Systemic effects of ulna loading in male rats during functional adaptation

Functional skeletal adaptation is thought to be a local phenomenon controlled by osteoctyes. However, the nervous system also may have regulatory effects on adaptation. The aim of this study was to determine the effects of loading of a single bone on adaptation of other appendicular long bones and whether these responses were neuronally regulated. Young male Sprague‐Dawley rats were used. The right ulna was loaded to induce a modeling response. In other rats, a second regimen was used to induce bone fatigue with a mixed modeling/remodeling response; a proportion of rats from each group received brachial plexus anesthesia to induce temporary neuronal blocking during bone loading. Sham groups were included. Left and right long bones (ulna, humerus, tibia, and femur) from each rat were examined histologically 10 days after loading. In fatigue‐ and sham‐loaded animals, blood plasma concentrations of TNF‐α, RANKL, OPG, and TRAP5b were determined. We found that loading the right ulna induced an increase in bone formation in distant long bones that were not loaded and that this effect was neuronally regulated. Distant effects were most evident in the rats that received loading without bone fatigue. In the fatigue‐loaded animals, neuronal blocking induced a significant decrease in plasma TRAP5b at 10 days. Histologically, bone resorption was increased in both loaded and contralateral ulnas in fatigue‐loaded rats and was not significantly blocked by brachial plexus anesthesia. In young, growing male rats we conclude that ulna loading induced increased bone formation in multiple bones. Systemic adaptation effects were, at least in part, neuronally regulated. © 2010 American Society for Bone and Mineral Research.     

Discrimination in health care against people with mental illness

This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with 'physician bias'. 'Diagnostic overshadowing' appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.     

Liver fat: effect of hepatic iron deposition on evaluation with opposed-phase MR imaging

PURPOSE: To retrospectively determine the effect of liver iron deposition on the evaluation of liver fat by using opposed-phase magnetic resonance (MR) imaging. MATERIALS AND METHODS: Committee on Human Research approval was obtained, and compliance with HIPAA regulations was observed. Patient consent was waived by the committee. Thirty-eight patients with cirrhosis (30 men, eight women; mean age, 58 years; range, 34-76 years) who underwent abdominal MR imaging and had contemporaneous liver biopsy were retrospectively identified. Two radiologists independently quantified liver fat according to the relative loss of signal intensity and compared this loss on opposed-phase and in-phase T1-weighted gradient-echo images. Liver fat percentage and presence of iron deposition were independently recorded by a pathologist. Generalized linear models, which included a mixed-random effects model, were used to determine the effect of iron deposition on the Spearman correlation coefficient for relative signal intensity loss versus histopathologically determined fat percentage. RESULTS: Liver iron deposition was found in 25 of 38 patients. Liver fat percentage (mean, 3%; range, 0%-25%) was identified histopathologically in 14 of 38 patients and in nine of 25 patients with iron deposition. For both readers, relative signal intensity loss at opposed-phase imaging was closely and significantly correlated (P < .05) with histopathologically determined liver fat percentage in patients without iron deposition (r = 0.7 for reader 1, r = 0.6 for reader 2), but no such correlation was found in patients with iron deposition (r = 0.1 for reader 1, r = -0.31 for reader 2; P > .05). CONCLUSION: Signal intensity loss on in-phase images caused by the presence of liver iron is a potential pitfall in the determination of liver fat percentage at opposed-phase MR imaging in chronic liver disease.     

