MR images mimic disc after discectomy

MRI of a 30-year-old woman 1 year after discectomy showed a residual disc-like tissue. The observation was initially confusing, but a close comparison of pre- and post-operative images suggested that the inferior wall of the anterior joint capsule had migrated superiorly after the removal of the disc and mimicked a residual disc on the follow-up MR images.     

Increased fragility in patients with fracture of the proximal humerus: a case control study

The aim of this study was to evaluate whether a fracture of the proximal humerus is associated with an increased prevalence of preceding fractures or a risk of subsequent fractures.

All patients who were treated at the Malmö General Hospital in 1987 for a fresh fracture of the proximal humerus were identified, representing practically all fractures of the proximal humerus in Malmö city (250,000) that year. Two hundred fifty-three adult patients, 54 men with an average age of 66 (24–90) and 199 women with a mean age of 74 (22–98) years, were included in the study together with 475 age- and gender-matched control persons. In 1999, fracture prevalence of patients and controls were rated by a survey at the Dept. of Radiology.

There was a significantly increased prevalence of previous fractures before 1987 in the humerus fracture group with an odds ratio (OR) of 3.5 [95% confidence interval (95% CI), 2.2–5.5] for a spinal fracture, OR 1.8 (95% CI, 1.3–2.6) for a previous fracture to the upper extremity, and OR 1.8 (95% CI, 1.2–2.6) for a preceding fracture of the lower limb.

The proximal humerus fracture also predicted a significantly increased risk of a subsequent fracture. The hazard ratio (HR) was 2.5 (95% CI, 1.7–3.7) for a forthcoming spinal fracture, HR 2.8 (95% CI, 2.0–3.7) for a future fracture of the upper extremity, and HR 2.0 (95% CI, 1.2–3.5) for a lower limb fracture. In a subgroup of male patients, an almost five times increased risk of sustaining subsequent extremity fractures was observed.

In summary, a fracture of the proximal humerus is associated both with increased prevalence of previous fractures of the spine and extremities and also predicting an increased risk of future fractures.     

Effects of antenatal corticosteroids on regional brain and non-neural tissue water content in the ovine fetus

OBJECTIVE: We examined the effects of maternal corticosteroid administration on water content in regional tissue in ovine fetuses at 60%, 80%, and 90% of gestation. METHODS: After catheters were placed in the fetuses, the ewes were given four 6-mg doses of dexamethasone or placebo injections 12 hours apart over 48 hours. Water content of fetal tissue was determined 18 hours after the last injection was given to the ewes. Tissue water was determined by wet-to-dry weight ratio in brain (cerebral cortex, caudate nucleus, cerebellum, midbrain, and medulla) and non-neural tissues (kidney, liver, muscle, and skin) at each gestational age. RESULTS: Water content (P <.05) in brain regions was lower in fetuses from dexamethasone-treated than placebo-treated ewes at 60% but not 80% or 90% of gestation and in non-neural tissues at each gestational age. CONCLUSIONS: Maternal treatment with a corticosteroid regimen similar to that used in the clinical setting was associated with small decreases in brain water content early but not later in gestation. This corticosteroid treatment regimen was also associated with decreased regional non-neural tissue water content at 60%, 80%, and 90% of gestation.     

Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified?

OBJECTIVE: Risks of circulatory diseases are increased substantially during late pregnancy and around the time of delivery. This study was undertaken to determine whether preeclampsia, multiple pregnancy, or cesarean delivery account for the majority of pregnancy-related risks of pulmonary embolism and stroke (caused by hemorrhage, infarction, and intracranial venous thrombosis). STUDY DESIGN: We analyzed a population-based cohort of 1,003,489 deliveries in Sweden. Relative risks of pulmonary embolism and stroke were modeled by use of Poisson regression. RESULTS: Preeclampsia was associated with 3- to 12-fold increases in risks of pulmonary embolism and stroke during late pregnancy, at delivery, and in the puerperium, and similar increases in risks were also observed for multiple pregnancies and cesarean delivery. These strong associations could not explain the overall pregnancy-related risks of pulmonary embolism and stroke. CONCLUSION: Preeclampsia, multiple birth, and cesarean delivery are important risk factors for pulmonary embolism and stroke, but they do not account for the majority of the excess risks associated with pregnancy.     

Allergic rhinitis and atopy in 18-year-old students

BACKGROUND: The aim of this study was to investigate the prevalence of allergic rhinitis and atopy in adolescents and whether air pollution in their schools contributed to allergic sensitization. METHODS: Analyses were performed in 1992-1994 on 511 18-year-old students at four schools and on the indoor air and floor dust of their classrooms. The students underwent skin-prick tests (SPTs) and a nasal lavage and answered a computer-based questionnaire containing questions on allergy and nasal symptoms. RESULTS: Atopy, defined as at least one positive SPT response, was found among 37% of the students, with no difference between students of the four schools, regardless of whether the data were adjusted for gender, hereditary disposition to allergy, and smoking habits. The number of students who had positive SPT and reported nasal symptoms when exposed to possible allergens, which were found among 35%, did not differ between the schools. No correlation was found between the prevalence of atopic individuals and the levels of different indoor air pollutants in the schools. CONCLUSION: The prevalence of allergic rhinitis among adolescents is very high and suggests that it is, at least at the time of our study and in comparison with other studies, still increasing. Our results indicate that the indoor air and floor dust at the schools of the students do not contribute to allergic sensitization.     

