Ultrasound (US) guided central venous catheterization of internal jugular vein on over 65-year-old patients versus blind technique

BACKGROUND AND OBJECTIVES: Performing a central venous catheterization (CVC) on older patients for long-term central intravenous therapy could be a very important procedure. It could be associated with a high incidence of related complications, especially on over 65-year-old, high risk, selected patients. METHODS: The authors analyzed the results of 72 central venous CVC of internal jugular vein performed on over 65-year-old patients with ultrasound (US) guide from January 1998 to April 2003. RESULTS: The average performing time was 4 min, with 98.7% of success, 0% of major complications, and 4.1% of minor complications (one mild vagal hypotension and two catheter dislocation). CONCLUSIONS: The US guided technique is a safer procedure especially in older patients; it affords an easier and more rapid cannulation of a central vein, drastically reducing major and minor complications.     

Virtual bronchoscopy in patients with central endobronchial stenosing lesions. Technique optimisation with single slice spiral CT

PURPOSE: To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy. MATERIALS AND METHODS: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy. RESULTS: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed. CONCLUSIONS: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.     

Acute traumatic acromioclavicular joint lesions: role of ultrasound versus conventional radiography

PURPOSE: To assess the diagnostic potential of ultrasound as compared to conventional radiography in quantifying the anatomic and structural damage and determining the grade of acute traumatic lesions of the acromioclavicular (AC) joint. MATERIALS AND METHODS: From September 2001 to September 2002, 18 patients (16 men, 2 women; age range: 17-78 years) who came to our Emergency Service with clinically suspected acute traumatic AC joint lesion were examined by ultrasonography with a variable frequency linear-array transducer (7.5-12 Mhz). The morphology of the AC joint peri-articular ligaments and soft tissues, distance between the edge of the acromion and the lateral margin of the clavicle, distance between the superior edge of the coracoid and the inferior margin of the clavicle were evaluated. Conventional radiography was performed prior to ultrasound using routine antero-posterior (A-P), single-film stress and "outlet" projections. All patients subsequently underwent clinical follow-up for a mean period of six months. RESULTS: On US examination, all patients presented AC ligament lesion associated with consistent intra- and extra-articular sero-haemorrhagic effusion. Six of the 18 patients had suffered indirect trauma. Diastasis of the AC joint with ligament lesion not associated with involvement of coracoclavicular (CC) joint and with ligament integrity was observed. Twelve of the 18 patients had direct trauma. Changes to AC and CC ligaments with consequent diastasis of both joints were observed. Measurements of AC and CC distance obtained on US examination corresponded to those obtained at conventional radiography in the A-P projection. At clinical follow-up, no variation in the previously established diagnosis was recorded in any patient. CONCLUSIONS: If appropriate methodology and adequate transducers are used, ultrasound is an accurate and reliable technique for the evaluation of acute AC joint injuries, complementing and correlating well with conventional radiography.     

A randomized prospective study of rhegmatogenous retinal detachment cases treated with cryopexy versus frequency-doubled Nd:YAG laser-retinopexy during episcleral surgery

PURPOSE: To evaluate the efficacy of cryopexy versus transpupillary frequency-doubled (532 nm) Nd:YAG laser-retinopexy according to anatomic and functional success and postoperative complications. METHODS: Seven hundred three patients with primary rhegmatogenous retinal detachment were enrolled. They underwent scleral-buckling surgery using randomly transpupillary frequency-doubled Nd:YAG laser or cryotherapy for retinopexy: patients were observed for a period of 6 months. The primary outcome was anatomic success at 6 months. Secondary outcomes included anterior segment complications, posterior segment complications, and postoperative visual acuity. RESULTS: There was no significant difference between the primary and secondary outcomes in the two treatment groups: the anatomic success rate was 83% in the transpupillary frequency-doubled Nd:YAG laser group and 83.1% in the cryotherapy group; the rate of postoperative complications and the postoperative visual acuity results are also similar in the two groups; the only barely statistically significant difference (P = 0.045) was the rate of macular holes, which were present only in five myopic patients treated with transscleral cryopexy. CONCLUSION: Transpupillary frequency-doubled Nd:YAG laser retinopexy, as cryopexy, served as a safe and effective means of creating chorioretinal adhesion during retinal reattachment surgery. The rate of postoperative complications was not influenced by the type of retinopexy.     

