Radioiodine therapy and percutaneous radiotherapy of struma maligna

Effective therapy of thyroid malignancies requires close cooperation between endocrinologists, surgeons and radiologists. Radioiodine offers the unique possibility of curing highly differentiated carcinoma even when it is in a disseminated state. Percutaneous radiotherapy is a proven treatment regimen for residual tumor tissue after surgery and iodine-131 therapy, for locally advanced carcinomas and for recurrences. The controversy surrounding postoperative "prophylactic" radiotherapy in differentiated carcinomas is discussed. The two treatment modalities using ionizing radiation - radioiodine and external irradiation - are reviewed and discussed with reference to indications, techniques, complications and results.     

An interesting case of arterial trauma after craniocerebral injury

A 63-year-old drunken man fell and hit his head on the ground. Apart from symptoms of alcoholisation no signs of severe injuries were found. The man died 2 1/2 days after the accident. The autopsy revealed a huge fracture system in the right parietal region. A branch of the medial cerebral artery was stretched between the cortex and one of the fracture lines, passing through a tear in the dura. Characteristics of this case were that no larger hemorrhage was found and the artery which was torn from the cortex showed no lesions. The case also indicates the immense relative movements between skull and brain which occur during such trauma.     

Small bowel perforation after duodenal stent migration: An interesting case of a rare complication

Duodenal stents are frequently used for palliating malignant gastric outlet obstruction.Successful stent placement relieves obstructive symptoms,is cost effective,and has a relatively low complication rate.However,enteral stents have the potential of migrating distally and rarely,even lead to bowel perforation.We present a rare case of a duodenal stent placed as a palliative measure for gastric outlet obstruction due to unresectable pancreatic cancer that migrated distally after a gastrojejunostomy resulting in small bowel perforation.     

Cutaneous angiosarcoma of the breast 7 years after lumpectomy and radiation therapy

A case of angiosarcoma of the skin of the breast is described in a woman 7 years after a primary breast carcinoma was treated by means of lumpectomy and irradiation. On mammograms, the angiosarcoma showed redevelopment of skin thickening and increase in breast density. Clinically, the skin showed patchy discoloration. Although there is an established association of angiosarcoma with lymphedema and therapeutic irradiation, there have been few other reports of this rare complication of local therapy for breast carcinoma. Recognition of the mammographic and clinical manifestations may help in the earlier diagnosis of additional cases.     

Effect of compression therapy on knee swelling and pain after total knee arthroplasty

Purpose

Knee swelling after total knee arthroplasty may impair postoperative mobilisation and training, and as medical elastic compression stockings are well tolerated and effective to prevent oedema, haematoma and postoperative pain after venous surgery, we wanted to study whether this effect could be transferred to total knee arthroplasty surgery reducing postoperative swelling and pain and thereby facilitating mobilisation and improving patient-reported knee function.

Methods

In a randomised controlled study, 88 patients were randomised to use either a medical elastic compression stocking or no stocking from the first postoperative day and the following 4 weeks after total knee arthroplasty. Outcome measures were knee, calf and ankle swelling, knee flexion, pain and patient-reported knee function.

Results

Seventy per cent of the swelling had occurred before application of the stocking the day after surgery. Knee, calf and ankle swelling and knee flexion measured on days 2, 7, 14 and 30 showed no significant difference between the two groups. Maximum pain level at rest and at walking was similar for both groups during the observation period. Also, the Oxford knee score was similar between the two groups on days 14 and 30.

Conclusion

We did not find any clinical effect using a medical elastic compression stocking after total knee arthroplasty.

Level of evidence

I.     

Histological and ultrastructural evaluation of Leeds-Keio ligament six years after implant A case report

We examined by light and electron microscopy study a Leeds-Keio ligament removed from a patient 6 years and 4 months after implant following rupture. The new ligament presented an outer capsule made up of bundles of collagen fibres running mainly perpendicular to the long axis of the ligament. Septa were seen emerging from the capsule and composed of bundles of collagen fibres surrounding the bundles of Dacron fibres. Each thread of Dacron was surrounded by a layer of connective tissue containing periodic acid-Schiff (PAS)-positive cells. The bundles of collagen fibres making up the outer capsule, the septa and the layer of connective tissue surrounding the Dacron threads were positive for anti-type I collagen antibody. The rehabitated Leeds-Keio ligament presented a specific organization at the septa zone, showing a layer of collagen fibrils alternating with a layer of cells. Our remodelling findings suggest a shoelace effect of the artificial ligament. On the other hand, the presence of type I collagen could be responsible for the good functional behaviour of this composite system. In conclusion, the factors that play an important role in determining this remodelling process and its mechanical function are unknown. Received: 1 August 1996 Accepted: 7 January 1997     

Bilateral peroneal nerve palsy after simultaneous bilateral total knee arthroplasty. Report of a case with rheumatoid arthritis

In this study, we report on a 46-year-old female patient with bilateral severe gonarthrosis due to rheumatoid arthritis. Simultaneous bilateral cemented total knee arthroplasty was performed. Bilateral common peroneal nerve palsy was observed on the second postoperative day. The electromyographic diagnosis was "bilateral axonotmesis". Complete clinical and electromyographic motor recoveries were seen on both sides within 6 months postoperatively. The sensorial deficit was still present on one side at 2 years postoperatively. Preoperative severe flexion contracture and epidural anesthesia were assumed as the risk factors for the development of the nerve palsy in this patient.     

