Is ultrasound really helpful in the detection of rib fractures?

OBJECTIVE: To determine the usefulness of ultrasound in the detection of rib fractures. PATIENTS AND METHODS: A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. RESULTS: Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. CONCLUSION: Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures.     

Frequencies of airborne moulds in Zagreb

Airborne fungi are sometimes associated with several respiratory diseases and allergies. This paper describes a study of qualitative and quantitative variations in the occurrence of airborne moulds in Zagreb area on three locations: centre of the city (C), Pharmaceutical Botanical Garden "Fran Kusan" (BG) and the mountain Medvednica (M) during autumn, winter, spring and summer 2002-03. Lower concentrations of airborne moulds were found in all three locations in autumn (up to 76.88 CFU/m3) and winter (31.46 CFU/m3), with significantly higher levels in C and BG than in M (P<0.001). In spring and summer, these concentrations were much higher in all sampling sites and were significantly higher in C (160.00 CFU/m3) and BG (134.00 CFU/m3) in spring than in M (90.07 CFU/m3) (P<0.001). In summer, significantly higher concentration was found in C (237.5 CFU/m3) than in BG (186.50 CFU/m3) (P<0.01), while concentrations in C and M (216.70 CFU/m3) were similar. Airspora belonging to 29 fungal genera were identified, and allergologicaly significant moulds, Cladosporium (up to 79.5%) and Alternaria (up to 59.4%) dominated in all sampling sites. Penicillium, Fusarium and Aspergillus were also constant fungal entities (43.0-70.5%), but in much lower concentrations than Cladosporium and Alternaria. Airsporas of Cladosporium and Alternaria were more frequent in spring and summer in all locations, with significantly higher concentrations in C and BG (P<0.05). The risk from allergies increases with higher airspora concentrations in spring and summer due to an increase in Cladosporium and Alternaria.     

Pharmacogenetics of methotrexate

Methotrexate (MTX) has proven efficient in the treatment of a number of malignancies, as well as non-malignant disorders characterized by a rapid cellular growth. Yet some patients might develop resistance, while others could have toxic side effects. MTX achieves its cytotoxicity through the inhibition of folate-dependent enzymes, suggesting that the genes controlling their activity or the levels of folate cofactors can modulate drug efficacy and, thus, the sensitivity of a patient to MTX. Indeed, several studies, conducted mostly in leukemia and rheumatoid arthritis patients, have addressed the potential for tailoring MTX therapy based on a patient's genetics. Several genetic variants have been shown to have a predictive role, among which the most frequently studied are those of methylenetetrahydrofolate reductase and thymidylate synthase genes. The other candidates, as well as gene-gene interactions, which may be even more important for the prediction of disease outcomes than the individual gene effects, are also briefly discussed.     

Seawater quality along the Adriatic coast, Croatia, based on toxicity data

The potential toxicity of organic extracts from 12 seawater samples from each of 24 sampling sites, collected during 1999-2001 along the Adriatic coast, Croatia, was analyzed with the Microtox toxicity bioassay. The results were consistent with the usefulness of Microtox for the detection of accidental toxic events. To determine the water quality of selected areas, cluster analysis for discrimination between groups with similar toxicity load and water quality index as a base for the ranking of sampling sites was introduced. Based on our experimental data, five classes of the quality index were defined, and so areas were ranked in five categories (excellent, good, fair, poor, and very poor) according to their potential toxic influence. The water quality of selected sites for the potential toxicity of organic extracts could be described as excellent at one sampling site, good at 15 sampling sites, and fair at eight sampling sites. Poor and very poor seawater quality was not detected.     

Labdanes and isopimaranes from Platycladus orientalis and their effects on erythrocyte membrane and on Plasmodium falciparum growth in the erythrocyte host cells

Six labdanes (1-6) and four isopimaranes (7-10), including three new natural products (7, 9, and 10), were isolated from Platycladus orientalis, and their structures determined using 1D and 2D NMR methods, ion-cyclotron resonance HRMS, and optical rotation data. Relative configurations of all chiral centers in the isopimaranes were determined using NOESY experiments at 600 and 800 MHz. Specific optical rotation data were used to correlate absolute configurations. Compounds 1-9 and aframodial (11) were tested for their in vitro antiplasmodial activity and for their ability to induce changes of erythrocyte shape in order to obtain data about possible correlation between the two effects. All compounds tested exhibited weak (IC(50) > 25 microM) in vitro antiplasmodial effects against Plasmodium falciparum strain 3D7. At the same time, the compounds caused echinocytic or stomatocytic changes of the erythrocyte membrane curvature, indicative of their incorporation into the lipid bilayer, in the concentration region where the antiplasmodial activity was observed. The antiplasmodial effect of these compounds thus appears to be an indirect effect on the erythrocyte host cell. Weak or moderate antiplasmodial activity observed with many other apolar natural products, in particular those with amphiphilic structures, is also likely to be an indirect effect.     