Maturity-onset diabetes of the young (MODY): a new challenge for pediatric diabetologists.

The differential diagnosis of hyperglycemia in childhood and adolescence has to take into consideration early-onset non-insulin-dependent diabetes, defined as maturity onset diabetes of the young (MODY). To date, mutations in genes of five proteins have been shown to cause MODY: glucokinase (MODY2), hepatic nuclear factor-1 alpha (HNF-1 alpha) (MODY3), hepatic nuclear factor-4 alpha (HNF-4 alpha) (MODY1), insulin promoter factor 1 (IPF-1) (MODY4) and hepatic nuclear factor-1 beta (HNF-1 beta) (MODY5), but other MODY genes still await elucidation. Clinical and metabolic heterogeneity of these subtypes of type 2 diabetes need to be defined, as deficiency of each factor has its own phenotype. Pediatric diabetologists should be aware of the increasing importance of MODY as a possible cause of hyperglycemia in children and adolescents. This will allow for the early diagnosis of these metabolic conditions and for the appropriate follow-up and treatment.     

Focal lesions in cirrhotic liver: what else beyond hepatocellular carcinoma?

Detection and characterization of focal lesions in the cirrhotic liver may pose a diagnostic dilemma. Several benign and malignant lesions may be found in a cirrhotic liver along with hepatocellular carcinoma (HCC), and may exhibit typical or atypical imaging features. In this pictorial essay, we illustrate computed tomography and magnetic resonance imaging findings of lesions such as simple bile duct cysts, hemangioma, focal nodular hyperplasia-like nodules, peribiliary cysts, intrahepatic cholangiocarcinoma, lymphoma, and metastases, all of which occur in cirrhotic livers with varying prevalences. Pseudolesions, such as perfusion anomalies, focal confluent fibrosis, and segmental hyperplasia, will also be discussed. Imaging characterization of non-HCC lesions in cirrhosis is important in formulating an accurate diagnosis and triaging the patient towards the most appropriate management.The detection and characterization of focal lesions in a cirrhotic liver on computed tomography (CT) and magnetic resonance imaging (MRI) is a challenging task due to the marked changes in the organ architecture. Although hepatocellular carcinoma (HCC) is the most frequent primary tumor arising in a cirrhotic liver, several other benign and malignant lesions may be encountered in this setting (1, 2). It is thus not surprising that CT and MRI have limited specificity for the diagnosis of HCC in cirrhosis.Imaging characterization of focal lesions in cirrhosis is of the utmost importance for appropriate patient management. The radiologist’s primary task is to maximize tumor detection (i.e., minimize false negatives), because missing the diagnosis of HCC may preclude potentially curative therapies, such as hepatic resection, percutaneous ablation procedures, and, in selected patients, liver transplantation. However, it is equally important to avoid the misdiagnosis of benign liver lesions as HCC (i.e., minimize false positives) because this diagnostic interpretation may incorrectly increase the tumor burden. This may also result in the ineligibility of the patient for potentially curative treatments or the inappropriate assignment of increased priority scores for patients on the waiting list for liver transplantation. In this paper, we discuss and illustrate CT and MRI features of both common and uncommon non-HCC liver lesions occurring in cirrhotic patients.     

口服避孕药：不会增加死亡风险

本研究旨在确定服用口服避孕药的女．胜其死亡风险是否高于未服用者。本次前瞻性试验研究，由英国全科医生资料库和（或）国家健康服务中心登记处提供始于1968年的死亡资料，对46112位女性持续观察了39年，其中未使用口服避孕药的女性为378006人年，曾服用者为819175人年，主要观察终点未口服和口服避孕药者之间全因和特异性死亡的相对风险。     

Seroprevalence and factors associated with herpes simplex virus type 2 among HIV-negative high-risk men who have sex with men from Rio de Janeiro, Brazil: a cross-sectional study

Background  

Herpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer disease in developing countries, including Brazil, and is especially prevalent among men who have sex with men (MSM). HSV-2 infection represents a risk factor for the acquisition and transmission of other sexually transmitted diseases. The goal of the present cross-sectional study was to estimate HSV-2 seroprevalence and to determine the factors associated with HSV-2 seropositivity in HIV-negative high-risk MSM from Rio de Janeiro, Brazil.