanteric region of the femur in various extensions. These areas showed a significant increase in signal intensity on the T2-weighted images. Because pain was resistant to conservative therapy all these patients were treated by core decompression of the femoral head in a prospective study. Bone cores were evaluated histologically using undecalcified sections and quantitative microradiography. The existence of intramedullary oedema in exactly the regions exhibiting the MRI pattern of bone marrow oedema was verified histologically; however, bone and marrow changes similar to those of early avascular necrosis (AVN) were also visible. (orig.)
Abstract Residual limb pain (RLP) and phantom limb pain (PLP) can be debilitating and can prevent functional gains following amputation. High correlations have been reported between RLP and the stump neuromas following amputation. Many treatment methods including physical therapy, medications, and interventions, have been used with limited success. Pulsed radiofrequency ablation (PRFA) has shown promise in treating neuropathic pain because of the inhibition of evoked synaptic activity. We present 4 amputees who were treated with PRFA after failing conservative management for their RLP and PLP. All 4 patients underwent PRFA and demonstrated at least 80% relief of RLP for over 6 months. One patient reported a complete resolution of phantom sensation while another patient had significantly de...
Chronic benign pain is commonly associated with chronic fatigue and depression. Depression and chronic fatigue syndrome are also associated with each other and often include pain. Psychologic factors are prominent in these conditions, and they may share neurobiologic factors as well. Management requires separately addressing each component of patients' distress and usually includes physical rehabilitation, education, administration of nonhabituating medications and often counseling. Depression may be a favorable prognostic sign, as it suggests a treatable condition and provides incentive for recovery. PMID:1876618
BackgroundGeneralized anxiety disorder (GAD) is the most frequent anxiety disorder in primary care patients. It is known that painful physical symptoms (PPS) are associated with...Full Text Available
Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular...Full Text Available
Morphine sulfate (MS Contin), a proven analgesic in the treatment of cancer pain and chronic benign pain, seems to be a good analgesic for the treatment of burn pain. MS Contin is morphine sulfate incorporated in a wax cellulose matrix delivery system. This wax cellulose delivery system gives MS Contin its duration of action. Ten patients were enrolled in an open-labeled, nonrandomized study. The study was designed to examine the analgesic efficacy of MS Contin in the burn population. Each patient remained in the study for 6 days. The efficacy of the analgesic regimen was subjectively measured by the visual pain scale. The MS Contin group was retrospectively compared with a group of patients who were given continuous intravenous infusions of morphine. The two groups were matched according to age, burn size, surgical procedures, and hospital ...
The authors assess the role of Computed Topography in the diagnosis and management of multiple myeloma (MM) and investigate if Computed Tomography findings can influence the clinical approach, prognosis and treatment. 273 multiple myeloma patients submitted to Computed Tomography June 1994, to December, 1996. The patients were 143 men and 130 women (mean age: 65 years): 143 were stage I, 38 stage II and 92 stage III according to Durie and Salomon's clinical classification. All patients were submitted to blood tests, spinal radiography and Computed Tomography, the latter with serial 5-mm scans on several vertebral bodies. Computed Tomography despicted vertebral arch and process involvement in 3 cases with the vertebral pedicle sign. Moreover, Computed Tomography proved superior to radiography in showing the spread of myelomatous masses into the soft tissues in a case with solitary permeative lesion in ...
The objective was to characterize imaging findings of benign notochordal cell tumors (BNCTs). Clinical and imaging data for 9 benign notochordal cell tumors in 7 patients were reviewed retrospectively. Conventional radiographs (n = 9), bone scintigrams (n = 2), computed tomographic images (n = 7), and magnetic resonance images (n = 8) were reviewed. Eight of the 9 lesions were stained with hematoxylin-eosin and microscopically examined. There were 3 male and 4 female patients with an age range of 22 to 55 years (average age, 44 years). Two patients had two lesions at different sites. The lesions involved the cervical spine in 4 patients, the lumbar spine in 2, the sacrum in 2, and the coccyx in 1. The most common symptom was mild pain. The lesions of 2 patients were found incidentally during imaging studies for unrelated conditions. Five ...
Back pain from osteoporosis is commonly related to compression fractures. The patient with vertebral compression fractures additionally suffers from an ongoing risk of recurrent fractures and postural abnormalities that can result in impaired respiratory function, leading to increased risk of morbidity. Weakened back muscles, especially the back extensor group, are felt to contribute significantly to this risk. The combination of pharmacologic and nonpharmacologic interventions, through physical activity, exercise, and modalities, are potential interventions that could be used to help reduce the pain of osteoporotic compression fractures as well as potentially reducing recurrent fracture rates.
Knee osteoarthritis (OA) is a common degenerative joint disorder and a major cause of pain and disability. The hypothesis tested in this study was that the passion fruit peel extract (PFP), a flavonoid-rich dietary supplement, would reduce symptoms due to knee OA. Thirty-three OA patients were enrolled in a randomized, double-blind, placebo-controlled trial with parallel-group design. Patients received either placebo or PFP pills (150 mg, daily) in a double-blinded fashion for 2 months. The OA clinical symptoms were evaluated monthly with Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. In the PFP group, there was a significant improvement in total WOMAC score and WOMAC subscale score of physical function after 30 days and pain after 60 days. At 60 days, reductions o...
Objectives Vietnamese patients? views on healthcare are changing as surgical interventions become more commonplace, but their views on perioperative care have remained largely unstudied during this period of rapid change. This study assesses Vietnamese patients? impression of anesthesia safety and postoperative pain in relation to clinical outcomes with the aim of improving patient-centered perioperative care. Methods The study cohort consisted of 180 hospitalized patients who were followed for 24?h following abdominal surgery. The assessments of these patients on the use of anesthesia and postoperative pain were measured by means of a 5-point Likert scale survey. Perioperative events were recorded on standardized forms by medical staff. The relationship between relevant factors affecting ...
A new method of administration of an opioid was recently registered: fentanyl transdermal (brand name: Durogesic), intended particularly for the indication range 'pain in cancer'. Fentanyl is lipid-soluble so that deposition in the skin takes place and the biological half-life is approximately 20 hours after removal of the plaster. It is safe to start on a basis of an equianalgesic conversion of 100:1 in relation to oral morphine, although this may entail some risk of fentanyl under dosage. The dose adjustment time is 12-24 hours before a constant fentanyl level is reached; therefore, after attaching the first sticking plaster, the original morphine dose should be continued for another 12 hours. In addition, the patient may, if necessary, be given supplementary morphine preferably as a short-acting drug. There seems to be no clear indication for transdermal fentanyl either in neuropathic pain or in chronic benign ...
Postamputation pain (PAP) affects over 60% of major limb amputees. One of the main challenges in treating PAP is the difficulty involved in identifying pain mechanism(s), which pertains to both residual limb pain (RLP) and phantom limb pain (PLP). In this study, sympathetic blocks were performed on 17 major limb amputees refractory to treatment, including 2 placebo-controlled blocks done for bilateral amputations. One hour postinjection, mean RLP scores at rest declined from 5.2 (SD 2.8) to 2.8 (SD 2.6) (P = .0002), and PLP decreased from 5.3 (SD 3.1) to 2.3 (SD 2.1) (P = .0009). By 1 week, mean pain scores for RLP and PLP were 4.3 (SD 2.9) and 4.2 (SD 3.0), respectively. Overall, 8 of 16 (50%) patients experienced ?50% reduction in RLP 1-hour postinjection, with the beneficial effects ...
Ewing's sarcoma classically presents as a hot spot on bone scan as a result of increased vascularity of the tumor and new bone formation. Purpose We report and analyze an uncommon pattern of a 'cold' lesion in Ewing's sarcoma on bone scan and its pathophysiologic significance. Case report A 15-year-old boy complaining of thigh pain. CT scan evoked Ewing's sarcoma or osteitis. MRI evoked chronic osteitis. Scintigraphy showed a fairly intense and heterogeneous uptake on the femoral lesion and no abnormal uptake elsewhere. Biopsy showed none pathologic pattern. Three months later, a second biopsy concluded to Ewing's sarcoma. Bone scan showed a larger lesion with peripheral intense uptake centered by enlarged 'cold' area in the left femoral diaphysis and no evident bone metastasis. The patient underwent chemotherapy and surgery. Three months later, bone scan showed ...
Frozen shoulder (adhesive capsulitis) is a common, painful and disabling condition which is typically slow to resolve. Patients with this condition will be seen in every musculoskeletal practitioner’s...Full Text Available
We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts...Full Text Available
Pericardial fat necrosis is an infrequent cause of acute chest pain and this can mimic acute myocardial infarction and acute pericarditis. We describe here a patient with the magnetic resonance imaging...Full Text Available
BackgroundWe have recently reported successful treatment of patients with chronic pain syndromes using human pooled intravenous immunoglobulin (IVIG) in a prospective, open-label...Full Text Available
The indications, contra-indications and technique of caudal epidural injections in the treatment of low back pain and sciatica are described. Of 201 patients treated by epidural injection, about 56%...Full Text Available
Background & objectives:Acanthamoeba keratitis (AK) is a painful and vision-threatening ocular infection. The differentiation of Acanthamoeba...Full Text Available
Seventy seven patients with soft tissue shoulder lesions including adhesive capsulitis and disorders of the rotator cuff and acromioclavicular joint were admitted to a trial comparing two different...Full Text Available
Purpose. To evaluate injection-associated pain, safety, and efficacy with the isotonic contrast medium iodixanol (Visipaque 270 mg I/ml) compared with iopromide (Ultravist 300 mg I/ml) in femoral arteriography. Methods. A multicenter, double-blind, randomized, parallel-group clinical investigation was carried out in 54 hospitals in Europe. Of the patients evaluated, 1225 received iodixanol and 1227 iopromide in conventional and/or digital subtraction angiography. Results. The iodixanol group reported statistically significantly less injection-associated pain (0.9%) than the iopromide group (9.5%) (p<0.001). Further, 4.1% in the iodixanol group experienced pain and/or severe heat sensation vs 19.8% in the iopromide group (p<0.001). In the iodixanol group, 1.8% of the patients experienced contrast-related adverse events vs 2.4% in the iopromide group (p=NS). Overall diagnostic ...
The purpose of this study was to evaluate the safety and efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) in patients with intrahepatic cholangiocarcinoma (ICCA) in a small, nonrandomized series. From February 2004 to July 2008, six patients (four men and two women; mean age 69.8 years [range 48 to 83]) with ICCA underwent percutaneous US-guided RFA. Preintervetional transarterial embolization was performed in two cases to decrease heat dispersion during RFA in order to increase the area of ablation. The efficacy of RFA was evaluated using contrast-enhanced dynamic computed tomography (CT) 1 month after treatment and then every 3 months thereafter. Nine RFA sessions were performed for six solid hepatic tumors in six patients. The duration of follow-up ranged from 13 to 21 months (mean 17.5). Posttreatment CT showed total necrosis in four of six tumors after one or two RFA ...
The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed. A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed. The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-#alpha# antagonists. Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-#alpha# antagonists is based on clinical and laboratory ...
We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine?+?0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two ...
The interscalenic block technique is widely used for ambulatory shoulder surgery despite a substantial number of failures and adverse effects. We prospectively evaluated satisfaction in 40 consecutive patients who underwent open Bankart repair under a single general anesthesic performed in an ambulatory care unit. The mean age of the patients was 23 years. There were 29 men and 11 women. Patients were evaluated postoperatively with a visual analog scale of pain (in the recovery room, at the time of discharge, and the day after and 1 week after surgery) via a home assessment questionnaire that included the following: effectiveness of oral pain medication, ability to perform activities of daily life, and overall satisfaction. One patient failed to be discharged because of a feeling of faintn...
Studies of the effectiveness of operant, relaxation, cognitive, and multimodal behavioural approaches to the treatment of chronic benign pain other than headache were evaluated. In general, the quality of the studies was poor, and most investigations lacked appropriate and adequate control conditions, outcome measures, and/or follow-ups. While outcome reports for all four behavioural treatments have been mainly positive, few data were found which conclusively demonstrate that any of the approaches are effective or that they are the treatment of choice. The data do, however, imply that behavioural approaches may help patients lead more normal and productive lives. Specifically, the literature suggests that: (1) the operant method leads to increased activity levels and decreased pain and drug intake, (2) the relaxation approach results in decreased EMG levels and some pain reductions, (3) the cognitive ...
Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation ...
Snapping or grating scapula is a condition of the shoulder girdle in which the patient complains of pain and an audible snapping sound which may be associated with pain. We evaluated the diagnostic value of the computed tomography (CT) scans using the clinical diagnosis of a grating scapula as the gold standard. This retrospective study reports the sensitivity, specificity, likelihood ratio and receiver operator characteristic curve for the CT scans and the k value as a measure of the interobserver agreement. None of the parameters validated the examination. We therefore concluded that CT scans are inappropriate for differentiation between a grating scapula and a normally functioning shoulder except in cases where bony abnormalities are present. (orig.)
Lumbar epidural anesthesia is useful in a variety of chronic benign pain syndromes, including lumbar radiculopathy, low back pain syndrome, spinal stenosis, and vertebral compression fractures. Given the increased number of epidural nerve blocks being performed, some have reported unexplained complications of a transient or permanent nature and with varying degrees of severity. However, no case has been reported of a broken epidural needle tip retained in the lumbar facet joint area. This represents the first reported case presentation of foraminal stenosis developing in a patient after a retained epidural needle tip. PMID:21286465
Background: Ecchymosis, oedema, haematoma and pain after SMAS-based facelift surgery are all the direct result of the physical trauma of surgery and subsequent inflammatory response. Hilotherapy is a novel form of cryotherapy that purports to minimise these events through single-use face masks circulating cooled, sterile water. This study was performed to assess the validity of Hilotherapy in this population of patients. Methods: Over 14 weeks fifty consecutive patients were randomised to post-operative facial cooling with Hilotherapy or management with standard dressings alone, while fifteen subsequent, consecutive patients were randomised to cooling of one side of the face but not the other. Assessment of ecchymosis, oedema, haematoma and pain was performed independently by clinical staf...
The solid-pseudopapillary tumor (SPT) of the pancreas is a rare type of exocrine pancreatic neoplasm. SPT predominantly affects young women and female children, and is usually discovered incidentally. This tumor is generally benign with a low incidence of malignancy. A 13-year-old girl was admitted to the hospital with a few weeks' history of mild abdominal pain and jaundice. On physical examination, there was no palpable mass. The laboratory tests showed increased SR, CRP, high bilirubin, amylase and lipase serum levels. Ultrasound imaging revealed a solid lesion in the region of the pancreatic head. On MRI, precise tumor localization in the head of the pancreas with pancreatic duct dilatation and compression of the common bile duct were visualized. Pancreaticoduodenectomy and cholecystectomy was performed with good clinical outcome. Microscopic and immunohistochemical studies indicated that tumor cells were typical of SPT without any signs of ...
Adenosine triphosphate (ATP) is an alternative to dipyridamole or adenosine in thallium-201 myocardial scintigraphy. However, the optimal dose of ATP has not been determined. A Doppler guide wire study showed the coronary flow velocity at a dose of 0.15 mg/kg of ATP was equal or higher than that at 0.14 mg/kg of adenosine or 0.56 mg/kg of dipyridamole. ATP was given intravenously to 67 patients with coronary artery disease at 0.15 mg/kg/min for 6 min. Thallium-201 was injected at 3 min, followed by immediate and delayed (3 hrs) tomographic imaging. There was no serious side effect during examination, although chest pain (26%), dyspnea (17%), and flushing (33%) were common. The sensitivity and specificity to detect coronary artery disease were 98 and 100%, respectively. The sensitivity to detect left anterior descending artery, left circumflex artery, and right coronary artery lesions was 94, 59 and 77%, respectively. ATP ...
Visceral hypersensitivity is currently considered a key pathophysiological mechanism involved in pain perception in large subgroups of patients with functional gastrointestinal disorders, including irritable bowel syndrome (IBS). In IBS, visceral hypersensitivity has been described in 20%?90% of patients. The contribution of the central nervous system and psychological factors to visceral hypersensitivity in patients with IBS may be significant, although still debated. Peripheral factors have gained increasing attention following the recognition that infectious enteritis may trigger the development of persistent IBS symptoms, and the identification of mucosal immune, neural, endocrine, microbiological, and intestinal permeability abnormalities. Growing evidence suggests that these factors ...
Aim: To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. Materials and methods: The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were ...
Abstract Recently, a study of patients with rheumatoid arthritis who developed herpes zoster while taking a tumor necrosis factor (TNF)- inhibitor reported a decreased incidence of postherpetic neuralgia. The objective of this study was to investigate whether patients on TNF- inhibitors who developed herpes zoster have a lower incidence of subsequent development of postherpetic neuralgia. A retrospective review of herpes zoster patients on TNF- inhibitors (infliximab, etanercept, or adalimumab) was conducted in 12 dermatology clinics. Medical records of such patients were reviewed thoroughly to confirm herpes zoster and TNF- inhibitors and any subsequent development of postherpetic neuralgia (pain score -3 out of 10 after 90 days of shingles onset) was noted. A total of 206 cases were revi...
Primary peritoneal malignant mixed mullerian tumors are very rare. We report the case of a patient presenting with pain in the right upper quadrant of the abdomen and in whom the physical examination demonstrated a peritoneal mass. Computed tomography (CT) confirmed the presence of a mass, with invasion of adjacent organs.
Studies on the determinants of pain-related support are needed to enhance couples-based treatments for pain. The purpose of this study was to determine the extent to which pain catastrophizing...Full Text Available
Fifty patients scheduled to undergo IVF received a standard anesthetic of fentanyl and propofol for induction, followed by propofol infusion, with Bispectral index values and modified Ramsey sedation scores recorded at 5-minute intervals for the duration of anesthesia care. Moderate sedation was found only transiently during the first 5-10 minutes of the oocyte retrieval, but thereafter the level of sedation increased, with deep sedation and general anesthesia measured in all patients as determined by both the Bispectral index scores and lack of response to painful stimulation.
Chronic mesenteric arterial ischemia is an uncommon condition associated a high morbidity and mortality. It is most Commonly caused by atherosclerotic occlusive disease. Patients may suffer epigastric or periumbilical postprandial pain ten to thirty minutes after eating. A case of chronic mesenteric artery stenosis, the diagnosis was performance with colonoscopy and biopsy. We present a case report of a patient with chronic mesenteric ischemia. Mesenteric arteriography was performed and documented estenosis of the mesenteric superior artery. Then percutaneous arteriography with angioplasty and implant of stent was performed. The patients became completely asymptomatic and normal colon mucous is observed in control colonoscopy. The purpose of this report is to present the case endoscopy, clinic and radiological features and to describe the percutaneous angioplasty and implant of stent. We believe that ...
AbstractBackground Few published data are available on the benefits of aspirin use in patients with unstable angina (UA). Hypothesis Aspirin use carries a mortality benefit in a population-based cohort of patients presenting with UA. Methods All residents of Olmsted County, Minnesota presenting to local emergency departments with acute chest pain from January 1985 through December 1992 having symptoms consistent with UA were identified through medical records. A total of 1628 patients were identified with UA and were stratified by aspirin use in-hospital and at discharge. Cardiovascular mortality and nonfatal myocardial infarction and stroke were assessed over a median of 7.5 years follow-up and all-cause mortality data over a median of 16.7 years. The mean age of patients with UA was 65 y...
Of 1850 patients with cholelithiasis diagnosed in the past 17 years, 1116 female and 734 male, 598 patients (32.3%) presented with one or more of three major symptoms, i.e., abdominal pain, fever and jaundice, whereas the remainder (67.7%) had none of these symptoms. The proportion of the asymptomatic patients was similar in all age groups, being around 70%. Only 20 per cent of 680 asymptomatic patients, followed for 10 to 17 years (median 13.3 years), developed biliary symptoms. Older patients over 70 years of age had a higher rate of change to the symptomatic group, as compared with younger patients under 70, 29.5% vs. 19.3%, respectively. During this period, carcinoma of the gallbladder developed in one of the asymptomatic patients (0.1%). Oral dissolution therapy was successful in only 4.2 per cent of attempted cases ...
IntroductionShoulder pain covers a wide range of problems and affects up to 20% of the population. It is not a specific diagnosis. Shoulder pain can be caused by problems with the...Full Text Available
BACKGROUND:In adults, it is well known that high levels of pain catastrophizing are related to increased pain and disability as well as to heightened anxiety and depression. However,...Full Text Available
BACKGROUND:Despite increasing attention to the epidemiology of pain, relatively little is known about the association between pain and health in children. In particular, no studies...Full Text Available
Stabbing paroxysmal pain due to neurological disease can often be controlled by anticonvulsants, whereas steady burning pain is often responsive to tricyclic antidepressants, and to neuroleptics. Overuse...Full Text Available
BackgroundAdequate pain assessment is critical for evaluating the efficacy of analgesic treatment in clinical practice and during the development of new therapies. Yet the currently...Full Text Available
Summary Background Pemphigus vulgaris and pemphigus foliaceus are rare, potentially life-threatening, autoimmune disorders characterized by antibodies to epidermal adhesion molecules. Clinical characteristics are painful chronic erosions of mucous membranes and of the skin. There are only few published studies on the impact of the disease on the health status (HS) of patients with these conditions. Objectives To assess the impact of disease on the HS of patients with pemphigus. Methods Fifty-eight patients enrolled at the Bullous Skin Diseases Unit of IDI-IRCCS in the period January-June 2006 were assessed for their HS using the Medical Outcomes Study 36-item short form health survey (SF-36) questionnaire and for anxiety and depression using the Institute for Personality and Ability Testin...
There are no specific diagnostic tests or a gold standard method for measuring disease activity and outcome in spondyloarthropathies (SpA). Many different methods have been developed to assess the signs and symptoms in SpA. The aim of this study was to evaluate the value of scintigraphy, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankilosing Spondylitis Disease Activity Index (BASDAI) in the evaluation of disease activity in early axial SpA diagnosed with magnetic resonance imaging (MRI). Thirty early MRI-positive axial SpA patients (23 males, 7 females) with a median age of 35 (18?55) years and a median duration of inflammatory low back pain of 24 (8?60) months were included in the study. In the patients with sacroiliitis, the sensitivity, specificity, and pos...
Computerized tomography-guided neurolytic splanchnic nerve block is a technique for relieving abdominal cancer pain; the goal is the alcoholic neurolytic interruption of the sensitive structures in retroperitoneal space. Computerized tomography yields accurate anatomical detailing and the course for needle placement and alcohol spread. January, 1993, to July, 1996, twenty-one bilateral splanchnic nerve blocks were performed through the posterior access. Forty-eight hours after alcoholism. 14 patients (66%) had complete pain regression; 52% of the patients needed no analgesics for 6 to 54 days and only 9 patients (42%) needed another low opioid therapy. Complications included hypotension and diarrhea in all cases. One had a cardiac arrest and diet 8 days after the procedure. There were no other complications. The whole procedure usually lasted 60 min (range: 45 to 90 min). Splanchnic ...
Forty cases of Ewing's sarcoma of various sites had attended the Department of Radiotherapy at the Wanless Hospital and the Miraj Medical Centre, attached to the Government Medical College, Miraj, Maharashtra, from January, 1970 through December, 1979. There were 28 male patients and 12 female patients in the series with a male to female ratio of 2.3:1. The youngest patient in the series was a female of 6 years of age with the tumour in the scapula and the oldest patient was a 32-year-old male with a lesion in the metacarpal bone. Sixty per cent of the cases were seen in the second decade. The average age of the patients was 13.5 years. The bones of the lower extremities were most commonly involved with the highest number (35 per cent) of the cases occurring in the femur. Involvement of the bones of the right side of the body was almost equal to that of the left side. Swelling over ...
Little is known about how sociodemographic factors relate to children’s chronic pain. This paper describes the pain, health, and sociodemographic characteristics of a cohort of children...Full Text Available
Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study...Full Text Available
Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronic pain related to advanced medical...Full Text Available
The aim of the study was to determine whether children with chronic benign pain are in contact with their general practitioner (GP) more frequently than those without chronic benign pain. A random sample...Full Text Available
The clinical results of electron beam therapy using intraoral cone in 8 cases of primary and recurrence carcinoma of tongue (T1 and smaller T2) were reported. The primary and recurrence cases were 5 and 3, respectively. In the 5 cases, a total dose of 10-30 Gy external radiation therapy were combined prior to electron beam therapy. The total dose of electron beam therapy varied from 40 to 60 Gy. In all cases, tumor showed good response and disappeared clinically. Radiation stomatitis, pain of the tongue with masticatory disturbance due to tenderness were complicated in all cases. These complications gradually disappeared 2 to 6 months after treatment. However, loss of body weight and bone exposure were not recognized in any case. Intraoral-cone electron beam therapy is thought to be available and has less complications comparing interstitial irradiation therapy from the review of literature. Within 6 months after radiation, submandibular ...
We encountered a case of Ewing's sarcoma. The patient was a 19 year-old girl, who visited a local physician because of pain in the left scapular region, and was referred to us. Roentgenograms of her left scapula revealed an irregular moth-eaten shadow which was suspected to be a malignant bone tumor. The histological diagnosis of Ewing's sarcoma was comfirmed by needle biopsy. The initial stage of treatment consisted of radiation therapy (6000 rads) and chemotherapy (VAC and ADR). At the end of the initial stage, the symptoms were improved, the size of the local lesion was reduced on the roentgenogram and there was no evidence of distant metastases. (author).
Ewing's sarcoma is the most common malignant bone tumour occurring in children and adolescents and exists in two different clinico pathological entities: osseous Ewing's sarcoma (OES) and extraosseous Ewing's sarcoma (EES). Five cases of primary epidural EES are described, which presented with non-specific symptoms leading to a long diagnostic delay. The median age at diagnosis was 22 years (range 13-36 years). The median diagnostic delay was 3 months. All patients had one or more neurological deficits. All underwent surgical exploration with a laminectomy and partial resection followed by adjuvant radiotherapy to a dose of 46-50 Gy and chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) alternating with ICE (ifosphamide, cisplatin and etoposide) for at least six cycles. The mean follow-up period is 21.2 months (range 11-32 months). Four of the five patients achieved a complete remission and are disease free at the time of ...
Percutaneous coronary revascularisation [PCR] improves angina and health related quality of life [HRQOL] compared to standard medical therapy. It is unknown whether PCR has the same benefits for patients with a history of CABG. Over a period of 5?years, we assessed HRQOL of patients undergoing PCR using Part 1 of the Nottingham Health Profile [NHP] at baseline 3, 12 and 24?months. We compared HRQOL after PCR in 255 patients with CABG to 2680 without. There were more males [81.1% v 69.6% p?=?0.002] and older patients [mean age 60.1?years v. 58.0 p?=?0.03] in CABG group. Perceived HRQOL improved at 24?months for pain, energy and emotional reaction but the improvement was less in the CABG group. However, mean NHP scores at 24?months for those with CABG had returned to baseline levels for slee...
Purpose. To examine the impact of residual limb osteomyelitis (RLO) on the rehabilitation of lower limb amputees. Method. Retrospective review of the casenotes of patients with RLO. Information sought included details of amputation, clinical features of investigations for and management of RLO and its effect on rehabilitation. Results. There were seven transfemoral and three transtibial amputees. Indications for amputation were vascular disease in nine cases, trauma in one. In each case, delayed wound healing or residual limb pain prompted radiological, hematological and microbiological investigations. Average time between amputation and diagnosis was 187 days. One patient died before treatment commenced. Two transtibial amputees were treated with intravenous antibiotics while rehabilitati...
