Two Related Occupational Cases of Legionella longbeachae Infection,Quebec, Canada

Two patients with no exposure to gardening compost had related Legionella longbeachae infections in Quebec, Canada. Epidemiologic investigation and laboratory results from patient and soil samples identified the patients’ workplace, a metal recycling plant, as the likely source of infection, indicating a need to suspect occupational exposure for L. longbeachae infections.     

Impairment assessment of lateral epicondylitis through electromyography and dynamometry

Objectives:

To investigate changes in muscular activity and strength of subjects diagnosed with lateral epicondylitis (LE). To assess the appropriateness of these measures in the patient’s follow-up.

Methods:

Twenty-four subjects (11 men and 13 women) with LE, were evaluated at baseline and after 5 weeks of an experimental treatment. Measurements included: the (1) pain-free grip (PFG), (2) maximal isometric strength, (3) surface electromyography (EMG) of forearm muscle (healthy and affected), (4) a visual analogue scale (VAS), and (5) the Patient Rated Tennis Elbow Evaluation (PRTEE) (Canadian-French version).

Results:

All subjects showed improvement in VAS and PRTEE. The maximal isometric strength during flexion and extension of the wrist and the EMG analysis failed to discriminate the affected from the healthy elbow during the initial assessment. Only the PFG measured with the elbow in extension could discriminate elbows with LE from the healthy ones.

Conclusions:

The use of the PFG with the elbow in extension seems to be the most indicated strength measurement to monitor the recovery of patients with LE. The EMG acquisition protocol used in this research was not adequate to monitor effectively the recovery of LE.     

Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques

OBJECTIVES: We sought to compare respiratory-gated high-spatial resolution magnetic resonance imaging (MRI) and radial MRI with ultra-short echo times with computed tomography (CT) in the diagnosis of asbestos-related pleural disease. METHODS: Twenty-one patients with confirmed long-term asbestos exposure were examined with a CT and a 1.5-T MR unit. High-resolution respiratory-gated T2w turbo-spin-echo (TSE), breath-hold T1w TSE, and contrast-enhanced fat-suppressed breath-hold T1w TSE images with an inplane resolution of less than 1 mm were acquired. To visualize pleural plaques with a short T2* time, a pulse sequence with radial k-space-sampling was used (TE = 0.5 milliseconds) before and after administration of Gd-DTPA. CT and MR images were assessed by 4 readers for the number and calcification of plaques, extension of pleural fibrosis, extrapleural fat, detection of mesothelioma and its infiltration into adjacent tissues, and detection of pleural effusion. Observer agreement was studied with the use of kappa statistics. RESULTS: The MRI protocol allowed for differentiation between normal pleura and pleura with plaques. Interobserver agreement was comparable for MRI and CT in detecting pleural plaques (median kappa = 0.72 for MRI and 0.73 for CT) and significantly higher with CT than with MRI for detection of plaque calcification (median kappa 0.86 for CT and 0.72 for MRI; P = 0.03). Median sensitivity of MRI was 88% for detection of plaque calcification compared with CT. For assessment of pleural thickening, pleural effusion, and extrapleural fat, interobserver agreement with MRI was significantly higher than with CT (median kappa 0.71 and 0.23 for pleural thickening, 0.87 and 0.62 for pleural effusion, and 0.7 and 0.56 for extrapleural fat, respectively; P < 0.05). For detection of mesothelioma, median kappa was 0.63 for MRI and 0.58 for CT. CONCLUSION: High-resolution MR sequences and radial MRI achieve a comparable interobserver agreement in detecting pleural plaques and even a higher interobserver agreement in assessing pleural thickening, pleural effusion, and extrapleural fat when compared with CT.     

Subtle radiographic presentation of a pleural effusion secondary to a cancer of unknown primary: a case study

Carcinoma of unknown primary sites is a clinical syndrome that represents many types of cancer. The mortality rate associate to this type of cancer is elevated and a rapid medical referral is required for patients presenting this condition. Pleural effusion may be the only visible sign. We report a case of pleural effusion secondary to a cancer of unknown primary site in a 60-year-old man that sought chiropractic care for radiating low back pain. The radiographic studies revealed a pleural effusion as one of the only significant finding. This article will address the clinical presentation, radiographic studies and a discussion on the radiographic detection of pleural effusion.     

Cross-cultural Adaptation of the Patient-rated Tennis Elbow Evaluation to Canadian French

IntroductionNo questionnaire is available to evaluate disability levels in French-speaking patients suffering from tennis elbow.Purpose of the StudyTo perform a cross-cultural adaptation of the English version of the Patient-rated Tennis Elbow Evaluation (PRTEE) into Canadian French.MethodsThe PRTEE was cross-culturally adapted to Canadian French according to well-established guidelines. Thirty-two patients with tennis elbow completed the prefinal version of the PRTEE. The construct validity, longitudinal validity, and responsiveness were assessed through comparisons with the Visual Analog Scale (VAS) measuring pain and the pain-free grip (PFG) at baseline, six weeks and three months. The internal consistency was assessed by Cronbach's alpha and the item-total correlations.ResultsThe adaptation process resolved the discrepancy between the forward and back translation. The scores of PRTEE were adequately distributed without floor or ceiling effect. Item completion was good. The correlation between the PRTEE and the VAS was moderate to high (r = 0.64–0.77) and statistically significant. There was also a low but significant correlation between the PRTEE and PFG (r = ?0.38 to ?0.48). For the longitudinal construct validity, the correlation with the VAS was moderate to high and statistically significant (r = 0.68 and 0.88, p < 0.01). The effect size (0.8; 1.0) and the standardized response mean (0.9; 1.0) were high and at least as good as the other outcomes. Internal consistency of the total score was high (Cronbach alpha = 0.93) and item-total correlations were substantial for all items (0.58–0.85).ConclusionsThis study supports linguistic and conceptual equivalence of our Canadian French version. Because this version of the PRTEE demonstrated good acceptability, construct validity, internal consistency, and responsiveness, it may be used in both research and clinical setting.Level of EvidenceN/A.