MRI evaluation of bulky tumor masses in the mesentery and bladder involvement in peritoneal carcinomatosis

AIM: Peritonectomy procedures with intraperitoneal chemohyperthermia are an effective but costly treatment for peritoneal carcinomatosis (PC). Consequently a proper selection of patients is necessary. We evaluated the benefit of MRI prior to surgery, in the detection of two of the main surgery contraindications: bulky mesenteric tumors and bladder implants. METHODS: Three experts retrospectively reviewed abdominal and pelvic MRI from 19 cases of surgically proved PC (ovary: 7; colorectal: 7; gastric: 2; pseudomyxoma peritonei: 2; appendix: 1). RESULTS: Mesenteric tumors were always identified as hypersignal masses on axial and coronal fat suppression gadolinium-enhanced T1 images (n=3). Three out of five bladder implants were detected. The two cases of bladder implants that were not detected on MRI were missed because the bladder was not filled. The best sequence for the detection of bladder involvement was axial T2-weighted images with bladder filling. CONCLUSIONS: Evaluating the preoperative resectability of PC is crucial for patient management. MRI seems to reliably detect bulky mesenteric tumors and bladder implants on condition the bladder is filled and appropriate sequences are used.     

Relevance of 10-min delayed recall in dementia screening

Within the context of early diagnosis of Alzheimer's disease (AD), there is a growing interest in neuropsychological screening tests. Amongst these tests, we focused on the largely used Memory Impairment Screen (MIS). The objective of the present work was to show that adding a 10-min delayed recall to the MIS, improves the test psychometric characteristics in order to detect dementia in the earliest stages. A prospective study was carried out on a cohort of 270 consecutive elderly ambulatory subjects attending the Broca Hospital Memory Clinic: normal controls ( n  = 67), mild cognitive impairment subjects ( n  = 98) and mildly demented patients [ n  = 105, Mini Mental State Examination (MMSE) = 23 ± 4]. This study consisted in testing the advantage of the 10-min delayed recall entitled MIS-D compared with the MIS. At a cut-off score of 6, the MIS-D revealed satisfying psychometric characteristics with a sensitivity of 81% and a specificity of 91%, whilst the MIS alone indicated a sensitivity of 60% and a specificity of 88% in detecting dementia. In demented patients with MMSE score ≥26, MIS-D properties still remained satisfying (sensitivity: 75%, specificity: 92%). MIS-D is a more relevant screening test than MIS alone at very early stages of dementia.     

Effect of chronic exposure to low doses of ionized radiation on embryonal development of the Japanese quail

Experiments on Japanese quail embryogenesis on a background of chronic exposure to gamma- and neutron doses comparable with the doses of ionized radiation inside the orbital space stations Mir and ISS, and exploration vehicles gave evidence that permanent absorption of low gamma-doses (0,15 cgy/d) did not impact development of the Japanese quail embryos. On the contrary, the neutron dose of 200 microgy/d imparted by the neutron flux of 30 particles/cm2s was hazardous to embryos as it caused morphological disorders in 12% of embryos.     

Acupuncture analgesia and its application in cranio-maxillofacial surgical procedures.

BACKGROUND: The present study investigated the use of acupuncture analgesia in maxillofacial surgery. PATIENTS AND METHODS: Acupuncture analgesia was applied in 120 patients. In 20 of these, surgery was carried out under general anaesthesia in combination with acupuncture analgesia. In 100 patients, acupuncture analgesia was applied in addition to traditional postoperative analgesia. In case of troublesome postoperative pain, it was necessary to carry out additional sessions (1-4) of acupuncture stimulation. RESULTS: When acupuncture analgesia was used, the pulse rate and blood pressure during surgery generally remained stable. In the present study serum cortisol was also measured and showed only minor elevation. DISCUSSION: The present study demonstrated favourable results when the first variant of the brake method of acupoint stimulation was used for 40-50 min with additional manual twirling of the needles. This involved inserting needles into the acupoints and, using slow, rolling manual movements increasing the amplitude step-by-step provoking simultaneous especially strong patient sensations. CONCLUSION: Acupuncture analgesia can be a useful adjunct to conventional anaesthesia in maxillofacial surgery.     

