Image-guided reconstruction of femoral fractures: is the staff progeny safe?

The potential of adverse effects to progeny caused by preconceptual and fetal exposure to ionizing radiation is an issue of increasing concern to orthopaedic surgeons and assisting staff. Are these fears justified? How effectively is the embryo or fetus protected, and should pregnant staff alter their duties? In this study, an anthropomorphic phantom was exposed fluoroscopically at two geometries common in surgical reconstruction of proximal femur fractures. Scatter radiation was converted to gonadal dose and embryo or fetal dose with and without use of a protective apron. The genetic risk for the orthopaedic surgeon after 10 years of occupational exposure was estimated to be 16,000 times lower than the natural frequency of heritable disease. The excess risk of childhood cancer associated with the dose accumulated during gestation was at least 600 times lower than the corresponding natural frequency. A properly shielded pregnant orthopaedic surgeon is allowed to do 14 hours of hip fluoroscopy during gestation, whereas 2100 hours of fluoroscopy are required for the induction of gross malformation or mental retardation to the growing embryo or fetus. The supplementary dose constraints for pregnant staff provide adequate protection to the unborn child without affecting regular personnel duties.     

Primary spinal cord oligodendroglioma: case report and review of the literature

Objects The objectives were to present a case of pediatric spinal oligodendroglioma and review the existing literature written in English on the subject of human spinal oligodendrogliomas. A comparison of the clinical, radiologic, and pathologic characteristics, as they relate to those already described in similar cases, was also attempted.Methods Thorough evaluation of the patients clinical course was undertaken. Presenting symptoms and signs are reported. The perioperative radiologic features of the case are presented and the intraoperative details as well as the pathologoanatomic findings and follow-up history are provided. We subsequently performed a thorough search in the literature focusing on the number, characteristics, treatment modalities, and prognosis of patients with spinal cord oligodendrogliomas.Conclusions Spinal oligodendrogliomas are a distinctly rare type of nervous system tumor, especially in the pediatric population. An international registry addressing all of their clinical and pathobiological characteristics would be of great benefit to patients harboring these rare tumors.     

Metabolic responses to exercise after carbohydrate loads in healthy men and women

PURPOSE: This study aimed to investigate gender differences in i) pancreatic insulin secretory (beta-cell sensitivity) and whole body insulin sensitivity responses to an intravenous carbohydrate (CHO) load, and (ii) metabolic responses to exercise after both intravenous and oral CHO loads. METHODS: Seven untrained healthy men and seven age-, body mass-, and VO2max-matched women performed two trials. In one trial they cycled for 60 min at 50% VO2max, starting 60 min after ingestion of a carbohydrate-rich meal (ME trial). In the other trial, subjects were infused with 20% dextrose solution to maintain blood glucose concentration at approximately 8 mmol x L(-1) for 60 min (INF trial), then the infusion rate was maintained constant during the following 60 min while exercising at 50% VO2max. RESULTS: There was no gender effect on beta-cell sensitivity (serum insulin: 161 +/- 37 and 159 +/- 28 pmol x L(-1) for men and women, respectively) and whole body insulin sensitivity (155 +/- 24 and 135 +/- 29 mg x KgFFM(-1) x min(-1) per pmol x L(-1) x 100 for men and women, respectively). This may explain the similarity in glycemic, substrate oxidation and other metabolic responses to exercise after both intravenous and oral CHO loads in men and women. CONCLUSION: These results suggest that moderate exercise performed in the postprandial state presents a similar challenge to the ability of healthy, untrained men and women to perform exercise without a substantial decline in plasma glucose concentration below fasting values.     

Dose reduction in maxillofacial imaging using low dose Cone Beam CT

OBJECTIVES: (a) To measure the absorbed dose at certain anatomical sites of a RANDO phantom and to estimate the effective dose in radiographic imaging of the jaws using low dose Cone Beam computed tomography (CBCT) and (b) to compare the absorbed and the effective doses between thyroid and cervical spine shielding and non-shielding techniques. STUDY DESIGN: Thermoluminescent dosimeters (TLD-100) were placed at 14 sites in a RANDO phantom, using a Cone Beam CT device (Newtom, Model QR-DVT 9000, Verona, Italy). Dosimetry was carried out applying two techniques: in the first, there was no shielding device used while in the second one, a shielding device (EUREKA!, TRIX) was applied for protection of the thyroid gland and the cervical spine. Effective dose was estimated according to ICRP(60) report (E(ICRP)). An additional estimation of the effective dose was accomplished including the doses of the salivary glands (E(SAL)). A Wilcoxon Signed Ranks Test was used for statistical analysis. RESULTS: In the non-shielding technique the absorbed doses ranged from 0.16 to 1.67 mGy, while 0.32 and 1.28 mGy were the doses to the thyroid and the cervical spine, respectively. The effective dose, E(ICRP), was 0.035 mSv and the E(SAL) was 0.064 mSv. In the shielding technique, the absorbed doses ranged from 0.09 to 1.64 mGy, while 0.18 and 0.95 mGy were the respective values for the thyroid and the cervical spine. The effective dose, E(ICRP), was 0.023 mSv and E(SAL) was 0.052 mSv. CONCLUSIONS: The use of CBCT for maxillofacial imaging results in a reduced absorbed and effective dose. The use of lead shielding leads to a further reduction of the absorbed doses of thyroid and cervical spine, as well as the effective dose.     

Pediatric thoracic lymphangiomatosis: is chest wall resection too radical?

Lymphangiomas account for 5% to 6% of all pediatric neoplasms. Complex pathologic processes often present a diagnostic and treatment challenge. Radical and major surgery might have a role in complex cases when medical treatment fails.     

Hemothorax due to extramedullary erythropoietic masses

We describe a 27-year-old male patient suffering from beta-thalassemia intermedia who presented with a nontraumatic spontaneous hemothorax due to extramedullary hemopoietic foci. In reviewing the literature, four similar reports were found. The details of this unusual entity are discussed.     

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

Objective While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine. We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy.Methods Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis.Results Patients were primarily women (87%), of mean age 44 years, who had been symptomatic for 8 years (standard deviation, 6.3 years). The predominant complaints were neck/back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%). Eighty-eight percent of patients reported worsening symptoms with neck extension. The neurological examination was consistent with cervical myelopathy: upper thoracic spinothalamic sensory level (83%), hyperreflexia (64%), inversion of the radial periosteal reflex (57%), positive Romberg sign (28%), ankle clonus (25%), positive Hoffman sign (26%), impaired tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%). MRI and contrast-enhanced CT imaging of the cervical spine revealed stenosis. The mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6, C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm respectively, (CT images). In 46% of patients, the AP spinal diameter at C5/6 measured 10 mm, or less, with the neck positioned in mild extension, i.e., clinically significant spinal canal stenosis. MRI of the brain revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1±1.8 mm), i.e., Chiari 1 malformation.Conclusion Our findings indicate that some patients who carry the diagnosis of fibromyalgia have both signs and symptoms consistent with cervical myelopathy, most likely resulting from spinal cord compression. We recommend detailed neurological evaluation of patients with fibromyalgia in order to exclude cervical myelopathy, a potentially treatable condition.