Suspected testicular torsion and ischemia: evaluation with color Doppler sonography

Color Doppler sonography was performed in 32 patients with a painful scrotum in whom testicular ischemia from torsion or postherniorrhaphy was clinically suspected. Surgical correlation was available in 15 patients, and scintigraphic correlation was available in 17 patients. Seven of the 32 patients were diagnosed as having testicular ischemia from torsion. Color Doppler flow imaging demonstrated a lack of intratesticular flow in six of the seven testes with torsion and relatively normal intratesticular flow in one of the patients with acute torsion. Normal or increased intratesticular flow was demonstrated by color Doppler in all 57 of the nonischemic testes. Using the single criterion of presence or absence of identifiable intratesticular flow, the authors found that color Doppler was 86% sensitive, 100% specific, and 97% accurate in the diagnosis of torsion and ischemia in the painful scrotum. Color Doppler sonography is an accurate, noninvasive means of rapidly assessing perfusion of the testis in the painful scrotum.     

GRAVES' DISEASE WITH ORGANIC MOOD SYNDROME (A Case Report)

A case of Graves'' disease with organic mood syndrome in a 3G year old man is reported. Patient had thyrotoxicosis and developed features of mania while in the hospital which necessitated antipsychotic drug therapy.KEY WORDS: Graves'' disease, ManiaFrank psychotic decompensation occurring in the background of Graves'' disease is an explosive clinical situation as manifestations range from severe manic excitement to total apathy. Although rare, the gravity of such situation warrants energetic intervention on both fronts. One such instance of organic mood syndrome with Graves'' disease is being presented, highlighting the problems encountered in the management.     

Sequence analysis of the coding region of human methionine synthase: relevance to hyperhomocysteinaemia in neural-tube defects and vascular disease

Elevated homocysteine (Hcy) levels are observed in two apparently unrelated diseases: neural-tube defects (NTD) and premature vascular disease. Defective human methionine synthase (MS) could result in elevated Hcy levels. We sequenced the coding region of MS in 8 hyperhomocysteinaemic patients (4 NTD patients and 4 patients with pregnancies complicated by spiral arterial disease, SAD). We identified only one mutation resulting in an amino acid substitution: an A-->G transition at bp 2756, converting an aspartic acid (D919) into a glycine (G). We screened genomic DNA for the presence of this mutation in 56 NTD patients, 69 mothers of children with NTD, 108 SAD patients and 364 controls. There was no increased prevalence of the GG and AG genotypes in NTD patients, their mothers or SAD patients. The D919G mutation does not seem to be a risk factor for NTD or vascular disease. We then examined the mean Hcy levels for each MS genotype. There was no correlation between GG- or AG-genotype and Hcy levels. The D919G mutation is thus a fairly prevalent, and probably benign polymorphism. This study, though limited, provides no evidence for a major involvement of MS in the aetiology of homocysteine-related diseases such as NTD or vascular disease.      

Medial collateral ligament of the knee: anatomy,management and surgical techniques for reconstruction

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. The incidence is reported to be 0.24 per 1000 per year, and twice as high in males. The majority of MCL injuries are isolated, occurring in young sportsmen and women. However, they can occur in association with other injuries of the knee, most commonly the anterior cruciate ligament. Most injuries to the medial supporting structures occur as a result of valgus forces; but in sports, these can be a result of skiing injuries or ‘cutting’ manoeuvres. The majority of MCL injuries heal well with non-operative management and rarely require surgery; but if acute injuries are insufficiently treated or missed, the result can be chronic laxity. This chapter reviews the existing literature on common history and examination findings in MCL injuries. There are a number of classification systems designed to grade the severity of injury, which are based on the amount of laxity and the ability of the assessor to feel an end-point. There has been significant advancement in the understanding of the anatomy and biomechanics of the different components of the MCL. The anatomical landmarks of the superficial and deep MCL as well as the posterior oblique ligament are discussed along with the function of these individual structures. Although most MCL injuries heal well with non-operative management, there are a number of indications for operative intervention. These include open and multi-ligament knee injuries, as well as chronic instability. Broadly these are divide into repair or reconstruction categories. Repair is best performed in acute cases, where surgery is indicated for other reasons such as a meniscal tear; whereas reconstruction is best reserved for chronic instability. The reconstruction techniques including the Lind and LaPrade are described.