Multiple myeloma: evaluation by CT

Although patients who have multiple myeloma usually have straightforward clinical symptoms and corroborative radiographs, in some instances, these patients will present atypically, with symptoms suggesting active disease but radiographs that are normal or nonspecific. We reviewed the records of 32 patients who had documented multiple myeloma and had undergone CT examinations, assessing the value of those examinations. Although CT is not indicated in all patients who have multiple myeloma, it is especially useful in patients who have bone pain and normal or nonspecific radiographs. CT provided confirmatory information in all cases in which lesions were seen on radiographs. CT also frequently demonstrated a greater extent of disease than could be appreciated on the radiographs.     

The Moore vitallium femoral-head prosthesis in fractures of the femoral neck.

A follow-up is given of early and late results in 109 arthroplasties with the self-locking Austin T. Moore vitallium femoral head prosthesis in fractures of the femoral neck on 106 patients. Operative indication was usually fresh medical fracture of the femoral neck in an elderly woman, or its late complication. The surgery was performed in a unit for general surgery also engaged in pre- and postgraduate teaching activities. Many operations were performed by residents engaged in general surgery or orthopaedics. Point scores according to a modification of Merle D'Aubigné's classification showed excellent or at least good results in 81 per cent of the 69 mobile patients. Because of deteriorated general physical condition 11 patients were chronically bed-ridden. Five patients could not be reached. In three instances the prosthesis was removed. 21 patients died, three during the stay in hospital and 18 later for reasons not connected with the operative procedure. The mortality during 40 months of observation corresponded fairly well to that expected in the age group for the population as a whole.     

Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

The associations of emotion regulation and dysregulation with the metabolic syndrome factor

OBJECTIVE: Emotion regulation has been associated with good, and dysregulation with poor subjective health; but it is unclear if emotion regulation is related to metabolic syndrome. METHODS: Associations between the metabolic syndrome factor (systolic and diastolic blood pressure, waist circumference, high-density lipoprotein, triglycerides, and glucose), emotion regulation (the strategies of repair and maintenance, self-perceived emotion regulation) and dysregulation (emotional ambivalence); and subjective health (self-rated health and psychosomatic symptoms) were studied using a structural equation modelling (SEM) approach. The participants (96 women, 85 men) were drawn from the Jyv?skyl? Longitudinal Study of Personality and Social Development (JYLS). RESULTS: High repair was associated directly to the low metabolic syndrome factor, while high maintenance, high self-perceived emotion regulation, and low emotional ambivalence were related indirectly to the low metabolic syndrome factor through good subjective health. CONCLUSIONS: Successful emotion regulation may have an association not only with the subjective experience of health, but also with physiological regulation systems, leading to a reduced risk for metabolic syndrome.     

Ultrasonically activated scalpel compared with electrocautery in tonsillectomy

The occurrence of postoperative bleeding, the quantity of operative bleeding and the duration of operation were retrospectively evaluated in 407 patients who underwent tonsillectomy within a 32-month period. They were operated on with either an ultrasonically activated scalpel (UAS), bipolar diathermy (BPD) or blunt dissection with monopolar diathermy (MPD) with the following results. (1) Primary bleeding was more common with MPD: MPD 7.1% vs. BPD 2.4% (p < 0.01) vs. UAS 1.0% (p < 0.001). Secondary bleeding was more common with UAS: UAS 19.6% vs. MPD 14.5% (p < 0.001) vs. BPD 14.5% (p < 0.01). There was no statistical significance in the differences between overall postoperative bleeding rates. (2) There was statistically significantly less operative bleeding with UAS:UAS 24.8 ml vs. MPD 58.7 ml vs. BPD 43.8 ml. (3) On the other hand, the operation time was on average longer with UAS: UAS 32.3 min vs. MPD 18.4 min vs. BPD 22.1 min. Our results suggest that UAS offers no significant advantage over MPD or BPD in tonsillectomy other than minimal operative bleeding possibly due to longer duration of operation.     

Risk of Guillain-Barré syndrome after measles-mumps-rubella vaccination

OBJECTIVE: To assess the postulated causal association between measles-mumps-rubella (MMR) vaccination and Guillain-Barré syndrome (GBS). STUDY DESIGN: Active retrospective study based on linkage of the nationwide hospital discharge register with individual vaccination records. All patients hospitalized for treatment of GBS in Finland between November 1982 and December 1986 were included in the study. RESULTS: During the study period, 189 patients were hospitalized for treatment of GBS, and approximately 630,000 vaccine recipients received 900,000 doses of MMR vaccine; 24 of the 189 patients represented the prevailing target population for MMR vaccination, of whom 20 were vaccinated. MMR vaccination did not cause any increase over the background incidence of GBS, and no clustering of cases of GBS occurred at any time point after administration of MMR vaccine. The interval between vaccination and onset of symptoms of GBS exceeded the designated risk period of 6 weeks in all cases, varying from 80 days to years. MMR vaccination after recovery from GBS did not cause relapses of the illness. Respiratory or gastrointestinal tract infection predated the onset of GBS by 3 to 30 days in 20 (83%) of the 24 patients. CONCLUSIONS: No causal association seems to prevail between MMR vaccination and GBS.     

Intraventricular haemorrhage in the preterm infant without hyaline membrane disease

The clinicopathological associations of 33 singleton infants who died with intraventricular haemorrhage (IVH) without hyaline membrane disease (HMD) ('IVH only') were compared with those of 39 infants who died with IVH+HMD over the same gestation range in order to determine what factors other than those related to HMD may contribute to the pathogenesis of IVH. The incidence of 'IVH only' was inversely related to gestational age in the Hammersmith birth population, whereas the incidence of IVH+HMD rose to a peak at 28-29 weeks' gestation. Infants with 'IVH only' lived longer on average than those with IVH+HMD despite a lower birthweight and shorter gestation. Infants who died in the first 12 hours from 'IVH only' had suffered severe birth asphyxia but in those who died later the main symptom was recurrent apnoea. Fewer infants with asphyxia but in those who died later the main symptom was.recurrent apnoea. Fewer infants with 'IVH only' were given alkali therapy or were connected to the ventilator as compared to those with IVH+HMD, but there were no differences in alkali therapy in those who lived for 12 hours or more. In the 'IVH only' group there was a high incidence of haemorrhage from other sites and of bacterial infections. It is suggested that, in the absence of HMD, extreme immaturity is the main factor determining the occurrence of IVH. Birth asphyxia, apnoeic attacks, haemorrhage, and infections may play subsidiary roles, possibly through development of metabolic acidosis.