Breast cancer mortality patterns and time trends in 10 new EU member states: mortality declining in young women, but still increasing in the elderly

Breast cancer is the cancer diagnosed most frequently in women worldwide. In Europe it is the most common cancer in the female population, with approximately 350,000 new cases diagnosed each year including 130,000 deaths. Incidence rates are increasing in the majority of European countries, whereas a decline in mortality rates has been observed in many West European countries since the late 1980s and early 1990s. Our study examines breast cancer mortality patterns and time trends in the new European Union (EU) member states and compares them with the situation in current EU member states. A Joinpoint regression analysis was used to assess temporal changes in mortality rates and the trends examined in the light of known risk factors, screening programs and advances in treatment. In the majority of the countries analyzed, a deceleration in the increase of mortality rates appeared, followed by a decrease of mortality in many of them in the second half of the 1990s. The declining tendency was visible primarily in young women, and to a lesser extent in middle-aged women, whereas in elderly women a continuing increase of mortality was observed. Analysis of mortality data, information from previous publications, as well as analysis of known factors influencing breast cancer risk suggest that changes observed are due mainly to recent advances in treatment rather than changes in lifestyle risk factors or the result of screening programs. Early detection and a shift toward more favorable stage distribution could have played the leading role for mortality decline in younger patients.     

The metabolic topography of posthypoxic myoclonus

Posthypoxic myoclonus (PHM) is a syndrome of action and intention myoclonus that occurs in some patients who survive a cardiac arrest. Using PET and statistical parametric mapping, the authors observed a significant bilateral increase in glucose metabolism in the ventrolateral thalamus and pontine tegmentum in patients relative to controls. Interventions such as deep brain stimulation that interrupt networks that involve these structures may be useful in patients with severe PHM.     

Histopathologic and immunocytochemical changes in the liver in patients with chronic hepatitis C

BACKGROUND: The presence of lymphocytes within the liver parenchyma is related to immunologically mediated liver damage in chronic hepatitis C. The aim of the study was to make histological, histochemical, and immunocytochemical assessment of liver biopsy specimens in patients with chronic hepatitis C virus (HCV) infection. METHODS: Biopsy specimens of 20 patients with chronic HCV disease were analyzed, using standard staining procedures to verify histologic liver lesions, as well as immunoenzymatic staining with monoclonal antibodies to detect CD4+ T-lymphocytes, B-lymphocytes, and macrophages. RESULTS: Micromorphologic characteristics of chronic active viral hepatitis C were present in all the patients, differing, however, by the level of their activity. Dominant changes were found within the portal space, consisting of mononuclear lympho-plasmocytic infiltration and macrophages. Immunocytochemical investigation of mononuclear and macrophageal infiltration showed the correlation between micromorphological findings and the degree of the activity. CONCLUSION: The presence of lymphocytic and macrophageal infiltration within the hepatic tissue directly correlated with the intensity of the liver damage. Analysis of the population of cellular infiltrate in the liver together with the monitoring of viremia level and the level of hepatocyte necrosis, could be useful tools for elucidation of the pathogenesis of chronic hepatitis C.     

Reactions after pneumococcal vaccine alone or in combination with influenza vaccine

We studied adverse reactions to immunisation in 541 individuals receiving simultaneous pneumococcal and influenza vaccination, and in 320 recipients of pneumococcal vaccine alone. Five days after immunisation, the participants completed a questionnaire covering systemic and local reactions to vaccination. Adverse effects were rated as mild if they did not interfere with the participant's daily activities, and moderate or serious if they moderately or markedly restricted these activities. There were no differences between the groups regarding general malaise, headache, myalgias and elevated body temperature. Redness at the injection site, but not soreness or swelling, occurred more frequently in individuals immunised simultaneously with both vaccines. Except for fever and local swelling, adverse reactions were significantly more frequent in women than in men in study groups. The rate of adverse reactions was higher in individuals less then 65 years of age than in older participants. Local reactions were reported by 358 (41.6%) participants, but they were mild and soon subsided. No serious reactions were reported. pneumococcal and influenza vaccine can be safely administered simultaneously.