Keratography as a guide to selective suture removal for the reduction of astigmatism after penetrating keratoplasty

After penetrating keratoplasty in 52 eyes, keratography refraction and keratometry were used to select appropriate interrupted sutures for removal in order to reduce astigmatism. All eyes had one continuous and either 12 or 16 interrupted nylon sutures. The keratographs were examined retrospectively and separated into six groups on the basis of similar mire patterns. The removal of single sutures associated with three of these patterns reduced astigmatism by the following average amounts: symmetrical oval pattern, 0.44 diopters (D); D-shaped oval pattern, 2.07 D; and focal indentation pattern, 6.60 D. The other three patterns--mildly disrupted mires, incomplete mires, and uninterpretable mires--did not allow quantification of results. Examples of these keratographic patterns are presented and recommendations are made for their use in the management of astigmatism following penetrating keratoplasty.     

Incidence of ankylosing hyperostosis of the spine (Forestier's disease) at autopsy

In a series of 75 spines studied at autopsy, the authors found 21 (28%) affected by ankylosing hyperostosis. The 21 cases included three in the cervical spine, 12 in the thoracic spine, and five in the lumbar spine. One case had both thoracic and lumbar spine disease. The average age was 65 years (range, 50-90 years). The mean weight was 85 kg, which was 20 kg more than the mean weight of the nonaffected subjects. Four cases had adult onset diabetes mellitus. No other endocrine or arthritic disease was noted either clinically or at autopsy. No abnormalities of calcium or phosphorus metabolism were found. The cause of death was unrelated to their spine disease, and clinical records were devoid of any major complaints referable to the spine.     

C-reactive protein as a predictor of fetal and maternal infective morbidity and fetal mortality

The value of maternal C-reactive protein (CRP) levels as predictors of fetal and maternal infective morbidity and fetal mortality was assessed prospectively over a 6-month period in all cases of premature rupture of the fetal membranes or suspected premature labour. Statistical analysis of results showed that CRP at a level of 1.32 mg/dl is a sensitive marker of infective morbidity in mother and neonate. Furthermore, there was a significant association between raised CRP levels and low-birth-weight babies, suggesting that intra-uterine infection is a major cause of prematurity in the study population.     

Choice of general practice for postgraduate training among medical graduates and undergraduates in Nigeria

A questionnaire survey of career choices was carried out among 112 medical graduates, after one year's internship (group I), during their National Youth Corps programme in Kaduna, Lagos, Cross River and Oyo states of Nigeria, and 365 final-year medical undergraduates (group 2) in the colleges of medicine in the corresponding states. A total of 13% in group I and 40% in group 2 were undecided as regards their first choice. Obstetrics and gynaecology was the most popular first choice in both groups. General practice ranked fifth among group I, but displaced surgery to rank second among group 2. The differences were statistically significant. A total of 41% of group I and 46% of group 2 preferred to work in a teaching hospital, reflecting the high preference for surgical specialties. Twenty-six per cent and 33.7% of respondents in groups 1 and 2 respectively wished to own their own practice or work in the private sector. General practice is a new specialty and its growth is supported by a national postgraduate training programme. A shift towards general practice is seen compared with previous studies of career preference among Nigerian medical graduates and students. This may be due to a changing balance of supply and demand in the medical work-force, or a better assessment of the nation's health problems and manpower needs.     

Urinary tract infection in the impaired host

In general, defects in phagocytosis and in humoral or cellular immunity do not appear to predispose to the acquisition of UTI but do influence the clinical manifestations and the severity, microbiology, and complications of infection once it is established. The incidence of UTI in immunosuppressed patients other than diabetics or renal transplant recipients is not higher than the incidence in nonimmunosuppressed individuals. The higher frequencies of infection seen in diabetics and in renal transplant recipients correlate best with the duration of bladder instrumentation rather than with glycosuria or immunosuppressive regimen. Neutropenia blunts the clinical manifestations of UTI and predisposes to bacteremia. Use of broad spectrum antibiotics results in alterations in indigenous flora, promotes urinary infections with resistant nosocomial pathogens, and predisposes to fungemia with hematogenous seeding of the urinary tract. Routine screening for detection of asymptomatic bacteriuria and prompt institution of antimicrobial therapy is indicated only in renal transplant recipients within 3 months of their surgery and not in any of the other diseases discussed.