Abstract Introduction.- Sling erosion/extrusion is a complication after suburethral sling insertion for female stress urinary incontinence that occurs in approximately 6% of patients. Symptoms may include vaginal discharge, infections, postcoital bleeding, and alterations of the sexual function. Little is known about the effect of sling erosion on the sexual function of the male partner. Aim.- The aim of this study was to determine male sexual function in partners of women who had undergone sling insertion for stress urinary incontinence and who developed sling erosion postoperatively. Main Outcome Measures.- Main outcome measures were the Brief Male Sexual Function Inventory (BMSFI) and visual analog scale (VAS) scores. Methods.- Male partners of patients who presented with sling erosion ...
A rare case of primary splenic cyst is shown in a young woman who had a left subcostal abdominal pain. Abdominal echography and CT scan revealed a cyst of the anterior aspect of the spleen. A sorologic test for hidatic disease was negative. On the basis of a presumed diagnostic of nonparasitic cyst, the patient was referred to a laparoscopic decapsulation with excision of the cysts wall not covered by splenic tissue. The patient was discharged 24 hours later. Histological report revealed epidermoid cyst. The laparoscopic approach has being recently considered an effective and less invasive alternative in the treatment of splenic diseases. We demonstrated that it should be considered for the treatment of splenic cysts present in a superficial location, with the advantage of organ preservation. (author)
The objective of this study was to examine the effect of a nonsteroidal anti-inflammatory drug (NSAID) plaster for knee osteoarthritis among Japanese patients. An open-labeled, randomized, controlled, multiclinic trial was performed involving outpatient clinic groups. Two comparative groups?plaster NSAIDs and oral NSAIDs?were randomly allocated. The drugs used were limited to the current top three in both groups in Japan. Treatments were assessed after four?weeks and compared with the baseline scores. Outcomes were evaluated by two psychometric measures: Japanese knee osteoarthritis measure, and pain with the visual analogue scale. The total number of patients included in the final evaluation was 165 (87 for the plaster group and 78 for the oral group). Between these two groups there were ...
A 60-year-old male was bitten by a venomous snake (Vipera ammodytes) and gradually developed signs of an allergic reaction including generalized itching, generalized rash, and chest discomfort. This was followed by severe retrosternal pain with electrocardiographic evidence of an inferior myocardial ischemia progressing to acute myocardial infarction. Cardiac enzymes and troponin, serum tryptase, and histamine were elevated. Coronary arteriography showed normal coronary arteries. This is a characteristic type I variant of Kounis syndrome, which is the concurrence of acute coronary syndromes with conditions associated with mast cell activation including allergic or hypersensitivity reactions as well as anaphylactic or anaphylactoid reactions. This is the first report to show that viper bite...
The purpose of this study was to evaluate the safety and efficacy of TACE with microspheres preloaded with doxorubicin in unresectable intrahepatic cholangiocarcinoma (UCH). Twenty patients with UCH were observed; 9 refused, preferring other palliative care or chemotherapy, and 11 agreed to be treated with one or more cycles of DC beads loaded with doxorubicin (100-150 mg) in a TACE procedure between February 2006 and September 2007. A total of 29 individual TACE procedures were performed. Follow-up imaging was performed on all patients before, immediately after, and 4 weeks after each TACE procedure to evaluate the response and need for further treatment. Each patient received i.v hydration, antibiotics, and medications against nausea and pain before TACE. Survival rate was calculated using Kaplan-Meier survival curve. A response rate of 100% followed RECIST criteria was observed. Eight of eleven ...
The synovial and bone uptake of tracer in the knees of patients with rheumatoid arthritis (RA) was quantified using {sup 99}Tc{sup m}-hexamethyl propylene amine oxime-labelled leucocytes and {sup 99}Tc{sup m}-methylene diphosphonate (MDP), respectively. Significant neutrophil migration and MDP uptake occurred in the knees of patients with RA irrespective of the disease duration. In all but one patient neutrophil migration was reduced after intra-articular steroid injection. The change in MDP uptake after steroid injection was variable. There was a significant correlation between the percentage reduction in neutrophil migration and pain score, while the latter correlated poorly with the change in MDP uptake. The quantification of the neutrophil component of the inflammatory process is a sensitive index for monitoring RA activity and response to pharmacological interventions, while quantitative bone ...
The synovial and bone uptake of tracer in the knees of patients with rheumatoid arthritis (RA) was quantified using "9"9Tc"m-hexamethyl propylene amine oxime-labelled leucocytes and "9"9Tc"m-methylene diphosphonate (MDP), respectively. Significant neutrophil migration and MDP uptake occurred in the knees of patients with RA irrespective of the disease duration. In all but one patient neutrophil migration was reduced after intra-articular steroid injection. The change in MDP uptake after steroid injection was variable. There was a significant correlation between the percentage reduction in neutrophil migration and pain score, while the latter correlated poorly with the change in MDP uptake. The quantification of the neutrophil component of the inflammatory process is a sensitive index for monitoring RA activity and response to pharmacological interventions, while quantitative bone scintigraphy should not ...
Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was ...
Intraspinal synovial cysts were diagnosed in six patients during a 5-year period and retrospectively studied. Plain films of the lumbar spine showed degenerative changes in all patients. Lumbar myelography showed a posterior and lateral defect caused by extradural compression. Using CT without contrast enhancement established the diagnosis in five of the six patients. In four cases MRI was performed, three before and after injection of gadolinium diethyline-triamine penta-acetic acid (Gd-DTPA). Including the patient with a false-negative CT, MRI was positive in all patients. (orig.)
Thirty-seven patients with histologic proof of cholangiocarcinoma at the confluence were examined by computed tomography (CT) to determine whether this examination is of value in the assessment of these patients for surgery and whether there are any features specific to this type of tumor. Thirty-two patientsshowed intrahepatic duct dilatation; six of these showed dilatation of ducts in one lobe only. Eighteen patients had intrahepatic low-attenuation areas, while eight had a mass lesion in the porta hepatis. The results of this study show that CT provides useful anatomic information preoperatively but that the appearances are nonspecific. Lobar atrophy is highly suggestive of hilar cholangiocarcinoma, either of long-standing or with unilateral portal venous involvement.
The evaluate the signs of aortic intramural hematoma with helical CT and the diagnostic role of this technique in patients with this condition. It was reviewed the CT findings of 396 patients submitted to emergency examinations for suspected aortic dissection from 1995 to 1999. Only 18 patients (6 women and 12 men) had CT signs of aortic intramural hematoma. Helical CT studies were carried out with the following parameters: slice thickness 10 mm, reconstruction index 10, feed 1.5 mm, conventional algorithm with minimum values of 130 kV and 125mA. All patients were examined with dynamic contrast-enhanced CT, before and after a power injection of 130 mL ionic contrast material. It was studied: hematoma localization and longitudinal extension; thickness and density of aortic wall; presence and location of intimal calcifications; integrity of intimal wall; hemo mediastinum and/or hemo thorax. Aortic wall ...
All patients with von Willebrand?s disease (vWD) who showed an arterial or venous thrombosis and were reported in the literature have been evaluated. 11 patients had arterial thrombosis while 19 had venous thrombosis for a total of 30 cases. 9 out the 11 cases with arterial thrombosis had myocardial infarction. Two had cerebral thrombosis. Associated risk factors for arterial thrombosis were available only for three patients who showed, respectively, smoking and dyslipidemia (2 cases) and smoking and intravenous desmopressin infusion (1 case). The majority of patients with venous thrombosis showed DVT with or without PE. Four patients presented with apparently isolated PE. In two instances thrombosis occurred in unusual sites (central retinal vein and portal vein, respectively). Several as...
The University of North Carolina Comprehensive Pain Center, which has been in existence since 1972, is a pain evaluation, treatment and research program based upon individual diagnosis, comprehensive...Full Text Available
Pain caused by chronic pancreatitis is medically intractable and resistant to conventional interventional or surgical treatment. We report a case of spinal cord stimulation (SCS) for intractable pain...Full Text Available
Sex differences in pain are frequently reported in the literature. However, less is known about possible sex differences in the experience of pain secondary to a disability. The current study...Full Text Available
In all mammals, tissue inflammation leads to pain and behavioral sensitization to thermal and mechanical stimuli called hyperalgesia. We studied pain mechanisms in the African naked mole-rat, an unusual...Full Text Available
BACKGROUND:Canadian chronic pain prevalence estimates range from 11% to 66%, are affected by sampling and measurement bias, and largely represent urban settings.OBJECTIVES:To...Full Text Available
Chronic neurogenous pain is often an extremely difficult condition to manage. In the orofacial region, trauma from injury or dental procedures may lead to the development of severe neuralgic pains and...Full Text Available
BACKGROUND:Reports indicate that characteristics of older adults with chronic pain may be different than those of younger persons.OBJECTIVE:To study...Full Text Available
ObjectiveTo examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period...Full Text Available
Idiopathic or functional abdominal pain (FAP) is common in school-age children and typically reflects a functional gastrointestinal disorder (FGID). FGIDs in adults have been distinguished by...Full Text Available
ObjectiveThe purpose of this study is to identify the factors affecting the failure of trials (<50% pain reduction in pain for trial period) to improve success rate of spinal...Full Text Available
The present case report documents the hitherto unusual application of camouflage orthodontics in one of our patients. Our female patient had previously been treated orthodontically alio loco and had also undergone bimaxillary orthognathic surgery. She presented with TMJ complaints, with associated pains. Despite a dental Class I and centrally seated condyles, her discs had prolapsed anteriorly without reduction and she had developed a massive degenerative-inflammatory TMJ disease. Skeletally, she was a Class II case despite previous orthognathic surgery. In addition, there was also an initial suspicion of rheumatic involvement that could not be confirmed. We distalized the entire lower dental arch without bicuspid extraction. Then we advanced the mandible with the Mandibular Anterior Repositioning Appliance (MARA).We discuss exactly how the modified camouflage therapy was structured and how the individual treatment steps ...
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 ...
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 ...
To assess the efficacy and resulting complications of tetracycline sclerotherapy in renal, hepatic, ovarian, and perivesical cysts. We retrospectively reviewed 23 cases of benign cysts (16 renal, 4 hepatic, 2 ovarian, and 1 perivesical) in 22 patients in whom the condition was diagnosed or confirmed by either ultrasound, CT, or cytology, and who underwent percutaneous tetracycline sclerotherapy. Using a 21-gauge Chiba needle, the target cyst was punctured under ultrasound guidance. Prior to the injection of 1500 mg of tetracycline diluted in 5 ml of normal saline, almost all the cystic content was aspirated, and at the end of the procedure the tetracycline was left in the cyst. During a period of between 3 and 22 months, 18 of the 23 cases were followed up. In six of the 18 cases followed up, the cysts either decreased in size by 10%, or collapsed completely. In seven cases a collapse of over 50% was noted, and in the remaining five the cyst recurred. In one of ...
The immune system modulates many key biological processes in humans. However, the exact role of the immune system in particle-associated periprosthetic osteolysis is controversial. Human tissue retrieval studies, in vivo and in vitro experiments suggest that the immune response to polymer particles is non-specific and macrophage-mediated. Lymphocytes may modulate this response. However direct lymphocyte activation by polymer particle-protein complexes seems unlikely. However, metallic byproducts may complex with serum proteins and lead to a Type IV, lymphocyte-mediated immune reaction. In predisposed individuals, this reaction may rarely lead to persistent painful joint effusions, necessitating debridement and excision of the bearing surfaces of the prosthesis. In these patients, retrieved...
Objective To investigate the impact on life quality of women with traumatic and non-traumatic origin fibromyalgia syndrome [FMS]. Method Women affected with FMS were selected and divided into two groups: those with traumatic origin FMS [Group 1] and those with non-traumatic origin FMS [Group 2]. A standard question form was used for the research, as well as the fibromyalgia impact questionnaire [FIQ] for evaluation of life quality. Results Seventy-two patients, 34 for Group 1 and 38 for Group 2 were analyzed. The main triggering symptoms were divorce [23.5 percent of cases] and death in the family [23.5 percent of cases]. In addition to diffuse pain, the main symptoms presented were poor sleep quality, weariness, and paresthesia, with no difference between the groups; migraine had a greate...
Deep brain stimulation (DBS) has been used for relieving chronic pain in patients that have been through other existing options. The septum has been one of the targets for such treatment. The purpose of this study was to determine the inhibitory effect of electrical stimulation in the medial septum diagonal band of broca (MSDB) on neuronal activity in the spinal cord of rats anesthetized with sodium pentobarbital. While unilaterally stimulating the MSDB, wide dynamic range neurons in the lumbar region of the spinal cord were recorded in response to graded mechanical stimulation of the hind paws (brush, pressure, and pinch). Stimulation was at 1, 5, 10, and 20V, at 100Hz, and 0.1ms duration. Significant bilateral reduction was observed in response to pressure (ipsilaterally: 0.90+/-0.05, 0....
Background: Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain. Objective: To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity. Data sources: Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed. Study selection: Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected. Data extraction: Two independent reviewers selected the studies, extracted th...
Computed Tomography (CT) of the spine was performed on 17 patients with myeloma in order to assess the role of the technique in recognizing and evaluating the extent of the lesions. Myelomatous lesions followed two patterns at CT: first of all, multiple focal lesions, whose density is either solid, liquid, or fatty; second, an extensive pattern involving the spongiosa of the vertebra, including the posterior arch. CT detected more lesions than conventional radiology; furthermore, the extent of the lesions was much better demonstrated by CT. CT should thus be performed: a) in case of pain and/or neurological findings in negative radiological examinations; b) to evaluate the extent of myelomatous lesions (mainly in the spine); c) in solitary myeloma CT may be performed on different bone segments with clinical symptomatology but normal X-ray findings.
In recent years, Obesity (defined as Body Mass Index > 30 kg/m2) has increased its prevalence reaching epidemic levels in countries such as The United States where it has became a national health issue. In Colombia the Obesity prevalence is figured around 14%. Treatment options for Obesity include life style modifications, pharmacologist management and surgical approach (Bariatric Surgery). This article describes a patient with previous bariatric surgery, who presents abdominal pain and melena owed to isquemic process of the alimentary limb caused by an internal hernia which is a potentially lethal condition if it is not highly suspected allowing its early diagnosis and treatment
Assessment of the results of laminectomy for lumbar disc lesions is unsatisfactory, but it seems that some degree of recurrent pain is virtually inevitable. The clinical features and incidence of the...Full Text Available
BackgroundLow back pain (LBP) is the most prevalent musculoskeletal condition and one the most common causes of disability in the developed nations. Anecdotally, there is a general...Full Text Available
BackgroundNonsteroidal anti-inflammatory drugs are commonly used to treat postoperative and chronic pain. Animal studies suggest these drugs act in part by blocking...Full Text Available
Interest and research into the mechanisms and treatment of neuropathic pain have increased during recent years, but current treatment is still far from satisfactory (Dworkin...Full Text Available
BackgroundStump and phantom pains are debilitating sequelae of amputations that are often resistant to treatment. The efficacy of pharmacologic therapies, including...Full Text Available
ObjectiveTo describe the prevalence, intensity, and functional impact of the following types of pain associated with upper-limb loss: phantom limb, residual limb,...Full Text Available
Background:Increasing evidence shows the importance of young age, estrogen receptor (ER), progesterone receptor (PR) status, and HER-2 expression in patients with breast cancers.Patients...Full Text Available
Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare entity, sometimes referred to as Herlyn-Werner-Wunderlich syndrome (HWW). It usually presents after menarche with progressive pelvic pain, sometimes with regular menses, and a palpable mass due to hemihaematocolpos. The diagnosis is generally made only if the suspicion of this genitourinary syndrome is raised. To highlight the imaging diagnostic clues in this rare condition. We report on 11 adolescents with this condition. Sonography mostly allowed the correct diagnosis by showing uterovaginal duplication, haematocolpos or haematometrocolpos, and the absence of the ipsilateral kidney. MRI provided more detailed information regarding uterine morphology, the continuity with each vaginal channel (obstructed and nonobstructed), and the bloody nature of the contents. Early and accurate diagnosis of this syndrome is important so that adequate and prompt surgical ...
The aim of the study was to determine whether children with chronic benign pain are in contact with their general practitioner (GP) more frequently than those without chronic benign pain. A random sample of children and adolescents aged between 0 and 18 years of age was drawn from the records of ten general practices. According to their responses to a pain questionnaire, subjects were assigned to the chronic benign pain group (n = 95) if they had pain of more than three months' duration, or to the control group (n = 105) if they had pain of less than three months' duration or no pain at all. All the subjects had an average GP consultation rate of 2.6 contacts per year. No significant age and sex differences were found. Chronic benign pain in childhood and adolescence is not related to increased use of healthcare ...
Computerized tomography of the adrenal glands was performed in 10 patients with Cushing's syndrome using a G.E. 8800 CT/T Body Scanner. The tomographic findings of unilateral adrenal masses in 4 patients were confirmed by surgery. In the remaining 6 patients, computerized tomography did not identify any masses, and both glands were well visualized and showed normal shape. In these patients, measurement of the adrenal glands revealed both normal (n=1) and enlarged glands (n=5). The findings of adrenalectomy (n=4) or transphenoidal surgery and follow-up (n=2) established the diagnosis of adrenal phyperplasia in all patients. (Author).
The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed. A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed. The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-{alpha} antagonists. Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-{alpha} antagonists is based on clinical and laboratory ...
Background Limited data is available for investigating the long-term safety and effects of intracoronary progenitor cell therapy in patients with acute myocardial infarction (AMI). Objective To assess the clinical course, NT-proBNP and MRI data as objective markers of cardiac function of the TOPCARE-AMI patients at 5-year follow-up. Design The TOPCARE-AMI trial was the first randomized study investigating the effects of intracoronary infusion of circulating (CPC) or bone marrow-derived progenitor cells (BMC) in 59 patients with successfully reperfused AMI. Results Five-year follow-up data were completed in 55 patients, 3 patients were lost to follow-up. None of the patientsshowed any signs of intramyocardial calcification or tumors at 5?years. One patient died during the initial hospitali...
The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm ...
Several randomized studies have been completed in prostate cancer that show a benefit to immediate postoperative treatment in patients undergoing prostatectomy. In one of the studies, there was even...Full Text Available
Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited....Full Text Available
Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or ...
Sex differences in pain are frequently reported in the literature. However, less is known about possible sex differences in the experience of pain secondary to a disability. The current study explored these issues in persons with limb loss (n = 335, 72% men) who were recruited as part of a postal survey. Participants provided ratings of phantom limb pain (PLP), residual limb pain (RLP), and general pain intensity. Participants also completed measures of pain-related interference, catastrophizing, coping, and beliefs. Results indicated that a greater proportion of males than females (86% vs 77%, respectively) reported the presence of PLP; however, this difference was no longer prominent when cause of limb loss was controlled. No sex differences were found in the presence of RLP, or in avera...
In response to an earlier published paper by Fordyce, some assumptions underlying the behavior management paradigm of chronic pain are critically discussed. While operant treatment has proved successful, the conclusion that operant factors play an important role in the development and maintenance of chronic benign pain is debated. Some empirical studies, regularly used to demonstrate this role, are re-evaluated. An alternative theory is proposed for chronic pain behavior, in which the role of a lower tolerance to proprioceptive stimuli, which may include more than just pain stimuli, is emphasized. PMID:3313200
To evaluate the role of positron emission tomography-computed tomography (PET-CT) in staging and determining early treatment response to chemotherapy in children with neuroblastoma (NB) and its correlation with the final outcome. Patients and Methods: Seventeen patients of NB with mean age of 51.5 months (age range 2-132 months; 14 males, 3 females) underwent serial "1"8F-fluorodeoxyglucose (FDG) PET-CT imaging. All 17 patients were for staging before any treatment. Twelve of 17 patients underwent "1"3"1I meta-iodobezylguanidine (MIBG) scan and bone scan. MIBG uptake was seen in the primary lesion in 11/12 patients. MIBG uptake in bones was seen in 3/12 patients. All bone lesions were concordant on MIBG and bone scan. Early response to chemotherapy was evaluated after two cycles using PET-CT. A 30% reduction in longest diameter was taken as cut-off value for ...
Objective: To assess dynamic MRI with Gd-DTPA enhancement for evaluating inflammatory changes in the subacromial bursa. Design and patients: We detected the signal intensity changes in dynamic MRI of the subacromial bursa, and confirmed these macroscopically by arthroscopy and histologically. The signal intensity was measured using built-in software, and the enhancement ratio (E ratio) was calculated from dynamic MR images. In addition, as a parameter of the rate of the increase in the signal intensity from 0 to 80 s, the mean increase per second in the E ratio was obtained as the coefficient of enhancement (CE). The correlation was studied of the E ratio and CE with the arthroscopic findings (redness, villous formation, thickening and adhesion), and of the E ratio and CE with the histological findings (capillary proliferation, papillary hyperplasia, fibrosis and inflammatory cell infiltration) of the subacromial bursa. Of patients with ...
BackgroundSome breast cancer patients receiving anti-angiogenic treatment show increased metastases, possibly as a result of induced hypoxia. The effect of hypoxia on tumor cell...Full Text Available
To determine the demographics, imaging findings, clinical symptoms, and prognosis of primary vertebral Ewing's sarcoma (PVES). A retrospective review of medical records and radiological studies of patients diagnosed with PVES from 1936 through 2001 in our institution and Department of Pathology consultation files was undertaken. Metastatic and soft tissue Ewing's sarcoma cases were excluded. From a total of 1,277 cases of Ewing's sarcoma, 125 (9.8%) had a primary vertebral origin. There were 48 females and 76 males. Patient ages ranged from 4 to 54 (mean 19.3, standard deviation 10.7, median 16) years. Vertebral column distribution was four cervical (3.2%), 13 thoracic (10.5%), 31 lumbar (25%), and 67 sacrum (53.2%). More than one vertebral segment was involved in ten cases (8%). Satisfactory imaging studies were available in 51 patients: 49 radiographs, 27 computerized tomography (CT), and 23 magnetic resonance imaging ...
The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA - after pedicled pelvic bone graft - revealed a regular arterial graft perfusion in 82%. (orig.).
Soluble TWEAK is a member of the TNF-alpha family of cytokines that has been shown to predict mortality in patients with heart failure. Pulmonary artery hypertension is a devastating disease, in which right ventricular function has been shown to be the major determinant of prognosis. In this hypothesis-generating study, we sought to evaluate the potential usefulness of sTWEAK in the prediction of disease severity in patients with pulmonary artery hypertension. We therefore conducted a retrospective analysis of sTWEAK serum levels in 95 stable patients with PAH. For all patients data on hemodynamic parameters, biomarkers and functional exercise tests were available. Compared to controls, patients with PAH showed significantly decreased levels of sTWEAK [median 314?pg/ml (interquartile range...
Contrast agent-enhanced CT scans in nine male patients with histologically proved benign lymphoepithelial lesions of the perotid gland were reviewed. All scans showed cystic-appearing masses with peripheral rim enhancement corresponding to the macroscopic appearance of the lesion. Five patients were seropositive for human immunodeficiency virus (HIV) infection or had infections seen in acquired immunodeficiency syndrome. Three patients were members of high-risk groups. Only one patient had symptoms of the SICCA syndrome. Once a rare cause of parotid gland enlargement, benign lymphoepithelial lesions have recently been seen with increasing frequency in patients with HIV infection. Although the CT appearance is not pathognomic, correlation results of aspiration cytology and with clinical history can lead to a preoperative diagnosis of a benign lymphoepithelial ...
Abstract Objective:- This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods:- Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results:- One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per-cent of the patientsshowed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the ...
Radionuclide x-ray fluorescence analysis was used for the determination of Fe, Zn, Br and Rb levels in whole blood from dilated cardiomyopathy patients and from a control group. The XRF-system consisted of a radionuclide source "1"0"9Cd, a semiconductor Si/Li detector connected to a multichannel analyzer. Fe content in blood of patients was significantly lower than that of the control. Zn content showed no deviation from normal range. Values for Br and Rb in patients highly exceed the range reported for them. (author) 4 tabs.; 9 refs.
A recently-developed BMT method combines a ''Perfusion Method'' (PM) for collecting bone marrow cells (BMCs) with the Intra-Bone Marrow (IBM) injection of BMCs (IBM-BMT). As distinct from the conventional aspiration method (AM), the PM allows rapid (within 1 h) collection of BMCs without T cell contamination (T cells < 10%). Therefore, no GvHD occurs. Moreover, the burden on donors, such as back pain, bleeding and infection, can be reduced. Full chimerism can be achieved even with only mild conditioning regimens if IBM-BMT is carried out, since IBM-BMT replaces not only the recipient's hemopoietic stem cells (HSCs) but also mesenchymal stem cells (MSCs) with donor-derived HSCs and MSCs. Using this method, we show that most currently intractable diseases are HSC or MSC disorders, and that t...
Background and aims. The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia. We aimed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination, as compared to usual care, in 4- to 12-year-old children. Methods. In all, 239 children were enroled by 25 family practitioners in an open-label study. After a pseudo-randomization, usual pain management (n = 132) was compared to a multifactorial strategy (n = 107) associating preliminary application of an anesthesic patch, preferential use of specified vaccines, child education by the parents and the doctor, parental accompaniment...
Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints. About 10-20% of people in most western countries have gallstones, and among them 50-70% are asymptomatic at the time of diagnosis. Asymptomatic gallstone disease has a benign natural course; the progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%. The majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain ("colic"). In the prelaparoscopy era, (open) cholecystectomy was generally performed for symptomatic disease. The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis. Despite some controversy, most authors agree that the vast majority ...
We used computerized tomography (CT) in the study of eight patients with macronodular splenic tuberculosis prior to the microbiological diagnosis. These patients underwent additional CT controls during and after tuberculostatic therapy. All the patients studed presented the acquired immunodeficiency syndrome (AIDS). Splenomegaly and numerosous round, hypodense lesions that showed no contrast uptake were found in all the subjects. Only three patients presented evidence of tuberculosis in plain radiography and/or chest X-ray. Two patients presented abdominal lymph nodes. None of them showed evidence of hepatic lesions or ascites. follow-up CT scans revealed a progressive reduction of the lesions, which eventually disappeared completely, and splenomegaly was considerably reduced. Anthough it is uncommon, we should suspect splenic involvement in ...
Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had ...
Bone scintigraphy was performed in 16 men with newly diagnosed prostatic carcinoma before orchiectomy as well as 2 weeks and 2 months after operation. The uptake in the lower thoracic and lumbar vertebrae was registered up to 240 min after injection of /sup 99m/Tc-MDP and was then calculated for each patient and vertebra. The relative standard deviation in measured uptake due to measuring technique was estimated to be +-7%. In eight patients, who had normal bone scintigraphies before orchiectomy, there were no changes in the uptake values after operation. The remaining eight patients had widespread metastatic involvement prior to treatment, six of these patientsshowed a so-called 'flare phenomenon' in the abnormal vertebrae which means an initial increase in uptake after operation followed by a decreased uptake in response to therapy. One ...
