99mTc ovalbumin labelled eggs for gastric emptying scintigraphy: in-vitro comparison of solid food markers

BACKGROUND: The reliability of solid phase gastric emptying measurements by scintigraphy requires a marker that remains within the solid component of the test meal, and which is not degraded by the gastric juice throughout the scintigraphic procedure. In Europe, foods are most often labelled with 99mTc rhenium sulfide macrocolloid (RSMC) but this solid phase marker was withdrawn from the market in January 2004. OBJECTIVE: To test other potential solid phase markers and to compare them to the reference marker RSMC. These markers were rhenium sulfide nanocolloid (RSNC), tin fluoride colloid (TFC), phytates and two albumins (Alb and AlbC). All were radiolabelled with 99mTc. METHODS: After quality control, each 99mTc marker was incorporated into the albumin of one egg. Then, egg white and yolk were mixed together, and a well-cooked omelette was prepared. Aliquots of the omelette were incubated with an acidic solution of pepsin at 37 degrees C which mimicked gastric juice. Unbound radioactivity in the supernatant fraction was measured at various times up to 3 h. RESULTS: The radiochemical purity was > 95% for all radiopharmaceuticals. During the in-vitro incubation, the percentage of 99mTc labelled colloids released from the omelette increased continuously: after 3 h, 5% for TFC and RSMC, 8% for phytates, and > 9% for the two albumins and RSNC. CONCLUSION: Considering quality controls and release of 99mTc during in-vitro incubation of the omelette, TFC showed the same behaviour as the reference marker RSMC. Thus, TFC seems to be the best candidate to replace RSMC for the radiolabelling of the solid phase of the gastric emptying test meal.     

Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff

BACKGROUND: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff. HYPOTHESIS: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: A prospective, randomized, single-blind study was carried out on 50 patients. The population was divided into 2 groups of equal numbers (navigation group and feedback group). In all patients, treatment-resistant pain was evident for longer than 6 months. A total of 3 therapy sessions of constant low-energy focused shock wave therapy was administered in weekly intervals in both groups. Local anesthesia was not applied. Radiographs and clinical assessment, including the Constant and Murley shoulder scoring system and the visual analog scale for pain, were performed both before therapy and after 12 weeks. In the navigation group, the calcium deposit was localized using a radiographically guided, 3-dimensional, computer-assisted device. The feedback group was treated after locating the point of maximum tenderness through palpation by the therapist with feedback from the patient. RESULTS: Both groups had significant improvements in the Constant and Murley score and the visual analog scale after 12 weeks. The results from the navigation group were statistically significantly superior to those of the feedback group. In the navigation group, 6 calcium deposits disappeared and 9 altered, compared to 1 disappearance and 12 alterations in the feedback group. No severe complications occurred. CONCLUSION: Three-dimensional, computer-assisted navigation reveals significantly better results and is therefore recommended when extracorporeal shock wave therapy is used in the treatment of calcific tendinitis of the rotator cuff.     

The familial predisposition toward tearing the anterior cruciate ligament: a case control study

PURPOSE: A study of 171 surgical cases and 171 matched controls was conducted to investigate whether a familial predisposition toward tearing the anterior cruciate ligament of the knee exists. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Patients who were diagnosed with an anterior cruciate ligament tear were matched by age (within 5 years), gender, and primary sport to subjects without an anterior cruciate ligament tear. All 342 subjects completed a questionnaire detailing their family history of anterior cruciate ligament tears. RESULTS: When controlling for subject age and number of relatives, participants with an anterior cruciate ligament tear were twice as likely to have a relative (first, second, or third degree) with an anterior cruciate ligament tear compared to participants without an anterior cruciate ligament tear (adjusted odds ratio = 2.00; 95% confidence interval, 1.19-3.33). When the analysis was limited to include only first-degree relatives, participants with an anterior cruciate ligament tear were slightly greater than twice as likely to have a first-degree relative with an anterior cruciate ligament tear compared to participants without an anterior cruciate ligament tear (adjusted odds ratio = 2.24; 95% confidence interval, 1.24-4.00). CONCLUSIONS: Findings are consistent with a familial predisposition toward tearing the anterior cruciate ligament. CLINICAL RELEVANCE: Future research should concentrate on identifying the potentially modifiable risk factors that may be passed through families and developing strategies for the prevention of anterior cruciate ligament injuries.     

