Pain and sensory disturbances following surgical repair of pectus carinatum

Background/Purpose

The purpose of this study was to assess the characteristics of persistent postoperative pain and sensory disturbances following surgical repair of pectus carinatum.

Observer variability in the evaluation of dual-isotope Tl-201/Tc-99m sestamibi rest/stress myocardial perfusion SPECT in men and women with known or suspected stable angina pectoris

BACKGROUND: Observer variability of dual-isotope myocardial perfusion imaging (MPI) with single photon emission computed tomography has rarely been investigated. The aim of our study was to evaluate the interpretive reproducibility with this technique. METHODS AND RESULTS: We report on 507 patients with known or suspected stable angina who were studied before coronary angiography. A 1-day thallium 201/technetium 99m sestamibi rest/stress MPI protocol was used. MPI was interpreted by 2 independent observers without knowledge of clinical data, using a 20-segment scoring model. By consensus, the overall rate of abnormal MPI was 49% (59% in men and 34% in women). The interobserver agreement for the whole group (kappa = 0.85) and for men and women separately (kappa = 0.86 and 0.82, respectively) was excellent with regard to the overall diagnosis (normal, reversible, or fixed defects) as well as left anterior descending and left circumflex artery vascular territories (kappa = 0.85 and 0.82, respectively). However, in the right coronary artery territory, agreement was excellent in men (kappa = 0.83) but moderate in women (kappa = 0.57). CONCLUSIONS: In a relatively large group of men and women with stable angina pectoris, interpretive reproducibility (overall and individual vessel diagnosis) was excellent, except in the right coronary artery territory of women, in which it was moderate.     

Histochemical studies of the extracellular matrix of human articular cartilage--a review

OBJECTIVE: This paper reviews the histochemistry of the extracellular matrix of human articular cartilage. No systematic review of histochemical knowledge and techniques in the study of articular cartilage has been published previously. METHODS AND RESULTS: Literature was searched in the Winspirs Medline database from 1960 to 2000. Only techniques applicable for bright field or polarization microscopy were considered. Unless otherwise noted, all applies to hyaline cartilage.The most widely used fixatives are adequate for routine staining of proteins, but proteoglycan fixation is problematic, and no one fixative can be recommended. Proteoglycan can be stained reliably but it is problematic that, at low substrate concentrations, these methods are not stoichiometric. Collagen can be stained efficiently, although attempts to differentiate collagen types have not been successful. CONCLUSIONS: Detailed studies of fixation and staining procedures should be carried out and standards for cartilage sampling, handling and evaluation agreed upon if results from different laboratories are to be compared.     

Intrathecal complement activation by the classical pathway in tick-borne encephalitis

Journal of NeuroVirology - Tick-borne encephalitis (TBE) is one of the most prevalent viral central nervous system (CNS) infections in Eurasia and neurological sequelae are common. The immune...     

Transition of nodular toxic goiter to autoimmune hyperthyroidism triggered by 131I therapy.

The use of 131I treatment in nodular toxic goiter is widely accepted. In this article, we describe transition of nodular toxic goiter into an autoimmune toxic goiter with development of thyrotropin receptor antibodies (TRAb) as a side effect of 131I treatment. In this retrospective study, 149 patients with nodular toxic goiter (100 with multinodular goiter, 49 with a solitary autonomously functioning toxic nodule) were studied. Of these 149 patients 100 became permanently euthryoid after 1 dose of 131I, and due to persistent hyperthyroidism, 32 patients needed 2-5 doses to became euthyroid. After becoming euthyroid, none of these 132 patients had relapse of hyperthyroidism in the follow-up period. Based on evaluation of the thyroid hormone variables, 17 of 149 patients had a distinctly different pattern in the changes in thyroid hormones. They developed an increase in FT4I 3-6 months posttreatment after an initial fall in FT4I. Twelve of these 17 patients were treated with antithyroid drugs before the initial 131I dose. On samples of frozen sera (-20 degrees C) anti-thyroid peroxidase (TPO) and TRAb were followed for 6 months after 131I treatment in these 17 patients. A similar follow-up was done in 20 patients (10 with and 10 without antithyroid drug pretreatment), randomly selected from the patients who did not relapse. In the remaining 112 patients, anti-TPO and TRAb levels were measured only before the 131I treatment. Of the 17 patients with relapse, 6 developed TRAb concomitant with recurrence of hyperthyroidism (4% of the study group). In 5 of the 17 patients TRAb values remained absent throughout the follow-up period. The remaining 6 patients had elevated TRAb values before 131I treatment. Among the 132 patients who did not relapse, an additional 7 cases with presence of TRAb were found. A total of 9% of the study group was found to have TRAb before 131I pretreatment. Anti-TPO was found in 20 of 149 patients (13%) before 131I treatment. Complications, either hypothyroidism or TRAb-associated hyperthyroidism, were seen in 8 of 20 patients (40%) with anti-TPO before 131I treatment, compared to 9 of 129 (7%) without (p<0.005). In conclusion, TRAb and a Graves' like hyperthyroidism can be triggered by 131I treatment in patients with nodular toxic goiter. The presence of anti-TPO seem to be a marker of an increased risk of development of TRAb-associated hyperthyroidism as well as hypothyroidism, but both side effects can be seen despite the absence of anti-TPO autoantibodies.     