Bone scintigraphy was performed in 16 men with newly diagnosed prostatic carcinoma before orchiectomy as well as 2 weeks and 2 months after operation. The uptake in the lower thoracic and lumbar vertebrae was registered up to 240 min after injection of "9"9"mTc-MDP and was then calculated for each patient and vertebra. The relative standard deviation in measured uptake due to measuring technique was estimated to be #+-#7%. In eight patients, who had normal bone scintigraphies before orchiectomy, there were no changes in the uptake values after operation. The remaining eight patients had widespread metastatic involvement prior to treatment, six of these patientsshowed a so-called 'flare phenomenon' in the abnormal vertebrae which means an initial increase in uptake after operation followed by a decreased uptake in response to therapy. One patient had a ...
The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin (Neosporin), and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys ...
For diagnosis of loosening or infection after implantation of a single-side or double-side total hip endoprosthesis 59 patients being in pain were investigated by a combination of bone scan (Technetium-99m DPD) and leucocyte scan (Indium-111 labelled leucocytes). The correlation between clinical results and scintigraphic findings revealed: bone scintigraphy detects loosening of prostheses with 95% sensitivity (45/47); bone scintigraphy excludes an instable prosthesis with 89% specificity (3/27). 45% of the loosened prostheses revealed an infection (21/47): leucocyte scintigraphy could detect 17 correct positive. Three leucocyte scans of 53 prostheses without clinical signs of infection were false positive. Therefore, leucocyte scintigraphy had a sensitivity of 91% and a specificity of 94% for detecting infection. Bone scintigraphy can detect loosening of prostheses with 93% accuracy, Indium-111 labelled leucocyte scintigraphy can detect ...
The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that ...
The results of nine years of study of the 237 patients who suffered from acute radiation syndrome (ARS) as a consequence of the Chernobyl accident are reported. Thirty-eight of these patients have died, 28 in the acute period in 1986, 5 in 1987-90 and 5 in 1992-93. The reasons for death show no clear tendencies. They include: gangrene of the lung, organic disease of the brain and spinal chord, hypoplasia of haematopoeisis, coronary heart disease, sarcoma and an automobile accident. Investigations have been carried out on an annual obligatory basis of the patients` haemopoietic, immune, nervous and endocrine systems. An analysis of the data is presented. Histograms are included showing the incidence of digestive tract, nervous system, respiratory and cardiovascular disorders, the frequency and degree of disablement and serum prolactin concentration. The types of skin damage sustained ...
Presented here is a case of a young woman, with an undiagnosed osteoid osteoma of the spine, which presented with painful scoliosis in adolescence and was treated by bracing until her accession to adulthood....Full Text Available
ObjectivesUse of prescription opioids for chronic pain is increasing, as is abuse of these medications, though the nature of the link between these trends is unclear....Full Text Available
BackgroundAnterior knee pain (AKP) is a common musculoskeletal complaint. It has been suggested that one factor that may contribute to the presence of AKP is a delay in the recruitment...Full Text Available
BackgroundThe objective of this study was to develop and validate a daily electronic Endometriosis Pain and Bleeding Diary (EPBD) for assessing treatment-related changes in endometriosis...Full Text Available
Shoulder pain is a common orthopedic condition seen by physical therapists, with many potential contributing factors and proposed treatments. Although manual physical therapy interventions for the cervicothoracic...Full Text Available
A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier...Full Text Available
Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published...Full Text Available
BackgroundSeverely disabling chronic pain in the adult population is strongly associated with a range of negative health consequences for individuals and high health care costs,...Full Text Available
Previous studies in several different trigeminal nerve injury/inflammation models indicated that the hyperexcitability of primary afferent neurons contributes to the pain pathway underlying mechanical...Full Text Available
Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in...Full Text Available
Lumbar epidural anesthesia is useful in a variety of chronic benign pain syndromes, including lumbar radiculopathy, low back pain syndrome, spinal stenosis, and vertebral compression fractures. Given...Full Text Available
Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy...Full Text Available
BackgroundNeuropathic pain (NP) is partially mediated by neuroinflammatory mechanisms, and also modulates local neurogenic inflammation. Dietary lipids, in particular the total amount...Full Text Available
... Search Help? Coping with Test Pain, Discomfort, and Anxiety Introduction | Be Prepared | Know Your Tests | Relax | Conclusion ... though they may feel some embarrassment, discomfort, or anxiety at the outset. If undergoing medical tests makes ...
BackgroundUntil now only limited research has been done on the prevalence of chronic pain in primary care. The aim of this investigation was to study the health care utilisation...Full Text Available
BackgroundChronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood....Full Text Available
Functional imaging has revolutionized the neurosciences. In the pain field it has dramatically altered our understanding of how the brain undergoes significant functional, anatomical and chemical changes...Full Text Available
Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress...Full Text Available
The aim of this study was to investigate whether astroglia in the medullary dorsal horn (trigeminal spinal subnucleus caudalis; Vc) may be involved in orofacial neuropathic pain following trigeminal...Full Text Available
ContextWhile opioids are increasingly used for chronic non-cancer pain (CNCP), we know little about opioid dosing patterns among individuals with CNCP in usual care...Full Text Available
To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. ...
The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity. Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was ...
A sensitive radio-assay for ferritin was developed and used to examine serum ferritin levels in 105 patients with recurrent oral ulceration (ROU), 41 patients with Behcet's syndrome (BS), 42 with other ulcerative oral lesions, 35 patients with non-ulcerative oral lesions and in 78 controls. Ferritin levels increased with age and were significantly higher in males than females. The mean ferritin concentrations in male patients with ROU, BS or with other oral ulcers were significantly reduced in comparison with controls, and in female patients were significantly reduced in those with major aphthous ulcers. The prevalence of low serum ferritin levels was about 8% in patients with ROU, 15% in BS and 9.5% in patients with other ulcerative oral lesions, compared with less than 3% in patients with non-ulcerative oral ...
Purpose: Efficacy and safety of the own single-center experience with moderately dosed radiosurgery (SRS) for limited (one to four) brain metastases were analyzed and correlated with patient- and treatment-related variables. Patients and Methods: Between 05/1998 and 10/2006, 93 patients received SRS for a total of 142 brain metastases. The median number of brain metastases treated per patient was one (range, one to four). 46 patients (49%) received initial SRS alone, 13 patients (14%) SRS with up-front whole-brain radiotherapy (WBRT), and 34 patients (37%) SRS for recurrent metastases after WBRT. Median dose was 16 Gy (range, 10-20 Gy). Results: Median overall survival (OS) was 7.5 months. The actuarial 6- and 12-month data for OS were 60% and 35%, for local brain control (LBC) 87% and 79%, and for distant brain control (DBC) 48% and 37%, ...
The frequency of peripheral pulmonary artery stenosis in patients after surgical repair of tetralogy of Fallot (TOF) ranges from 20 to 40%. This can be either primary or secondary to the surgical intervention. The influence of resulting lung perfusion alterations on the life quality of patients is difficult to predict. The aim of this study was to compare the utility of the diagnostic procedures in this group of patients, with particular focus on lung perfusion scintigraphy. This study comprised 104 patients who underwent repair of TOF at ages from 5 months to 25 years. The patients have been followed up for from 4.2 to 25 years. On the basis of chest X-ray peripheral pulmonary artery stenosis was suspected in 11 patients, in 12 on the basis of echocardiography examination. Lung perfusion scintigraphy has been performed on 87 patients. The ...
BackgroundAδ and C fibers are the major pain-conducting nerve fibers, activate only partly the same brain areas, and are differently involved in pain syndromes....Full Text Available
The utilization of health care services in children and adolescents with chronic benign pain was studied in a Dutch population sample of 254 chronic pain sufferers aged 0-18 years. Children and adolescents who had reported chronic pain (continuous or recurrent pain >3 months) in our previous prevalence study were asked to keep a 3-week diary on their pain and to fill out questionnaires on background factors, health care use and the impact of pain. Parent ratings were used for children aged 0-11 years, self-report was used in adolescents (12-18 years). In a 3-month period, in 53.4% of the cases medication was used for pain, and general practitioners and specialists were consulted for pain in 31.1% and 13.9% of subjects, respectively. Physiotherapists, psychologists and alternative health providers were visited by 11.5, ...
Coronary angiography provides anatomical information whereas thellium myocardial scintigraphy measures resistive tissue perfusion. Because of this fundamental difference. The authors question the validity of using coronary angiography as the gold standard to judge thellium myocardial scintigraphy. The authors studied 20 patients undergoing elective percutaneous coronary angioplasty who fulfilled the following criteria: (1) history of chest pain; (2) angiographically significant single vessel disease (>50% stenosis); (3) no prior myocardial infarction. All patients underwent maximal exercise thallium single photon emission computed tomography (T1-SPECT). Tl-SPECT was scored visually according to a 0 to 3 scale (0=absent uptake; 1=markedly decreased uptake; 2=minimally decreased uptake; 3=normal uptake). Translesional gradient and percent stenosis were measured before and after angioplasty. The authors found that ...
Twenty-three patients with intracranial meningiomas were examined by means of magnetic resonance tomography (MRT). In 13 patients the paramagnetic contrast medium gadolinium DTPA was used. Meningiomas show only slight changes in signal intensity compared with brain in the spin-echo mode, the greatest contrast being found on photon density images (TR 1600 ms, TE 35 ms). In T1 images more than 50% of the patientsshowed a low signal margin between tumour and brain. Hyperostosis of the calvarium is easily recognised, but MRT is unreliable for showing tumour calcification. After intravenous injection of gadolinium DTPA, there was marked homogeneous uptake in the meningiomas. These signs are useful for the diagnosis of a meningioma by MRT. (orig.).
Procedures for {sup 131}I ablation in renal failure are not known. In one patient receiving dialysis, detailed dosimetry and health safety aspects were obtained. The results showed insignificant contamination of equipment, but a surprisingly significant reduction in biologic half-life of {sup 131}I due to efficient dialysis extraction. The data indicate that {sup 131}I ablation can be done safely and easily during dialysis but that much higher {sup 131}I doses must be used to achieve equivalent results to those obtained in patients with normal renal function.
Surgical resection is the only curative treatment strategy for intrahepatic cholangiocarcinoma (CC). Therefore, accurate staging is essential for appropriate management of patients with CC. We assessed the usefulness of 2-["1"8F]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the staging of CC. We undertook a retrospective review of FDG PET images in 21 patients (10 female, 11 male; mean age 57 years) diagnosed with CC. Ten patients had hilar CC and 11, peripheral CC. Patients underwent abdominal magnetic resonance imaging (MRI) (n=20) and computed tomography (CT) (n=12) for the evaluation of primary tumours, and chest radiography and whole-body bone scintigraphy for work-up of distant metastases. For semi-quantitative analysis, the maximum voxel standardised uptake value (SUV_m_a_x) was obtained from the primary tumour. All peripheral CCs showed intensely ...
To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39-89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0-64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. The median follow--up time was 62 months (2-202 months).The 5-year overall survival, locoregional ...
The accurate staging of rectal carcinoma is very important for treatment planning. The histological data obtained from surgical specimens of 22 patients with rectal carcinoma were compared with pre-and postoperative endorectal US findings and with preoperative CT results. According to an adapted version of Astler and Coller classification, the different degrees of tumor spread into the rectal wall were represented as follows: stage A: 1 patient; stage B1: 5 patients; stage B2: 6 patients; stage C1: 1 patient; stage C2: 8 patients and stage D: 1 patient. Preoperative staging, based on the overall results of CT and US, was in agreement with histology in 19 of 22 cases. Individual analysis of US and CT results, in comparison with histological data, showed US staging accuracy to be 77.3% (17/22 ...
The present study was undertaken in 27 children with localized Ewing's sarcoma treated at our hospital. In 9 cases the lesion was central and in 18 peripheral. Treatment consisted of: 1) Chemotherapy with 6 drugs (vincristine, cyclophosphamide, methotrexate, bleomycin, dactinomycin and doxorubicin) for one year in all patients; 2) Radiotherapy in 24 patients at a dose of 30-40 Gy in the entire bone with a booster dose of 10-15 Gy in the lesion. In 7 patients debulking surgery was performed followed by irradiation. Two cases with tumor in expendable bones and one with extensive destructive lesion in the tibia underwent radical surgery. One patient suffered local recurrence (femur) and 6 developed distant metastases. The remaining 20 (74%) patients were alive and tumor-free after follow-up periods of 17-80 months. Among the 12 patients with extremity lesions who ...
Eight patients, one male and seven females, with no pre-existing hypothalamic-pituitary disease, who developed symptoms of hypopituitarism following cranial irradiation for nasopharyngeal carcinoma were studied 5 years or more after radiotherapy. All were GH deficient. Four of the patients with no GH response during insulin tolerance tests (ITT) showed increased GH in response to synthetic human growth hormone releasing factor (GRF-44). Four patients had impaired cortisol responses to ITT, and gradual but diminished cortisol responses to ovine corticotrophin releasing factor (CRF-41). There was no significant difference between mean peak increments in response to ITT and those in response to CRF-41. TSH responses to TRH were delayed in five and absent in two patients; four of these had low free T4 index. Prolactin was raised in all seven women and increased further in response to ...
In the paper six cases of facial osteomyelitis as a complication of chronic sinusitis in hemophiliac-AIDS patients are reported. Osteomyelitis was suggested by an increasing of erythrocyte sedimentation rate. The diagnosis was confirmed by a positive {sup 99m} Tc MDP scintigraphy. The patients were submitted to clinical treatment. The erythrocyte sedimentation rate and 67-gallium citrate scans were used in the follow-up of the therapy. Three patients had negative gallium after three weeks of organism-specific antibiotic therapy; in two patients the gallium scintigraphy remained positive. One patient did not undergo the radionuclide scan for this clinical conditions. These results suggest that MDP scans showed higher sensitivity and specificity in detection of bone disease in chronic sinusitis. Gallium scans appeared to be valuable tool in the follow-up of the ...
Acute pneumothorax is a frequent complication after percutaneous pulmonary radiofrequency (RF) ablation. In this study we present three cases showing delayed development of pneumothorax after pulmonary RF ablation in 34 patients. Our purpose is to draw attention to this delayed complication and to propose a possible approach to avoid this major complication. These three cases occurred subsequent to 44 CT-guided pulmonary RF ablation procedures (6.8%) using either internally cooled or multitined expandable RF electrodes. In two patients, the pneumothorax, being initially absent at the end of the intervention, developed without symptoms. One of these patients required chest drain placement 32 h after RF ablation, and in the second patient therapy remained conservative. In the third patient, a slight pneumothorax at the end of the intervention gradually increased ...
To determine clinical predictors and accuracy of {sup 123}I-FP-CIT SPECT imaging in the differentiation of drug-induced parkinsonism (DIP) and Parkinson's disease (PD). Several clinical features and {sup 123}I-FP-CIT SPECT images in 32 patients with DIP, 25 patients with PD unmasked by antidopaminergic drugs (PDu) and 22 patients with PD without a previous history of antidopaminergic treatment (PDc) were retrospectively evaluated. DIP and PD shared all clinical features except symmetry of parkinsonian signs which was more frequently observed in patients with DIP (46.9%) than in patients with PDu (16.0%, p<0.05) or PDc (4.5%, p<0.01). Qualitatively {sup 123}I-FP-CIT SPECT images were normal in 29 patients with DIP (90.6%) and abnormal in all patients with PD, and this imaging technique showed high ...
Study Design Best evidence synthesis. Objective To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population. Summary of Background Data The evidence on burden and determinants of neck has not previously been summarized. Methods The Bone and Joint Decade 2000?2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to...
Psychological distress and postamputation pain were investigated in a sample of 582 males with long-term limb amputations (mean time since amputation 639.3 months, standard deviation 166.1; range 240-784 months). Prevalence of significant depressive symptoms (Hospital Anxiety and Depression Scale [HADS]-D score?8) was 32.0%, and 34.0% of respondents met the screening criterion for clinical anxiety (HADS-A score?8). Nearly one quarter (24.6%) of respondents reported significant post-traumatic psychological stress symptoms (Impact of Event Scale scores?35). In total, 87.8% experienced either phantom or residual limb pain. Affective distress scores differed according to the respondents' type of pain experience. Respondents who experienced residual limb pain reported significantly hig...
Recent literature indicates that torsion of the left ventricle (LV) is a promising predictor for response to cardiac resynchronisation therapy (CRT). Among patients with severe heart failure, 45 to 75% of patientsshow rigid body rotation, where the base and apex rotate in the same direction, instead of normal, opposite rotation. The occurrence of this phenomenon seems to be a good indicator for response to CRT. From this review, it can be concluded that LV torsion might be a welcome addition to current selection criteria.
Two clinical strains of Escherichia coli (2138) and Enterobacter cloacae (7506) isolated from the same patient in France and showing resistance to extended-spectrum...Full Text Available
Fifty-six tuberculosis patients and twenty-eight control subjects were evaluated in a comprehensive investigation of cellular and humoral immune function in pulmonary TB. The patient group showed significantly...Full Text Available
The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters(PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwelltime and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial ...
The subjective experience of one's environment is constructed by interactions among sensory, cognitive, and affective processes. For centuries, meditation has been thought to influence such processes by enabling a nonevaluative representation of sensory events. To better understand how meditation influences the sensory experience, we used arterial spin labeling functional magnetic resonance imaging to assess the neural mechanisms by which mindfulness meditation influences pain in healthy human participants. After 4 d of mindfulness meditation training, meditating in the presence of noxious stimulation significantly reduced pain unpleasantness by 57% and pain intensity ratings by 40% when compared to rest. A two-factor repeated-measures ANOVA was used to identify interactions between meditation and pain-related brain activation. Meditation reduced pain-related activation of the ...
BackgroundIrritable bowel syndrome (IBS) and functional dyspepsia (FD) show considerable overlap and are both associated with psychiatric comorbidity. The present study aimed to...Full Text Available
Liver biopsies in nine of 70 male alcoholics seen during a 12 month period showed predominantly portal fibrosis with fatty change, but little or no alcoholic hepatitis. None of the 30 female alcoholics...Full Text Available
A 30-year-old man with acquired immune deficiency syndrome (AIDS) and Kaposi's sarcoma had a palpable thyroid mass and cervical lymphadenopathy. Nuclear medicine and ultrasound scans revealed multiple thyroid nodules. Results of biopsy showed Kaposi's sarcoma metastatic to the thyroid.
Serial studies of iron transport in patients on maintenance dialysis showed normal or raised values in almost all subjects and a transient increase soon after the start of dialysis in three. These...Full Text Available
The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal...Full Text Available
Corneal biopsy specimens from 3 patients with Cogan's microcystic corneal dystrophy were examined by light and electron microscopy. Specimens were taken from corneas showing microcysts, geographic or...Full Text Available
Sera from multiple sclerosis patients with relapsing-remitting disease and normal subjects were tested for antibody to myelin basic protein by a sensitive radioimmunoassay. The results showed a marginally...Full Text Available
Purpose: To assess the relationship between large intracranial vessel occlusive vasculopathy (vasculopathy) and radiation therapy, and to clarify the clinical efficacy of magnetic resonance (MR) imaging in the diagnosis and screening of the vasculopathy. Methods and Materials: We retrospectively evaluated the medical records and serial MR images for 32 pediatric patients, in whom radiation therapy had been given to fields including the circle of Willis and major cerebral arteries. All children had periodically undergone follow-up neurologic assessment and MR imaging examinations at Kanagawa Children's Medical Center for more than one year after radiation therapy (range 1.3-14 years). Patients who had not remained free of tumor progression up to the time of final evaluation were excluded. Results: Vasculopathy developed in 6 of 32 patients 2-13 years after radiation therapy. Three of them presented with transient ischemic ...
Mycobacterium xenopi is one of the most common agents responsible for nontubercolar mycobacterial pulmonary disease on AIDS patients. These lesions have been studied with conventional radiography while CT has been used in patients with a specific mycobacterioses or non-AIDS pulmonary conditions from Mycobacterium xenopi. 12 AIDS patients were examined. They had pulmonary lesions from Mycobacterium xenopi, patients age ranged 30 to 46 years. All patients had CD4 blood levels lower than 250 cells/mL and Mycobacterium xenopi in the sputum. All patients underwent a standard chest radiograph and a CT examination. CT images were evaluated by three radiologists independently and the definitive diagnosis was made in the presence of a fourth radiologist. Chest CT showed parenchymal consolidation in 66% of cases, associated with bilateral basal bands ...
Purpose: To assess the role of CT in the evaluation of traumatic and spontaneous oesophageal perforation. Materials and methods: From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material. Results: In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of ...
Patients with acute myocardial infarction (AMI) and diabetes mellitus, as well as patients admitted with elevated blood glucose without known diabetes, have impaired outcome. Therefore intensive glucose-lowering therapy with insulin (IGL) has been proposed in diabetic or hyperglycaemic patients and has been shown to improve survival and reduce incidence of adverse events. The current manuscript provides an overview of randomised controlled trials investigating the effect of IGL. Furthermore, systematic glucose?insulin?potassium infusion (GIK) has been studied to improve outcome after AMI. In spite of positive findings in some early studies, GIK did not show any beneficial effects in recent clinical trials and thus this concept has been abandoned. While IGL targeted to achieve normoglycaemi...
17 patients with chronic aortic dissection were examined by MRI. In 12 patients, comparison between gradient echo sequences and SE sequences was possible. Gradient echo sequences, unlike SE sequences, permitted evaluation of flow in the true and false lumen, reliable differentiation between thrombus and flowing blood and clear delination of the intimal flap. An additional comparison between transoesophageal ultrasound and MRT in 15 patientsshowed significant advantages in favour of MRI. In three patients MRI was able to detect more proximal origins of the dissection. Moreover, MRI allowed evaluation of the major aortic branches and their relation to the dissection; this was not possible with ultrasound. MRI plays an important role in the follow-up of chronic aortic dissections. (orig.).
Summary The presence of human heterophilic antibodies against horse immunoglobulins (HHA-HI) was determined by ELISA in sera from healthy volunteers and from patients who received equine antivenom for therapy of snake bite envenoming. These patients were selected from two independent clinical studies: one in Colombia in which patients received antivenom constituted by whole IgG (n=25); and the other in Brazil where an antivenom constituted by F(abprime)2 fragments was administered (n=31). Results show that healthy volunteers have antibodies, mainly of the IgG class, able to react with whole equine IgG. Additionally, patients have IgG antibodies that react both with whole equine IgG and F(abprime)2 fragments. In both clinical studies, no significant differences were observed in the HHA-HI t...
Therapeutic decisions are quite clear-cut for asymptomatic gallstone disease and acute cholecystitis. However, the appropriate therapeutic course for older patients with chronic cholecystitis may be less obvious. Watchful waiting may be reasonable for patients with mild and infrequent symptoms. For healthy patients, cholecystectomy is recommended if symptoms are becoming more frequent and severe. Laparoscopy may reduce the complication rate and be safely performed even in those with underlying medical illness. Oral dissolution therapy can be attempted for qualifying symptomatic patients who are at poor surgical risk or who refuse surgery. Shock wave lithotripsy and contact dissolution therapy show some promise but are currently experimental. PMID:8339941
The authors have evaluated bone mineral content in the vertebral spongiosa by means of Computed Tomography. The method proposed by Genant and Cann [17, 18] has been applied to examine 164 healthy volunteers and 108 patients. Both healthy males and females showed a progressive bone mineral loss increasing with age; the bone mineral loss was most severe in females during the 4th and 5th decade of life. Pathology included patients with osteoporotic fractures (vertebral and femural neck), patients with partial gastrectomy, renal failure, primary hyperparathyroidism, Cushing syndrome, corticosteroid therapy. Bone mineral values were significantly lower in most pathologic groups. Computed Tomography proves thus to be a valuable method to assess bone mineral content and to identify patients at risk for fractures.
Abstract Recent reports showed many patients with chronic fatigue syndrome (CFS) harbor a retrovirus, xenotropic murine leukemia-related virus (XMRV), in blood; other studies could not replicate this finding. A useful next step would be to examine cerebrospinal fluid, because in some patients CFS is thought to be a brain disorder. Finding a microbe in the central nervous system would have greater significance than in blood because of the integrity of the blood-brain barrier. We examined cerebrospinal fluid from 43 CFS patients using polymerase chain reaction techniques, but did not find XMRV or multiple other common viruses, suggesting that exploration of other causes or pathogenetic mechanisms is warranted. Ann Neurol 2011;
Ten patients with traumatic femoral neck fracture were studied with MR imaging (0.5 T, Magnetom, Siemens): unenhanced (multiecho, TR/TE = 1,600/30--240 [repetition time/echo time, msec]; gradient echo, TR/TE = 315/14, #theta# = 90 degrees) and Gd-DTPA enhanced (0.1 mM/kg body weight, Magnevist, Schering; gradient echo, TR/TE = 315/14, #theta# = 90 degrees). MR images were compared with clinical-radiographic findings. Digital subtraction angiography of the femoral head (FH) in five patientsshowed complete interruption of blood supply to the FH in three patients (signal intensity of FH did not increase on postcontrast images) and intact FH arteries in two patients (FH signal increased on postcontrast images, as did the healthy-side signal).
ObjectiveTo address the characteristics of hearing loss in patients with Turner syndrome (TS), we evaluated hearing levels of patients with TS and analyzed causative factors.Study designThirty-three patients with TS (8 to 40 years of age) were studied through the use of audiological measurements, and causative factors were explored.ResultsTwenty cases (35 of 66 ears tested) showed high-frequency (8 kHz) sensory neural hearing loss (HFQ-SNHL). Fifteen cases (26 ears) and 15 cases (24 ears) of the impaired 20 cases were unresponsive to distortion-product otoacoustic emissions and transient-evoked otoacoustic emissions, respectively. HFQ-SNHL showed little relation to the history of middle ear infection and puberty, although middle ear infections were seen in 11 of the 20 cases. The hearing t...
Artifical valve prostheses are often regarded as a contraindication for magnetic resonance imaging (MRI), although preliminary in vitro studies suggested, that patients with these metallic implants might safely undergo MR examination. This study reports on the experience with a group of 89 patients with 100 heart valve prostheses who were examined by spin-echo MR and gradient-echo MR. MR examination was performed in all patients without complications. The spin-echo sequence showed advantages in the depiction of anatomical structures like paravalvular abcesses. Anatomical structures adjacent to the artificial valve were clearly visivle and the metal components of the valves showes no or only small artifacts. Artifacts were accentuated when using gradient-echo sequences. Gradient-echo sequences provided valuable information regarding the presence of valvular insufficiency. ...
Pulmonary clearance of an aerosol of "9"9Tc"m DTPA was measured in 21 non-smoking AIDS and pneumocystosis patients. The results were compared with those of pulmonary scintiscanning with gallium. All the patients exhibited increased clearance, evidence of a considerable alteration in alveolar permeability. This increase was also observed in patients with normal chest X-rays and normal blood gases. The average clearance in these patients was 6 #+-# 2% min"-"1 as compared with a normal 1.1 #+-# 0.3% min"-"1. Conversely, only four out of eight patients with normal chest X-rays had abnormal gallium scans. Clearance returned to normal after recovery. Measurement of DTPA clearance appears to be a very sensitive indicator for the detection and follow-up of pneumocystosis. However, it is not very specific since it can be increased by tobacco poisoning, drug abuse and the presence of ...
