Bone-like polyethelyne burr-hole cover

OBJECTIVE: Several materials are available for covering burr holes but none of them are ideal with respect to biocompatibility, strength and morbidity. With these properties in mind, our objective was to design a porous polyethylene device, which looked like bone and provides protection and cosmesis while being quick and easy to apply. METHODS AND MATERIALS/RESULTS: A burr-hole cover was created to cover small cranial defects and craniostomies. Using high-density polyethylene, this cover was designed to resemble the bony structure of the skull. Its porous architecture allows for tissue ingrowth and bony integration. It consists of a cylinder which fits into the burr hole and a cap which can be sutured or anchored with titanium screws. CONCLUSIONS: The "bone-like" burr-hole cover provides adequate protection, biocompatibility and cosmesis and is simple to use. Alternative implants can be toxic to surrounding tissues, costly and time consuming to apply. This high-density polyethylene cover is compatible with surrounding tissue as well as being of a porous nature and the material it is made from offers high tensile strength for adequate protection.     

Reinfarction as a complication of acute myocardial infarction. PRIMVAC Registry data

INTRODUCTION AND OBJECTIVES: The clinical profile of patients with acute myocardial infarction (AMI) who have reinfarction (REAMI) during their stay in the intensive cardiologic care unit (ICCU) is not well known. The aim of this study was to identify factors predictive of REAMI, as well as its global incidence and mortality. PATIENTS AND METHOD: All patients with AMI admitted to the ICCU of 17 hospitals in the Comunidad de Valencia (Spain) in the period 1995-2000 (PRIMVAC Registry) were included. Differential characteristics between patients with or without REAMI were determined, and odds ratios (OR) for possible predictive factors were estimated with their 95% confidence intervals by logistic regression. RESULTS: A total of 12,071 patients were included. Mean age of the patients was of 65.5 years, the percentage of women was 23.8%, and the incidence of REAMI was 2.8%. The REAMI group was significantly older than the non-REAMI group. Female sex was significantly more common in the REAMI group. More diagnostic and therapeutic procedures were carried out, more drugs were used and there were more complications in the REAMI group. Mortality was significantly higher in the REAMI group (37.8% vs 12.6%). Only age, diabetes mellitus, previous myocardial infarction and the appearance of Q waves in the electrocardiogram were independently associated with the presence of REAMI. CONCLUSIONS: REAMI in the ICCU was associated with high mortality. Some clinical factors present during the first few hours after AMI were associated independently with the appearance of REAMI.     

CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings

OBJECTIVE: This article reviews various CT protocols for appendicitis, identifies key CT findings for diagnosing appendicitis, discusses unusual manifestations such as chronic and recurrent appendicitis, and profiles imaging features that differentiate appendicitis from other inflammatory and neoplastic ileocecal conditions. Patients were studied with helical CT. CONCLUSION: CT is a highly accurate, noninvasive test for appendicitis, but the optimal CT technique is controversial. Major complications of appendicitis (perforation, abscess formation, peritonitis, bowel obstruction, septic seeding of mesenteric vessels, gangrenous appendicitis) and their management are discussed. Abdominal CT is a well-established technique in the study of acute abdominal pain and has shown high sensitivity and specificity for diagnosing and differentiating appendicitis, providing an accurate diagnosis in the early stages of disease.     

Outcome of ablation of thyroid remnants with 100 mCi (3.7 GBq) iodine-131 in patients with thyroid cancer

A retrospective study was conducted on 186 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100 mCi (3.7 GBq) iodine-131 after total thyroidectomy. Six months to one year after ablation, 155/186 patients (83%) had a negative scan. Diagnostic scanning with 5 mCi (185 MBq) performed 72 h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values < 2% were associated with a higher ablation efficacy (94%), from 2 to 5% showed 80% success and values > 5%, 60% (p < 0.05). There were no significant differences between the responsive and no responsive groups in terms of age, sex, histological type or size of the primary tumor. 11% of the patients with low stimulated Tg (< 2 ng/ml) presented discrete thyroid bed uptake on follow-up diagnostic scan (< 0.5%) without definitive residual disease and 89% had negative uptake on scan. The patients with Tg > 2 ng/ml presented thyroid bed (10/12) or ectopic (2/12) uptake on follow-up diagnostic scan. An ablative dose of 100 mCi shows a high rate of efficacy, especially when cervical uptake is < 2%; no difference was noted between patients assessed by scan within 72 h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg < 2 ng/ml.