Risk factors for foot fracture among individuals aged 45 years and older

A case-control study undertaken among members of five Northern California Kaiser Permanente medical centers sought to identify risk factors for foot fractures among persons aged 45 years and older. Foot fracture cases (n=920) and frequency matched controls (n=2366) were interviewed between October 1996 and May 2001 using a standardized questionnaire. Foot fractures occurred most often while walking or climbing stairs. While 60% of foot fractures resulted from falls, 20% were attributed to other causes, such as hitting the foot or tripping on sidewalks and curbs. Having a self-reported history of physician-diagnosed diabetes [adjusted odds ratio (OR)=1.45, 95% confidence interval (CI)=1.10–1.91] or cataracts (OR=1.40, 95% CI=1.07–1.83), having a self-reported foot problem (OR=1.38, 95% CI=1.06–1.78 for two or more foot problem versus no foot problems), having difficulty walking in minimum light (OR=1.86, 95% CI=1.14–3.05) and having had a prior fracture (OR=1.20, 95% CI=1.05–1.37) were associated with increased risk. Putative protective factors for osteoporotic fractures, such as menopausal hormone therapy use, thiazide or water pill use, high calcium intake, and high body mass index were not associated with foot fracture risk. These findings suggest that risk factors for foot fractures among older people differ in part from risk factors for other fracture sites generally considered to be osteoporotic, such as the hip, vertebrae, and forearm.     

Percutaneous skeletal biopsy

Percutaneous bone biopsy has become an accepted means for tissue diagnosis in indeterminate metastatic disease, whereas needle biopsy for the evaluation of primary skeletals neoplasms is controversial. Needle biopsies are also of value in the diagnosis of inflammatory lesions and eosinophilic granuloma. The diagnostic accuracy of this procedure ranges from 50 to 94% in malignant disease, but is less favorable in benign disease. The low complication rate of about 0.2% makes the percutaneous approach an attractive alternative to surgical biopsy.     

MaSTR™: an effective probabilistic genotyping tool for interpretation of STR mixtures associated with differentially degraded DNA

International Journal of Legal Medicine - The recently developed probabilistic genotyping software package MaSTR™ (SoftGenetics LLC) was used to develop statistical weight estimates for a...     

Laparoscopic live donor nephrectomy: Current practice and results of renal transplantation

Objective: In 2009, 1659 patients with end‐stage renal failure in Hong Kong were waiting for a renal transplant. The overall number of renal transplants carried out locally remains low, with an even lower number being live donor donations. Yet, live donor kidney transplantation yields results that are consistently superior to those of deceased donor kidney transplantation, and laparoscopic donor nephrectomy (LDN) is increasingly accepted worldwide as a safe and preferred surgical option. We aim to evaluate the outcome of LDN in our setting, and to compare with that of deceased donors in this retrospective review. Patients and Methods: A total of 12 patients received LDN over the study period of 2006–2009. Standard left transperitoneal LDN was carried out. Grafts including three with double vessels were prepared using the bench technique. The postoperative outcomes up to 1 year for both the donors and the recipients were studied. Contemporary results for the 47 deceased donor kidneys were studied and compared. Results: All donors had an eventful recovery. The operating time was 225.0 ± 67.4 min. The hospital stay was 5.6 ± 2.3 days. The recipient outcomes including hospital stay and creatinine levels at discharge and 1 year were 11 days, 121 umol/L and 116 umol/L, respectively. Specifically, no ureteric stricture or graft loss was noted at the 1‐year follow up. Recipient complications included haematoma (1 patient), renal artery stenosis (1 patient) and redo of vascular anastomosis (1 patient). In contrast, the deceased donor graft recipients had a hospital stay of 11 days, and creatinine levels of 205 umol/L on discharge and 205 umol/L at 1 year, respectively. The delayed graft function rates for the live donor and deceased donors group were 0% and 14.9%, whereas the 1‐year graft survival rates were 100% and 87.2% respectively. Conclusion: The results showed that the donor morbidity rate was low, as reflected by the short hospital stay. Also, the overall parameters of recipients were good. In particular, no ureteric stricture was noted, and graft survival was 100% at 1 year. Living donor kidney transplant program using the laparoscopic technique is a viable option to improve the pool of kidneys for transplantation.     