The loss of #alpha#-globin gene transcriptional activity rarely occurs as an acquired abnormality during the evolution of myeloproliferative disease or preleukemia. To test whether the mutation responsible for the loss of #alpha#-globin gene expression (hemoglobin H disease) in these patients is linked with the #alpha#-globin genes on chromosome 16, the authors transferred chromosome 16 from preleukemic patients with acquired hemoglobin H disease to mouse erythroleukemia cells and measured the transcriptional activity of the human #alpha#-globin genes. After transfer to mouse erythroleukemia cells, the expression of human #alpha#-globin genes from the peripheral blood or marrow cells of preleukemic patients with acquired hemoglobin H disease was similar to that of human #alpha#-globin genes transferred to mouse erythroleukemia cells from normal donors. These data showed that factor(s) in the mouse ...
Eight patients who had received megavoltage therapy for Cushings' disease 5-12 years previously have been reviewed. The long term response to this therapy was assessed with respect to efficacy of treatment in inducing continued remission and disturbance of hypothalamic-pituitary function. One patientshowed clear evidence of relapse of Cushings' disease. One patient had unequivocal hypopituitarism. Basal levels of growth hormone (GH), TSH, LH, and FSH were not statistically different from controls, but provocative testing revealed significant abnormalities of response of cortisol/ACTH, GH, prolactin and LH. Six out of eight patients had absent diurnal cortisol variation and five patients had elevated serum prolactin levels. Thus, in this group of patients normal pituitary-adrenal function has not been satisfactorily restored. It is clear ...
Eight patients who had received megavoltage therapy for Cushings' disease 5-12 years previously have been reviewed. The long term response to this therapy was assessed with respect to efficacy of treatment in inducing continued remission and disturbance of hypothalamic-pituitary function. One patientshowed clear evidence of relapse of Cushings' disease. One patient had unequivocal hypopituitarism. Basal levels of growth hormone (GH), TSH, LH, and FSH were not statistically different from controls, but provocative testing revealed significant abnormalities of response of cortisol/ACTH, GH, prolactin and LH. Six out of eight patients had absent diurnal cortisol variation and five patients had elevated serum prolactin levels. Thus, in this group of patients normal pituitary-adrenal function has not been satisfactorily ...
Angiotensin II has adverse actions in heart failure including vasoconstriction, aldosterone secretion, and activation of the sympathetic nervous system. Valsartan, a potent specific angiotensin II type 1 receptor blocker, may produce beneficial effects in heart failure. The purpose of this study was to evaluate the steady-state pharmacokinetics of valsartan 40, 80, and 160 mg each given every 12 h for 7 days in heart failure patients. Eighteen patients with chronic stable heart failure and left ventricular ejection fractions power model, showed that doubling the dose increased the AUC and Cmax 1.8 times. The pharmacokinetics of valsartan are predictable in heart failure patients within the dose range of 40-160 mg BID. Age did not appear to have influenced the valsartan clearance in heart failure patients. The pharmacokinetic values were higher in heart failure ...
Some studies suggest that giving radiation therapy after surgery for hilar cholangiocarcinoma improves the survival rate; however, many of these studies did not specify numbers of subjects or provide an impartial analysis. Thus, we evaluated the effectiveness of radiation therapy as adjuvant treatment after surgery and attempted to establish appropriate adaptation standards. We reviewed the records of 69 patients who underwent surgery for hilar cholangiocarcinoma between June 1980 and April 1998. Thirty-nine patients were treated with surgery followed by radiation therapy and 30 were treated with surgery alone. The clinicopathologic features that might have influenced prognosis were similar in the patients who received radiation therapy and those who did not. Radiation as adjuvant therapy did not have a beneficial effect on overall survival (P=0.554, log-rank test); however, it tended to improve survival in the group of ...
Continuous ambulatory peritoneal dialysis (CAPD) is a generally well-tolerated treatment. However, some patients exhibit such complications as to prevent the continuation of treatment. Peritonitis is the major problem, but the continuation of treatment may also be undermined by different complications, such as peritoneal leakage, hernia, catheter malfunctioning, and scrotal-penile edema; a careful investigation of the patient is always needed in such cases. From November 1985 to February 1990, we examined 20 patients, who had presented with different types of complications in the course of dialysis. Peritoneography demonstrated 3 cases of abdominal hernias, 2 cases of patency of the peritoneal-vaginal duct, and 2 cases of catheter obstruction. Peritoneal CT allowed the identification of leakage in 3 patients, while the combined use of the two techniques showed adhesions or ...
The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long-term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short-term outcome. The long-term group had a 3-year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short-term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry ...
Identity is a part of self-consciousness, which is also expressed as ''being in the world'' which one in turn shows to others as the Self. The assessment of the Self in a population of patients with Alzheimer's disease, according to a multidimensional definition (physical, social, spiritual), showed that the social self was impaired, and the severity of impairment of the self was correlated to apathy and lack of semantic autobiographical memory. It also appears that ipseity is selectively affected by the disease.
Purpose: To analyze p53, bcl-2, c-myc, and cyclooxygenase-2 protein expression changes and examine their relationship with various antioxidant enzymes in esophageal carcinoma patients. Methods and Materials: Patients in Group 1 underwent transhiatal esophagectomy and those in Group 2 were administered chemoradiotherapy followed by surgery after 4 weeks of neoadjuvant therapy. Results: The relationship analysis among the various protein markers and antioxidant enzymes showed an inverse correlation between bcl-2 and superoxide dismutase/catalase in tumor tissues, irrespective of the treatment arm followed. An important positive association was observed between bcl-2 and reduced glutathione levels in the tumor tissue of patients receiving neoadjuvant therapy. Another apoptosis-modulating marker, c-myc, in the tumor tissue of Group 2 patientsshowed similar pattern ...
January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps were used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the ...
January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps were used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the ...
Eleven patients who had undergone cardiac surgery were studied by means of high-field MR imaging (1.5 T). Six patients had aortic root and valve replaced with a Bjork-Shiley (BS) composite tubular aortic graft prosthesis for acute dissection of ascending aorta. In the other 5 patients with rheumatic calcific aortic disease, the valve had been replaced with a BS prosthesis. As a whole, MR studies were 14. Previous evaluations of magnetic field effects had seem carried out ex vivo on both BS valves and BS composite prostheses, on surgical ligation clips (Tantalium and Stainless) and on stainless wires for sternal closure. In 4 patients (2 BS composite grafts, and 2 BS valves) MRI diagnosed chronic dissection of both arch and descending aorta. In 1 of them, with a bs valve, associated localized acute dissection of ascending aorta was observed. In 3 patients with BS composite grafts, ...
The utilization of nuclear medicine bone scanning examinations early in the diagnostic process allows physicians to render prompt and correct treatment in urgent or difficult athletic cases. Bone scanning should be performed for athletic injuries whenever (1) x-rays are normal but bone or joint pain persists; (2) x-rays are positive but it cannot be determined if the findings are acute or chronic; (3) soft-tissue injuries present and x-rays are not useful; and (4) bone pain or joint impairment present without a history of trauma.89 references.
Objective: The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed. Methods: A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study. Results: A total of 47 articles were included on the measurement properties of 8 different questionnaires. The meth...
Dengue, a major public health problem throughout subtropical and tropical regions, is an acute infectious disease characterized by biphasic fever, headache, pain in various parts of the body, prostration,...Full Text Available
ObjectiveNeuralgic amyotrophy (NA) is a distinct clinical syndrome that is characterized by the acute onset of shoulder and arm pain, weakness, and sensory loss. The purpose of this...Full Text Available
The physical demands of performing on musical instruments can cause pain, sensory loss, and lack of coordination. Five cases illustrate common problems. Knowledge of the interaction between the technique...Full Text Available
Opinion statementCritical limb ischemia (CLI), defined as chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease, is the most advanced...Full Text Available
The antinociceptive effects of honokiol and magnolol, two major bioactive constituents of the bark of Magnolia officinalis, were investigated on animal paw licking responses and thermal...Full Text Available
We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The ...
To assess the malignant potential of small({<=}15mm) portal defects seen on CT arterial portography, the findings of CT hepatic arteriography and lipiodol CT were reviewed. In 91 patients who underwent both CTAP and CTHA, small portal defects were reviewed for frequency, multiplicity and location. We prospectively evauluated changes in the size and enhancement pattern of malignant lesions on follow up CT according to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. Among the 91 patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and of undetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that were hyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases, respectively. Location and multiplicity did not show statistically ...
Full text: Tumour ablation with radiofrequency (RF) energy is a relatively new procedure for the treatment of focal malignant disease. At our institution this is currently being used in the treatment of certain liver and lung lesions with the patients involved being enrolled in clinical trials. The poster describes the technique used at our institution for the placement of the radiofrequency ablation electrode using CT fluoroscopy. Criteria for patient selection are included. Complications from the procedure are described, as well as follow up appearances and results. Our results from the treatment of primary and secondary lesions in the liver correlate well with published literature. Treatment is still not as successful as surgical resection but there is significantly less morbidity. Where this method may be appropriate is when the patient is not a candidate for surgical resection. The treatment of colorectal metastases in ...
Quantitative bone scintigraphy was performed in 24 patients with prostatic carcinoma before orchiectomy and up to one to four years after operation. The gamma camera count rate was recorded over the lower thoracic and all lumbar vertebrae 4 h after injection of [sup 99m]Tc-MDP. Twelve patients has normal bone scintigrams throughout the study. They showed from two years after operation a slight increase in count rate values compared with the preoperative values, probability due to hormonal changes after orchiectomy and to age-related alterations in skeletal metabolism. Twelve patients had abnormal bone scintigrams. They showed as a response to treatment the flare phenomenon with an increase in count rate over the abnormal vertebrae when measured two weeks after operation followed by a decrease after two months. The lowest count rate values were obtained between six months and one ...
Quantitative bone scintigraphy was performed in 24 patients with prostatic carcinoma before orchiectomy and up to one to four years after operation. The gamma camera count rate was recorded over the lower thoracic and all lumbar vertebrae 4 h after injection of "9"9"mTc-MDP. Twelve patients has normal bone scintigrams throughout the study. They showed from two years after operation a slight increase in count rate values compared with the preoperative values, probability due to hormonal changes after orchiectomy and to age-related alterations in skeletal metabolism. Twelve patients had abnormal bone scintigrams. They showed as a response to treatment the flare phenomenon with an increase in count rate over the abnormal vertebrae when measured two weeks after operation followed by a decrease after two months. The lowest count rate values were obtained between six months and one year ...
MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every ...
Dynamic quantitative bone scintigraphy was performed on 31 men with prostatic carcinoma before orchiectomy as well as 2 weeks, 2 and 6 months postoperatively. After injection of technetium methylene diphosphonate Tc 99m ("9"9"mTc-MDP) the count rate was recorded as serial images over the lower thoracic and all the lumbar vertebrae from 1 to 240 min post-injection. Thirteen men had normal bone scintigrams with no changes in "9"9"mTc-MDP content at the four different investigation times. Eighteen men had skeletal metastases. Throughout the study half of the abnormal vertebrae in these patientsshowed an abnormal count rate after only 6 min post-injection. After 1 h it was possible in almost all abnormal vertebrae to predict abnormal bone uptake. In response to therapy a 'flare phenomenon' with an increase in count rate was seen 2 weeks after orchiectomy followed by a decrease 2 months postoperatively in most of the abnormal vertebrae. The count ...
A simple, short and sensitive direct radio-immunoassay technique for the determination of salivary cortisol concentration was employed to assess saliva as a medium for evaluating cortisol response during endocrine testing in 9 controls and 40 patients. Results in controls suggested that an adequate salivary cortisol response to insulin hypoglycaemia was an increase of 150% above the basal value with a minimum peak of 15 nmol/l. Thirty-three patients were classified as being either good or poor responders to insulin hypoglycaemia on the basis of criteria for plasma cortisol levels. When the defined salivary cortisol response was used for assessment, all 33 patients were correctly categorized into the same response groups. The salivary cortisol response to intramuscular tetracosactin in 3 patients and an intravenous dexamethasone infusion in 4 patients confirmed the value of saliva as ...
Objective: To analyze the early response of uveal melanomas in patients treated with ruthenium-106 brachytherapy. Materials And Methods: In the period between April 2002 and July 2003, 20 patients diagnosed with uveal melanoma were submitted to ruthenium-106 brachytherapy. The calculated dose delivered at the apex of the tumor ranged between 55 Gy and 100 Gy. Patients with lesions greater than 5 mm were submitted to transpupillary thermotherapy concomitantly with ophthalmic plaque insertion. Results: As regards the lesions site, 75% of the lesions were located in the choroid, 15% in the iris, and the remainder 10% in the ciliary body. In a median 19-month-follow-up, the progression-free survival for brachytherapy was 69%, and 87% for associated brachytherapy and transpupillary thermotherapy. A significant tumor height reduction was observed after treatment. No patient was submitted to enucleation. ...
Iodixanol is a new nonionic dimer, isotonic with blood at all clinically relevant concentrations. Iodixanol (270 mg I/ml) was compared in a double-blind, randomized, parallel-group, phase-III study to the monomeric nonionic iohexol (300 mg I/ml) for evaluation of safety, tolerability and radiographic efficacy during cerebral CT. One hundred adult patients scheduled to undergo contrast-enhanced cerebral CT were randomly allocated to receive either iodixanol or iohexol. All completed the trial. Safety was evaluated by recording discomfort and other adverse events, tolerance by assessing intensity and incidence of discomfort. Radiographic efficacy was assessed from the diagnostic information and the radiographic density. No serious adverse events occurred. One patient (2 %) in the iodixanol group and one patient (2 %) in the iohexol group experienced a transient reddening at the neck and lower neck-line, respectively. Both ...
Twenty-seven histologically confirmed cases of localised Ewing's sarcoma were treated by two different regimes. Radiotherapy alone was used in 13 cases and a combination of chemotherapy and radiotherapy in 14. Single agent chemotherapy (cyclophosphamide) was given sequentially in nine patients and cyclophosphamide and actinomycin-D in five. There is a significant difference in the response to these different regimes. Only 69.2% of patients treated by radiotherapy alone were disease-free, for a median period of 10.4 months and metastases were noticed in 53.8% of cases. The disease-free survival in patients treated by combination therapy (radiotherapy and chemotherapy) was 18.4 months and metastases were seen in only 42.9%. However, no metastases were seen in patients who received cyclophosphamide and actinomycin-D, during a period of 14 months and only one patient ...
Tuberous sclerosis complex (TSC) is an inherited disorder characterized by the presence of cortical tubers, the majority of which are solid and show high signal on FLAIR images. Low-signal tubers are less frequent. To evaluate cystic cortical tubers in patients with TSC on the basis of their appearance on FLAIR images. MR examinations of 73 patients were retrospectively reviewed and 17 children (aged 25 days to 12.3 years) with a typical cyst-like tubers were selected for further analysis. The age of the patients, the number of lesions, and the shape and MR intensity were analyzed. Cyst-like cortical tubers were detected in 82% of children below 7 years of age and in 18% of those older then 7 years (P=0.00086). Most of the cystic lesions were of the shrunken type (72%), the expansile type being less frequently seen (28%). FLAIR images confirm the cystic character of some of the cortical tubers in TSC ...
Brain MRI was carried out in patients with chronic liver diseases. No abnormal findings were recognized in patients with chronic viral hepatitis, while 59.2% of cirrhotics showed a symmetrically strong signal in basal ganglia on T1 weighted image in MRI. This finding significantly related with lowered Fischer`s ratio of serum amino acid, increased levels of serum phenylalanine, tyrosine and hyaluronic acid, prolonged prothrombin time and decreased platelet counts in the peripheral blood. Overt hepatic encephalopathy was observed in 6 of 34 patients with the strong signal in MRI during follow-up period, while none of patients without that finding developed hepatic encephalopathy. These results have indicated that the strong signal in basal ganglia on MRI appears in cirrhotic patients with severe liver dysfunction, and it is an useful index in the early diagnosis ...
Quantitative bone scintigraphy was performed at 4 and 24 h after injection of {sup 99m}Tc-MDP. The lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4 h-uptake values. For patients with normal scintigrams the count rate at 24 h was below the 4 h level and the mean 24 h/4 h ratio was determined to be 0.85 {+-} 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards ...
Quantitative bone scintigraphy was performed at 4 and 24 h after injection of "9"9"mTc-MDP. The lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4 h-uptake values. For patients with normal scintigrams the count rate at 24 h was below the 4 h level and the mean 24 h/4 h ratio was determined to be 0.85 #+-# 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards lower ...
Transplantation has emerged as the therapy of choice for many patients with end organ failure. One of the major goals is to tailor immunosuppressive therapy to the individual needs of every patient to balance the risk for rejection and over-immunosuppression. This will require diagnostic tools that can detect harmful processes in the allograft early, and that can be measured repeatedly. This review will consider recent advances in our understanding of the molecular nature of these processes and how this information is being utilized to design novel diagnostic assays to non-invasively monitor allografts. Highlighted is the need for large-scale prospective multi-centre studies to validate assays that show early promise in single centre studies.
Gallium imaging is increasingly being used for the early detection of complications in patients with AIDS. A 26-year-old homosexual man who was HIV antibody positive underwent gallium imaging for investigation of possible Pneumocystis carinii pneumonia. Widespread cutaneous focal uptake was seen, which was subsequently shown to be due to mycobacterium avium-intracellulare (MAI) septicemia. This case demonstrates the importance of whole body imaging rather than imaging target areas only, the utility of gallium imaging in aiding the early detection of clinically unsuspected disease, and shows a new pattern of gallium uptake in disseminated MAI infection.
The combination of fentanyl and droperidol, Innovar, was compared to flunitrazepam (1-2 mg) in a higher dosage (2.5-5 ml) for i.m. premedication. We measured psychological (ESB) and physiological (blood pressure, heart rate, p.cortisol) stress parameters before and after premedication. Side effects were registered. The day after surgery the patients were asked about the quality of premedication. Flunitrazepam reduced anxiety; Innovar did not. After Innovar the feeling of weakness increased significantly compared to flunitrazepam. Two patients panicked and refused operation. Other severe side effects were not observed. There were slight advantages for flunitrazepam on physiological stress. Patients were more satisfied with flunitrazepam than with Innovar premedication. The results show that Innovar also in a higher dosage cannot be recommended for premedication. PMID:6391270
Lobar emphysema is an uncommon cause of respiratory distress in infancy. Congenital heart disease is seen in about 20% of the patients with infantile (congenital) lobar emphysema. We described six infants with lobar emphysema. In three of them a congenital heart disease was demonstrated by cardiac catheterization and cineangiography; two had a tetralogy of Fallot with right aortic arch and the third infant a ventricular septal defect. The pulmonary angiography showed stretching of the arteries with very poor filling of the peripheral arteries and a characteristic smaller pulmonary vein in the affected lobe. In all the six patients the pulmonary artery pressure was normal. All the patients underwent lobectomy with good results. We feel that a preoperative cardiac catheterization and cineangiography is of value in this very sick group of infants. (orig.).
MRI findings in 13 patients with monolateral parotid tumor were compared with US, sialographic and CT findings. MRI did not allow an accurate diagnosis in 2 patients with diffuse chronic parotitis. MRI was superior to CT in 1 case in defining the intraglandular site of the lesion, and in 2 patients in showing the extraglandular involvement. MRI proved to be superior to CT thanks to its contrast resolution and to multiplanar imaging. MRI high contrast resolution made it possible to demonstrate neoplastic lesions of 4 mm in diameter. The lesion has low signal intensity on T1-weighted images and high signal intensity on T2-weighted. Parotid tumors cannot be characterized by signal intensity alone: only morphology allows to discriminate between benign and malignant lesions. To conclude, US is a screening method, while MRI is helpful in detecting multifocal lesions and in evaluating the tumor extent.
Abstract In this brief report, we have described the fine-needle aspiration cytology (FNAC) of a hepatosplenic T-cell lymphoma (HSTCL) in a 60-year-old female patient. The patient complained of fever and heaviness of left upper abdomen. Ultrasound-guided FNAC of the spleen showed immature lymphoid cells, and a diagnosis of primary non-Hodgkin lymphoma of spleen was offered. Subsequently, the patient underwent splenectomy and wedge biopsy of liver that confirmed the cytological diagnosis. The lymphoma cells were positive for CD3 immunostain. Primary hepatosplenic T-cell lymphoma is a rare entity and may often pose diagnostic problems on FNAC. Diagn. Cytopathol. 2010. 2010 Wiley-Liss, Inc.
14 surgical patients with non-hepatobiliary diseases were studied with "9"9"mTc-EHIDA imaging to evaluate the effect of total parenteral nutrition (TPN) on the hepatobiliary function. Duration of TPN ranged from 6-56 days, 10 of the 14 patients Beijing within 10 days. The results showed that: (1) 11 of 14 patients had abnormal scintigraphic features. The most prominet findings were delayed liver excretion and prolonged blood clearance time. This fact suggests that not only the rate of excretion of the bile from the liver is decreased but the uptake ability of the hepatorcyte is also impaired. (2) The effect of TPN on liver function is reversible. It was concluded that in order to prevent irreversible damage of hepatobiliary function caused by TPN, the duration of TPN should not be too long and oral intake of nutrients should be resumed as soon as possible.
In 9 over 12 patients who underwent cardiac transplantation computed tomography was performed. In 5 of them CT was obtained also before the surgical treatment. In all patients angio-CT technique was performed, while the ECG-gated technique was employed only before surgery. CT shows changes in morphology of both atria but over all of the right one, and rotation of the heart on the longitudinal axis. The conditions of the pericardium are particulary well demonstrated: in 5 cases pericardial effusion was observed, 3 times localized and 2 times diffuse. Only in 1 patient a small thrombus in the right atrium was demonstrated. CT allows the possibility to obtain simultaneously information on mediastinum, lung and pleura. Pleural effusion, pulmonary infections and mediastinal complications are easily demonstrated.
Purpose: To report the detection of con-compacted ventricular myocardium (NVCM) with MRI compared to echocardiography in 8 patients. Material and methods: Non-compaction of the ventricular myocardium is a congenital disorder characterized by an altered structure of the myocardial wall resulting from an intrauterine arrest in endomyocardial embryogenesis. The morphological findings consist of a prominent meshwork of multiple myocardial trabeculations and deep intertrabecular recesses, communicating with the left ventricular cavity. 8 consecutive patients (mean age 7.3 years) with clinical and echocardiographic signs of NCVM were examined by MRI (1.5 T, Vision, Siemens) in short axis and 2- and 4-chamber views, using T_1-weighted TSE and Cine-GRE in 6 patients and true FISP sequences in 2 patients. MRI and echocardiography were evaluated for visibility, signs of NCVM and involvement of myocardial wall ...
Isocapnic hyperventilation with cold air (IHCA) is a reliable technique for assessing indirect bronchial hyperresponsiveness in patients with asthma. Impedance measurement of the respiratory system by the forced pseudorandom noise oscillation technique is a sensitive technique to assess changes in bronchial tone after IHCA. The aim of this study was to evaluate the effect of 6 weeks of treatment with beclomethasone dipropionate, 1,000 microg x day-1, on IHCA in asthmatic patients, measured with both forced oscillation technique and flow-volume recordings. Forty patients with mild asthma were included in this double-blind, placebo-controlled parallel-group study. Stratification on the basis of sex was performed to overcome differences in airway diameter. At entry and every 2 weeks during the treatment period, IHCA was performed and patient diaries were evaluated. Characteristic changes in forced ...
The puborectalis syndrome is a defecation disorder supported by the nonrelaxation of puborectalis sling with consequent dyschezia. They report on a series of 98 patients submitted to clinical examination, defecography, anorectal manometry, electromyography and intestinal transit time studies. The main symptoms of puborectalis syndrome in their patients were incomplete defecation (89 %) and intermittent evacuation (63 %); 28 % of patients turned to finger defecation. In all patients, defecography showed an abnormal increase in puborectalis impression on the posterior anorectal wall, reduced anorectal angle opening under straining (mean value: 113 deg) and prolonged expulsion time with barium pooling in the ampulla (mean evacuation time: 38 seconds). Such anorectal abnormalities as rectal mucosal prolapse (47 cases) and anterior rectocele (36 cases) were also associated. In 33 of 98 ...
The puborectalis syndrome is a defecation disorder supported by the nonrelaxation of puborectalis sling with consequent dyschezia. They report on a series of 98 patients submitted to clinical examination, defecography, anorectal manometry, electromyography and intestinal transit time studies. The main symptoms of puborectalis syndrome in their patients were incomplete defecation (89 %) and intermittent evacuation (63 %); 28 % of patients turned to finger defecation. In all patients, defecography showed an abnormal increase in puborectalis impression on the posterior anorectal wall, reduced anorectal angle opening under straining (mean value: 113 deg) and prolonged expulsion time with barium pooling in the ampulla (mean evacuation time: 38 seconds). Such anorectal abnormalities as rectal mucosal prolapse (47 cases) and anterior rectocele (36 cases) were also associated. In 33 of 98 ...
To determine MTRs for normal structures and benign diseases in the breast two-dimensional magnetization transfer imaging was performed in 62 patients and in 3 young female volunteers. With regard to the MTRs of measurements in the normal breast tissues, fat tissues which is close to simple cysts in MTRs show little transfer of longitudinal magnetization. MTRs of the muscles was 15.15{+-}6.22%, which exceeded those of breast parenchyma. The breast parenchyma didn`t show the change of MTR value due to the difference of patient age and due to variable amount of fat and fibrous tissues. Breast parenchyma in the two young volunteers clearly showed biphasic change of MTR values in accordance with the menstrual cycle; little transfer value was due to hydration in the postovulatory period and high transfer value was due to dehydration in the preovulatory period. In the remaining one ...
To determine the usefulness of carbon dioxide(CO_2) indirect portography during TIPS procedure. We evalvated eight patients who had undergone TIPS due to variceal hemorrhage or ascites caused by portal hypertension. All patients but one with complete situs inversus underwent wedged right hepatic venography for visualization of the portal vein using CO_2. For CO_2 indirect portal venography, 50cc of CO_2 was injected by hand without prior injection of a small amount of CO_2. In three patients a 5-F angiographic catheter was wedged into the right hepatic vein, and in the other five a 9-F sheath from a Ring's transjugular access set was adjunctively wedged into the right hepatic vein over the 5-F catheter. The time required for portal vein puncture was defined as the time between the indirect portal venography procedure and the first procedure after successful portal vein puncture. All patients ...
The role of radiation therapy in local tumor control and decreased incidence of pulmonary metastasis is reported in 271 patients who were entered into the Intergroup Ewing's Sarcoma Study with more than one year follow-up and on whom all radiotherapy records were reviewed. The majority of the patients were irradiated to the primary tumor with doses of 4500 to 6500 rad in five to six weeks in combination with systemic administration of three drugs (vincristine, actinomycin-D and cyclophosphamide) or four drugs (vincristine, actinomycin-D, cyclophosphamide and adriamycin). One of the groups of patients was treated with three drugs and bilateral pulmonary irradiation (1500 rad, uncorrected dose, in two weeks). Preliminary analysis shows an overall local primary tumor control of 89%. Patients with lesions in the pelvis had a local failure rate of 17% (9 of 52) and in the humerus 23% (7 ...
The long-term survival of serologically incompatible red cell units was measured in five patients with antibodies to high-frequency antigens. Initially, the survival of 1 ml of "5"1Cr-labeled incompatible red cells was measured over 1 hour. After demonstrating that the 1-hour survival times were successful (greater than 70%), each patient then received 5 ml of the same "5"1Cr-labeled red cells followed by the transfusion of the remainder of the red cell unit. The long-term T 1/2Cr survival for each case was patient 1 (anti-McCa), 15 days; patient 2 (anti-JMH), 12 days; patient 3 (anti-Kna), 31 days; patient 4 (anti-McCa), 12 days; and patient 5 (anti-Hya), 14 days. Each antibody tested in an in vitro homologous macrophage assay showed less than 5 percent phagocytosis. Anti-JMH was the only antibody to react with IgG ...
