The role of bone scintigraphy in the assessment of chronic wrist pain without any trauma history

Bone scintigraphy of the hands and wrists represents an important adjunct imaging technique that complements plain film radiographic examination in the evaluation of chronic wrist pain. In this study, the effectiveness of bone scintigraphy was investigated in the evaluation of chronic wrist pain in the patients without the history of trauma and any radiological and rheumatological abnormalities. Seventy-one patients with normal conventional radiographs and unexplained wrist pain were evaluated prospectively between 1998 and 2003 in our hand surgery clinic. There was no trauma history and no specific physical examination findings in the patients. The bone scintigraphy was done in all patients. Fifty-two of the all patients had normal scintigram. Seventeen of the remaining 19 patients showed increased activity over triquetrum (5 cases), lunatum (4 cases), trapezium (4 cases), hamatum (2 cases) and psiforme (2 cases). As the additional radiological investigations like MRI and CT revealed no bony abnormalities, the results of bone scintigraphy were evaluated as chronic ligamentous injuries. Two patients had diffuse increased uptake compatible with synovitis. The evaluation of bone scintigraphy correlated with clinical findings is effective to choose the most efficient treatment method in chronic wrist pain.     

Restless legs syndrome affecting the head region: “restless head syndrome”

Neurological Sciences - Restless legs syndrome (RLS) is a well-established disease that has recently been shown to have variants affecting the arms, face, abdomen, and genital area. To our...     

Protein S and protein C level changes with adjuvant tamoxifen therapy in postmenopausal women

Tamoxifen citrate is a synthetic antiestrogen that provides survival benefit when given as adjuvant treatment in postmenopausal women with breast cancer. Venous thrombophlebitis may complicate tamoxifen treatment at a rate of approximately one per 800 treatment-years. To explore the possible procoagulant effects associated with tamoxifen therapy we evaluated changes in protein S and C activity levels in 58 postmenopausal women with surgically resected breast cancer who were disease-free and participating in a double-blind, placebo-controlled, randomized toxicity study of tamoxifen. The changes in protein C activities for the tamoxifen group (mean level = 113%) compared to those in the placebo group (mean level = 115%) were not significant (p = 0.45). Protein S activity levels increased while protein C activity levels decreased from baseline at 24 months in both tamoxifen and placebo groups. We conclude that the possible thrombophlebitis-promoting effect of tamoxifen in postmenopausal women is unlikely to be explained on the basis of protein S and protein C activity level changes.     

Repeated attacks of venous air embolism during endoscopic sinus tumor surgery: a case report

Repeated attacks of venous air embolism during an operation is a very rare situation. We report a case of multiple venous air emboli during an endoscopic surgery of a sphenoidal sinus tumor.     

Post-traumatic knee pain leading to the diagnosis of spondyloarthropathy

The authors report a patient with persistent left knee pain after traumatic injury. The initial bone scan seemed to confirm a valgus stress knee injury. The final diagnosis, however, was focal inflammation of the knee ligaments (enthesopathy) related to ankylosing spondylitis. The diagnostic procedure and the results of other imaging modalities are presented. The bone scan findings are discussed.     

Assessment of the lateral ligaments of the ankle after healed fractures

BACKGROUND: Lateral ligament complex injuries are difficult to diagnose immediately after ankle fracture, and treatment is focused on the fracture. This study examines the prevalence of ligamentous injuries after severe ankle fractures. METHODS: Lateral ligament instability can be revealed by inversion and anterior stress views after fracture healing. The results of 54 inversion and anterior stress examinations of the ankle after fracture healing, using a Telos stress device at 15 kPa force, were compared with uninjured ankles. RESULTS: No patient had 5 degrees or more of talar tilt or 6 mm or more of anterior displacement of the talus in uninjured ankles; however, in ankles with fractures, we found abnormal talar tilt angle in 12 and excessive anterior displacement in five. An abnormal inversion stress test was found to be considerably more common in the fractured ankles. CONCLUSION: Our study revealed that lateral ligament injuries may occur simultaneously with ankle fractures, with the most frequently injured being the calcaneofibular ligament.     