Low-iodine diet revisited: importance in nuclear medicine imaging and management

PURPOSE: The need for a low-iodine diet (LID) to maximize the results of radioactive iodine uptake (RAIU), nuclear medicine thyroid scintigraphy, and ultimately treatment of thyroid cancer patients is widely accepted. Failure to follow the prescribed diet can alter RAIU results, thyroid scan findings, and poststudy management. OBJECTIVE: Provided is a case presentation that illustrates the need for adequate patient understanding and compliance with the LID. METHODS: We present the clinical history, laboratory values, and pertinent imaging of a 21-year-old woman with papillary thyroid cancer. The patient's post-thyroidectomy I-123 and 2 subsequent thyroid (I-123 and post-RAI ablation I-131) scintigraphy examinations are reviewed as well as the patient's urine iodine levels. RESULTS: In this case of a woman with papillary thyroid cancer, the nuclear medicine whole body and neck pinhole images revealed that compliance to an LID positively impacts the overall management. After an LID was followed, the patient's urine iodine level appropriately declined from the previously elevated level. Initial negative results on thyroid scintigraphy caused by noncompliance with the LID became positive when the patient adhered to the prescribed dietary regimen. CONCLUSION: An LID is an integral element in the management of differentiated thyroid cancer. Proper guidance and emphasis on the implementation of the diet needs to be provided to patients. Noncompliance may lead to false negative imaging results, misleading the medical professionals and patient. Potentially inadequate management of the patient's thyroid cancer may follow.     

Mohs Micrographic Surgery for Granular Cell Tumor Using S-100 Immunostain

BACKGROUND: Granular cell tumor (GCT) is an uncommon tumor of neural origin. Most commonly it is found in the head and neck region and rarely on the foot. The pathologic diagnosis is often confirmed by immunohistochemical staining for S-100 protein. The standard treatment is complete excision. Two previous cases of GCTs treated by Mohs micrographic surgery (MMS) have been reported in the English literature. The immunohistochemical stain S-100 was not used in these cases. OBJECTIVE: Describe the use of S-100 immunohistochemical stain on MMS frozen sections in clearing a GCT of the foot with extension along nerves without involvement of perineurium. METHODS: Tissue was embedded and cut using standard Mohs surgical methodology. Frozen sections were stained with hematoxylin and eosin and with an immunoperoxidase method for S-100 protein using a Ventana automated stainer. RESULTS: MMS in combination with S-100 was successfully performed on a GCT on the plantar surface of our patient's foot. The S-100 immunohistochemical stain was helpful in tracking the extension along nerves of the GCT which was not evident with hematoxylin and eosin alone. CONCLUSION: Using S-100 immunohistochemical stain on the MMS frozen sections can increase the diagnostic accuracy for complete removal of GCT.     

Pancreatic β-cell dysfunction in type 2 diabetes: Implications of inflammation and oxidative stress

Insulin resistance and pancreatic β-cell dysfunction are major pathological mechanisms implicated in the development and progression of type 2 diabetes(T2D). Beyond the detrimental effects of insulin resistance, inflammation and oxidative stress have emerged as critical features of T2D that define β-cell dysfunction. Predominant markers of inflammation such as C-reactive protein, tumor necrosis factor alpha, and interleukin-1β are consistently associated with β-cell failure in preclinical models...     

Assessing the safety and compatibility of silver based wound dressings in a magnetic resonance environment

Introduction

Silver dressings are an integral part of the management of burn patients. Package inserts assert a lack of compatibility and safety with magnetic resonance imaging (MRI) and recommend removal prior to any MRI procedure, although there is no clear evidence to support this recommendation. Dressing removal is associated with increased pain, anxiety, stress, and analgesia use. This study was to determine whether these products produce MRI image distortion or if the agitation of the silver particles generates enough heat which might produce further skin damage.

Methods

Hind limbs from euthanized pigs were used in a 7 T MRI scanner with three standard silver wound dressings. Images were obtained with both dry and wet dressings. Temperature was assessed before and during MRI by probes inserted between the dressing and skin. Images were independently reviewed by a radiologist and MR physicist for distortion.