Background and purpose: Local treatment for non-metastatic Ewing's sarcoma family tumors (ESFTs) is controversial. Results achieved in a single institution in patients with ESFT of the humerus are presented. Materials and methods: Patients treated between 1983 and 2000 for ESFT of the humerus were included. The impact of local treatment (surgery, radiotherapy or both) on outcome was assessed. Results: 55 patients: 34 males (62%); 21 females (38%); mean age: 17.9 (range: 3-40). Local treatment: surgery in 27 patients (49%), radiotherapy in 17 (31%) and surgery followed by radiotherapy in 11 (20%). After a mean follow-up of 15 years (range: 7-25 years), 27 patients (49%) remained continuously disease free, 27 (49%) relapsed and one died of chemotherapy toxicity. The local recurrence rate was 13% overall: 18% (3/17) after radiotherapy, 7% (2/27) after surgery and 19% (2/11) after ...
Lipiodol, lipid soluble contrast media, was applied to 59 patients, who was clinically suspected to have hepatic tumor, in the Department of Diagnostic Radiology, Seoul National University Hospital. The results of the clinical use of Lipiodol were as follows: 1. The clinical diagnosis was hepatocellular carcinoma (HCC) in 50 cases, cavernous hemangioma in 4 cases, metastasis in one case and others in 4 cases. 2. After hepatic arteriography, Lipiodol only was injected in 28 cases, mixture of Lipiodol and Mitomycin was injected in 22 cases and transcatheter arterial embolization was performed additionally after injection of Lipiodol and Mitomycin in 9 cases. 3. Among the 50 cases of HCC, Lipiodol was accumulated in the lesion in 49 cases. However, similar accumulation of Lipiodol occured in a metastatic cancer and cavernous hemangiomas. 4. Plain radiographic patterns of Lipiodol accumulation could be divided into fine granular type, nodular type and linear or ...
1. Ro 15-8081 (Hoffmann-La Roche, Basle, Switzerland) is a novel mixed 5-HT/noradrenaline uptake inhibitor producing potent antinociceptive effects in animal pain models. 2. In healthy man, two models...Full Text Available
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains an enigmatic medical condition. Creation of the (NIH) Chronic Prostatitis Collaborative Research Network (CPCRN) funded by...Full Text Available
Severe affective and behavioral dysregulation, labeled as severe mood dysregulation (SMD), is a widely spread phenomenon among adolescent psychiatric patients. This phenotype constitutes severe impairment across multiple settings, including various symptoms, such as non-episodic anger, mood instability, and hyperarousal. Moreover, SMD patients often show depression and reduced need for sleep. Despite a lifetime prevalence of 3.3%, systematic research is still scarce, and treatments that have been established do not account for the range of symptoms present in SMD. Considering the circadian dysfunctions, two hormones, melatonin and cortisol, are essential. When these hormones are dysregulated, the circadian rhythm gets out of synchrony. Since evidence is emerging showing that the worse the ...
We analyzed 16 radiographic features of primary Ewing's sarcoma in 342 patients from the IESS 7299 (Intergroup Ewing's Sarcoma Study) for prognostic significance. Of these, 3 features demonstrated a statistically significant relationship to survival: maximal tumor dimension, tumor location, and an appearance of honeycombing within the lesion. Those individuals with primary lesions centered in the pelvis, femur, or humerus had a worse survival rate than those with lesions centered elsewhere. Similarly, we observed an inverse relationship between the greatest dimension of the osseous portion of the lesion and survival. The radiographic finding of honeycombing also showed a statistical association with improved survival. However, this feature was observed infrequently, and its significance should be assessed further. Otherwise, no other feature that we analyzed showed any relationship to patient prognosis. ...
This review briefly discusses the clinical and basic science rationale for vagus nerve stimulation (VNS) in treatment-resistant depression (TRD). As the number of treatment failures for depression increases, the likelihood of achieving remission during acute treatment decreases, and the risk of relapse increases with the number of treatment failures. Two open trials of adjunctive VNS for TRD showed positive acute results and a growing benefit over time. The results of the acute randomized controlled trial were not significant for the primary outcome (response by HRSD-24), but the secondary measure (IDS-SR-30) was significant for VNS. A 12-month nonrandomized comparative analysis of patients receiving adjunctive VNS with TRD patients receiving treatment as usual showed significant results f...
Rectus sheath hematomas are a frequent but sometimes misdiagnosed disease in patients under anticoagulative drugs, hemodialysis, or simply in the elderly. The most frequent localization is in the lower part of the abdomen: the explanation lies in the anatomy of the abdominal wall, especially in the arcuate line of the rectus sheath. Aim of this work is to explain the reason of the almost constant location correlating the anatomy with the CT features. The rectus abdominis muscle lies between the aponeuroses of the transverse and oblique muscles which form the so called rectus sheath. This arrangement is found from the costal arch to a level approximately between the umbilicus and the pubic symphisis, where the rear layer of the rectus sheath ends with a curved edge, called the arcuate or semicircular line of Douglas. Beneath this line the aponeuroses of the three muscles pass in front of the rectus which is separated from the peritoneum only by the fascia ...
Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of ...
To evaluate the current situation and implementation of embolization of uterine leiomyomas into the treatment concept in women with symptomatic uterine leiomyomas in Germany. A questionnaire addressing the clinical background of uterine myomas, recommended treatment concepts, preclinical evaluation, technical approach and complications was sent to 164 departments of gynecology and radiology in Germany. 33 radiological departments and 19 gynecological departments submitted a completed questionnaire. Only 7 departments of radiology reported to have own experience with embolization of uterine leiomyomas, while only 2 departments of gynecology considered embolization as an alternative treatment option in patients with symptomatic leiomyomas. 18/33 radiological departments offer this treatment option but get no patient referrals. Agreement was found concerning the indications for treatment, preclinical evaluation by ultrasound and MRI, preferable ...
This paper is a progress report on the role of radiation therapy (RT) in local tumor control and the decreased incidence of pulmonary metastasis in 251 patients entered in the Intergroup Ewing's Sarcoma Study. All were followed for more that 1 year, and their RT records were reviewed. Doses to the primary tumor in the range of 4,500--6,500 rad were administered over approximately 5 to 6 weeks in combination with 4 drugs, i.e., vincristine (VCR), dactinomycin (DAC), cyclophosphamide (CY), and adriamycin, or only the first 3. One group of patients received the 3 drugs and bilateral pulmonary irradiation (approximately 1,500 rad in 2 wk). Preliminary analysis showed a local primary tumor control of approximately 90%. Patients with lesions in the pelvis and humerus had local failure rates of 13% (7 of 54) and 21.4% (6 of 28), respectively. The treatment groups differed significantly in the incidence of ...
Purpose: To determine the value of MRI in the postoperativ evaluation of a singular ventricle compared to echocardiography and cardiac catheterization. Materials and methods: Thirty-one patients (range: 6 months to 30 years) with a functional single ventricle following palliative corrective operations. Five patients had a Blalock-Taussig-Shunt, 8 patients a Glenn-Anastomosis and 18 a cavopulmonary shunt (6 with classic Fontan-Circulation, 12 with modified cavopulmonary anastomosis). The results in terms of postoperative morphologic changes were compared to percutaneous echocardiography (31/31) and cardiac catheterization (6/31). Results: Echocardiography, which was performed on all patients, could not visualize the entire length of the tunnel, the Glenn-Anastomosis or the central pulmonary arteries in 70% of the patients due to an inadequate acoustic window. MRI was able to ...
Cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were measured by stable xenon computerized tomography (Xe-CT) and acetazolamide test in 15 patients with cerebrovascular disease before and after extracranial-intracranial (EC-IC) bypass surgery for minor stroke, reversible ischemic neurological deficit or transient ischemic attack. All had angiographically shown occlusive lesions of the major arterial trunk. In the present series, global analysis showed that the bypass did not increase the resting rCBF, but did increase the rCRC. We divided the patients into four groups according to the preoperative resting rCBF and rCRC. All 3 patients with normal resting rCBF and reduced rCRC showed postoperative improvement of rCRC. Of 6 patients with reduced CBF and reduced CRC, three had postoperative increase in resting CBF and four had increased CRC. ...
In diabetic patients with autonomic neuropathy, it is suggested that there is a reduced uptake of [sup 123]I-metaiodobenzylguanidine (MIBG) in the heart. We compared the difference of myocardial [sup 123]I-MIBG accumulation between 4 diabetic patients with triopathy and 6 patients without it. In all 10 patients, coronary angiography and [sup 201]Tl imaging (rest and 4 hours later) were performed. [sup 123]I-MIBG (111 MBq) was administered intravenously and its imaging was recorded on 15 minutes and 4 hours after injection. In all 4 cases with triopathy, [sup 123]I-MIBG imaging showed defect in apical and inferior region. In 2 out of 6 cases without triopathy, rapid clearance was noticed in apical and inferior region. There was no significant stenosis in right coronary artery and no defect in initial and delayed [sup 201]Tl images in all cases. We concluded that diabetic autonomic ...
Brain glucose metabolism was evaluated in four patients with acquired immunodeficiency syndrome (AIDS) dementia complex using ["1"8F]fluorodeoxyglucose (FDG) and positron emission tomography (PET) scans at the beginning of therapy with 3'-azido-2',3'-dideoxythymidine (AZT, zidovudine), and later in the course of therapy. In two patients, baseline, large focal cortical abnormalities of glucose utilization were reversed during the course of therapy. In the other two patients, the initial PET study did not reveal pronounced focal alterations, while the post-treatment scans showed markedly increased cortical glucose metabolism. The improved cortical glucose utilization was accompanied in all patients by immunologic and neurologic improvement. PET-FDG studies can detect cortical metabolic abnormalities associated with AIDS dementia complex, and may be used to monitor the metabolic ...
Thirty-four patients with prostatic carcinoma were studied with quantitative bone scintigraphy and whole-body counting (WBC) 1 and 24 h after injection of [sup 99m]Tc-MDP before as well as two weeks and two months after orchiectomy. Thirteen of the patients had normal bone scintigrams and WBR at the three different investigations; 21 had skeletal metastases. The latter showed throughout the study higher local gamma camera count rates as well as WBR values than the patiens with normal scintigrams. In these patients a ''flare phenomenon'', with an increase in count rate two weeks after orchiectomy followed by a decrease two months post-operatively, was seen with quantitative bone scintigraphy but not with WBC. However, WBC may be a valuable method indicating the total extent of skeletal metastases in the body, while quantitative bone scintigraphy is more accurate in the ...
Thirty-four patients with prostatic carcinoma were studied with quantitative bone scintigraphy and whole-body counting (WBC) 1 and 24 h after injection of "9"9"mTc-MDP before as well as two weeks and two months after orchiectomy. Thirteen of the patients had normal bone scintigrams and WBR at the three different investigations; 21 had skeletal metastases. The latter showed throughout the study higher local gamma camera count rates as well as WBR values than the patiens with normal scintigrams. In these patients a ''flare phenomenon'', with an increase in count rate two weeks after orchiectomy followed by a decrease two months post-operatively, was seen with quantitative bone scintigraphy but not with WBC. However, WBC may be a valuable method indicating the total extent of skeletal metastases in the body, while quantitative bone scintigraphy is more accurate in the interpretation of individual skeletal ...
Objective: To investigate the value of MRI in the diagnosis of hepatic hilar cholangiocarcinoma. Methods: Sixty-four patients with hepatic hilar cholangiocarcinomas confirmed by surgery or pathology underwent MRI using a 1.5-T superconductive MR system including conventional unenhanced MRI, MRCP and dynamic contrast-enhanced MRI with Gd-DTPA. Results: Dilatation of the intrahepatic biliary tree with narrowing, occlusion or filling defects in the hepatic hilar bile ducts was noted in all 64 cases. Unenhanced MR[ showed T_1- and T_2-hyperintense hilar masses in 42 patients and was normal in the remaining 22 patients. The hilar masses demonstrated slow, progressive and delayed enhancement patterns. There was enhancement of the thickened bile duct wall with luminal narrowing in the 22 patients without hilar masses. Conclusion: The characteristic MRI findings of enhancing hepatic hilar ...
Objective: To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma, especially in the complex cases of which the hepatic ducts are invaded. Methods: Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses. The cause of hilar obstructions in these patients were all cholangiocarcinoma, including Bismuth classification type II (n 12), IIIa (n 17), IIIb (n 10), and IV (n 6). Two or 3 stents were placed in the configuration of T, Y or X over the strictures. Results: Stent placement with 2 or 3 endoprostheses was successful in all patients. All patientsshowed significant decrease in serum bilirubin level. The mortality rate within 30 days of stent placement was 2.2% (1/45). The mean survival and stent patency times were ...
Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with ...
To assess the utility of magnetic resonance (MR) imaging in the study of pediatric patients with clinical suspicion of pituitary disease. We studied 18 patients aged 7 to 18 years.Fifteen had hormonal disturbances, two presented amenorrhea and 1 complained of headache, fever and symptoms of polyuria and polydipsia. All the patients were examined using a Siemens SP 42 1-Tesla MRI scanner. Sagittal and coronal T1-weighted spin-echo images were obtained; in addition T2-weighted spin-echo or fast spin-echo imaging was performed in ten cases and intravenous gadolinium was administered in nine. We found 9 patients with hypothalamic-pituitary dysgenesis, 2 with germinoma, 2 cases of pituitary hemosiderosis in patients with thalassemia, 2 cases of microadenoma, one abscess, one case of idiopathic central diabetes insipidus and one of Langerhans cell histiocytosis. MR enabled us to assess ...
Lupus pernio of the nose is the most characteristic cutaneous lesion of sarcoidosis. It is cosmetically disfiguring and can be the cause of significant morbidity. In particular, the affected skin is often red or purple due to increased vasculature. It is particularly resistant to both surgical and medical therapy. We describe a patient with lupus pernio affecting her nose, which showed a dramatic improvement following treatment with the pulse dye laser (PDL). A biopsy taken after treatment showed the continued presence of sarcoidal granulomas. We therefore feel that treatment with the PDL is an effective tool in improving the cosmetic appearance of lupus pernio, but does not influence the underlying disease process. PMID:11360426
The quality of the end product from andrology services continues to lack consistency and in some cases fails to meet the needs of the end users (patients or clinicians). Results of external quality assessment (EQA) schemes continue to show unacceptably wide variation for the results of a single specimen. Some laboratories are able to show that the results of semen analyses relate to both natural and assisted pregnancy and are therefore useful in the management of the infertile couple, whereas others claim that their value is limited to the identification of severe male factor infertility. With wide variation in standardisation of methodology, levels of staff training and quality assurance, it is entirely understandable that such discrepancies persist. The following article proposes that Qu...
In order to stress the role of computed tomography (CT) in the evaluation of benign spinal osteoblastoma, the authors examined by CT 10 patients with surgically and histologically proved osteoblastomas of the spine. Basing on surgical and histopathological findings CT proved to be a very important method for attesting the presence of the tumors (usually showed by radiographic examination), and specially for their staging and follow-up. CT in fact showed the real extent of the tumor into the spinal canal and towards the paraspinal soft tissues, and allowed the aerly detection of post surgical relapses. The authors conclude that CT is a primary diagnostic modality for preoperative planning and follow-up of benign osteoblastoma.
Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr/sup 85/-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.
Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR"8"5-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author).
Quantitative bone scans were evaluated in 16 patients with osteoporosis and in a control group of 7 healthy subjects. Along with a detailed biochemical analysis of calcium-phosphorus metabolism and standartized reongenographs, a quantitative dynamic bone scintigraphy was performed according to the method proposed by the authors. The bone-accumulating factor K_b was determined on the base of mathematical analysis of the graph reflecting activity changes in bone tissue unit during the investigation, the blood-elimination factor K_h and kidney-elimination factor K_k. In addition the accumulation index AI (in %) was calculated as a relation between the activity in bone tissue unit, registered in 20 min interval, and the activity in soft tissues for the same time. Whereas the static gamma camera scintigraphy, made 3-4 hrs after injecting of the osteotrope radiopharmaceuticals, showed no specific changes in the patients examined, ...
We present changes in the p53 gene in a group of 70 thyroid tumours and 40 blood samples obtained from children from Belarus. Three thyroid tumours show a polymorphism in exon 6 (codon 213) and 5 tumours show a polymorphism in intron 6, 37 bp upstream to the 5'-end of exon 7. Only one patient has a mutation in exon 7 (codon 258) resulting in an amino acid substitution in the protein p53. The distribution of polymorphisms in the 40 blood samples was as follows: three patients had a polymorphism in exon 6 and two persons had a polymorphism in intron 6. One polymorphism in intron 6 was also found in the group of 30 healthy children from Belarus. The fact that the differences in the sequence in p53 found in the tumours was also seen in the blood of these patients demonstrates that they are polymorphisms not induced by radiation exposure. It is difficult to conclude, if the polymorphisms ...
Central nervous system (CNS) manifestations in acquired immunodeficiency syndrome (AIDS) patients are an early and common feature. The spectrum of AIDS-related CNS diseases are encephalitis caused by the human immunodeficiency virus(HIV) itself, opportunistic infection, infarct and malignancy. We experienced two cases of CNS involvement in AIDS and they were serologically diagnosed as HIV encephalitis and CNS toxoplasmosis, respectively. In the case of the HIV encephalitis patient, brain MRI showed a non-enhancing lesion with high signal intensity on T2WI and low signal on T1WI and there was no mass effect on the right frontal lobe, periventricular white matter, splenium of the corpus callosum or bilateral basal ganglia. In the other case of CNS toxoplasmosis, MR showed multiple nodular and rim enhanced mass lesions in the right basal ganglia, thalamus and periventricular white matter, which were of low ...
Purpose: With intracranial tumors a flat, contrast-enhancing, probably dural structure adjacent to the tumor can occasionally be observed on gadolinium-DTPA enhanced MR images. Therefore we have attempted to evaluate a tumor infiltration of this enthancement on MRI. Material and Methods: This study included 50 patients. 19 patients had a dural thickening at the tumor base (13 meningiomas and 6 metastases), while 31 patients did not (12 meningiomas and 19 metastases). Studies included plane T_2-weighted spin echo (SE) images as well as T_1-weighted axial, coronal, or sagittal plains with and without contrast agent. Histopathological examinations, were done on the tumor base adjacent to the dura mater. Results: 7 of 12 meningiomas showed a meningeal thickening on MRI with histopathologically proven tumor infiltration as did also 5 of 6 metastases. But 3 of 12 meningiomas and 15 of 19 metastases without ...
The aim of the present study was to test a mathematical model of the biochemical processes in the parathyroid glands responsible for the secretion of parathyroid hormone resulting from extracellular calcium reduction. A double exponential curve described the parathyroid hormone secretion induced by rapid lowering of blood-ionized calcium in humans with normal as well as abnormal parathyroid tissue. Our data show that it was possible to establish a simple mathematical model of the parathyroid hormone response to blood-ionized calcium lowering, sufficient to fit experimental data obtained from patients with abnormal and normal parathyroid tissue. The fitted parameters showed no significant differences between patients with insulin-dependent diabetes mellitus and controls. In primary hyperparathyroidism, the parathyroid hormone production and steady-state transport across the cell membrane were increased, ...
Purpose: Patients with ataxia-telangiectasia (A-T) show greatly increased radiation sensitivity and cancer predisposition. Family studies imply that the otherwise clinically silent heterozygotes of this autosomal recessive disease run a 3.5 to 3.8 higher risk of developing cancer. In vitro studies suggest moderately increased cellular radiation sensitivity of A-T carriers. They may also show elevated clinical radiosensitivity. We retrospectively examined patients who presented with severe adverse reactions during or after standard radiation treatment for mutations in the gene responsible for A-T, ATM, considering a potential means of future identification of radiosensitive individuals prospectively to adjust dosage schedules. Material and Methods: We selected 20 cancer patients (breast, 11; rectum, 2; ENT, 2; bladder, 1; prostate, 1; anus, 1; astrocytoma, 1; Hodgkins lymphoma, 1) ...
Primary Ewing's sarcoma of the skull is a very rare entity. We report MRI findings in a case of Ewing's sarcoma of the greater wing of sphenoid in a 4-year-old patient. Magnetic resonance imaging showed markedly heterogenous signal intensity with areas of haemorrhage and necrosis. It also demonstrated the exact extent of tumour due to its multiplanar capabilities and was, therefore, helpful in planning surgery. Copyright (2002) Blackwell Science Pty Ltd
Computed tomography was performed on 5 patients with chronic cerebral paragonimiasis. CT showed solitary or multiple, amorphous, round, or oval calcifications, and ventricular enlargement in all 5 cases. A large low-density area is also found in 4 of the 5 cases. These CT findings are compatible with previously reported findings of simple X-ray films of the skull, pneumoencephalography, and pathological studies. (author).
A prospective, side-by-side comparison study of two different lasers for the treatment of solar- induced telangiectasia was carried out in 14 patients at the Beckman Laser Institute and Medical Clinic. The argon tunable dye laser (Coherent, Palo Alto, Calif.) was used in the method modified from Orenstein and Nelson to completely treat discrete telangiectasias on one cheek. Specifically, the argon tunable dye laser (ATDL) was set at 0.7 - 0.8 watts, 585 nm wavelength, shutter-pulsed at 0.1 second duration with a spot size of 0.1 mm, and individual vessels were 'traced out' with 4X loupe magnification. Each patient's opposite cheek was then treated in the standard fashion with the flashlamp pulsed dye laser (Candela, Natick, Mass.) using a technique similar to Polla's et al. Specifically, the flashlamp pulsed dye laser (FPDL) was set at 585 nm wavelength, pulsed mode of 450 microseconds pulse duration, spot size of 5 mm, overlapping 10 - 20%, ...
Quantitative bone scintigraphy was performed in patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months after operation. The count rate was recorded as serial gamma camera images over the lower thoracic and all lumbar vertebrae from 1 to 240 min and at 24 h after injection of "9"9"Tc"m-MDP. In almost all abnormal vertebrae an increased count rate was observed within one hour after injection. Most of the vertebrae which were considered normal at 4 h after injection, but had an increased 24h/4h ratio developed into abnormal vertebrae later in the study. The patients with normal bone scintigrams showed no change in "9"9Tc"m-MDP uptake during the study. The reproducibility of quantitative bone scintigraphy was found to be #+-# 7% (1 SD). In response to therapy, most of the patients with abnormal bone scintigrams showed an increase in count rate two ...
The authors carried out a retrospective study on 4 years' work on a series of patients with proved active tuberculosis examined in the Departments of Bronchopneumology and Infectious Disease of the Arezzo Civil Hospital. The population was heterogenerous from the immunologic viewpoint. This paper compared the effectiveness of Computed Tomography (CT) with that of conventional chest radiography (CR) in the diagnosis and prognosis of tuberculosis. All patients underwent chest CR in double projection and conventional CT studies of the chest; 16 patients were also submitted to high resolution CT (HRCT). Consolidation was the most frequent parenchymal lesion in immunocompetent patients; it was often associated with cavitation, with no clear topographic prevalence in the upper lobes. Pleural effusion, as the only sign of disease and with empyema features, was found in 10 immunocompetent ...
To examine and evaluate the predominant and common etiologic agent(s) of urinary tract infection (UTI) in Sukkur city and to determine their current antibiotic susceptibility/resistance trends. Nine hundred sixty six patients out of 1430 abnormal urine reports (showing significant abnormalities such as protein, pus, red cells) were asked to give second sample. The urine samples were examined by both urine test strip (Combur 10 Test, Roche) and microscopically (wet preparation) followed by culture and sensitivity. The culture sensitivity was done on urine samples of which bacterial numbers were estimated as more than 105CFU. The study was conducted at Safeway Diagnostic and Research Laboratory Sukkur and the Department of Microbiology, Shah Abdul Latif University Khairpur, Sindh from March 2001 to March 2003. Eight hundred fifty-two (88.2%) showed Escherichia spp followed by Klebsiella spp (6.9%) and proteus spp (4.9%). ...
Authors obtained T1-weighted MRI images of the femoral head after fracture of the femoral neck and classified the signals into four patterns to investigate the sequential changes of the femoral head. The T1-weighted MRI images obtained initially after femoral neck fracture showed a normal pattern in 10 of the 15 hip joints studied. MRI images obtained subsequently still showed the normal signal pattern in eight of the 10 hip joints which had shown the normal pattern in the first MRI, while two of the 10 joints subsequently showed a band pattern. The joint with the homogeneous pattern in the first MRI subsequently showed a band pattern. Of the three joints with an inhomogeneous pattern in the first MRI, two joints showed a subsequent band pattern, and the other a normal pattern. The joints which showed a band pattern continued to show a ...
In order to consider some procedures to prevent errors in radiotherapy based in learned lessons of accidental expositions and in accordance with information contained in international reports elaborated by International Atomic Energy Agency (IAEA) and of the data base availability by the European group Radiation Oncology Safety Information System (ROSIS) on the events, a research of the occurred errors was performed. For the evaluation of the incidents a data base based in the ROSIS and added plus a parameter was created 'type of error'. All the stored data make possible the evaluation of the 839 incidents in terms of frequency of the type of error, the process of detention, the number of reached patients and the degree of severity. Of the 50 types of found errors, the type of error more frequently was 'incorrect treatment coordinate', confirmed with the data of literature and representing 28,96 por cent of the total of the ...
Cockayne syndrome (CS) is a rare autosomal recessive disease, which shows diverse clinical symptoms such as photosensitivity, severe mental retardation and developmental defects. CS cells are hypersensitive to killing by ultraviolet (UV)-irradiation and defective in transcription-coupled repair. Two genetic complementation groups in CS (CS-A and CS-B) have been identified. We analyzed mutations of the CSA gene in 5 CS-A patients and identified 3 types of mutations. Four unrelated CS-A patients (CS2OS, CS2AW, Nps2 and CS2SE) had a deletion including exon 4, suggesting that there is a founder effect on the CSA mutation in Japanese CS-A patients. Patient CS2SE was a compound heterozygote for this deletion and an amino acid substitution at the 106th glutamine to proline (Q106P) in the WD-40 repeat motif of the CSA protein, which resulted in a defective nucleotide excision repair. ...
The aim of this work was to develop several strategies and software-packages for the evaluation of in-vivo-data of the human brain, which were acquired with high-resolution 1H-MRSI at 1.5 and 3 T. Several studies involving phantoms, volunteers and patients were performed. Quality assurance studies were conducted in order to evaluate the reproducibility of the applied MR-techniques at both field strengths. A qualitative comparison-study between MRSI-data from a 1.5 T clinical MR-scanner and a 3 T research MR-scanner showed the advantages of the more advanced MRSI sequences and higher field strength (3 T). A study involving patients with primary brain tumours (gliomas) was performed in cooperation with the Department of Neurosurgery (University of Erlangen-Nuremberg). The methods developed in the course of this study, such as the integration of MRS-data into a stereotactic-system, the segmentation of metabolic maps and the ...