Bowel transition points: multiplicity and posterior location at CT are associated with small-bowel volvulus

PURPOSE: To retrospectively evaluate the sensitivity and specificity of the number and location of bowel transition points at computed tomography (CT) in the diagnosis of small-bowel volvulus, with surgical findings as the reference standard. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was waived. One hundred adult patients who had undergone preoperative CT and who had surgically proved non-abdominal wall hernia small-bowel obstruction (n=68) or small-bowel volvulus (n=32) were retrospectively identified. The patients included 61 women and 39 men with a mean age of 57 years (range, 18-96 years). One reader, blinded to the diagnoses, recorded the number of transition points at CT, the anteroposterior location of each transition point relative to the anterior edge of the spine, and the presence or absence of a whirl sign. Statistical analyses were performed with the Fisher exact test, unpaired t tests, and multiple logistic regression. RESULTS: The frequency of the finding of multiple transition points was significantly higher in patients with volvulus (19 [59%] of 32) than in patients without volvulus (11 [16%] of 68) (P<.001). Transition points associated with volvulus were less likely to be located more than 7 cm anterior to the spine (four [12%] of 32 patients) than were transition points not associated with volvulus (31 [46%] of 68 patients) (P<.005). The whirl sign was an additional significant independent predictor of volvulus (P<.05). When all three of these predictors were present, the specificity for small-bowel volvulus was 100%. CONCLUSION: The presence of multiple transition points with a posterior location at CT in an adult with small-bowel obstruction is significantly associated with volvulus.     

Superficial endometrial spread of squamous cell cervical carcinoma: a diagnostic challenge at magnetic resonance imaging

The magnetic resonance imaging findings in a case of superficial endometrial spread of squamous cervical carcinoma are presented. Early enhancement of a relatively small cervical mass was associated with a fluid-distended endometrial cavity. An irregular layer of early-enhancing tumor was seen lining the endometrial cavity. Histopathologic examination confirmed the presence of an invasive squamous cell carcinoma of the cervix that superficially spread into the lower uterine segment and endometrial cavity, replacing most of the endometrial lining as a layer of tumor. The tumor also deeply invaded the myometrium in a permeative fashion throughout the bulk of the uterine body. Failure to appreciate the cervical abnormality might have resulted in an imaging diagnosis of endometrial carcinoma. We report this challenging case to broaden the described spectrum of magnetic resonance imaging findings in cervical carcinoma, because recognition of this unusual pattern of tumor spread may facilitate correct radiological interpretation.     

Accuracy of plain abdominal radiographs in the detection of retained surgical needles in the peritoneal cavity

OBJECTIVE: To determine the accuracy of plain abdominal radiographs in the detection of retained surgical needles of varying size in the peritoneal cavity. SUMMARY BACKGROUND DATA: Accidental retention of surgical foreign bodies in the peritoneal cavity is estimated to occur once in every 1000 to 1500 abdominal operations and early prevention and identification of retained foreign bodies is increasingly important because of mounting public awareness. Most of the existing literature on the imaging detection of surgical foreign bodies has focused on retained sponges, even though retained needles may account for up to 50% of such objects and the true accuracy of plain abdominal radiographs in the detection of retained needles is not well established. METHODS: Eight plain radiographs were obtained of a 41 kg pig cadaver after placement of a total of 39 surgical needles of varying size (4-77 mm in length) in a randomized selection of the 9 segments of the peritoneal cavity. Five radiologists independently reviewed the radiographs and indicated the location of all suspected retained needles. Analyses were performed using the known site and size of placed needles as the standard of reference. RESULTS: In total for all readers, 195 needles were detectable in 360 abdominal segments. The overall mean accuracy, sensitivity, and specificity for plain radiographs in the detection of retained surgical needles were 74% (267 of 360), 69% (135 of 195), and 80% (132 of 165), respectively. Sensitivity for needles 25 mm or more in length was significantly (P < 0.0001) higher than that for needles of 11 to 24 mm or 10 mm or less, with respective values of 99% (69 of 70), 84% (46 of 55), and 29% (20 of 70). Readers demonstrated moderate interobserver agreement, with a multireader kappa value of 0.60. CONCLUSIONS: Abdominal radiographs have high sensitivity and interobserver agreement in the detection of retained surgical needles over 10 mm in length, but smaller needles are detected with significantly lower sensitivity and the utility of plain abdominal radiographs in this setting is more debatable.