Fleischner Lecture. Imaging the respiratory system in the first few years after discovery of the X-ray: contributions of Francis H. Williams, M.D.

Imaging of the respiratory system developed with exceptional rapidity in North America during the spring of 1896, after Roentgen's discovery of X-rays in November 1895, largely because of the efforts of a unique physicians, Francis H. Williams. With great zeal, this pioneer used fluoroscopy for early detection of tuberculosis and other life-threatening chest disorders. By the summer of 1896, he had accumulated more than 100 volumes containing tracings of clinical chest fluoroscopy. As a result of his extensive clinical experience, his dedication to patients' welfare, and his sense of scientific inquiry, several inventions and many landmark clinical observations were made in the first few years after the discovery of the X-ray. These included (1) the invention of a "densitometer" for standardized measurements of relative X-ray attenuation of the lung, (2) the invention of a "seehear" device to correlate auscultative findings and fluoroscopic observations, (3) the recognition that fluoroscopy was more accurate than percussion for estimating mediastinal displacement, (4) the discovery that clinically occult tuberculosis and congestive heart failure could be detected with fluoroscopy, (5) the documentation that unilateral chest disease caused decreased ipsilateral ventilatory compliance and increased contralateral ventilation, (6) the identification of the classical imaging characteristics of tuberculosis, pneumonia, pneumothorax, tension pneumothorax, pleural effusion, hydropneumothorax, emphysema, congestive heart failure, and air trapping. In April 1896, Dr. Williams described the "air bronchogram" in a radiograph of a patient with pneumonia.     

Histological and ultrastructural evaluation of Leeds-Keio ligament 20 years after implant: a case report

We were capable of undertaking a histological and ultrastructural evaluation of an intact Leeds-Keio ligament implanted 20 years ago to assess the neoligamentization process inside this artificial ligament. The histological evaluation disclosed a collagen fibrils orientation very close to the structure of a normal anterior cruciate ligament (ACL) where the collagen fibres are multidirectional [Strocchi et al. in J Anat 180(3):515–519, 1992]. On the other hand we found an unimodal distribution of collagen fibrils in the reconstructed ACL. This suggests that even at long-term follow-up stress exerts a variable influence. The multidirectional arrangement of collagen fibres resembles a normal ACL, but the unimodal distribution of fibrils is quite different from those seen in normal tendon and ligaments which tend to have a bimodal peak [Decker et al. in J Submicrosc Cytol Pathol 23:9–21, 1991; Strocchi et al. in J Anat 180(3):515–519, 1992]. Studies based on biopsy suffer from the potential weakness that the specimen may not have been representative of the entire prosthesis. Further long-term studies, possibly with the entire prosthesis and not only a biopsy, would highlight the behaviour and remodelling of this artificial ligament in greater detail and could be important for the development of future generations of artificial ligaments or tissue engineering ACL reconstruction.     

Sports and physical activity after cementless total hip arthroplasty with a minimum follow‐up of 10 years

The present retrospective cohort study was conducted to compare sporting activity levels before and a minimum of 10 years after primary cementless total hip arthroplasty (THA). A consecutive series of 86 patients with a mean age at surgery of 52 years (range, 21–60 years) was evaluated 11 years after surgery (range, 10–12 years). Pre‐ and post‐operative sporting activities were assessed at routine follow‐up using the University of California, Los Angeles activity score and the Schulthess Clinic sports and activity questionnaire. Post‐operative health‐related quality of life was measured using the Short‐Form 36 (SF‐36) questionnaire and compared with age‐matched reference populations from the SF‐36 database. Eleven years after THA, 89% of preoperatively active patients had returned to sport. Comparing sports activity preoperatively (before the onset of symptoms) and 11 years after THA, no significant difference was found for the mean number of disciplines or session length. A significant decline in high‐impact activities was observed, while participation in low‐impact activities significantly increased. Health‐related quality of life compared well against a healthy age‐matched reference population and was significantly higher than in a reference group of patients with osteoarthritis. The majority of patients were able to maintain their physical activity level in the long term after primary cementless THA, compared with the activity level before the onset of restricting osteoarthritis symptoms. However, a change in disciplines toward low‐impact activities was observed.     

