The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results

To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.     

Brain serotonin transporter binding in non-depressed patients with Parkinson's disease

Early post-mortem data suggest that damage to brain serotonin neurones might play a role in some features (e.g., depression) of Parkinson's disease (PD). However, it is not known whether such damage is a typical characteristic of living patients with PD or whether the changes are regionally widespread. To address this question we measured, by positron emission tomography imaging, levels of the brain serotonin transporter (SERT), a marker for serotonin neurones, as inferred from binding of [¹¹C]-3-amino-4-(2-dimethylaminomethyl-phenylsulfanyl)-benzonitrile (DASB), a second generation SERT radioligand, in subcortical and cerebral cortical brain areas of clinically advanced non-depressed (confirmed by structured psychiatric interview) patients with PD. SERT binding levels in PD were lower than those in controls in all examined brain areas, with the changes statistically significant in orbitofrontal cortex (−22%), caudate (−30%), putamen (−26%), and midbrain (−29%). However, only a slight non-significant reduction (−7%) was observed in dorsolateral pre-frontal cortex, an area implicated in major depression. Our imaging data suggests that a modest, regionally widespread loss of brain serotonergic innervation might be a common feature of advanced PD. Further investigation will be required to establish whether SERT binding is more or less decreased in those patients with PD who also have major depressive disorder.     

Effects of intracerebral estradiol on the dorsal immobility response in the rat

The effects of intracerebral implants of 17 beta estradiol and cholesterol in five brain regions were tested on the duration of the dorsal immobility response in ovariectomized female rats. The dorsal immobility response was significantly prolonged by 4-hr implants of 17 beta estradiol in the dorsal striatum and nucleus accumbens, but not in the cortex, the globus pallidus, or the substantia nigra pars compacta. These data further support previous evidence that estradiol acts directly on the striatum to affect behavior in the rat.     

ES05ROUTINE PARAFIBROMIN IMMUNOHISTOCHEMISTRY OF LARGE PARATHYROID ADENOMAS IS NOT AN EFFECTIVE SCREENING STRATEGY FOR CARCINOMA

Purpose Parathyroid carcinoma (PC) is rare and accounts for less than 1% of all cases of primary hyperparathyroidism (PHPT). The definitive histopathologic diagnosis of PC requires unequivocal invasion or metastasis which may be absent at first presentation. As a result, many cases of PC can only be diagnosed retrospectively. Parafibromin is the protein encoded by HRPT2 which is mutated and not expressed in many parathyroid carcinomas. Given that PCs generally weigh more than parathyroid adenomas (PA)s, we hypothesized that amongst large PAs there may be a high incidence of occult PC which could be identified by negative staining for parafibromin. Methodology 57 parathyroid glands weighing greater than 2 grams excised from 1998–2006 were identified from the University of Sydney Endocrine Surgical Database. Two specimens with a histopathologic diagnosis of PC were excluded. Immunohistochemical staining for parafibromin was performed on the remaining 55 PAs. Results Of the 55 specimens stained for parafibromin only one definite negative stain was detected. This case was originally classified as an “atypical adenoma” because it showed nuclear and architectural atypia without unequivocal evidence of invasive growth. In view of the negative staining for parafibromin it therefore probably represents occult carcinoma. There has been no evidence of recurrence or metastasis after 6.5 years. Conclusions Complete loss of staining for parafibromin is very rare in giant parathyroid adenomas suggesting that occult carcinoma is equally rare. As a result routine immunohistochemical staining for parafibromin does not appear to be an effective screening test for carcinoma in large PA without histopathologic features of PC.     

Causation, therapy and complications of treating mandibular fractures - a retrospective analysis of 10 years]

BACKGROUND: Fractures of the mandible are a common form of facial injury. The aetiological factors associated with mandibular fractures and the trends in these factors over a 10-year period are reported. METHODS: A retrospective survey was carried out of 724 patients presenting with a fracture of the mandible over the 10-year-period 1994-2003. Patients; records were reviewed and analyzed according to age, sex, cause of injury, anatomic site of fracture, treatment and postoperative complications. RESULTS: Over the 10-year-period the rate of mandibular fractures remained constant (mean 40,7%). There were no changes in the age group (mean 33,3 years) or in the higher prevalence in male (male-female-ratio 2,3 : 1). The major causes of fractures were assaults (38,6%) and accidental fall (27,3%). The most common fracture site was the condylar region (47,0%) followed by the angle (29,4%). Most fractures were treated by closed reduction until 2002, thereafter surgical treatment increased noticeable. The complication rate was 8,9% and the most common complications were hardware exposure and infection. CONCLUSION: Fractures of the mandible are a prevalent form of facial injury. Aetiological factors show no significant change over the 10-year-period. Complication-rate is low and will support the tendency towards surgical treatment.     

Eye signs that alert the clinician to a diagnosis of AIDS.

One of the hallmarks of progressive immune deficiency is a steady decline in the absolute number of CD4+ T-lymphocytes. As the immune response thus becomes suppressed, opportunistic systemic infections such as protozoal (Pneumocystis carinii pneumonia, disseminated toxoplasmosis), viral (Cytomegalovirus pneumonitis and colitis and persistent invasive herpes simplex lesions), fungal (cryptococcossis and esophageal candidiasis) and bacterial infections (atypical mycobacterial and extrapulmonary tuberculosis) set in to claim their toll. Ocular complications occur in about 75% of AIDS patients and may be divided into four categories: Retinal microangiopathy, Opportunistic infections, Tumours, Neuro-ophthalmological lesions. Only the most frequently occurring manifestations will be highlighted.     

Computer-assisted analysis of wall motion of the right ventricle in a normal patient sample and diagnosis of right heart infarction using transesophageal echocardiography

Using 2D and M-Mode transesophageal short axis cross sections, right ventricular systolic wall motion was quantified in 15 normal patients. A further group of 39 patients with right ventricular infarction was investigated. In the normal group fractional shortening of the septum was -19.6% (-45 to 8%), that of the lateral wall 51.6% (37 to 73%), of the posterior wall 33.9% (5 to 50%) and of the anterior wall 42.7% (18 to 57%). Right ventricular infarction (RVI) was associated in 33 patients with posterior left ventricular infarction (85%) and in three patients with anterior infarction. In two cases only an isolated RVI was found. Right ventricular dilation occurred in 24 patients (61%). Hemodynamic criteria were fulfilled in eleven out of 21 patients (53%). RVI was confirmed in one patient by surgery and in ten patients by autopsy. Recognition of regional wall motion abnormalities by transesophageal echocardiography permits an accurate bedside identification of RVI. 2D and M-Mode registration of the short axis improves RVI assessment. Wall motion analyses offer the possibility to determine the extent of right ventricular infarction.