Long-term follow-up by means of a questionnaire of 109 patients with long-lasting orofacial pain

The aims were to follow-up, analyse and compare the pain status after 4-9 years with that at the baseline examination of 109 consecutive patients referred to the Pain Group at the Faculty of Odontology in Malm?, Sweden during the period 1988-1993 due to long-lasting orofacial pain. A further aim was to identify predictive factors of significance for pain alteration. 85 (78%) women with a median age of 51 years and 24 (22%) men with a median age of 60 years were included in the study. A survey of the pain status at the follow-up was conducted by means of a mailed questionnaire. The questionnaire covered the following aspects: pain alteration, pain intensity, pain location, medication and education. After one reminder, the non-responding patients were called for a telephone interview. A response level of 85% was obtained. Significant improvements were noted by the patients in the answers of the questionnaire in mainly three areas; the patients answered individually that pain relief had occurred, pain intensity rated on the VAS was lower at follow-up compared to the baseline examination and a decrease in drug use was reported. The responses indicated pain relief for 75% of the patients. However, only 27% of the patients experienced total disappearance of pain. Medication at baseline with opioids, muscle relaxants with central effect, antidepressants, neuroleptics, hypnotics or sedatives was found to be a predictive factor for persistent pain.     

Endoneurial capillary abnormalities presage deterioration of glucose tolerance and accompany peripheral neuropathy in man

To explore whether microangiopathy is associated with disturbed glucose tolerance and peripheral neuropathy, we assessed endoneurial capillary morphology in sural nerve biopsies from men with diabetes, impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). Baseline morphology was related to glucose tolerance and neuropathy at baseline and at follow-up 6 years later. Capillary density (in number per millimeters squared) at baseline was higher in subjects with diabetes (n = 10) compared with those with NGT (n = 5) at follow-up (median [interquartile range]) (86.0 [24.3] vs. 54.9 [17.1]; P = 0.0200) and in those progressing from IGT to diabetes (n = 4) compared with those with persistent IGT (n = 4) (86.7 [25.2] vs. 54.1 [14.6]; P = 0.0433). The capillary luminal area (in micrometers squared) was lower in subjects with NGT progressing to IGT (n = 2) or subjects with IGT progressing to diabetes (n = 3) compared with subjects with constant NGT (n = 6) or constant IGT (n = 4) (11.9 [2.4] vs. 20.8 [7.8]; P = 0.0201). The capillary basement membrane area (in micrometers squared) was increased in patients with peripheral neuropathy (n = 10) compared with those without (n = 7) (114.6 [68.8] vs. 75.3 [28.7]; P = 0.0084). In conclusion, increased capillary density was associated with current or future diabetes, decreased capillary luminal area with future deterioration in glucose tolerance, and increased basement membrane area with peripheral neuropathy.     

Balancing: a basic process in end-of-life cancer care

In this grounded theory study, the authors interviewed caregivers and patients in end-of-life cancer care and found Balancing to be a fundamental process explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages were Weighing--sensing needs and wishes signaled by patients, gauging them against caregiver resources in diagnosing and care planning; Shifting--breaking bad news, changing care places, and treatments; and Compensating--controlling symptoms, educating and team-working, prioritizing and "stretching" time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or "Walking a fine line," at best an optimized situation, at worst a deceit.     

General parental education in Sweden: participants and non-participants

OBJECTIVE: To study factors of importance for participation in parental education within routine child health care. DESIGN: All parents of children born during 1 year were invited by the district nurse to participate in parental education; their participation during the infant year was registered. SETTING: Catchment area of two health centres in V?xj?, Sweden. SUBJECTS: 221 infants and their parents. MAIN OUTCOME MEASURES: Number of educational sessions for mothers and fathers. RESULTS: 63% of mothers and 20% of fathers attended at least one session. These mothers attended a mean of 5.7 (SD 2.2) sessions and these fathers a mean of 2.8 (SD 2.3) sessions. Logistic regression analyses showed that the only variable of significance for participation was being a first-time parent (odds ratio 3.9 for the mothers and 3.7 for the fathers). Odds ratios above 2.0 (non-significant) were found for married mothers and Swedish mothers, as well as for Swedish fathers. CONCLUSION: It is still a considerable problem to get certain groups involved in routine parental education in Swedish child healthcare programmes.