The influence of sex and pre-operative obesity on biomechanics two years after total knee arthroplasty: A longitudinal cohort study

BackgroundSex and obesity may influence knee biomechanics associated with poor outcomes following primary total knee arthroplasty (TKA) however their long-term impact has not been investigated.Research questionDoes sex and/or pre-operative obesity influence change in gait biomechanics from pre-TKA to two-years after TKA, and do knee biomechanics return to normal two-years after TKA?MethodsIn this longitudinal study, gait analysis was performed on 78 patients undergoing TKA for knee osteoarthritis prior to surgery (baseline), and on 66 (85 %) of these who returned at the two year follow-up. Gait biomechanics were also collected on a reference sample of 40 asymptomatic participants. Knee variables were analyzed according to time (pre- and post-TKA), sex (men and women), pre-operative obesity (obese vs non-obese), and group (TKA vs reference). Mixed linear regression models were used to examine the effects of TKA, obesity status, gender and all interactions.ResultsThere were two-year reductions in peak knee frontal plane angle (mean difference −7.21°; 95% confidence intervals −9.37 to −5.05), peak knee adduction moment (KAM) (-17.64Nm; −23.04 to −12.24) and KAM impulse (-9.40Nm.s; −12.04 to −6.77) in males. These and other variables were unchanged in women. At two years, men exhibited a greater varus-valgus thrust excursion (4.9°; 2.7–7.2), and a lower peak knee frontal plane angle (−4.4°; −7.1 to −1.7) and peak KAM (−13.1Nm; −20.9 to −5.4), compared to the reference sample. Biomechanics at two years did not differ between pre-operative obesity subgroups, or between female TKA patients and the reference sample.SignificanceChanges in gait biomechanics two years after TKA are influenced by sex but not obesity. Men but not women showed altered knee biomechanics two years following TKR and compared to a reference sample. It is unknown whether these altered biomechanics in men impact longer term clinical outcomes and satisfaction following surgery.     

Nasolacrimal drainage obstruction after radioiodine therapy: case report and a review of the literature

The authors report a 54-year-old woman with papillary thyroid carcinoma (Lindsay type, pT2 N0 M1) with pulmonary metastases. After a total thyroidectomy, a series of 3 radioiodine therapies were performed with a cumulative dose of 700 mCi I-131. After termination of the therapy, the patient was initially without complaints, but approximately 6 months later, epiphora was noted, first only of the right eye and eventually of both eyes. A whole-body I-131 scan performed 1 year after final radioiodine therapy showed atypical tracer accumulation in both medial orbital regions. This finding was new compared with the scan that was done 1 year before. Dacryocystography revealed bilateral occlusion of the lacrimal drainage system. A review of the literature shows that epiphora and lacrimal duct alterations are rarely investigated and potentially underestimated side effects after high-dose radioiodine therapy.     

Meier-Gorlin syndrome with prenatal ultrasound findings and successful growth hormone therapy: Six years follow-up of a rare case

Meire-Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by a triad of short stature, microtia, and absent or hypoplastic patella. We report a 5-year-old male affected with the subtype MGS1, secondary to c.c2292t mutation of ORC1 gene. Our patient''s features included a triangular face, micrognathia, and delayed motor development. To the edge of our knowledge, this is the first diagnosed Iranian MGS patient and sixth case in the middle east. MGS1 subtype has never shown improvement to growth hormone therapy, therefore underlying molecular defect was suggested to be responsible for patients’ short stature rather than growth hormone deficiency. However, our patients’ growth velocity was improved by growth hormone. We recommend more studies to specify the role of ORC1 gene in this syndrome. In addition, this case report describes the prenatal investigations and sonographic examinations of MGS1 for the first time.     

An intramural hematoma of the small intestine, during anticoagulant therapy: radiological course. Concerning one case]

The authors present a case of intramural hematoma of the small intestines during anticoagulant treatment. With reference to this case, they study the frequency, etiopathogenesis and anatomy of this hematoma and particularly look at the radiological manifestations. In this respect they distinguish three stages in the evolution. The first, when the straight X-ray of the abdomen and barium followthrough demonstrate an axial stenosis of the small intestines with dilation of the proximal loops; the second (between the 7th and 20th days) when the loop affected by the hematoma takes on a characteristic "palissade" or "spring" -like sausage appearance; finally the third (after the 3rd week), when only thickening of the haustrations persists with progressive return to normal. The radiological diagnosis is discussed, not only with intramural hematomas of the small intestines of other etiologies (traumatic, during pancreatitis, during disorders in hemostatis), but also with conditions giving rise to similar radiological pictures: malabsorption, inflammatory conditions, etc.     

Wilson's disease. X-ray CT and MRI aspects of the brain in a case before treatment

Wilson disease is an autosomal recessive disorder of copper metabolism. The case of a young girl is reported here, with CT and MRI data before any treatment. The unusual MR presentation on T2 weighted sequences is studied, and compared with those described in patients under treatment.