Spontaneous Uterine Venous Rupture During Labour: A Case Report With Postoperative Ultrasonographic Findings

EDITORIAL COMMENT: We accepted this case for publication to remind readers that although uterine rupture during labour in a primigravida is extremely uncommon it does occur, or at any rate nulliparas can develop abdominal pain and shock in labour with a haemoperitoneum resulting from a tear in a vein in the lower posterior uterine wall. When one sees the hugely dilated uterine and ovarian venous plexuses at Caesarean section it is easy to believe that bleeding from such a vessel during labour could be prodigious. This case suggests that a dilated vein with blood flow derangements may be the cause. Nonetheless, as the authors warn us, the necessary response is not a precise diagnosis, but rapid laparotomy. See also Editorial Comment to Chin MMS, Harvey JA, Duffy BL. Uterine rupture during labour in a primigravida. Aust NZ J Obstet Gynaecol 1996; 36: 210.     

Foot Polydactyly and Polysyndactyly: Genetic Implications in Two Families

The purpose of this study was to determine the genetic characteristics of foot polydactyly and identify its inheritance pattern by analyzing familial pedigree. Five cases from 2 Korean families were studied: 1 is a family whose members have been affected for 4 generations and the other for 2 generations. Using peripheral blood samples, we performed chromosomal analysis using the banding technique with Giemsa stain and karyotyping. We investigated the shape and structure of 46 chromosomes, looking for translation, deletion, inversion, ring chromosome, and isochromosome abnormalities. All peripheral blood samples demonstrated no chromosomal abnormalities, though the genetic nature of foot polydactyly and a new genetic locus was identified recently by other studies. Familial pedigree analysis suggested that polydactyly was inherited as an autosomal dominant trait in the first family. The mode of inheritance for the second family could not be determined due to an insufficient number of family members. The result of this study brought us to the conclusion that, while genetic factors play a major role in polydactyly, other factors may contribute to its occurrence.     

Loneliness among elderly people living in Stockholm: a population study

The purpose was to investigate experienced loneliness among the elderly. The material included 1725 people, aged 75 and over. The study describes relationships between loneliness, social network, cognitive function and health. Thirty-five per cent experienced loneliness, and a higher percentage was found among women. A gradual increase in loneliness was found up to the age of 90, after which a levelling was found. Elderly persons living together with a partner experienced less loneliness. There were no significant differences between those with and without children. Ten per cent reported not having any friends and, of these, one out of two experienced loneliness. A high frequency of experienced loneliness was found among elderly people with reduced cognitive function. Subjectively experienced bad health and loneliness were strongly related to each other, i.e. a person who experienced loneliness did usually not feel completely healthy.     

Biliary and pancreatic secretions influence experimental duodenal ulcer without affecting gastric secretion in the rat

The effect of the absence of biliary and/or pancreatic secretions in the duodenum or the enhanced presence of bile at the proximal duodenum on the incidence, severity, number, and location of cysteamine-induced duodenal ulcers was investigated in the rat. Cysteamine produced ulcers on the anterior wall of the duodenum in 75% and on the posterior wall (kissing ulcers) in 50% of the animals. Diversion of biliary and/or pancreatic secretions from the duodenum increased both the severity and the incidence of the posterior duodenal ulcers. Diversion of bile to the proximal duodenum, on the other hand, decreased the severity as well as the incidence of the anterior duodenal ulcers. Mortality in rats receiving cysteamine correlated with the severity of ulcers. Taurocholic acid at nontoxic doses given subcutaneously or orally to nonoperated rats and rats which had bile diverted to the proximal duodenum aggravated the cysteamine-caused duodenal ulcers. Neither proximal nor distal diversion of bile had a major effect on gastric secretion of acid and pepsin in normal or cysteamine-treated rats. We conclude that both bile and pancreatic secretions may directly influence the development of cysteamine-induced duodenal ulcers in the rat.These studies were supported in part by a grant (AM25229) and Research Career Development Award (AM00600) to S. Szabo from NIH and U.S. Public Health Service.     

Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis

BACKGROUND CONTEXT: Although posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases is routine, there are few reports on double-level PLIF. PURPOSE: To evaluate the clinical outcomes of double-level PLIF. STUDY DESIGN/SETTING: A retrospective study of operated cases in Gifu, Japan. PATIENT SAMPLE: Nineteen patients (8 men and 11 women, 59.5+/-10.2 years) who underwent double-level PLIF between 1996 and 2001. OUTCOME MEASURES: Operation time, blood loss, complications, the Japanese Orthopaedic Association (JOA) score for back pain and lumbar sagittal alignment were evaluated. METHODS: Patients were examined retrospectively at follow-ups of 3.6+/-1.7 years. Primary diseases were spondylolisthesis, spinal canal stenosis, degenerative scoliosis and herniated intervertebral disc. Fusion areas were L3 to L5 in 15 cases and L4 to S1 in 4 cases. RESULTS: The mean JOA score increased from an initial score of 12.9+/-3.5 to 21.3+/-4.9 at the final follow-up. There was a positive correlation (R=0.718, p<.001) between the increase in lordotic angle and the increase in the JOA score. Several parameters suggested that the surgical invasiveness was not minimal. CONCLUSION: Double-level PLIF provided satisfactory results and preserved lumbar spine lordosis.     

Motion artifact reduction of diffusion‐weighted MRI of the liver: Use of velocity‐compensated diffusion gradients combined with tetrahedral gradients

Purpose:

To assess the effect of motion artifact reduction on the diffusion‐weighted magnetic resonance imaging (DWI‐MRI) of the liver, we compared velocity‐compensated DWI (VC‐DWI) and VC‐DWI combined with tetrahedral gradients (t‐VC‐DWI) to conventional DWI (c‐DWI) in the assessment of apparent diffusion coefficients (ADCs) of the liver.

Materials and Methods:

In 12 healthy volunteers, the liver was scanned with c‐DWI, VC‐DWI, and t‐VC‐DWI sequences. The signal‐to‐noise ratio (SNR) and ADC of the liver parenchyma were measured and compared among sequences.

Results:

The image quality was visually better for t‐VC‐DWI than for the others. The SNR for t‐VC‐DWI was significantly higher than that for VC‐DWI (P < 0.05) and comparable to that for c‐DWI. ADCs in both hepatic lobes were significantly lower for t‐VC‐DWI than for c‐DWI (P < 0.01). ADC in the left lobe was significantly lower for VC‐DWI than for c‐DWI (P < 0.01). Although ADC in the left lobe was significantly higher for c‐DWI (P < 0.01), no significant differences in ADCs were found between the right and left lobes for VC‐DWI and t‐VC‐DWI.

Conclusion:

The use of a t‐VC‐DWI sequence enables us to correct ADCs of the liver for artificial elevation due to cardiac motion, with preserved SNR. J. Magn. Reson. Imaging 2013;37:172–178. © 2012 Wiley Periodicals, Inc.     

Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers

Cigarette smokers deposit less collagen, expressed as hydroxyproline, in granulation tissue than nonsmokers. We studied the effect of abstinence from smoking and transdermal nicotine patches on deposition of hydroxyproline, proline, type I procollagen, and total proteins. Fifty-four healthy smokers were studied during 10 days of smoking and again from days 10 to 20 following smoking cessation. After the first 10 days of abstinence they were randomized to double-blind treatment with transdermal nicotine patches of 25 mg/day or placebo for a period of 10 days. During this period and during smoking, an expanded polytetrafluoroethylene tube was implanted into the subcutis. Following removal of the implant, total amino acids and peptides were extracted. Hydroxyproline and proline were analyzed by high-pressure liquid chromatography, type I procollagen was analyzed by enzyme-linked immunoassay, and total proteins were determined colorimetrically. In the 39 subjects who complied with the study protocol, abstinence from smoking did not affect the deposition of hydroxyproline, proline, type I procollagen, or total protein in the implants. During abstinence, the type I procollagen level increased by 18% in the transdermal nicotine patches group and decreased by 10% in the placebo group (p<0.05). We conclude that 20 days of abstinence from smoking does not affect collagen deposition in granulation tissue. However, in abstinent smokers, transdermal nicotine patches appears to increase type I collagen synthesis.