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598]

Background  

There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first) at term; external cephalic version (ECV) – the turning of a breech baby to a head-down position and/or planned caesarean section (CS). Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful.     

Splenic pregnancy: a case report and review of the literature

Primary splenic pregnancy is the least common form of extrauterine pregnancy. We report a case of splenic pregnancy occurring in a 29-year-old woman presenting with acute abdomen and hemoperitoneum. Recognition of this rare form of gestation is of critical importance, owing to the risk of exsanguination and death, and should be considered in the differential diagnosis of acute abdomen in women of reproductive age.     

Appendicular colic and the non-inflamed appendix: fact or fiction?

AIMS: Appendicoliths cause acute appendicitis and appendicular perforation. Do appendicoliths cause acute abdominal pain in the absence of acute appendicitis? METHODS: A retrospective observational study was undertaken of histology reports of all appendicectomy specimens from children < 16 years of age between January 1995 and December 2001. Specimens were categorised as perforated or uncomplicated acute appendicitis, non-inflamed, and "incidental" (removed during abdominal surgery for other indications). The presence of an appendicolith was noted. Clinical details were supplemented by selected case note review. Specimens in which the diagnosis of appendicitis or the presence of an appendicolith were not clearly defined (n = 20) were reviewed by an experienced, independent pathologist. RESULTS: 601 consecutive appendicectomy reports were analysed. The mean age of the study population was 9 years (range 1 day - 15.9 years) and there were 357 boys. An appendicolith was identified in 31/118 (26%) cases of perforated appendicitis, 60/352 (17%) cases of uncomplicated appendicitis, 12/59 (20%) cases of non-inflamed appendices, and only 1/72 (1%) cases of incidental appendicectomies. All patients with an appendicolith in the non-inflamed appendix group had presented with acute abdominal pain mimicking acute appendicitis. The frequency of an appendicolith in perforated appendicitis was significantly greater than in uncomplicated acute appendicitis (chi (2) = 4.8, 1 df, p < 0.05). There was no significant difference in the frequency of an appendicolith between non-inflamed appendices and acute appendicitis (either perforated or intact). Appendicoliths were rarely found in incidental appendicectomies, but these patients were younger. The frequency of appendicoliths in non-inflamed appendices was much greater than that expected from published autopsy data. CONCLUSION: Appendicoliths may cause acute abdominal pain that mimics acute appendicitis.     

Thoracoamniotic shunting for fetal pleural effusions with hydrops

OBJECTIVE: The purpose of this study was to evaluate perinatal outcome after thoracoamniotic shunting for fetal pleural effusions with hydrops. STUDY DESIGN: This was a retrospective study. RESULTS: Shunting was performed immediately after diagnosis and was successful in all 54 of the cases that were attempted. There were 7 pregnancy terminations, 9 in utero deaths, and 38 live births, of which 7 children died in the neonatal period and 31 children survived. Among the liveborn infants, 27 infants were delivered preterm (71%), of whom 7 infants (15%) had preterm premature rupture of membranes and 4 infants (8.5%) had chorioamnionitis. Perinatal death (23/54 infants; 43%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (9 cases). All 31 survivors had chylothorax; for 28 of the survivors, the chylothorax was primary, and for 3 survivors, the chylothorax was the result of right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome. CONCLUSION: After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.     

Rare manifestations of sirenomelia syndrome: a report of five cases

Five cases of sirenomelia presented with rare manifestations are discussed. Three neonates were born alive and died within 2 to 12 hours after birth. One case was the offspring of a triple in vitro fertilization pregnancy with history of early intrauterine death of one of the triplets. The main features included fusion of lower extremities (five of five), renal agenesis (three of five), polycystic renal dysplasia (two of five), anal atresia with large bowel hypoplasia (three of five), pulmonary hypoplasia (four of five), and single umbilical artery (five of five). Other features that have only rarely been associated with sirenomelia included concurrence of congenital heart disease and neuroblastoma, gallbladder agenesis, and upper extremity defects.