Distortions induced by radioactive seeds into interstitial brachytherapy dose distributions

In a previous article, we presented development and verification of an integral transport equation-based deterministic algorithm for computing three-dimensional brachytherapy dose distributions. Recently, we have included fluorescence radiation physics and parallel computation to the standing algorithms so that we can compute dose distributions for a large set of seeds without resorting to the superposition methods. The introduction of parallel computing capability provided a means to compute the dose distribution for multiple seeds in a simultaneous manner. This provided a way to study strong heterogeneity and shadow effects induced by the presence of multiple seeds in an interstitial brachytherapy implant. This article presents the algorithm for computing fluorescence radiation, algorithm for parallel computing, and display results for an 81-seed implant that has a perfect and imperfect lattice. The dosimetry data for a single model 6711 seeds is presented for verification and heterogeneity factor computations using simultaneous and superposition techniques are presented.     

Anti-Saccharomyces cerevisiae Antibodies in Acute Myocardial Infarction.

BACKGROUND: Elevated anti-Saccharomyces cerevisiae antibody (ASCA) immunoglobulin (IgG) and IgA levels were first described in the serum of Crohn disease patients and have increasingly been reported in other inflammatory diseases. The role of in situ and remote inflammation in atherosclerosis is a major area of interest. In this study, we compared ASCA IgG and IgA levels in acute myocardial infarction (AMI) and controls to investigate the possible role of ASCA in AMI. METHODS: Serum samples were obtained from 140 consecutive patients who presented to the emergency department with acute chest pain. AMI was diagnosed by electrocardiography and serial enzymes. Patients ruled out for acute coronary event were grouped as controls. ASCA IgA and IgG levels were determined using enzyme-linked immunosorbent assay. Groups were compared for statistically significant difference. RESULTS: ASCA IgG titers ranged between 0.1 and 31.0 RIU/mL (mean 4.92) in the AMI group and 0.1 and 6.0 (mean 0.84) in the controls. The groups were found to differ very significantly (p = .001). ASCA IgA titers ranged between 2.0 and 200.0 RIU/mL (mean 13.73) in the AMI group and 2.0 and 11.5 RIU/mL, (mean 4.25) in controls. The groups differed significantly (p = .32). AMI and controls were also analyzed for ASCA IgA and IgG positivity. Both groups differed significantly from controls (p = .013). CONCLUSION: Elevated ASCA IgA and IgG levels as well as ASCA positivity in the AMI might suggest use of ASCA as a marker for atherosclerotic plaque instability. It might also provide a link between inflammatory processes and increased cardiovascular risk. Further studies are needed on a Saccharomyces cerevisiae-based diet, related intestinal colonization, and associated inflammation, autoimmune disorders, and cardiovascular events.     

Plasma adrenocorticotropic hormone in the rat demonstrates three different rhythms within 24 h

Secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary is rhythmic and episodic, as reflected by fluctuations in plasma concentrations of ACTH. The present work was designed to further characterize the patterns of ACTH secretion that occur simultaneously within a 24-hour period in the rat. To accomplish this, blood collection protocols with sampling intervals of 2 min, 15 min, and 4 h were used in awake, chronically cannulated rats. Plasma samples were assayed for immunoreactive ACTH, and resultant data were analyzed for significant pulsatile secretory episodes. We observed three different patterns of ACTH secretion within a 24-hour period. Circadian variation occurred with peak plasma ACTH levels in the early evening. In addition, plasma ACTH exhibited two types of episodic variation: (1) episodic bursts with variable amplitudes that occurred approximately three times per hour which have been referred to as 'micropulses', and (2) prolonged elevations of plasma ACTH that occurred approximately 14 times in 24 h which have been referred to as 'larger ultradian' secretory episodes. These latter episodes appeared to consist of groups of relatively high amplitude micropulses. The physiological significance, functional interactions, and location of the controlling oscillator(s) of these different rhythms remain to be determined.     

Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery

Background

The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery.

Methods

Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43–78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41–81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed.

Results

For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46).

Conclusion

In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.