Results

None of the dressings exhibited significant temperature increases nor produced significant distortion that influenced imaging quality.

Conclusion

Our data suggests silver containing wound dressings do not cause a significant increase in dressing temperature or image distortion and thus their removal is not warranted for clinical MRI examinations.     

机器人经腹腔镜行前列腺根治性切除术60例的初步结果

目的评价机器人经腹腔镜行前列腺根治性切除术的可行性和效果。方法利用da Vinci机器人外科手术系统对60例局限性前列腺癌患者施行机器人经腹腔镜行前列腺根治性切除术。患者年龄53～75岁，平均63．7岁；Gleason评分5～9，平均6；术前前列腺特异性抗原(PSA)5．5～38．3ng／ml，平均9．4ng／ml。结果术前机器人准备时间平均28(10～90)min，手术平均时间200(95～330)min。术中平均失血量355(50—1200)ml，输血7例(12％)。术后平均1d恢复正常饮食。术后平均导尿管留置时间7d，平均住院时间3d。1例发生吻合口漏尿者紧急手术探查和重新吻合，1例因膀胱颈挛缩行经尿道膀胱颈切开，1例因严重尿路感染行静脉输入抗生素。30例术前有性生活的患者术后6个月内自动恢复或经PDE5抑制剂或PGEl药物治疗后恢复性功能。术后3个月随访38例，完全控尿21例(55％)，轻度尿失禁9例(24％)，中度尿失禁8例(21％)。随访至术后6个月24例，完全控尿17例(71％)，轻度尿失禁4例(17％)，中度尿失禁3例(12％)。结论机器人经腹腔镜前列腺根治性切除术术中失血少、术后患者疼痛小、恢复快、住院时间短，使盆腔内难以进行的腹腔镜手术变得简单、方便，更加灵巧和准确。     

Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome

Background/Purpose

Complications of open conversion, hypercarbia, and intestinal injury have plagued minimally invasive approaches to congenital diaphragmatic hernia (CDH) repair in neonates. To safely begin using minimally invasive techniques for neonatal CDH repair, we formulated preoperative selection criteria and operative techniques that would enhance chances for successful thoracoscopic primary diaphragm repair and uncomplicated outcome.

Methods

During the period from January 2003 to October 2004, neonates were selected for thoracoscopic CDH repair using anatomic and physiologic criteria. Anatomically, all patients were required to have stomach in the abdomen by radiography. Physiologically, all patients were required to be on minimal ventilator support with preoperative ventilator peak inspiratory pressures in the low 20s mm Hg. No patient could have clinical evidence of pulmonary hypertension at the time of surgery. Thoracoscopic CDH repair was performed using 3 trocars (3 and 5 mm). The hernia contents were reduced into the abdomen using 5-mm Hg insufflation, and the diaphragms were repaired primarily using interrupted 3-0 Ethibond simple sutures (Ethicon, Inc, Piscataway, NJ). Posterolateral diaphragm stitches were passed around the posterolateral ribs and tied extracorporeally.

Results

Thirty neonates with CDH were admitted to Children's Hospital Boston and Vanderbilt Children's Hospital during the study period. Eight patients (27%) met selection criteria and 7 underwent thoracoscopic CDH repair. Primary diaphragmatic repair was successfully accomplished thoracoscopically in all neonates without perioperative complication. Preoperative anatomic criteria correlated accurately with intact esophageal hiatus and primary diaphragm repair. Physiologically, each patient tolerated intrathoracic insufflation and CDH repair without clinical pulmonary hypertension or blood pressure lability. Three patients had intraoperative respiratory acidosis that was reversed with ventilator changes. Operative times averaged 152 minutes and ranged from 212 to 106 minutes. Postoperative mechanical ventilation ranged from 0 to 7 days, and the length of hospitalization ranged from 5 to 32 days. Longest follow-up has been 17 months. One patient required reoperation for recurrent CDH at 10 months after repair, but there have been no other long-term complications.

Conclusions

Neonatal thoracoscopic CDH repair is safe in selected patients who have good preoperative pulmonary function and anatomy amenable to primary diaphragmatic repair. A wider range of neonates may be acceptable for thoracoscopic CDH repair with increasing surgical experience.