111Indium-transferrin for localization and quantification of gastrointestinal protein loss

Objective. To evaluate the indium-111 (¹¹¹In)-transferrin method as a means of localization and quantification of gastrointestinal protein loss. Methods. Fourteen patients and 15 healthy subjects underwent an ¹¹¹In-transferrin study consisting of abdominal scintigraphy, whole-body counting measurement and determination of plasma activity of ¹¹¹In during the course of 5 days. Two of the patients went through a subsequent chromium-51–trichloride test with analysis of radioactivity in faeces in order to compare the results of the two methods. Results. The patients had a mean±SEM whole-body loss of ¹¹¹In of 10.9±2.9% for 96 h, while the healthy controls lost 1.8±1.3% (p=0.0045). The decay in plasma activity followed biexponential kinetics. The characteristic plasma transit time was 5.0±1.0 h in patients and 12.1±1.5 h in controls (p=0.0007). Scintigraphically, patients had obvious abdominal foci of activity, while the control subjects showed diffuse activity. Anatomic localization of the leaking spot seemed more uncertain. By comparison with the ⁵¹Cr trichloride test, the loss of radio-labelled protein appeared to be in the same order of magnitude. Conclusions. Quantification of gastrointestinal protein loss can be done without collecting faeces. Normal subjects have a loss of a few per cent, making the ¹¹¹In-transferrin method comparable with the former standard using ⁵¹CrCl_3–trichloride. Plasma measurements of ¹¹¹In are not predictive of the magnitude of the loss. Scintigraphic localization of the site of the loss needs to be optimized, for instance by serial imaging or image fusion with an anatomical modality.     

Continuous methimazole therapy and its effect on the cure rate of hyperthyroidism using radioactive iodine: an evaluation by a randomized trial

BACKGROUND: A randomized clinical trial was performed to clarify whether continuous use of methimazole (MTZ) during radioiodine ((131)I) therapy influences the final outcome of this therapy. DESIGN: Consecutive patients with Graves' disease (n = 30) or a toxic nodular goiter (n = 45) were rendered euthyroid by MTZ and randomized to stop MTZ 8 d before (131)I (-MTZ; n = 36) or to continue MTZ until 4 wk after (131)I (+MTZ; n = 39). Calculation of the (131)I activity included an assessment of the (131)I half-life and the thyroid volume. RESULTS: The 24-h thyroid (131)I uptake was lower in the +MTZ group than in the -MTZ group (44.8 +/- 15.6% vs. 62.1 +/- 9.9%, respectively; P < 0.001). At 3 wk after therapy, no significant change in serum free T(4) index was observed in the +MTZ group (109 +/- 106 vs. 83 +/- 28 nmol/liter at baseline; P = 0.26), contrasting an increase in the -MTZ group (180 +/- 110 vs. 82 +/- 26 nmol/liter; P < 0.001). The number of cured patients was 17 (44%) and 22 (61%) in the +MTZ and -MTZ groups, respectively (P = 0.17). Cured patients tended to have a lower 24-h thyroid (131)I uptake (50.1 +/- 13.8% vs. 56.4 +/- 17.1%; P = 0.09). By adjusting for a possible interfactorial relationship through a regression analysis (variables: randomization, 24- and 96-h thyroid (131)I uptake, type and duration of disease, age, gender, presence of antithyroid peroxidase antibodies, thyroid volume, dose of MTZ), only the continuous use of MTZ correlated with treatment failure (P = 0.006), whereas a low 24-h thyroid (131)I uptake predicted a better outcome (P = 0.006). CONCLUSION: Continuous use of MTZ hinders an excessive increase of the thyroid hormones during (131)I therapy of hyperthyroid diseases. However, such a strategy seems to reduce the final cure rate, although this adverse effect paradoxically is attenuated by the concomitant reduction of the thyroid (131)I uptake.     

The effects of practicing target-shooting sport on the severity of inattentive,hyperactive, and impulsive symptoms in children: a non-randomised controlled open-label study in Denmark

Abstract

Purpose: Target-shooting sport requires mental effort and concentration. Training may reduce inattentiveness and distractibility. There is little knowledge if children with symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from practicing target-shooting sport.

Materials and methods: Our study aims to investigate this in a non-randomised controlled open-label study of 128 children, 10–14 years of age, with ADHD-symptoms. The intervention-group (n?=?64) practiced target-shooting in local shooting associations once a week for 6 months. The control group (n?=?64) received treatment as usual. Primary outcome: teacher-rated ADHD-RS-IV-total score. Secondary outcomes: (a) parent-rated ADHD-RS-IV-total score; (b) teacher- and parent-rated Strengths-and-Difficulties-Questionnaire (SDQ); (c) self-rated quality of life (KIDSCREEN-27-total score); and (d) four objective measurements of ADHD-symptoms using the QbTest^?. The data were collected at baseline and after 6 months.

Results: When estimating the marginal effect of the intervention on our primary outcome, the teacher-rated ADHD-RS-IV, we found no significant effect (mean change between groups (contrast)=2.23; p?=?0.193). However, we did find significant beneficial effects on four of the eight secondary outcomes, including the parent-rated ADHD-RS-IV-total score (contrast = 4.76; p?=?0.024), the parent-rated SDQ-total score (contrast = 2.09; p?=?0.027), and on the QbTest^? measurements of the Reaction Time Variation (RTVar) (contrast = 36.96; p?=?0.013), and of Omission Errors (contrast = 7.57; p?=?0.019).

Conclusions: Despite the negative result on the primary outcome, the robust findings on these secondary outcomes in this open-label study indicate proof of concept that practicing target-shooting sport may have some beneficial effects on the severity of ADHD-symptoms in children. No adverse events were reported. Randomised trials of this non-pharmacological intervention are needed.