Craniosynostosis: image quality, confidence, and correctness in diagnosis

The authors used the diagnosis of craniosynostosis to compare subjective evaluation of image quality with objective diagnostic utility. They studied in detail the responses of one observer, who read plain radiographs, computed tomographic (CT) scans, and three-dimensional reconstructions of CT scans (obtained with three different methods) for 82 patients with this diagnosis. The observer rated image quality and certainty in diagnosis made from each image. Subjective and objective performances were found to be strongly linked. High-quality images served as the basis for more accurate diagnoses than low-quality images. The increase in diagnostic performance results primarily from increased specificity, a fact that suggests that specificity and the concomitant diagnosis of normalcy are the focus of attention when image quality is evaluated.     

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience

Background

The aim of this study was to evaluate the efficacy of heat cured ‘poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects.

Methods

17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64).

Results

The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results.

Conclusion

70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results.Key Words: Cranial reconstruction, Mini bone plates, Cranial prosthesis     

Water and DMSO membrane permeability characteristics of in-vivo- and in- vitro-derived and cultured murine oocytes and embryos

Although embryo cryopreservation is routine for many mammalian species, it is important to know how the fundamental cryobiology of these cells changes with development. Progressive cleavage divisions result in a reduction in the blastomere surface area available for water and cryoprotectant mass transport. Therefore, the membrane permeability of murine oocytes, zygotes, 2-cell, 4-cell, and 8-cell embryos to water (Lp), and dimethylsulphoxide (PDMSO), and the reflection coefficient, sigma (sigma) were determined. Oocytes or zygotes were recovered, cumulus cells removed, then cultured until use. Oocytes and embryos were immobilized and perfused with treatment solutions at 24 degrees C. Osmotically induced cell volume changes over time were videotaped followed by image analysis. The Lp values in the presence of dimethylsulphoxide (DMSO) were 0.77, 0.81, 0.94, 0.86, and 1.10 microm/min/atm, and the PDMSO values were 1.85, 2.04, 2.41, 1.95, and 1.25x10(-3) cm/min for oocytes, zygotes, 2, 4, and 8-cell embryos respectively. The Lp values in the presence of DMSO were significantly (P < 0.05) higher than those in the absence of DMSO. Treating the whole embryo as a single osmotic entity leads to significantly (P < 0.05) elevated PDMSO estimates relative to those based upon measurements of individual blastomeres. These data indicate that both Lp and PDMSO estimates are lower when predicted on an individual blastomere basis. The data also show that neither Lp nor PDMSO differ among oocytes, zygotes, 2-cell and 4-cell embryos. However, the significantly higher Lp and lower PDMSO of the 8-cell stage support the hypothesis that fundamental cryobiological differences may require developmental stage- specific embryo cryopreservation protocols.      

COMPARISON OF INTRACERVICAL PROSTAGLANDIN E2 AND INTRAVENOUS OXYTOCIN IN INDUCTION OF LABOUR

154 patients requiring induction with unfavourable cervix at varying period of gestation were studied. Patients were distributed into two groups. 76 patients were induced with 0.5 mgm single dose intracervical application of Prostaglandin E2 gel and remaining 78 patients with Oxytocin and efficacy of the two methods of induction was compared. Labour was established within 24 hours in 71.4% of primigravidas and 91.7% of multigravidas in the prostaglandin treated group compared to 65.6% of primigravidas and 89.1% of multigravidas in the oxytocin group. The study found substantial improvement in cervical score 12 hours after application of intracervical prostaglandin E2 gel and decrease in Caesarean section rate with no major adverse effect to mother or neonate.KEY WORDS: Induction, Intracervical Prostaglandin E2 gel, Oxytocin     

An Examination of Women's Alcohol Use and Partner Victimization Experiences Among Women With Protective Orders

This study examined associations of women's alcohol use with self-reported experiences of male-perpetrated intimate partner violence among a sample of women with protective orders. Participants were 676 women with a protective order against a male intimate partner from three rural areas and one urban area. Multivariate analyses indicated that women's substance use was associated with psychological abuse tactics and severity of physical and sexual victimization in the last year of the relationship. Women's alcohol use was associated with the severity of physical violence within the last year of the relationship, whereas illegal drug use had associations with the number of verbal abuse, degradation and jealousy/control tactics. There was a significant interaction of women's alcohol and drug use with the severity of sexual assault.     

In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review

Background  

Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D).     

Improving Osteoporosis Assessment in the Fracture Clinic

INTRODUCTION

The aim of this study was to compare the effectiveness of different ways of referring patients to an osteoporosis assessment service at an orthopaedic fracture clinic of a hospital in the UK.

PATIENTS AND METHODS

Three methods of identifying and referring to an osteoporosis assessment service were evaluated.

RESULTS

Relying on doctors for such a referral gave a catchment rate of only 1.6%. Involving patients themselves, asking them to self-refer, increased the catchment rate to 63% (P < 0.0001). Having a specialist osteoporosis and fracture liaison nurse present in clinic and reviewing the notes of patients checking in, to see if they match criteria for osteoporosis assessment, further increased catchment to 77% (P = 0.036).

CONCLUSIONS

Simply having an osteoporosis assessment service and strict criteria to identify which patients should be referred to such a service will not necessarily increase catchment rate for osteoporosis patients. A nurse physically present in the clinic provided the best result, and supports the need of investing in an osteoporosis and fracture liaison nurse.