Eight of 100 normotensive children who had pyelonephritic scarring secondary to urinary infection and vesicoureteric reflux were found in an earlier study to have increased plasma renin activity (PRA). Because the risk of these patients becoming hypertensive is between 10% and 20% and because renin activity may play a part in the pathogenesis of the hypertension, PRA and blood pressure were studied in 98 of the original group after five years of follow up. Two patients could not be traced, and other factors that might influence blood pressure or PRA led us to exclude 13 others, 10 of whom were girls taking oral hormonal contraceptives. Increased PRA was found in 11 of the remaining 85 patients but not in five of the eight patients with increased PRA in the first study. Of eight children identified as hypertensive in the follow up study, only three had had increased PRA five years previously. In normal ...
The purpose was to evaluate low-dose CT colonography without cathartic cleansing in terms of image quality, polyp visualization and patient acceptance. Sixty-one patients scheduled for colonoscopy started a low-fiber diet, lactulose and amidotrizoic-acid for fecal tagging 2 days prior to the CT scan (standard dose, 5.8-8.2 mSv). The original raw data of 51 patients were modified and reconstructed at simulated 2.3 and 0.7 mSv levels. Two observers evaluated the standard dose scan regarding image quality and polyps. A third evaluated the presence of polyps at all three mSv levels in a blinded prospective way. All observers were blinded to the reference standard: colonoscopy. At three times patients were given questionnaires relating to their experiences and preference. Image quality was sufficient in all patients, but significantly lower in the cecum, sigmoid and rectum. The two ...
A selected series of 24 patients with displaced medial femoral neck fracture, treated with closed reduction and osteosynthesis with cancellous bone screws (ASIF), were investigated. During an observation period of 6 to 26 months, serial hip joint scintigraphies were performed and compared with serial X-ray examinations. At the first scintigraphic examination performed on average 5-6 weeks after the fracture, two separate investigators found a decreased amount of activity or no activity in the femoral head of 10 and 8 patients, respectively. At the second scintigraphic examination performed on average 11.1 weeks after the fracture both investigators found no activity or a decreased amount of activity in 8 patients. This figure declined to 7 during the following period, because one patient with decreased activity was recorded as having normal activity 15 months after the fracture. These 7 ...
Cervix cancer is the most common female cancer in Korea. In spite of their relatively local invasive tendency, still 44% of patient will develop recurrent cancer This result suggests that more aggressive local treatment may increase the cure rate but increased complication risk also cannot be avoidable. Various institutions proposed different treatment regimen, but recommended dose were about 4500 cGy for whole pelvis and 8000 cGy at point A, even though they agreed that those doses may not be satisfactory for control of bulky disease. 96 cases of invasive cervical cancer, treated with postoperative or primary radiation therapy were analyzed to determine the complication rate and prognostic factor in our treatment regimen which is 500-1000 cGy higher than other institution. Mean follow up duration was 21 months. Symptomatic patients including mild but persistent abdominal discomfort was 46%, but only 1 patient (1%) had ...
BACKGROUND: Denys-Drash Syndrome (DDS) is an uncommon disorder that appears sporadically and in rare cases may be inherited as an autosomal dominant trait It manifests either at birth or within the first year of life and typically consists of the triad of congenital nephropathy, Wilms tumour and intersex disorder. CASE REPORT: A 10 year-old Caucasian girl was referred to the Dental Department, at Glasgow Royal Hospital for Sick Children by her Paediatric Nephrologist Consultant. The patient was being teased by her peers over her markedly discoloured teeth. The dental history revealed that the patient was a regular dental attendee from an early age. She was dentally anxious having only experienced dental treatment under general anaesthesia (GA) when she was 4 years old. Apparently her primary dentition also showed a generalised discolouration. TREATMENT: This consisted of multiple visits for diet analysis and tooth brushing ...
a-Dystroglycan is an extracellular adhesion protein that is known to interact with different ligands. The interaction is thought to stabilize the integrity of the plasma membrane. The N-terminal part of a-dystroglycan may be proteolytically processed to generate a small 38kDa protein (a-DG-N). The physiological significance of a-DG-N is unclear but has been suggested to be involved in nerve regeneration and myelination and to function as a potential biomarker for neurodegenerative and neuromuscular diseases. In this report we show that a-DG-N is released into different body fluids, such as lachrimal fluid, cerebrospinal fluid (CSF), urine and plasma. To investigate the significance of a-DG-N in CSF we examined the levels of a-DG-N and known neurodegenerative markers in CSF from patients di...
Much progress has been made in the clinical, biological and technical aspects of the T-cell-depleted haploidentical hematopoietic stem cell transplantation (HSCT). Our experience demonstrates that infusing a megadose of extensively T-cell-depleted hematopoietic peripheral blood stem cells after an immuno-myeloablative conditioning regimen in acute leukemia patients ensures sustained engraftment with minimal GvHD without the need of any post-transplant immunosuppressive treatment. Since our first successful pilot study, our efforts have concentrated on developing new conditioning regimens, optimizing the graft processing and improving the post-transplant immunological recovery. The results we have so far achieved in high risk acute leukemia patientsshow that haploidentical transplantation ...
Background: This study investigates the psychometric properties of the Patient Health Questionnaire-2 (PHQ-2) in the general population of Hong Kong. Methods: Random sampling was used to recruit 6028 participants aged 15years or over. Among them, 203 were surveyed twice within a two-week period. Participants completed the Chinese version of the PHQ-9 (including 2 items of the PHQ-2), the Chinese Health Questionnaire, the Happiness Scale, the SF-12, and questions about diagnosis and health service utilization. Internal consistency, test-retest reliability, construct and discriminant validity of the PHQ-2 were assessed. Results: Cronbach's a was 0.76. The test-retest reliability over two weeks calculated by intraclass correlation was 0.70. Spearman correlation results showed that the PHQ-2 s...
A Quantitative Computed Tomography (QCT) method, simplifying the well-known technique proposed by Genant (1982) and applied to a standard third generation whole body CT scanner is described. This technique was applied in the measurement of the trabecular bone which has high sensitivity for metabolic changes. The BMC (Bone Mineral Content) measured in different groups of subjects (healthy postmenopausal patients versus women with postmenopausal osteoporosis) showed a highly significant difference (p<0.001). The precision of repositioning (coefficient of variation 1.8% to 2.3%, obtained in healty male patients) and the good, linear relationship computed from the phantom values, minimize measurement errors. Since this method is quickly applied and involves low-dose radiation-exposure, it could be introduced in the clinical study of metabolic bone diseases.
The practice of medical tourism depends on successfully informing potential patients about procedure options, treatment facilities, tourism opportunities, travel arrangements, and destination countries. The promotion of medical tourism includes a wide range of marketing materials such as flyers, booklets, and websites. Yet, there is a paucity of knowledge about the dissemination, content, and reception of these promotional materials. Drawing on a thematic content analysis of the promotional print material distributed at the first medical tourism trade show in Canada in 2009, the main purpose of this article is to identify and understand the messages and images that companies use to market India as a global destination. While researchers and news media frequently cite low cost procedures as...
In a 47-year-old male patient a bronchopleural fistula was apparent 22 days after extended right-sided diaphragma-pericardio-pleuro-pneumonectomy for pleuramesothelioma. The thoracic cavity was infected. Rethoracotomy was performed and the fistula was closed using an omental pedicle flap. The bronchial stump became tight and the cavity fluid became sterile. No abdominal complications were seen. The patient died 8 months later from malignant pericardial infiltration. The ability of greater omentum to revascularize ischemic tissue, to absorb fluid and to resist local infection is proved and used in several subspecialities of surgery. Nevertheless the use of the greater omentum in the management of bronchopleural fistula has been rarely published. The reported case shows that the closure of a large bronchopleural fistula is possible by using the attributes of the omental tissue. PMID:2264043
Since the fluoroscopic image during nasoenteral tube placements is used for guidance and not for diagnosis, a lower contrast image with increased quantum mottle can be easily tolerated. The three methods to reduce the radiation dose rate investigated consisted of removing camera from the image intensifier output phosphor, and setting the fluoroscopic mA to the minimum value so that the kVp could be maximized. Fluoroscopic frozen video frames of a clinical tube insertion comparing the images with and without the dose-saving techniques are presented. Measurements of the radiation dose rates using a Plexiglas phantom show that the dose for patient and staff during fluoroscopic-guided nasoenteral tube placements can be reduced by over a factor of 10 without significantly adversely affecting the actual placement procedure. (author).
A successful boron neutron capture treatment (BNCT) of a patient with multiple liver metastases has been first given in Italy, by placing the removed organ into the thermal neutron column of the Triga research reactor of the University of Pavia. In Finland, FiR 1 Triga reactor with an epithermal neutron beam well suited for BNCT has been extensively used to irradiate patients with brain tumors such as glioblastoma and recently also head and neck tumors. In this work we have studied by MCNP Monte Carlo simulations, whether it would be beneficial to treat an isolated liver with epithermal neutrons instead of thermal ones. The results show, that the epithermal field penetrates deeper into the liver and creates a build-up distribution of the boron dose. Our results strongly encourage further studying of irradiation arrangement of an isolated liver with epithermal neutron fields.
To evaluate the usefulness of portable chest radiographs by Fuji computed radiography (FCR) in ICU, FCR radiographs of 56 patients who were admitted to General Intensive Care Unit of Keio University Hospital were compared with the conventional portable images. Because FCR could show two differently processed images in one film and allowed a wide range of image reproduction, visualization of the trachea, bone soft tissues and catheters by FCR was easier than that by the conventional radiography. Repeated radiographs by FCR had similar optical densities and limited exposure errors. Furthermore, radiation was reduced than that of the conventional radiography. In conclusion, FCR is thought to be a useful technique for portable chest radiography in ICU patients. (author).
To evaluate the usefulness of portable chest radiographs by Fuji computed radiography (FCR) in ICU, FCR radiographs of 56 patients who were admitted to General Intensive Care Unit of Keio University Hospital were compared with the conventional portable images. Because FCR could show two differently processed images in one film and allowed a wide range of image reproduction, visualization of the trachea, bone soft tissues and catheters by FCR was easier than that by the conventional radiography. Repeated radiographs by FCR had similar optical densities and limited exposure errors. Furthermore, radiation was reduced than that of the conventional radiography. In conclusion, FCR is thought to be a useful technique for portable chest radiography in ICU patients. (author).
Abstract Background: Dementia with Lewy bodies (DLB) is a common dementia of the elderly. A significant cholinergic deficit has been demonstrated that may be responsive to treatment by cholinesterase inhibitors (ChEIs). Methods: A 24-week, open-label study was designed to assess the efficacy and safety of a ChEI, galantamine, in 50 patients with DLB. Results: This study showed beneficial effects with galantamine in 2 of the 3 primary efficacy parameters. The scores on the Neuropsychiatric Inventory (NPI-12) improved by 8.24 points from baseline (p = 0.01) especially in visual hallucinations and nighttime behaviors (p = 0.004). The scores on the Clinician's Global Impression of Change improved by 0.5 points from baseline (p = 0.01). The third primary efficacy parameter, the Cognitive Drug R...
In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.
Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty....Full Text Available
In recent years RNA interference (RNAi) has rapidly become the most widely used tool for gene knockdown due to its high specificity and potency. RNAi is an evolutionarily conserved mechanism...Full Text Available
According to the International Headache Society, idiopathic stabbing headache (ISH), an indomethacin-responsive headache syndrome, is a paroxysmal disorder of short duration manifested as head pain...Full Text Available
Cryoanalgesia (the use of cold to provide anesthesia or analgesia) is the oldest anesthetic and analgesic still in current clinical use. Its intraoperative use in providing postoperative analgesia for...Full Text Available
When attempting to feed on their hosts, ticks face the problem of host hemostasis (the vertebrate mechanisms that prevent blood loss), inflammation (that can produce itching or pain and thus...Full Text Available
BackgroundAdhesive capsulitis is a common, painful, and disabling condition that has been managed with corticosteroid injections for over 50 years. There is debate over the use of...Full Text Available
BackgroundDistraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies,...Full Text Available
ObjectivesThe updated Rome III criteria for pediatric functional gastrointestinal disorders (FGIDs) include new FGID categories and changes to the Rome II criteria...Full Text Available
This paper discusses the clinical application and main objective of testicular imaging. The authors present cases that represent a spectrum of the abnormalities which might be detected by testicular imaging, with special attention given to testicular torsion and the acute diseases which may mimic it clinically. Accuracy of the test is noted.
... Previous Topic Pain Next Topic Scars and wounds Prostheses Prostheses (pross-THEE-sees) are man-made substitutes ... covered by medical insurance (this includes wigs). Breast prostheses: Contact your local chapter of the American Cancer ...
Indomethacin, a potent nonsteroidal anti-inflammatory drug, has been used in the treatment of various kinds of pains, inflammation and arthritis. However, oral administration of indomethacin produces...Full Text Available
Osteoid osteoma of the spine is a relatively rare bone-forming tumor. Pain that is worse at night and relieved by aspirin and muscle contracture are the most characteristic symptoms of spinal osteoid...Full Text Available
Antagonists for kainate receptors (KARs), a family of glutamate-gated ion channels, are efficacious in a number of animal models of neuropathologies, including epilepsy, migraine pain, and anxiety....Full Text Available
The inflammatory process has direct effects on normal and abnormal wound healing. Hypertrophic scar formation is an aberrant form of wound healing and is an indication of an exaggerated function of...Full Text Available
A 63-year-old man was admitted to our hospital with a complaint of right lateroabdominal pain. He was diagnosed with metastatic colon cancer, and then developed multiple brain embolic infarctions 7...Full Text Available
Posterior spinal ligament pathology is becoming increasingly recognized as a significant cause of low back pain. Despite the growing clinical importance of interspinous ligament degeneration in low...Full Text Available
BackgroundThe analgesic effect of perioperative low doses intravenous lidocaine has been demonstrated after abdominal surgery. This study aimed to evaluate whether...Full Text Available
The somatic sensory system responds to stimuli of distinct modalities, including touch, pain, itch, and temperature sensitivity. In the past century, great progress has been made in understanding the...Full Text Available
Local anesthetics are able to induce pain relief by binding to the sodium channels of excitable membranes, blocking the influx of sodium ions and the propagation of the nervous impulse. Ropivacaine...Full Text Available
The first case of human sparganosis in Canada is reported in a 23-year-old woman who emigrated from Greece in 1969. Examination of a ribbon-like worm removed from a painful swelling in the neighbourhood...Full Text Available
The purpose of this investigation was to determine the association between gender and the prevalence and incidence of patellofemoral pain syndrome (PFPS). One thousand five hundred and twenty-five participants from the United States Naval Academy (USNA) were followed for up to 2.5 years for the development of PFPS. Physicians and certified athletic trainers documented the cases of PFPS. PFPS was defined as retropatellar pain during at least two of the following activities: ascending/descending stairs, hopping/jogging, prolonged sitting, kneeling, and squatting, negative findings on examination of knee ligament, menisci, bursa, and synovial plica, and pain on palpation of either the patellar facets or femoral condyles. Poisson and logistic regressions were performed to determine the association between gender and the incidence and prevalence of PFPS, respectively. The incidence rate for PFPS was 22/1000 person-years. Females ...
BackgroundLeukotrienes (LTs) belong to the large family of lipid mediators implicated in various inflammatory conditions such as asthma and rheumatoid arthritis. Four distinct types...Full Text Available
This case describes a 10-year-old girl who developed a Ewing's sarcoma in her proximal fibula. The radiologic features mimicked those of a unicameral bone cyst. The presence of pain and the atypical location led to a prompt biopsy and the correct diagnosis. The mechanism of this unusual radiographic presentation is discussed. (orig.)
Examination of a painful hip is fairly concise and reliable at detecting the presence of a hip joint problem. Hip joint disorders often go undetected, leading to the development of secondary disorders....Full Text Available
Low back pain is common during pregnancy. However, the prevalence of symtomatic lumbar disc herniation is rare, and cauda equina syndrome due to disc herniation during pregnancy is even rarer. We report...Full Text Available
BackgroundChronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there...Full Text Available
Multiple disease-specific systematic reviews on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive. To date, there have been two systematic reviews that...Full Text Available
IntroductionChest pain with ST-segment elevation is a rare clinical problem during dobutamine stress testing. Although beta-agonists treatment prior to dobutamine stress testing...Full Text Available
Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze...Full Text Available
A 23-year-old woman presented to our hospital with nonspecific pain in the abdomen. She underwent radiological investigations, which revealed a solid and cystic mass in the tail end of the pancreas....Full Text Available
BackgroundBlood sampling through heel lancing is the most common invasive painful procedure performed on newborn infants.Case PresentationWe report...Full Text Available
BackgroundAcute low back pain is a very common symptom and reason for many medical consultations. In some unusual circumstances it could be linked to a rare aetiology.Case...Full Text Available
The overarching goal of medical training is to nurture the growth of knowledgeable, caring and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional...Full Text Available
The analgesic activity of nine substituted N-pyrrolylcarboxylic acids, previously reported as anti-inflammatory agents, has been evaluated. The effects on nociception were examined in male Wistar rats by the Randall-Selitto paw-pressure test. The compounds were administrated in doses 10, 20, and 40 mg/kg both i.p. and p.o. As a whole, the activities of 3-(N-pyrrolyl)propanoic acids 3e-3h and 2-[3-(ethoxycarbonyl)-2-methyl-5-phenyl-1H-1-pyrrolyl]-3-methylpentanoic acid 3i were comparable with or superior to that of metamizole used as a reference (200 mg/kg, i.p.), whereas only 3a from among the N-pyrrolyl-acetic acids 3a-3d showed analgesic activity on the inflamed paw. The compounds found most promising to increase the pain threshold significantly were the same ones with the higher anti-inflammatory activity registered in our previous study: 3-[3-(ethoxycarbonyl)-2-methyl-5-(3-nitrophenyl)-1H-1-pyrrolyl]propanoic acid 3e, together with its ...
Aim: Rheumatoid arthritis is a limiting disease having, among its pathological features, the inflammation of synovial tissue with progressive and later destruction of the articulation. This leads to joint deformation and loss of its function, generating pain and reducing the mobility of the affected articulation. The aim was to evaluate "1"6"6Ho-Hydroxyapatite ("1"6"6 Ho-HA) as potential radiopharmaceutical for the symptomatic treatment of chronic and acute arthritis. Materials and Methods: Holmiun-166 was produced by irradiation of Ho_2O_3 at La Reina Research Reactor, Nuclear Chilean Energy Commission. Hydroxyapatite was in-house synthesized. Its labelling and quality controls follows the internationally accepted procedures. An antigen's arthritis was induced to eight New Zealand rabbits with the "1"6"6 Ho-HA radiochemical being administered thereafter in two dosage modalities (single and double). The compound therapeutic efficiency was evaluated based upon ...
In an epidemiological study of the somatic late effects risk following incorporation of a short lived #alpha#-emitter, 1473 ankylosing spondylitis patients treated with repeated intravenous injections of "2"2"4Ra in the years 1948 - 75, have been observed in the GSF. The usual therapeutic plan consisted of a total of 10 - 12 injections of 1.036 MBq (28 #mu#Ci) of "2"2"4Ra each, given at weekly intervals; this would result in an cumulative #alpha#-dose of 0.56 - 0.67 Gy to the marrow-free skeleton of a 70-kg-man (standard man). These patients have been followed together with a control group of ankylosing spondylitis patients not treated with radioactive drugs and/or X-rays. Until May 1993 (mean follow-up time 19.9 yr), 595 patients of the exposure group and 722 patients of the control group have died, causes of death have been ascertained for 578, resp. 668 ...
Purpose: Budd-Chiari syndrome is a fairly uncommon disease in Europe. This often leads to its late diagnosis. The syndrome is characterised by portal hypertension and splanchnic congestion due to obstruction of hepatic venous outflow. This paper describes the treatment of three patients with Budd-Chiari syndrome by interventional therapeutic techniques and discusses alternative treatment modalities. Patients and Methods: The first patient presented with veno-occlusive disease and was treated by the placement of a transjugular intrahepatic portosystemic stentshunt. The second patientshowed an occlusion of the major hepatic veins. After percutaneous recanalisation, a stent was placed in the right hepatic vein which remained patent. The third patient had a membranous obstruction of the right hepatic vein which was treated by percutaneous balloon dilatation. ...
Objective: To compare the histopathology of nodular fasciitis (NF) with the magnetic resonance imaging (MRI) findings in order to evaluate the basis of the MR signal characteristics. Design and patients: Ten patients with NF, nine females and 1 male, with an age ranging from 13 to 58 years (mean 26.8 years) were studied. MRI findings, available in all 10 patients, were compared with the histopathology in nine patients, and an area-to-area comparative study of the whole specimen section histopathology and MRI was performed in two patients. Results: On the basis of an excisional biopsy or resection specimen, the nine lesions were classified into myxoid (n=4), cellular (n=3) and fibrous (n=2) subtypes. Four myxoid lesions with a subcutaneous location showed a homogeneous SI comparable with muscle on T1-weighted images, high SI on T2-weighted images, and had ...
The accuracy of dose computation within the lungs depends strongly on the performance of the calculation algorithm in regions of electronic disequilibrium that arise near tissue inhomogeneities with large density variations. There is a lack of data evaluating the performance of highly developed analytical dose calculation algorithms compared to Monte Carlo computations in a clinical setting. We compared full Monte Carlo calculations (performed by our Monte Carlo dose engine MCDE) with two different commercial convolution/superposition (CS) implementations (Pinnacle-CS and Helax-TMS's collapsed cone model Helax-CC) and one pencil beam algorithm (Helax-TMS's pencil beam model Helax-PB) for 10 intensity modulated radiation therapy (IMRT) lung cancer patients. Treatment plans were created for two photon beam qualities (6 and 18 MV). For each dose calculation algorithm, patient, and beam quality, the following set of clinically relevant dose-volume ...
A patient with a totally edentulous maxilla and a seVere Class III intermaxillary relationship in the anterior region was treated by implants. In the mandible, there were 10 teeth between the second premolars. The inclination and width of the maxillary anterior residual bone were measured on cephalometric X-ray film obtained before treatment. The results of cephalometric analysis did not support clockwise rotation of the mandible or lingual angling of the maxillary anterior teeth by use of prosthesis to improve the Class III relationship. Ten implants were simultaneously placed in the maxilla. Then, a maxillary temporary full bridge was seated after reduction of the crown lengths of the mandibular anterior teeth. An apically positioned flap operation was performed to eliminate periodontal pockets and to obtain clinically suitable crown lengths of the mandibular anterior teeth. A noncemented, screw-retained maxillary full bridge and a conventional mandibular full ...
Haemangiomas usually develop within the first few weeks of life, most regressing spontaneously before the age of 7 years. Some may ulcerate or compromise a vital function, in which case systemic corticosteroids, surgery or radiotherapy may be helpful. All of these treatment modalities are associated with significant morbidity. Treatment with the 585 nm flashlamp pulsed dye laser is safe and effective in the management of superficial vascular malformations. We report seven patients, under 12 months of age, who presented with proliferative haemangiomas, causing functional impairment. Ulcerated lesions were present in four patients. The patients were treated with the 585 nm pulsed dye laser (fluences 7.0-9.25 J/cm2), at intervals of 4-8 weeks. All of the lesions showed a significant reduction in size, together with improvement in the colour and integrity of the overlying skin. Treatment with the 585 nm ...
The anatomical patterns of anorectal malformations have so far been studied according to the principles which inspire Pena's technique for the surgical treatment of anorectal anomalies. Thus, the diagnostic study of anorectal malformation has by the authors been considered a work of classification, but of identification. Among the diagnostic procedures in use in author's Institute, preoperative CT of pelvis is performed to assess the presence and to define the development of muscular sphincteric structure towards prognostic evaluation of continence, the major long-term goal. Seven patients, aged 1-30 months, with anorectal anomalies were studied with preoperative CT of the pelvis. CT scans showed well-developed sphinteric muscles in 3 patients (2 with recto-ureteral and 1 with recto-vestibular fistulas), poorly-developed muscular structure in 3 patients (with recto-vaginal, cloacal and prostatic ...
MRI provides a non-invasive diagnostic tool complementing echocardiography on one hand, and showing advantages over echocardiography, on the other hand, especially after corrective procedures. The multiple different MRI sequences need to be adapted to examinations of children and patients with congenital heart disease (CHD), and can be used to detect morphologic changes, blood-flow in the heart and thoracic vessels and diastolic or systolic function of myocardium. Several factors determine the success of the examination of a complex congenital heart disease or a postoperative situs. Pediatric radiologists and radiologists experienced in congenital heart diseases have to work in close cooperation. Echocardiography should be performed before MRI. The results of prior examinations and the clinical history of the patients, including possible palliative or reconstructive operations, must be available before MRI to guide the ...
The MRI and CT appearances in 48 patients with histologically confirmed benign and malignant pleural abnormalities were compared retrospectively. Abnormal pleural changes were shown in 47 out of the 48 patients by high signal intensity of the pleura in T_2-weighted sequences and in contrast enhanced T_1-weighted sequences on MRI. CT showed abnormalities in 45 out of 48 patients. Delineation of pleural and pulmonary changes by CT was possible in 13 out of 23 cases, and pleural disease from effusions in 15 out of 28 cases. T_2-weighted MRI was successful in 14 out of 23 and 4 out of 28 cases, respectively. T_1-weighted images after contrast were successful in 20 out of 23 and 22 out of 28 cases, respectively. Indications of malignant pleural disease were the presence of mediastinal or circumferential involvement or involvement of the entire pleura, thickness of more than 10 mm and nodular changes. The ...
Fourteen patients with cervical hip fractures were treated with internal fixation using titanium screws. The femoral head vitality was evaluated with "9"9Tc"m-MDP scintigraphy and scintimetry within 2 weeks postoperatively and by serial low field magnetic resonance imaging (MR). Two patients with reduced radionuclide uptake (femoral head ratio =# 1.0), MR revealed a focal decrease of the signal intensity in the femoral head or neck at 2, 3 and 7 months after fracture, respectively. The radiographs in one of these patients were normal at 7 months after fracture. The second one showed signs of necrosis at 16 months and the last one developed delayed/non-union. With a non-ferromagnetic osteosynthesis the healing course after femoral neck fracture can be studied with low field MR equipment without disturbing artifacts. The time period between ischaemia and definite abnormalities on MR may embrace several ...
Ten patients with suspected islet cell tumors (seven with possible gastrinomas, three with insulinomas) underwent diagnostic evaluation with dynamic CT scanning, routine CT scanning, angiography, and sonography. Venous sampling was also performed in selected instances. Nine sites of gastrinoma and three insulinomas were confirmed surgically in eight patients. Two patients had negative surgical explorations. Routine CT demonstrated five of the nine gastrinomas and one of two insulinomas. Angiography was positive in six of nine gastrinomas and all three insulinomas. Sonography showed only two of the nine gastrinomas and two of the three insulinomas. Dynamic CT scanning demonstrated three additional lesions (two gastrinomas, on insulinoma) not visible on routine CT scanning. Although most of these lesions were visible arteriographically, dynamic CT scans at the appropriate level localized the pathology in ...
The volume of cortical activation as detected by functional magnetic resonance imaging (fMRI) in the visual cortex has previously been shown to be reduced following optic neuritis (ON). In order to understand the cause of this change, we studied the cortical activation, both the size of the activated area and the signal change following ON, and compared the results with results of neuroophthalmological testing. We studied nine patients with previous acute ON and 10 healthy persons served as controls using fMRI with visual stimulation. In addition to a reduced activated volume, patientsshowed a reduced blood oxygenation level dependent (BOLD) signal increase and a greater asymmetry in the visual cortex, compared with controls. The volume of visual cortical activation was significantly correlated to the result of the contrast sensitivity test. The BOLD signal increase correlated significantly to both the results of the ...
