The effects of minor hip flexion, abduction or adduction and x-ray beam angle on the radiographic joint space width of the hip

OBJECTIVE: Joint pain may cause patients to hold their limbs in mild flexion, abduction or adduction to minimize pain, regardless of the extent of articular pathology, and these positional changes may have substantial effects on the interpretation of radiographic joint space. We aimed to study the impacts of minor degrees of flexion, abduction or adduction of the hip, as well as the angle of the x-ray beam on the radiographic joint space width (JSW) of the hip joint. METHODS: In the first part of the study, 65 patients (44 males, 21 females, mean+/-SD age 49+/-17) without clinical evidence of hip osteoarthritis (OA) who underwent intravenous pyelography (IVP) were studied. The hips were differentially positioned during the sequential radiographs required for the IVP procedure. Baseline radiographs were taken at 15 degrees internal rotation of the hips [the standard position for anteroposterior (AP) pelvis radiography]; additional positions included the hips at 15 degrees and/or 30 degrees flexion, and 15 degrees adduction and/or 30 degrees abduction. Radiographic JSWs were measured at three sites using a dial caliper: superomedial, superolateral, and the point of narrowest JSW. In the second part, 15 patients without clinical evidence of hip OA who underwent supine abdominal radiography for non-rheumatological indications were evaluated by standard (AP) pelvis x-ray in the same setting and JSW measurements were made as described above. RESULTS: When the average of the three measurements of the JSW was taken for each hip, baseline JSW was 4.38+/-0.55 mm (mean+/-SD). Positioning of the hip significantly (P<0.01) affected the radiographic JSW, with apparent widening during adduction and 30 degrees flexion, (JSW 4.56+/-0.51 mm and 4.53+/-0.58 mm, mean+/-SD), respectively, but narrowing during abduction (4.17+/-0.59 mm, mean+/-SD). Fifteen degree flexion of the hip did not result in statistically significant change in JSW measurements. Upon comparison of the AP pelvis view with the supine abdominal view, neither the average JSW nor the point of narrowest JSW differed significantly, although the superolateral JSW was significantly greater on the AP pelvis view (P=0.02). CONCLUSIONS: Subtle positional changes in the hip, such as may occur during pain or in OA, may artifactually alter the measured radiographic JSW. Thus, longitudinal studies which employ hip JSW to assess disease progression may yield biased results due to changes in pain rather than structure unless care is taken to ensure constant positioning of the hip.     

Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study

The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 mug oral and 400 mug vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n=40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6+/-1.5) and vaginal (mean, 7.2+/-0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4+/-0.2) and vaginal (mean, 3.6+/-1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients' pain perception and satisfaction mainly due to side effects.     

Synthesis and antimicrobial activity of some novel derivatives of benzofuran: part 1. Synthesis and antimicrobial activity of (benzofuran-2-yl)(3-phenyl-3-methylcyclobutyl) ketoxime derivatives

The reaction of salicylaldehyde with 1-phenyl-1-methyl-3-(2-chloro-1-oxoethyl) cyclobutane (1) and potassium carbonate was used to prepare (benzofuran-2-yl)(3-methyl-3-phenylcyclobutyl) methanone (2) for the starting reagent purposes. (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl) ketoxime (3) was synthesized from the reaction of the compound (2) with hidroxylamine. New derivatives of (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl) ketoxime (3) such as, O-glycidylketoxime (4) and O-phenylacylketoxime (5a-c) were obtained very high yields. Alkyl, allyl and aryl substituted N-oxime ethers (6a-e) were obtained from the reaction compound 3 and various halogen contained compounds. The syntheses of the compounds (7a-f) were carried out from the reaction of the compound (4) and different amines such as, isopropyl amine, natrium azide, morpholine and piperazine. All of the synthesized compounds were tested for antimicrobial activity against Staphylococcus aureus ATCC 6538, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 8739, Klebsiella pneumoniae ATCC 4352, Pseudomonas aeruginosa ATCC 1539, Salmonella typhi, Shigella flexneri, Proteus mirabilis ATCC 14153 and Candida albicans ATCC 10231. Among the synthesized compounds (benzofuran-2-yl)(3-phenyl-3-methyl cyclobutyl)-O-[2-hydroxy-3-(N-methylpiperazino)] propylketoxime (7d) was found the most active derivative against S. aureus ATCC 6538. The compounds 2, 5b, 6b, 6c, 7b and 7f showed very strong and the same antimicrobial effect against C. albicans ATCC 10231. Similarly (benzofuran-2-yl)(3-phenyl-3-methylcyclobutyl)-O-benzylketoxime 6a showed good antimicrobial effect against C. albicans ATCC 10231. None of the other compounds exhibited activity against the other test microorganisms.     

Intracranial abscesses associated with chronic suppurative otitis media

Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.The authors did not receive any financial support for the present study.     

Effect of the histone deacetylase inhibitor depsipeptide on B-cell differentiation in both TEL-AML1-positive and negative childhood acute lymphoblastic leukemia

The fusion protein TEL-AML1 in t(12;21)+ acute lymphoblastic leukemia (ALL) recruits co-repressors and histone deacetylases (HDAC), which transrepress AML1 target genes. Normal bone marrow cells were more resistant to HDAC inhibitor FK228 induced cell killing than were cells from ALL patients with or without t(12;21). FK228 induced differentiation in ALL, irrespective of the presence of t(12;21).     

Mud bath dermatitis due to cinnamon oil

A case of long-lasting, extensive eczematous and bullous dermatitis affecting exposed areas (arms and legs), beginning within 24 hr after having a mud bath with cinnamon essential oil in a spa, in a 74-year-old woman, is reported. Patch tests with the GEIDC standard battery and the dental battery (including clove essence and eugenol), cinnamon essence and its components were carried out 5 years later. Fragrance mix, cinnamon essence, eugenol, cinnamic alcohol and cinnamic aldehyde yielded a positive result. To our knowledge, this is the first case of cinnamon dermatitis after a mud bath.     

FDG PET CT assessment of treatment response after yttrium-90 ibritumomab tiuxetan radioimmunotherapy

Yttrium-90 ibritumomab tiuxetan (Zevalin; IDEC Pharmaceuticals Corp., San Diego, CA) is the first radioimmunotherapy agent approved by the U.S. Food and Drug Administration (FDA) for treatment of non-Hodgkin lymphoma. In a randomized clinical trial comparing Zevalin with rituximab, the overall response rate was 80% and 56%, respectively. Response was determined by assessing the size of lymph nodes on CT scans. FDG PET has been well accepted as an accurate imaging study for staging non-Hodgkin lymphoma and evaluating response to treatment. Simultaneous FDG PET and CT imaging (PET CT) provides coregistered functional PET images with anatomic CT images. We describe 2 cases of non-Hodgkin lymphoma treated in which response was followed using PET CT.