Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

Cement penetration using a tibial punch cement pressurizer in total knee arthroplasty

This study describes a new tibial cement punch pressurizer to enhance cement penetration into the metaphyseal cancellous bone of the tibial plateau. Thirty knees of 15 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were randomly selected to receive the tibial cement punch pressurizer on one side, with the opposite side serving as control. Using computerized and radiographic evaluation of both knees 2 weeks postoperatively, the punch pressurizer achieved 132 times better penetration of the cement. The tibial punch cement pressurizer offers a simple technique to provide reliable cement penetration and tibial component fixation in TKA.     

Chromosomal imbalances associated with anaplastic transformation of follicular thyroid carcinomas

The genetic alterations that underlie the progression of follicular thyroid carcinoma towards anaplasia are still largely uncharacterised. We compared the Comparative Genomic Hybridization (CGH) profiles of 20 follicular (FTCs), 12 poorly differentiated (PDTCs) and seven anaplastic thyroid carcinomas (ATCs), in order to identify the chromosomal imbalances potentially associated with cancer progression. We found: (i) when considering that a 'direct' transformation of FTC towards anaplasia occurs, the defined significantly important alterations were the increase of gains at 3q (P<0.05) and 20q (P<0.01), and the increase of losses at 7q (P<0.05) and Xp (P<0.01); (ii) regarding poorly differentiated carcinomas as an intermediate independent entity in the anaplastic transformation of follicular cancers, evidenced as important alterations towards anaplasia, were the proportional decrease in copy sequences at 7p, 7q, 12q and 13q resulting from the significant decrease of DNA gains at 7p and 12q (P<0.05), and the significant increase of losses at 7q and 13q (P<0.05). These results unveil the chromosomal regions where genes of interest in thyroid anaplastic transformation are to be located, and demonstrate that different gene dosage copy sequence imbalances are associated to the 'direct' pathway of transformation of follicular into anaplastic cancers and to the progressive FTC --> PDTC --> ATC pathway.     

Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation

BACKGROUND: Constipation is a frequent symptom in pediatric clinical practice, although the underlying pathogenesis is not fully understood. Estimating the colonic transit time may help identify subgroups of patients with different physiopathologic mechanisms. METHODS: Thirty children with normal bowel habits and 38 children with chronic idiopathic constipation, aged 2 to 14 years, were studied. The total and segmental colonic transit times were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. RESULTS: The observed upper reference values were 19.02 hours for the right colon, 19 hours for the left colon, 32 hours for the rectosigmoid colon, and 45.7 hours for the total colon. Fifty percent of the children with chronic idiopathic constipation had colonic transit times within reference values, whereas 37% had left colonic and rectosigmoid delays and 13% had global delay in all colonic segments (colonic inertia). Paradoxic anal contraction was observed in 64% of the constipated children with distal delay but in none of the subjects with colonic inertia. CONCLUSIONS: Estimating colonic transit time is a simple and noninvasive technique for classifying patients with constipation. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.     

Assessment of the quality and psychological impact of information delivered using official consent forms in digestive endoscopy

AIM: To test the impact of information brochures and informed consent forms in patients undergoing digestive endoscopy procedures. METHOD: All patients undergoing digestive endoscopy procedures during a two-month period were given information about the procedure to be performed by delivery of an information form produced by the French Endoscopy and Gastroenterology Societies. The patients were then asked to sign an inform consent form. A questionnaire about the informed consent form and the consent experience was given to all patients after the endoscopic procedure. RESULTS: The questionnaire was completed by 108 consecutive patients. The informed consent form was completely read by 96.3% and understood by 95%. Sixteen percent asked for complementary information, all about complications. Twenty percent were distressed by the explanations. Receiving written information was surprising for 22.2% of the patients, and distressing for 18.5% mainly when endoscopy was planned without general anesthesia (P=0.01 versus general anesthesia). Obtaining informed consent was qualified as a normal procedure for 47.2%, but distressing for 19.4%. It was considered by 41.1% as a way for doctors to be discharged from their obligations. CONCLUSION: The informed consent forms written by scientific societies are easy to understand. One third of the patients were distressed or surprised to be given oral or written information. To sign a written consent form before an endoscopy procedure is considered to be a means of discharging practitioners from their responsibilities for 30% of the patients.     

Management of cervical cerclage at term: remove the suture in labor?

OBJECTIVE: To assess the risks and benefits to patients who carry to term after undergoing a Shirodkar cerclage where the cerclage is not removed until the patient presents in labor. METHODS: A retrospective analysis was conducted examining all patients who underwent a Shirodkar cerclage employing a 5 mm Mersilene band. All the cerclages were placed by a single operator over a twenty five year span, from 1/01/74 till 10/01/98. Only patients who delivered vaginally or were allowed a trial of labor were included. In all cases, the cerclage was removed under regional anesthesia after the patient presented to the hospital in labor. RESULTS: Ninety six cerclage procedures were performed over that period. Eighty two pregnancies qualified for review. Sixty two patients delivered vaginally (76%). Nine cesareans were indicated for failure to progress in labor (11%) with cervical dystocia possibly implicated in one. There were no cases of ruptured uteri or the development of uterine windows. Of the 82 pregnancies there were five cases (6%) of minor cervical laceration. CONCLUSION: Allowing patients to proceed to labor with a Shirodkar, cerclage in place, does not increase the risks of cervical dystocia, cervical laceration, or uterine rupture above the reported incidence for these complications in patients in whom the cerclage is removed prophylactically.