Fourteen surgical patients with non-hepatobiliary diseases were studied with "9"9Tc"m EHIDA imaging to evaluate the effect of total parenteral nutrition (TPN) on the hepatobiliary function. The duration of TPN ranged from 6 to 56 days; for 10 of the 14 patients it was between 6 to 10 days. The results showed that: (1) 11 of 14 patients had abnormal scintigraphic features. The most prominent findings were delayed liver excretion and prolonged blood clearance time. This fact suggests that not only the rate of excretion of the bile from the liver is decreased but the uptake ability of the hepatocyte is also impaired. (2) The effect of TPN on liver function is reversible. The authors conclude that in order to prevent irreversible damage of hepatobiliary function caused by TPN, the duration of TPN should not be too long and oral intake of nutrients should be resumed as soon as possible. (author). 9 refs, 3 ...
We developed a new breast surface coil for the supine position. The subjects consisted of 9 patients with breast cancer varying from 46 to 60 years of age (average: 52). The cancer image of the SPGR (CE+) method was compared with that of the FSMTC (MTC-SPGR (CE+)) method and that of the FSMTC (MTC-SPGR with fat-saturation (CE+)) method in the sagittal section after injection of Gd-DTPA (0.1 mmol/kg). Quantitative analyses were performed before and after injection of Gd-DTPA in 6 patients. Three patients were excluded from the quantitative analyses owing to the clear detection of tumors in the fat tissue. Signal intensity measurements were systematically performed in each region of interest (ROI), i.e. the cancer lesion, the surrounding mammary gland. Statistical analyses showed significant differences between the lesions using the FSMTC (MTC-SPGR (CE+)), and the FSMTC (MTC-SPGR with fat-saturation ...
A custom-built graphite-coated transmission ionization chamber is compared to the VacuDAP 2001 (VacuTec, Dresden, Germany), which has transparent conductive electrodes. A study was made of the dependence of response on x-ray tube potential for both types of chamber under identical conditions of exposure using over-table and under-table x-ray tubes. Since the calibration factor is the dose-area product of the radiation incident on the patient per chamber reading, it depends on the intrinsic response of the chamber as well as the effect of material in the beam between the x-ray tube and patient. Differences of about 20% were measured between the intrinsic and the over-table calibration factors and between the over-table and the under-table calibration factors for both chambers. The VacuDAP display is specifically calibrated for the over-table condition and would overstate the actual DAP in the under-table case. The intrinsic response of the ...
Quantitative bone scintigraphy was performed on 23 white females with post-menopausal osteoporosis and vertebral compression fractures. These patients were then entered into a randomized, double-blind clinical trial or sodium fluoride therapy (NaF=14, placebo=9) which included repeat bone scintigraphy every six months. Scintigraphic images were acquired for 500K counts per image over the total body with computer acquisition over the posterior thoracic and lumbar spine. Images were obtained on a wide field-of-view gamma camera two hours after injecting 15 mCi of Tc-99m MDP. Data analysis showed a significant reduction in the activity ratio of abnormal vertebral body to normal vertebral body in those patients treated with sodium fluoride (paired t-test p=0.0095). No significant change was observed in the control group of (p=0.142). These results suggest that sodium fluoride therapy promotes more rapid healing of osteoporotic ...
Identification of factors that determine individual patient risk for recurrence and progression in superficial papillary carcinoma of the bladder is a subject of extensive research as it would be a major outcome in patient management. It has been well recognized that traditional prognostic markers as tumor grade and stage are not accurate enough in predicting biological behavior. A large number of markers have been investigated as potential prognostic factors and relatively few can help in predicting outcome. Material and Methods: Forty-nine cases undergoing complete transurethral resection for primary superficial papillary transitional cell carcinoma were subjected to clinicopathologic evaluation as well as immunohistochemical staining for p53, bcl-2, cytokeratin 20 and Ki-67. The CAS-200 image analyzer was used to estimate the Ki-67 labeling index. Results: Recurrence was observed in 19 cases (38.8%) and progression in 7 cases (14.3%) with a ...
In this work, thermoluminescent dosimeters have been used to measure entrance surface doses (ESDs) of patients undergoing mammographic screening at the University College Hospital, Ibadan, Oyo state. The mean glandular doses (MGDs) were also calculated using the measured ESDs. The results showed that the ESDs ranged from 0.26 mGy to 21.26 mGy for the mediolateral oblique (MLO) views and 0.08 mGy to 5.36 mGy for the craniocaudal (CC) views. The calculated MGD ranged from 0.07 mGy to 3.57 mGy for the MLO views and 0.02 mGy to 0.98 mGy for the CC views. The possible reasons for the large variations in the individual ESD values and MGD values for both views are discussed using patients' data, equipment specific data and the technical parameters used for the examinations. Comparison showed that the mean ESD values and MGD values reported in this work are below published values. The mean of the ...
In this work, thermoluminescent dosimeters have been used to measure entrance surface doses (ESDs) of patients undergoing mammographic screening at the University College Hospital, Ibadan, Oyo state. The mean glandular doses (MGDs) were also calculated using the measured ESDs. The results showed that the ESDs ranged from 0.26 mGy to 21.26 mGy for the mediolateral oblique (MLO) views and 0.08 mGy to 5.36 mGy for the craniocaudal (CC) views. The calculated MGD ranged from 0.07 mGy to 3.57 mGy for the MLO views and 0.02 mGy to 0.98 mGy for the CC views. The possible reasons for the large variations in the individual ESD values and MGD values for both views are discussed using patients' data, equipment specific data and the technical parameters used for the examinations. Comparison showed that the mean ESD values and MGD values reported in this work are below published values. The mean of the calculated MGD ...
Background. In multiple myeloma 5 different infiltration patterns can be differentiated: 1. Normal appearance of bone marrow, 2. focal involvement, 3. homogeneous diffuse infiltration, 4. combined diffuse and focal infiltration, 5. 'salt-and pepper' pattern with inhomogeneous bone marrow with interposition of fat islands. Methods. For the fast and total acquisition of all patterns a combination of a T1-weighted spin echo sequence and a fat suppression technique is superior. The focal involvement is clearly demonstrated as areas of high signal intensity on e.g. STIR images. Diffuse involvement can be quantified objectively by calculation of the percentage of signal intensity increase after contrast material injection. MRI is superior to X-ray in focal and diffuse involvement. With ultrafast sequences a 'screening' of the whole red bone marrow as for myeloma infiltration is possible. Prognosis. In prognosis studies diffuse infiltration is inferior to focal involvement. ...
Each disease affecting the bile ducts tends to produce characteristic pattern of biliary dilatation: recurrent pyogenic cholangitis causes dilatation and straightening of the larger (central) intrahepatic ducts: clonorchiasis causes dilatation of the smaller (peripheral) intrahepatic ducts; and carcinoma along the extrahepatic ducts causes (proportional) dilatation and tortuosity of both larger and smaller intrahepatic ducts. To evaluate the specificity of the pattern and morphology of the dilated biliary tree on CT scans (CT characterization) three independent radiologists who were unifamiliar with the cases were asked to classify 62 CT scans in patients with obstructive jaundice. The case population consisted of 14 cases with recurrent pyogenic cholangitis, 18 cases with clonorchiasis and 30 cases with carcinoma along the extrahepatic ducts, which were intermixed randomly. Classification was made only on the basis of CT characterization: those scans ...
Each disease affecting the bile ducts tends to produce characteristic pattern of biliary dilatation: recurrent pyogenic cholangitis causes dilatation and straightening of the larger (central) intrahepatic ducts: clonorchiasis causes dilatation of the smaller (peripheral) intrahepatic ducts; and carcinoma along the extrahepatic ducts causes (proportional) dilatation and tortuosity of both larger and smaller intrahepatic ducts. To evaluate the specificity of the pattern and morphology of the dilated biliary tree on CT scans (CT characterization) three independent radiologists who were unifamiliar with the cases were asked to classify 62 CT scans in patients with obstructive jaundice. The case population consisted of 14 cases with recurrent pyogenic cholangitis, 18 cases with clonorchiasis and 30 cases with carcinoma along the extrahepatic ducts, which were intermixed randomly. Classification was made only on the basis of CT characterization: those scans ...
The main purpose of this work is to report the personal experience with addition of contrast-enhanced multiphase helical CT to unenhanced CT (Lipiodol CT) in the evaluation of patients with hepatocellular carcinoma treated with chemoembolization and to analyze the present role of oily agent CT. It has been retrospectively reviewed the examinations of 42 consecutive patients submitted to globla chemoembolization over a 2-year period. CT was performed 18-30 days after the treatment. The Lipiodol CT study was carried out with volume acquisitions. It has been considered as nodules all well-defined areas with dense oily agent uptake; uptake itself was classified as: 0=absent, I=lower tha 10% of the tumor volume; II=lower than 50%, III=50%, IV=homogeneous. Contrast-enhanced helical CT was performed with the 2-phase technique in 28 patients and with the 3-phase technique in 14; it has been considered as nodules all well-defined ...
Aim: The purpose of this prospective study was to evaluate the value of immunoscintigraphy (ISG) with anti-225.28S in clinically suspected ocular melanoma. Methods: For this purpose standardized ISG was performed in 36 patients using both planar acquisition and emission computed tomography (ECT). Ocular melanoma was present in 31 patients. In 21 patients therapy was enucleation of the eye. These specimens were evaluated by histology and immunohistochemistry in 11 of 21 patients. Results: Regarding the clinical diagnosis, ISG was positive only in 15 of 31 patients with ocular melanoma, regarding histology in 11 of 21 and regarding immunohistochemistry in 5 of 6 patients with a positive immunoreaction. 5 patientsshowed no immunoreactivity, their ISG was negative. Conclusion: Thus a good correlation between ISG and ...
Iron overload has been described in patients undergoing chronic hemodialysis. The present study was undertaken to evaluate a rapid, noninvasive method for determination of skin iron by the technique of diagnostic x-ray spectrometry (DXS). Thirty-five patients receiving chronic hemodialysis treatment entered the study and were compared with 25 normal controls. Since pathological skin iron deposition occurs mainly at the dermal-epidermal junction in the basal cells of the epidermis, measurements were made in the thenar eminence representing mainly epidermal tissue (FeE), and in the forearm representative mainly of dermis (FeD). The mean +/- SD FeE iron concentrations were equivalent to 14.5 +/- 8.8 and 18.2 +/- 10.2 parts per million wet weight tissue (ppm) and both were significantly higher than in normal controls in which they averaged 9.2 +/- 2.5 ppm (P less than 0.005) and 10.2 +/- 3.2 ppm (P less than 0.001), respectively. There was ...
Recently the association of a rare disease named ''nephrogenic systemic fibrosis'' (NSF) with the administration of gadolinium-containing contrast media, especially gadodiamide (Omniscan, GE-Healthcare), was described. NSF is a scleroderma-like disease characterised by widespread tissue fibrosis. Until now, NSF cases were observed only in patients with kidney disease. Almost all patients were suffering from chronic renal insufficiency, 90 % of them required renal replacement therapy. The true incidence of the disease is unknown. First retrospective analyses of selected collectives of patients with end-stage renal disease showed 2 - 5 % cases of NSF after administration of Gadolinium-containing contrast agents with an odds ratio of 20 - 50 in comparison to non-exposed controls. NSF is a serious adverse reaction, which may result in severe disabilities and even death. ...
Iodixanol is a new nonionic dimer, isotonic with blood at all clinically relevant concentrations. Iodixanol (270 mg I/ml) was compared in a double-blind, randomized, parallel-group, phase-III study to the monomeric nonionic iohexol (300 mg I/ml) for evaluation of safety, tolerability and radiographic efficacy during cerebral CT. One hundred adult patients scheduled to undergo contrast-enhanced cerebral CT were randomly allocated to receive either iodixanol or iohexol. All completed the trial. Safety was evaluated by recording discomfort and other adverse events, tolerance by assessing intensity and incidence of discomfort. Radiographic efficacy was assessed from the diagnostic information and the radiographic density. No serious adverse events occurred. One patient (2 %) in the iodixanol group and one patient (2 %) in the iohexol group experienced a transient reddening at the neck and lower neck-line, respectively. Both ...
Background and purpose: We evaluate the feasibility of concomitant and adjuvant docetaxel combined with three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation in high-risk prostate carcinomas. Methods: Fifty men with high-risk localized prostate cancer (16), locally advanced (28) or very high-risk prostate cancer (6) were included. Seventy Gy were delivered on prostate and seminal vesicles in 35 fractions, concurrently with weekly docetaxel (20 mg/m"2). Three weeks after the completion of 3D-CRT, docetaxel was given for 3 cycles (60 mg/m"2), every 3 weeks. Patients had to receive LHRH agonist during 3 years. Results: The intent to treat analysis shows that four patients out of 15 stopped prematurely the chemotherapy due to grade 3-4 acute toxicity. In the per protocol analysis, 46 patients completed a full-dose chemoradiation regimen representing 413 cycles: five ...
Purpose. To report a comparative prospective long-term functional analysis after Riboflavin UV A corneal cross-linking (CXL) in three different age groups of patients affected by progressive keratoconus (KC). Methods. Functional analysis comprised paediatric patients (?18 years) included 152 eyes (29.5%); intermediate group (19-26 years) 286 eyes (55.4%), and adults (?27 years) 78 eyes (15.1%). CXL was performed according to the Siena protocol by using the Vega CBM (Caporossi-Baiocchi-Mazzotta) X linker (CSO, Florence, Italy) at Siena University by the same authors. Pre- and post-op examinations included UCVA, BSCVA, corneal topography, and surface aberrometry (CSO Eye Top, Florence, Italy), at 48 months followup. Results. At 48 months followup paediatrics, intermediate, and adult patientsshowed a mean gain in UCVA of +0.2, +0.14 and +0.12 Snellen lines. BSCVA gained by a mean of +0.21, +0.2, and +0.1 ...
We wanted to evaluate the long-term results of a dual expandable nitinol stent for the palliative treatment of malignant gastroduodenal strictures. The dual stent consists of two stents; an outer partially nylon covered stent and an inner bare nitinol stent. The outer stent was placed into the stricture and this was followed by coaxial placement of the inner bare stent. Using fluoroscopic guidance, dual expandable stents were placed in 86 patients with inoperable malignant gastroduodenal strictures. The technical and clinical success, the complication, survival and the stent patency were evaluated during the follow-up period. Stent placement was technically successful in 83 of the 86 patients. After stent placement, 74 of the 85 patientsshowed improvement of their symptoms. During the mean follow-up period of 133 days, 24 patients (28%) developed recurrent symptoms due to ...
{sup 99m}Tc-N-pyridoxyl-5-methyl-tryptophan (PMT) scintigraphy, which exhibits highly specific for the diagnosis of primary hepatocellular carcinoma (HCC), was performed for recurrent HCC following non-surgical treatment. Eighty-four patients (total 351 examinations) were selected for the study. The ability of PMT scintigraphy to diagnose recurrent HCC after treatment was compared with that of computed tomography, ultrasonography and angiography. The results showed that sixty-three (75%) of 84 cases demonstrated positive findings during our follow-up period, most of the tumors initially showing positive findings remained PMT positive when they recurred and PMT studies shortly after treatment demonstrated wider tracer uptake rather than the actual tumor area. In conclusion, PMT scintigraphy for patients with HCC after non-surgical treatment exhibited high accuracy in identifying viable HCC only for ...
In this work, thermoluminescent dosimeters have been used to measure entrance surface doses (ESDs) of patients undergoing mammographic screening at the University College Hospital, Ibadan, Oyo state. The mean glandular doses (MGDs) were also calculated using the measured ESDs. The results showed that the ESDs ranged from 0.26mGy to 21.26mGy for the mediolateral oblique (MLO) views and 0.08mGy to 5.36mGy for the craniocaudal (CC) views. The calculated MGD ranged from 0.07mGy to 3.57mGy for the MLO views and 0.02mGy to 0.98mGy for the CC views. The possible reasons for the large variations in the individual ESD values and MGD values for both views are discussed using patients data, equipment specific data and the technical parameters used for the examinations. Comparison showed that the mean...
We report a patient who developed occlusion of the intracranial major arteries induced by radiation therapy for craniopharyngioma. The patient, a 9-year-old boy, presented with deterioration of vision, nausea and vomiting. He underwent a right ventriculo-peritoneal shunt operation, and the tumor was partially removed. Postoperatively, he received focal radiation therapy with total of 60 Gy. Preoperative cerebral angiography, cerebral vessels had no sigh of occlusive lesion or stenosis. One year after irradiation, he started to have repeated cerebral ischemic attacks. But no regrowth of the tumor was detected on CT scans. Two years and 8 months after irradiation, he suddenly had right hemiparesis. Cerebral angiography revealed severe stenosis of the right anterior cerebral artery (precommunicating segment), middle cerebral artery (horizontal portion) and terminal portion of the right carotid artery. Left carotid angiography ...
We report a patient who developed occlusion of the intracranial major arteries induced by radiation therapy for craniopharyngioma. The patient, a 9-year-old boy, presented with deterioration of vision, nausea and vomiting. He underwent a right ventriculo-peritoneal shunt operation, and the tumor was partially removed. Postoperatively, he received focal radiation therapy with total of 60 Gy. Preoperative cerebral angiography, cerebral vessels had no sigh of occlusive lesion or stenosis. One year after irradiation, he started to have repeated cerebral ischemic attacks. But no regrowth of the tumor was detected on CT scans. Two years and 8 months after irradiation, he suddenly had right hemiparesis. Cerebral angiography revealed severe stenosis of the right anterior cerebral artery (precommunicating segment), middle cerebral artery (horizontal portion) and terminal portion of the right carotid artery. Left carotid angiography ...
We studied 64 ADHD children patients group (4 {approx} 15 ys, mean age: 8 {+-} 2.6 ys. M/F: 52/12) and 12 normal group (6 {approx} 7 ys, mean age: 9.4 {+-} 3.4 ys, M/F: 8/4) of the brain had been used to analysis of blood flow between normal and ADHD group. For analysis of Children ADHD, we used 12 children's mean brain images and made Template image of SPM99 program. In crease of blood flow (P-value 0.05), the result of normalized images to Template image to offer from SPM99 program, showed significant cluster in inter-Hemispheric and occipital Lobe, in the case of normalized images to children template image, showed inter-hemispheric and parietal lobe.
Chest radiograms obtained by using Fuji Computed Radiography (FCR) system were compared to conventional film/screen radiograms. The FCR images showed better image quality in diagnostic information than the conventional chest images. In FCR, the radiation exposure to patient for chest examination could be reduced up to one tenths of conventional chest examination. The main advantages or FCR were considered to depend on the contrast processing and frequency processing properties. The use of FCR in clinical work may improve both diagnostic quality and radiation exposure.
The main purpose of this paper is to stress the importance of CT depiction of the mandibular incisive canal. This anatomical structure contains a major neurovascular bundle and is thus very important in the planning of mandibular implants in the canine-incisive area. The importance of careful assessment of the mandibular canal course before implantology is now widely recognized. The same holds true for the canine-incisive region in the jaw, to detect the incisive canal if present and prevent any complications from its accidental damage. CT with a dedicated software showed the incisive canal in a large number of patients, which calls for precise reporting of its presence, course, and relationships with teeth.
Three cases of primitive suprasellar germinomas are reported: the tumors show typical clinical signs (diabetes insipidus, disfunctions), but CT findings are not so specific. It is very important to reach a correct diagnosis based on clinical and radiological findings, because of very high radiosensibility of the tumor. The accuracy of preoparative diagnosis has been enhanced by CT in addition to conventional neuroradiological examinations. Due to the possible risk of meningeal spreading following biopsy, some authors prefer to avoid biopsy and to treat directly the patient by radiotherapy; a rapid reduction of the tumor size at the dose of 30 Gy suggest a possible germinoma.
In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tessue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an hystological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choiches and strategies.
Renal arteriovenous fistula or pseudoaneurysms developing after invasive procedures are either asymptomatic or show only transient symptoms. We describe here a case of symptomatic renal artery pseudoaneurysm that presented with gross hematuria and azotemia. The pseudoaneurysm of renal artery was diagnosed by ultrasonography and abdominal magnetic resonance imaging (MRI), and it was successfully treated by percutaneous transcatheter coil embolization. A high index of suspicion is essential for the early diagnosis and treatment of delayed gross hematuria in patients with history of percutaneous nephrostomy. PMID:17180737
Spectral appearance and concentrations of the most prominent metabolites are affected by brain development. This knowledge is essential for the detection of pathological changes in pediatric patients. This paper discusses specific conditions of MR spectroscopic examination of children and the effects of age on MR spectra quality and quantitation of the studied metabolites. Clinical examples show several diseases that are reflected in changes in "1H MR spectra due to pathological alterations in the biochemical pathways of the observed metabolites. Attention is given to the main metabolites such as N-acetylaspartate, creatine/phosphocreatine, cholines, lactate, inositol, etc.
The bone scans of 33 patients (pts) with recent subcapital fractures (fx) of the femur were evaluated prospectively to determine their value in predicting femoral head visability. Each of the 33 pts (ll men, 22 women, age range 30-92) had a pre-operative bone scan within 72 hrs of the fx (23 pts within 24 hrs). Anterior and posterior planar views of both hips and pinhole views (50% of pts) were obtained 2 hrs after administration of Tc-99m HDP. The femoral head was classified as perfused if it showed the same activity as the opposite normal side or if it showed only slightly decreased activity. Femoral heads showing absent activity were classified as nonperfused. Overall, 20 of the 33 pts showed a photopenic femoral head on the side of the fx. Only 2 pts showed increased activity at hte site of the fx. Internal fixation of the fx was performed in 23 pts, 12 of ...
L-[3-"1"8F]-#alpha#-methyltyrosine ("1"8F-FMT) is an amino-acid tracer for positron-emission tomography (PET). We have conducted a clinicopathologic study to elucidate the correlation of angiogenesis with "1"8F-FMT and 2-["1"8F]-fluoro-2-deoxy-D-glucose ("1"8F-FDG) uptake in patients with non-small cell lung cancer (NSCLC). Thirty-seven NSCLC patients were enrolled in this study, and two PET studies with "1"8F-FMT and "1"8F-FDG were performed. Uptake of PET tracers was evaluated with standardized uptake value. Vascular endothelial growth factor (VEGF), CD31, CD34, L-type amino acid transporter 1 (LAT1) and Ki-67 labeling index of the resected tumors were analyzed by immunohistochemical staining, and correlated with the clinicopathologic variables and the uptake of PET tracers. The median VEGF rate was 45% (range, 10-78%). High expression was seen in 30 patients (81%, 30/37). VEGF expression was statistically associated with ...
Forty-five patients with recent cervical hip fractures were included in a prospective, clinical, radiographic and sequential scintimetric study. Striking changes in radionuclide uptake over the entire hip region on the fracture side were found during the first 5 postoperative months. Fractures that healed without complications showed the highest relative femoral head uptake at 1 week and a peak value at 6 weeks, followed by a gradual decline at the subsequent examinations. Fractures with complications (redisplacement, nonunion, or late segmental collapse) showed a lower initial uptake and a more gradual increase and only a slight tendency towards increased uptake after 3 months. The accuracy in predicting nonunion with scintimetric examination alone is high both at 1 and at 6 weeks, and the accuracy is almost equally high with combined scintimetric, radiographic, and clinical assessment 3-5 months postoperatively.
Somatostatin receptor scintigraphy (SRS) is a valuable method for the detection of somatostatin receptor-positive lesions. Most gastrinomas (over-)express the somatostatin receptor subtype 2 which can be targeted by In-111 labeled Octreotide. Different studies show a high sensitivity of SRS for the localization and staging of gastrinomas. SRS seems to be superior to other non-invasive imaging modalities and has been proven to significantly contribute to patient management. However, the sensitivity depends on the size and exact localization of the tumors. Smaller lesions and lesions located in the duodenum show a significantly lower sensitivity. In any case, SRS belongs to the routine imaging procedure for gastrinomas for localization and staging and can also be used for evaluation of the tumor progression. (author)
Full text: Introduction. Children, especially premature infants and neonates, are at a much higher risk to obtain an X ray induced disturbance of life - particularly cancer. On the one hand this is due to their longer life expectancy and on the other hand it is due to their higher cell proliferation rate. The paediatric radiology unit of the Inselspital Bern recently installed some of the most advanced X ray equipment nowadays available. It is based on the two latest digital technologies: double read computed radiography (CR) and direct digital radiography (DR). Only the implementation of these digital radiography systems permits the digital acquisition and additionally the analysis of acquired data. The systematic analysis of large amounts of biometric data and exposition data is the basis for further dose reduction and a systematic quality control (QC). Patients are increasingly critical concerning radiation exposure - especially parents regarding their children. ...
In this article is reviewed the role of Computed Tomography (CT) in thoracic complications following ortho topic liver transplantation (OLT). In a post-OLT population of 567 patients transplanted in the Italian institutions, 100 patients (17.6%) were examined with chest CT. It was reviewed data relative to the total number of examinations, clinical and/or radiographic indications, the CT technique-i.e., conventional (with (out) intravenous, i.v., contrast material) or high-resolution (HRCT). It also reviewed the radiologic patterns and their correlation with the other clinical, bronchoscopic and/or laboratory results. Of 152 chest CT examinations, 45 (29.6%) were performed because of clinical indications, 31 (20.4%) because of a radiographic abnormality, 64 (42.1%) because of clinical and radiographic abnormality, 64 (42.1%) because of clinical and radiographic indications, while in 12 cases (7.9%) the reasons were unknown; 133/152 (87.5%) ...
Purpose Cisplatin plus gemcitabine is a standard regimen for first-line treatment of advanced non-small-cell lung cancer (NSCLC). Phase II studies of pemetrexed plus platinum compounds have also shown activity in this setting. Patients and Methods This noninferiority, phase III, randomized study compared the overall survival between treatment arms using a fixed margin method (hazard ratio [HR] < 1.176) in 1,725 chemotherapy-naive patients with stage IIIB or IV NSCLC and an Eastern Cooperative Oncology Group performance status of 0 to 1. Patients received cisplatin 75 mg/m(2) on day 1 and gemcitabine 1,250 mg/m(2) on days 1 and 8 (n = 863) or cisplatin 75 mg/m(2) and pemetrexed 500 mg/m(2) on day 1 (n = 862) every 3 weeks for up to six cycles. Results Overall survival for cisplatin/pemetrexed was noninferior to cisplatin/ gemcitabine (median survival, 10.3 v 10.3 months, respectively; HR = 0.94; 95% CI, 0.84 to 1.05). ...
Purpose: Liposarcoma is the most common soft tissue sarcoma in adults. The purpose of the study was to correlate MR imaging features with the four ICD subclasses. Methods: 28 patients with liposarcoma were examined preoperatively on a 1.0 T MRI system, using spin echo sequences, gradient echo imaging and STIR sequences. In all patients, classification of the liposarcomas was made by histologic diagnosis (ICD-10-M-classification). Results: Well differentiated liposarcomas (9 patients) showed a number of MRI features consistent with lipoma (well defined mass high signal intensity (SI) on T{sub 1} images, low signal on T{sub 2} images, no or only little signal increase of tumour tissue after contrast material application, no necrosis). Not well differentiated liposarcomas (myxoid 14 patients, pleomorphic three patients, round cell two patients) ...
Hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease, and has been linked to increased morbidity and mortality in critically ill patients....Full Text Available
The present investigation was aimed to assess the usefulness of biliary agents scintigraphy in the diagnosis of hepatocellular carcinoma (HCC) and to ascertain the relationship between the uptake of these agents and the degree of HCC differentiation. Forty-four patients with this hepatic cancer were included in the study. Liver scans were performed 20 min and 3 hr after the administration of 99mTc diisopropyliminodiacetic acid (DISIDA). DISIDA scintigraphy could not be assessed in six cases. In 16 (42%) out of the remaining 38 patients, the tumor exhibited equal or greater radioactivity uptake than the surrounding liver. In six out of these 16 patients, tumor uptake was apparent in the early and delayed hepatic scans, while in the other ten subjects radioactivity uptake by the HCC could only be detected in the 3-hr delayed scans. In the remaining 22 patients, HCC appeared as a cold area. Tumor location ...
Pulsatile hormone secretion is observed in almost every hormonal system. The frequency of episodic hormone release ranges from approximately 10 to 100 pulses in 24 hours. This temporal mode of secretion is an important feature of intercellular information transfer in addition to a dose-response dependent regulation. It has been demonstrated in a number of experiments that changes in the temporal pattern of pulsatile hormone secretion specifically regulate cellular and organ function and structure. Recent evidence links osteoporosis, a disease characterized by loss of bone mass and structure, to changes in the dynamics of pulsatile parathyroid hormone (PTH) secretion. In our study we applied nonlinear and linear time series prediction to characterize the secretory dynamics of PTH in both healthy human subjects and patients with osteoporosis. Osteoporotic patients appear to lack periods of high predictability found in normal humans. In contrast ...
Full text: A 51-year-old woman with end stage renal failure secondary to Haemolytic Uraemic syndrome underwent a cadaveric renal transplant. A routine post transplant DTPA scan was performed which demonstrated satisfactory renal transplant perfusion and function. Incidental note was made of tracer uptake in the pelvis in the mid-line, which was suspected to be a uterine fibroid. This was confirmed on ultrasonography and at surgery. One week post transplantation the patient became acutely unwell and at laparotomy a perforated diverticular abscess was drained. Intraoperatively the transplant kidney was examined and the surgeon thought there was a area of infarction. This was confirmed on biopsy. As the patient's creatinine was rising a repeat DTPA study was performed. Perfusion and function of the transplant kidney was virtually absent while Doppler studies showed no flow. The patient however continued to ...
This study was performed to evaluate the diagnostic usefulness of double-phase Tc-99m MIBI parathyroid scintigraphy with single photon emission computed tomography (SPECT) in patients with hyperparathyroidism. We also evaluated the relationship between Tc-99m MIBI uptake and oxyphil cell contents in parathyroid glands. The subjects were 28 parathyroid glands of 10 patients who underwent Tc-99m MIBI parathyroid scintigraphy and parathyroidectomy for clinically suspected hyperparathyroidism. Early and delayed pinhole images were obtained at 15 minutes and 2 hours after injection of Tc-99m MIBI, and SPECT images were followed. The weight and oxyphil cell contents of parathyroid tissue were obtained from pathologic specimen, and the scintigraphic findings were compared with histopathology. In surgical histopathology, 6 parathyroid adenomas and 9 parathyroid hyperplasias were confirmed. The sensitivity, specificity, and positive predictive value of ...
OBJECTIVE: To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds. METHODS: Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators ...
Background: Pleural biopsy and cytology are standard procedures for the investigation of pleural disease. Recent medical literature has suggested that image-guided pleural biopsy shows improved sensitivity for the diagnosis of pleural malignancy, when compared with the more commonly performed reverse bevel needle biopsy such as Abrams' needle. In our centre there has been an increasing trend towards performing image-guided pleural biopsies, and to our knowledge there is no large published series documenting the complication rate and diagnostic yield. Methods: The radiology and pathology databases were searched for all image-guided [computed tomography (CT) and ultrasound (US)] pleural biopsies from January 2001 to December 2004. All imaging and histology were reviewed, and final diagnostic information about patients was obtained from the respiratory multidisciplinary team database and patient notes. A record was made of ...
We examined the abnormalities of regional cerebral blood flow(rCBF) in children with attention deficit hyperactivity disorder(ADHD) without comorbidity using statistical parametric mapping(SPM) method. We used the patients with not compatible to DSM-IV diagnostic criteria of ADHD and normal rCBF pattern in visual analysis as normal control children. Tc-99m ECD brain SPECT was performed on 75 patients (M:F=64:11, 10.0{+-}2.5y) with the DSM-IV diagnostic criteria of ADHD and 13 normal control children (M:F=9:4, 10.3{+-}4.1y). Using SPM method, we compared patient group's SPECT images with those of 13 control subjects and measured the extent of the area with significant hypoperfusion(p<0.01) in predefined 34 cerebral regions. Only on area of left temporal lobe showed significant hypoperfusion in ADHD patients without comorbidity (n=75) compared with control ...
The purpose of this study was to assess experimentally and clinically the usefulness of Fuji Computed Radiography (FCR) in angiographic examinations. FCR had a spatial resolution with much lower X-ray exposure doses, although the resolution of FCR was generally inferior to conventional films. When a contrast medium of 1% iodine concentration was used, FCR pinpointed a mass 1.5 mm in diameter; and conventional film could detect a mass 2.2 mm in diameter. The contrast of iodine in FCR examinations was stable. A high sensitivity of imaging plate allowed a wide range of visualization. In 148 selective angiographic examinatinons for 138 patients, FCR-subtraction images were superior to conventional film angiography for contrast resolution; it had a high sensitivity in detecting areas, such as the mediastimun and left lobe of the liver, and tumor stains in capillary phase. The capability of FCR arteriogram was as good as film arteriogram even with a half concentration of ...
The purpose of this study was to assess experimentally and clinically the usefulness of Fuji Computed Radiography (FCR) in angiographic examinations. FCR had a spatial resolution with much lower X-ray exposure doses, although the resolution of FCR was generally inferior to conventional films. When a contrast medium of 1% iodine concentration was used, FCR pinpointed a mass 1.5 mm in diameter; and conventional film could detect a mass 2.2 mm in diameter. The contrast of iodine in FCR examinations was stable. A high sensitivity of imaging plate allowed a wide range of visualization. In 148 selective angiographic examinatinons for 138 patients, FCR-subtraction images were superior to conventional film angiography for contrast resolution; it had a high sensitivity in detecting areas, such as the mediastimun and left lobe of the liver, and tumor stains in capillary phase. The capability of FCR arteriogram was as good as film arteriogram even with a half concentration of ...
We investigated the descriminative ability of total body bone-mineral expressed as the total body bone-density (TBBD) measured by dual photon absorptiometry (DPA) in 79 healthy premenopausal women, 27 healthy postmenopausal women, and 120 female osteoporotic fracture patients presenting with either Colles' fracture, vertebral fracture or femoral neck-fracture. TBBD was compared to the bone-mineral density of the lumbar spine (BMD{sub spine}) also measured by DPA, and to the bone-mineral content of the forearms (BMC{sub forearm}) measured by single photon absorptiometry (SPA). TBBD, BMD{sub spine} and BMC{sub forearm} showed that all the fracture patient groups had significantly reduced bone-mass. Using receiver operating characteristic (ROC) analysis, we found that TBBD had a tendency towards better discriminative ability than BMD{sub spine} or BMC{sub forearm} with regard to the discrimination between healthy ...
To assess the contribution of adrenal-derived androgens in women with hirsutism, adrenal scintigrams under dexamethasone suppression (DS) were performed on 35 women with increasing facial or body hair and irregular or absent menses. Based upon the DS regimen chosen (8 mg/d for 2 days or 4 md/d for 7 days before the injection of 6..beta..-(/sup 131/I)iodomethylnorcholesterol), three imaging patterns were identified. The first was the absence of uptake before 3 days (8-mg DS) or before 5 days (4-mg DS) after injection. This imaging pattern was seen in 17 of the 35 patients studied and was considered normal. The second pattern was bilateral uptake earlier than 3 days (8-mg DS regimen) or 5 days (4-mg DS) after injection. This was seen in 13 of the 35 patients and was interpreted as bilateral early visualization. Adrenal-vein catheterization performed on six patients with this pattern showed increased ...
Individuals with male factor infertility resulting from idiopathic oligo-, astheno- or teratozoospermia are frequently offered IVF in an attempt to increase their chances of having a child. A concern remains whether these infertile males have an elevated risk of transmitting chromosomal abnormalities to their offspring. Sperm chromosomal complements from these men were assayed using the human sperm/hamster oocyte fusion system and fluorescence in situ hybridization (FISH) on sperm nuclei. For each of 5 infertile patients, 100 sperm karyotypes were analyzed and multicolour FISH analysis was performed on a minimum of 10,000 sperm nuclei for each chromosome-specific DNA probe for chromosomes 1 (pUC1.77), 12 (D12Z3), X (XC) and Y (DYZ3). As a group, the infertile patientsshowed increased frequencies of both numerical ({chi}{sup 2}=17.26, {proportional_to} <0.001) and total abnormalities ({chi}{sup 2}=7.78, {proportional_to} ...
We report the results of a prospective clinical study using a new self-expanding nitinol stent (Enterprise) designed for the treatment of wide-necked intracranial aneurysms. We treated 31 saccular, wide-necked intracranial aneurysms in 30 patients. Ten aneurysms had recanalized after prior endovascular treatment without a stent, and 21 aneurysms had not been treated before. Stent deployment was successful in all procedures. Additional coil embolization was performed in all aneurysms. Initial complete angiographic occlusion was achieved in 6 aneurysms, a neck remnant was left in 18 aneurysms and there were 7 residual aneurysms. Angiographic follow-up examinations of 30 lesions after 6 months demonstrated 15 complete occlusions, 8 neck remnants and 7 residual aneurysms. One patient refused the 6-month angiographic follow-up. Spontaneous occlusion of the aneurysm had occurred in 14 patients, and 6 aneurysms ...
Although the radioisotope liver scan has primarily been of use in the detection of the intra-hepatic space occupying lesions, there has been an increasing awareness of its use in evaluation of liver function. In this study, the degree of hepatomegaly, changes in shape and mottling radiodensity on each lobe and splenic visualization in the liver scans done with colloidal radiogold were numerically expressed as scores under the arbitrary standard in 210 patients with liver cirrhosis. The clinical value of this scoring system was studied with special regards to the correlation between the radiogold hepatic uptake half time and conventional liver function tests. Following were the results; 1) The normal scan appeared in 6.7% of 210 patients with liver cirrhosis. 2) The colloidal radiogold hepatic uptake half time was abnormally and progressively prolonged in parallel to severity of hepatocellular dysfunction. The mean hepatic uptake half time in ...
Problems and solutions in the diagnosis and operative treatment were clarified by retrospective evaluation of cases of intramedullary tumor in which MRI and surgery had been performed. The subjects were 16 patients (21-75 years old, mean age: 45 years) whose tumor was surgically removed between 1991 and 1998. MRI was performed preoperatively, and T1-weighted images, T2-weighted images, and enhanced images were obtained. Angiography was also performed in some cases. The histological diagnosis based on the MRI findings before surgery were compared with the pathological diagnosis after the operation. In 9/16 cases (56%), the preoperative histological diagnosis based on the MR images was the same as the pathological diagnosis after the operation. In 8 of the 11 cases (73%) whose images showed clear tumor margins and well shaped the tumor, the tumors were completely removed. The concordance rate between the pathological diagnosis during and after ...
The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible ...
Patients with Ewing's sarcoma who present with a central axis or proximal extremity primary and/or with metastatic disease have a poor prognosis despite aggressive combination chemotherapy and local irradiation. In this high risk group of patients, total body irradiation (TBI) has been proposed as a systemic adjuvant. To aid in the design of a clinical TBI protocol, the authors have studied in the in vitro radiation response of two established cell lines of Ewing's sarcoma and human bone marrow CFUc. The Ewing's lines showed a larger D_0 and anti-n compared to the bone marrow CFU. No repair of potentially lethal radiation damage (PLDR) was found after 4.5 Gy in plateau phase Ewing's sarcoma cells. A theoretical split dose survival curve for both the Ewing's sarcoma lines and human bone marrow CFUc using this TBI schedule shows a significantly lower surviving fraction (10"-"4-10"-"5) for the bone marrow ...
A cross sectional study on the mineral density of the 3rd lumbar vertebral trabecular bone was carried out in 123 children less than 15 years old, comprising 44 controls, and 79 patients affected with conditions which are at risk for developing metabolic derangement of skeletal bone (34 patients taking antiepileptic drugs (AED), 29 undergoing glucocorticoid (GC) therapy and 16 bedridden patients), by using quantitative computed tomography (QCT) with a CaCO{sub 3} phantom. Serum Ca and alkaline-phosphatase (Alp) levels were measured at the time of QCT examinations in all. The results obtained were as follows: The QCT values in the control children showed neither age dependency nor a sexual difference before puberty. The QCT values in each group showed significant difference with one another; the control group>the AED group>the GC group>the bedridden group ...
Background: This study was conducted to examine the effects of prophylactic misoprostol prior to intrauterine device (IUD) placement in nulliparous women. Study Design: Nulliparous, reproductive-aged women desiring an IUD for contraception were randomized to receive 400 mcg of buccal misoprostol or placebo 90 min prior to IUD insertion. Subjects completed a series of 100-mm visual analogue scales (VAS, anchors: 0=none, 100 mm=worst imaginable) to measure their perceived pain at several times points (anticipated pain, leg positioning, speculum placement, tenaculum placement, IUD insertion, equipment removal and 5 min postinsertion). Secondary outcomes included provider ''ease of placement'' (100-mm VAS, anchors: 0=easy, 100 mm=extremely difficult), side effects and retention of the IUD afte...
SummaryBackground Persistent Lyme Disease Symptoms (PLDS) have included fatigue, headaches, poor concentration and memory, lightheadedness, joint pain, and mood disturbances. Evidence-based guidelines committees disagree over the severity of PLDS. The 2004 International Lyme and Associated Diseases Society (ILADS) concluded that PLDS are severe. The 2006 Infectious Disease Society of America (IDSA) guidelines committee concluded that PLDS are nothing more than the "aches and pains of daily living" and an ad hoc International Lyme group concluded that PLDS are "symptoms common in persons who have never had Lyme disease." Hypothesis Clinical trials validate the severity of persistent Lyme disease symptoms. Evaluation of the Hypothesis There are 22 standardized instruments used to measure the...
Pyogenic sacroiliitis is a rare entity in children. Diagnosis is often delayed because of its variable clinical presentation, low suspicion by the examining physician, and rare findings on radiographs. Delayed diagnosis, however, results in complications such as iliopsoas abscess. We report the case of a 12-year-old girl hospitalized with a 21-day history of fever, pain in the left iliac fossa, and flexion contracture of the hip. On examination, she had fever (38.9 ^oC), psoitis, localized tenderness at the left sacroiliac joint, and pain elicited by lateral compression of the pelvis. The abdominal examination was normal. The erythrocyte sedimentation rate was 130mm in the first hour, C-reactive protein was 186mg/l, and the white blood cell count was 18,400/mm^3, with 79% neutrophils. Urin...
The aim of this study was to observe both the clinical signs and symptoms of wounds at risk of infection, that is critically colonised (biofilm infected) and antimicrobial-performance of an ionic silver alginate/carboxymethylcellulose (SACMC) dressing, in comparison with a non silver calcium alginate fibre (AF) dressing, on chronic venous leg and pressure ulcers. Thirty-six patients with venous or pressure ulcers, considered clinically to be critically colonised (biofilm infected), were randomly chosen to receive either an SACMC dressing or a non silver calcium AF dressing. The efficacy of each wound dressing was evaluated over a 4-week period. The primary study endpoints were prevention of infection and progression to wound healing. The SACMC group showed a statistically significant (P = 0.017) improvement to healing as indicated by a reduction in the surface area of the wound, over the 4-week study period, compared with AF controls. In ...
The adverse effects and diagnostic accuracy of thallium-201 myocardial SPECT after intravenous infusion of adenosine triphosphate (ATP) were studied and compared with SPECT examinations with other type of loading. The subjects of the study were 147 patients with or without coronary artery disease, who underwent some type of loading SPECT and coronary arteriography (CAG) within 30 days. Myocardial ischemia was evaluated qualitatively in SPECT and was compared with CAG for the diagnostic accuracy of coronary artery disease. The degree of myocardial uptake defect was also calculated semiquantitatively using visual scoring method and compared with coronary artery severity score. The adverse effects occurred in 46.7% of ATP loading SPECT which was more frequent that DIP loading SPECT, but all of them were transient and mild. As for the diagnostic ability the ATP loading SPECT was as effective as other type of loading in qualitative interpretation, and the perfusion ...
A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with /sup 99m/Technetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio less than or equal to 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio < 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that /sup 99m/Tc-MDP ...
A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with "9"9"mTechnetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio #<=# 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio < 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that "9"9"mTc-MDP scintimetry performed ...
35 patients with ankle sprain were examined by MRI and stress radiographs. 13 were operated afterwards, 22 patients underwent a functional conservative therapy and were examined by MRI and stress radiographs and second time after three months. MRI reports were correct in 12 of 13 operated cases. After conservative therapy we did not find any disrupted ankle ligament. MRI showed intact ligaments thickened by scar. (orig./MG) [Deutsch] 35 Patienten mit klinischem Verdacht auf Aussenbandruptur wurden mit der MRT untersucht. 13 Patienten wurden operiert, 22 konzervativ therapiert. Letztere wurden nach drei Monaten erneut mit MRT und gehaltenen Aufnahmen untersucht. Die MRT-Befunde stimmten in 12 von 13 Faellen mit den operativ erhobenen Befunden ueberein. Nach dreimonatiger konzervativer Therapie waren alle 22 Sprunggelenke stabil. Die rupturierten Baender stellten sich verdickt und durchgaengig dar. (orig./MG)
The primary aim was to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma (CCC) and consequently to determine the capability of MRI/MRCP for staging CCC. Fifteen patients that underwent MRI/MRCP and surgical treatment were retrospectively included. Two radiologists evaluated MR images to assess delayed periductal enhancement, extent of bile duct stenosis, liver parenchymal and vascular involvement and presence of liver atrophy. An agreement between delayed enhancement of the bile duct walls and perineural neoplastic spread showed a very good correlation factor (0.93). The overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (p < 0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the ...
Purpose: To determine the diagnostic value of high resolution MR imaging with a circularly polarised (c.p.) body phased-array coil for the staging of pelvic lymph nodes in cervical carcinoma. Material and methods: 42 patients with histologically proven carcinoma of the cervix were studied on a 1.5 T scanner by using a c.p. body phased-array coil. The imaging protocol included T_2-weighted turbo-spin-echo (TSE) and T_1-weighted spin-echo sequences pre and post IV application of Gd-DTPA; slice thickness was 5-7 mm and pixel size 0.53 mm"2. Lymph nodes with a diameter of #>=#8 mm were considered to have metastatic involvement. MR imaging results were compared with histopathologic findings. Results: MR imaging showed enlarged lymph nodes (#>=# 8 mm) in 16 of 18 patients with histologic proof of lymph node metastases (sensitivity 89%). In 22 of 24 cases MR findings were true negative (specificity 92%). Diagnostic accuracy ...
New experiment of radiography in using Fuji Intelligent Diagnostic X-ray System was first reported in XV International Congress of Radiology, 1981. By utilizing this system instead of traditional screen/film system, high density imaging plate in conjunction with computed image processor was developed, this is FCR. However, as the numerous problems in regard to the basic side of FCR system are found, it is expected that these are solved by investigators at their earliest opportunities. The purpose of this study is to reduce the radiation doses of the patients at radiography of the chest by using FCR system installed in our Department of Radiology in July, 1984. Experimentally we measured the radiation doses of the patient having the each breast of 18, 20, 22 and 24cm in thickness at radiography of the chest by using VICTOREEN MODEL 666 survey meter. The results obtained were as follows: 1) By using FCR system the radiation doses of the chest ...
New experiment of radiography in using Fuji Intelligent Diagnostic X-ray System was first reported in XV International Congress of Radiology, 1981. By utilizing this system instead of traditional screen/film system, high density imaging plate in conjunction with computed image processor was developed, this is FCR. However, as the numerous problems in regard to the basic side of FCR system are found, it is expected that these are solved by investigators at their earliest opportunities. The purpose of this study is to reduce the radiation doses of the patients at radiography of the chest by using FCR system installed in our Department of Radiology in July, 1984. Experimentally we measured the radiation doses of the patient having the each breast of 18, 20, 22 and 24cm in thickness at radiography of the chest by using VICTOREEN MODEL 666 survey meter. The results obtained were as follows: 1) By using FCR system the radiation doses of the chest ...
Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the ...
Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the ...
The relationship between serum PG I, PG II levels and extent of atrophic gastritis was examined. The subjects were 64 patients (male: 32, female: 32, 51.9 years old on average) with established diagnosis of either atrophic gastritis or normal. In the X-ray gastric examination, Fuji Computed Radiography (FCR) was used to obtain clear-cut images of the gastric area. Concerning the serum PG I level, patients in the group with atrophic gastritis showed lower levels than those of the people in the group with no atrophic change, but the variation was wide, and no definite tendency was seen in the relationship between the atrophic change and the serum PG I levels. Concerning the serum PG II level, as the atrophic change progresses, the serum PG II level tended to increase gradually. A significant reduction in the PG I/II ratio was seen in the group with atrophic changes (p<0.01) in comparison with the group with no atrophic ...
The relationship between serum PG I, PG II levels and extent of atrophic gastritis was examined. The subjects were 64 patients (male: 32, female: 32, 51.9 years old on average) with established diagnosis of either atrophic gastritis or normal. In the X-ray gastric examination, Fuji Computed Radiography (FCR) was used to obtain clear-cut images of the gastric area. Concerning the serum PG I level, patients in the group with atrophic gastritis showed lower levels than those of the people in the group with no atrophic change, but the variation was wide, and no definite tendency was seen in the relationship between the atrophic change and the serum PG I levels. Concerning the serum PG II level, as the atrophic change progresses, the serum PG II level tended to increase gradually. A significant reduction in the PG I/II ratio was seen in the group with atrophic changes (p<0.01) in comparison with the group with no atrophic ...
The authors present a comparison between the diagnostic accuracy of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in the articular pathologies of the knee. CT and MRI were performed in 30 patients who subsequently underwent surgery. CT and MRI results were compared on three bases: technique, definition of normal anatomy, and diagnostic accuracy. CT allowed a standardization of the technique, while MRI was superior in defining normal anatomy - especially in the study of capsulo-ligamentous structures. In all cases the use of both CT and MRI allowed a correct diagnosis, showing the site, extent and gravity of the lesion. CT proved to be superior to MRI in 4 cases, while MRI corrected CT diagnosis in 11 cases; in 15 patients both techniques had the same diagnostic accuracy. Meniscal tears were better identified by CT, while MRI was superior in the detection of ligamentous lesions and in the characterization of ...
ObjectiveTo identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients.Full Text Available
Carcinoma in situ in the contralateral testis was diagnosed in 27 of 500 patients (5.4%) with unilateral testicular germ cell cancer. Eight of the 27 patients received intensive chemotherapy for spread...Full Text Available
ObjectiveWe sought to determine the clinical outcomes of patients undergoing surgical aortic valve replacement with hemodynamically confirmed severe pulmonary hypertension and aortic stenosis and compare them with the outcomes of patients not undergoing aortic valve replacement and patients undergoing aortic valve replacement with mild-to-moderate pulmonary hypertension. MethodsA total of 317 patients with severe aortic stenosis (aortic valve area 35 mm Hg) was present in 81 patients, of whom 35 (43.2%) underwent surgical aortic valve replacement. We compared the clinical outcomes of these 35 patients with the 46 patient...
To compare the accuracy in the detection and staging of various malignant tumors with high resolution whole-body MRI using parallel imaging with whole-body dual-modality PET-CT. Preliminary results of an interim analysis from a prospective, blinded study are presented, in which 20 patients (mean age 59 years, range 27-77 years) with different oncological diseases underwent whole-body dual modality FDG-PET-CT screening for tumor search or staging in case of confirmed or suspected metastatic disease. All patients also underwent whole-body MRI imaging with the use of parallel imaging (iPAT). High-resolution coronal T1w- and STIR-sequences of 5 body levels with 512 x 512 matrix, axial fast T2w imaging of lung and abdomen (HASTE), contrast-enhanced dynamic and static T1w-sequences of liver, brain, abdomen, and pelvis were performed. Using a 32-channel whole-body MRI scanner (Magnetom Avanto, Siemens Medical Solutions) with a total field of view of ...
Mycobacterium xenopi is one of the most common agents responsible for nontubercolar mycobacterial pulmonary disease on AIDS patients. These lesions have been studied with conventional radiography while CT has been used in patients with aspecific mycobacterioses or non-AIDS pulmonary conditions from Mycobacterium xenopi. 12 AIDS patients were examined. They had pulmonary lesions from Mycobacterium xenopi, patients age ranged 30 to 46 years. All patients had CD4 blood levels lower than 250 cells/mL and Mycobacterium xenopi in the sputum. All patients underwent a standard chest radiograph and a CT examination. CT images were evaluated by three radiologists independently and the definitive diagnosis was made in the presence of a fourth radiologist. Chest CT showed parenchymal consolidation in 66% of cases, associated with bilateral basal bands ...
Percutaneous osseointegrated prostheses are being investigated as an alternative strategy to attach prosthetic limbs to patients. Although the use of these implants has shown to be promising in clinical trials, the ability to maintain a skin seal around an osseointegrated implant interface is a major challenge to prevent superficial and deep periprosthetic infections. The specific aim of this study was to establish a translational load-bearing ovine model to assess postoperative limb compensation and gait symmetry following a percutaneous osseointegrated implant. We tested the following hypotheses: (1) the animals would return to pre-amputation limb loads within 12-months; (2) the animals would return to a symmetrical gait pattern (stride length and time in stance) within 12-months. The results demonstrated that one month following surgery, the sheep loaded their amputated limb to a mean value of nearly 80% of their pre-amputation loading condition; by 12-months, ...
AbstractIn a previous study using male rats, a correlation was found between the development of “at-level” allodynia in T6-7 dermatomes following severe T8 spinal contusion...Full Text Available
During their life, intervertebral discs undergo degenerative changes which need not necessarily become lesions. Conventional X-rays do not provide information on the condition of the intervertebral discs, so MRT or CT are recommended as primary techniques as they are non-invasive. Invasive methods like myelography and especially discography should not be used unless a case is highly problematic. In infants with pains in the back, MRT should be carried out as early as possible as there is nearly always an organic cause. (orig.)
... 03/08/2011 Professor named Chair at Epworth Hospital Professor Nilmini Wickramasinghe from the College of Business at RMIT University has been named Epworth Chair, Health Information Management , by Epworth HealthCare. 26/07/2011 Study investigates drug-free relief for tension headaches As Australia marks its first National Pain Week ...
BackgroundPostherpetic neuralgia (PHN) is a painful and difficult to treat complication of acute herpes zoster. Current treatment options provide only partial relief and are often...Full Text Available