Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976–2006)

Background Dermatitis artefacta (DA) is defined as all dermatological, self‐inflicted skin lesions, where the patient denies having produced the lesions. Objectives The purpose of this study is to make a single‐centre retrospective clinical review of patients diagnosed as DA of the breast. Materials and methods During a 30‐year period (1976–2006), patients diagnosed as DA of the breast, seen in the Department of Dermatology of the Virgen Macarena Hospital in Seville, were recorded. Clinical and epidemiological features are described. Results A total of 27 women with a mean age of 34.33 years were selected representing 13.43% of the total of DA patients recorded (n = 201) in this period. The most frequent clinical forms were: excoriations (nine patients, 33.33%) and ulcers (nine patients, 33.33%), followed by burns (six patients, 22.22%), blisters (one patient, 3.70%), contact dermatitis (one patient, 3.70%) and haematomas (one patient, 3.70%). Ten of the cases were located exclusively on the breasts, whereas 17 had also other locations such as face in seven cases, arms in five cases, abdomen in five cases and the entire body in two cases. Cutaneous lesions were treated with occlusive bandages using zinc paste or plaster splint when necessary. Conclusion To our knowledge, this is the major series of DA of the breast studied. This complicated psychodermatological condition requires a correct diagnosis, appropriate management and psychiatric assessment.     

Acute spinal cord injury: MR imaging at 1.5 T

Thirty-seven magnetic resonance (MR) imaging studies were performed with a 1.5-T magnet and surface coils in 27 patients with suspected spinal cord injuries. Imaging was performed 1 day to 6 weeks after injury. Cord abnormalities were seen with MR in 19 patients, while skeletal and/or ligamentous injuries were seen in 21 (78%). Three types of MR signal patterns were seen in association with cord injuries. Acute intraspinal hemorrhage was seen in five patients with cord injuries and demonstrated decreased signal intensity on T2-weighted images obtained within 24 hours of injury. Cord edema and contusion had high signal intensity on T2-weighted images and were observed in 12 cases with cord injury. Neurologic recovery, determined in 16 patients, was insignificant in patients with intraspinal hemorrhage; however, patients with cord edema or contusion recovered significant neurologic function. MR at 1.5 T is extremely useful in the diagnosis of acute cord injury and also demonstrates potential in predicting neurologic recovery.     

Computer-aided detection of amorphous calcifications

OBJECTIVE: Computer-aided detection (CAD) systems have been used successfully to detect malignant calcifications on mammography, with sensitivities ranging from 86% to 99%. Amorphous calcifications are a subset of small indistinct calcifications of intermediate concern that have a 20% likelihood of being malignant and that are frequently overlooked on mammography. The purpose of our study was to determine the sensitivity of one commercially available CAD system for detecting amorphous calcifications. MATERIALS AND METHODS: A commercially available CAD system evaluated mammograms of 82 patients with 85 mammographically detected and histologically sampled groups of amorphous calcifications (21 malignant, 14 high risk, and 50 benign). The sensitivity of the system for detecting the calcifications on at least one image of the two-view mammographic examination (case sensitivity) and on each individual mammographic image (image sensitivity) was determined. Findings were correlated with results from large core needle biopsy or surgical excision in each case. RESULTS: The CAD system detected amorphous calcifications in 43 of 85 cases (case sensitivity, 51%) and in 59 of 146 mammographic images (image sensitivity, 40%). The case sensitivities by histologic outcome were 57% for malignant calcifications, 29% for high-risk calcifications, and 54% for benign calcifications. An average of 2.0 false-positive marks were displayed per case. CONCLUSION: The CAD sensitivity for malignant amorphous calcifications is markedly lower than previously reported for all malignant calcifications. Breast imaging radiologists who use CAD systems should continue to search diligently for these difficult-to-detect lesions.     

Posterior Approach for Subtalar Joint Distraction Arthrodesis by Compact External Fixation: A Technique Guide

Subtalar joint arthrodesis is a commonly used surgical procedure for the management of rearfoot pathologic features. We present a technique guide for a posterior incisional approach to subtalar joint arthrodesis for correction of a calcaneal deformity secondary to calcaneal fracture malunion. This technique uses a monolateral external fixation device for controlled distraction and intercallary allograft placement. In contrast to a standard lateral approach, this incision provides better visualization of the joint space, and the use of a distractor enhances access to the joint surfaces for fusion preparation and maintains alignment while internal fixation is applied. A 44-year-old male underwent isolated subtalar joint arthrodesis to repair a malunion of a nonsurgically managed calcaneal fracture sustained 1 year before the surgical intervention. Controlled distraction was applied using a Hoffmann^® Compact? MRI external fixation device. This device maintained distraction and tibial–calcaneal alignment until placement of the allograft–bone marrow aspirate. The use of external fixation is a viable option for distraction arthrodesis in subtalar joint fusions. It facilitates frontal plane deformity correction. We have described the surgical technique and presented a case in which the posterior approach with distraction was successfully used in subtalar joint arthrodesis. At 12 weeks postoperatively, serial radiographs displayed incorporation of the graft, with distraction maintained at the subtalar joint arthrodesis site. At the 3-month follow-up visit, the patient had successfully transitioned to weightbearing in a CAM walker without any complications.     

Simulated pulmonary nodules: detection with dual-energy digital versus conventional radiography

Performance of a prototype dual-energy digital chest radiography unit in detecting calcified and noncalcified simulated pulmonary nodules was compared with that of a highly optimized, conventional system. Nodules ranging in size (0.5, 1.0, and 1.6 cm), in number (five to 11), and in calcium content (0-25 mg) were superimposed over the lungs of a frozen, unembalmed, human chest phantom. For each technique, six observers examined 50 posteroanterior projections with different randomized nodule locations. Detection consisted of locating and assigning a level of confidence to each perceived nodular opacity. The resulting plots of the true-positive fraction versus the mean number of false-positive calls per projection indicate that for both calcified and noncalcified nodules, the digital unit performed significantly better (P less than .01).     

经腹腔镜开窗减压术治疗巨大非寄生虫性脾囊肿是有效的保脾术式

原发性脾囊肿是一种罕见的疾病,目前尚缺乏对该疾病的理想治疗方法的相关研究.大多数原发性脾囊肿是上皮性囊肿.近几年,腹腔镜脾脏外科手术普及率不断提高.该研究报告了关于经腹腔镜保脾手术治疗脾囊肿的相关经验.1996年至2006年间,作者治疗了11例有症状的非寄生虫性脾脏巨大囊肿病人.病人均诉左上腹涨满症状,触诊可扪及腹部包块.术前腹部超声及CT均已明确诊断.病人接受经腹腔镜脾脏囊肿部分切除术或脾脏囊肿开窗减压术.结果发现,7例病人为脾脏间皮囊肿,2例为脾脏表皮样囊肿,2例为脾脏假性囊肿,没有发现囊肿癌变.手术操作时间为62～85 min,无中转开腹.     

Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

Background

Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital''s capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations.

Methods

The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission.

Results

From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene.

Conclusions

The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.