Pitfalls in the diagnosis of acute pulmonary embolism on spiral computer tomography

Spiral computer tomography (CT) has become a widely accepted clinical tool in the diagnosis of acute pulmonary embolism. The accuracy of computed tomography in diagnosing pulmonary embolism has increased over the past 10 years, parallel to technological improvements. However, as with most imaging techniques, interpretative pitfalls may occur for a variety of reasons. These include technical problems caused by respiratory motion artifact, improper bolus timing, streak artifact, and patient body habitus. In addition, misinterpretation of normal bronchovascular anatomy may lead to an erroneous diagnosis. This article discusses the various diagnostic pitfalls and methods to minimize and overcome them.     

Comparison of rectus abdominis muscle and musculoperitoneal flap in closure of urinary bladder defects in a rat model

To study the histological differences between a muscle flap and a musculoperitoneal flap used as a urinary bladder wall substitute, we prospectively studied these flaps in 24 Wistar albino rats. In 12 rats a rectus abdominis muscle flap including the overlying peritoneum (RAMP flap) was sutured into a surgical defect of the bladder wall. The rectus abdominis muscle flap was interposed without peritoneum (RAM flap) in the other 12 rats. The animals were killed on postoperative day 6 (6 RAMP flaps and 6 RAM flaps) and day 90 (5 RAMP flaps and 5 RAM flaps) to obtain early and late histological results. The 2 remaining rats (1 RAMP flap and 1 RAM flap) died before 90 days. Partial resurfacing of the flaps muscle surface with urothelium was observed on the sixth postoperative day in both the RAMP and the RAM group. At that time, no significant histological difference in the urothelium was observed between the RAMP and the RAM flaps. After 90 days, resurfacing with urothelium was complete in both groups. We concluded that a urothelium or peritoneum lining is not needed to protect a muscle flap against contact with urine. Histologically, the presence of peritoneum in the early postoperative period seems to have had a positive effect on the quality of neo-urothelium.     

Should We Give Prophylactic “Renal‐Dose” Dopamine After Coronary Artery Bypass Surgery?

OBJECTIVE: A prospective double-blind randomized study undertaken to assess the effect of postoperative prophylactic "renal-dose" dopamine on post-coronary artery bypass grafting surgery's clinical outcome. METHODS: Eighty-five consecutive patients undergoing CABG operation were randomized to receive either 3-5 microg/kg/min dopamine (group D, n = 41) or saline as placebo (group P, n = 45) for 48 postoperative hours. Clinical outcome parameters were collected for four postoperative days. RESULTS: Preoperative and operative parameters were similar in both groups. Four patients from group P and none from group D reached an end-point of the study (oliguria, renal dysfunction) and received dopamine. Two patients from group P and none from group D needed an additional inotropic support. Mean arterial pressure values were similar during the first 24 hours after operation, but left atrial pressure values tended to be higher in group P (10 +/- 4 vs 7 +/- 3 mmH2O, p = 0.18). The mean pH was higher in group D at 8 hours after operation (7.38 +/- 0.2 vs 7.36 +/- 0.3, p = NS), due to higher bicarbonate levels (23 +/- 2 mmol/l vs 21 +/- 2, p = 0.49). The incidence of lung congestion in chest X-rays and CT scans was significantly higher in group P (50% vs 29%, p = 0.073 at 48 hours postoperatively). Room air blood O2 saturation and maximal expiratory volume tended to be higher in group D (at 72 hours after operation- 92 +/- 4 vs 90%+/- 5, p = 0.29 and 646 +/- 276 vs 485 ml +/- 206, p = 0.16, respectively). There was no statistical difference in urine output but the amount of furosemide given to patients in group P was significantly higher (during the first 8 hours 2.5 +/- 0.5 vs. 0.3 mg +/- 1.6, p = 0.07). Plasma creatinine levels were significantly lower in group D (at 24 hours 0.93 +/- 0.02 vs 1.05 mg/dL +/- 0.02, p = 0.02). Mobilization after surgery was faster in group D. CONCLUSIONS: Prophylactic dopamine administration after coronary artery bypass grafting surgery improves patient hemodynamic and renal status, reduces the need for additional medical support (inotropes and furosemide) and thus, provides stable postoperative course.     

Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results?

INTRODUCTION: The aim of the study was to evaluate the results of total hip arthroplasty (THA) due to avascular necrosis (AVN) of the femoral head and to establish whether the cause of AVN affects the results. MATERIAL AND METHODS: A group of 68 patients, 17-82 years of age (mean: 49.9 years) underwent 84 total hip arthroplasties due to AVN. The patients were divided into subgroups according to the etiology of AVN of the hip joint. The results of each group were evaluated by the Harris Hip score (HHS) at 3-18 years (mean: 6.2 years). The complication rate was also assessed. RESULTS: The mean preoperative HHS was 28.5+/-4.5 as opposed to a postoperative HHS of 86+/-10. The revision rate was 16.7%. Etiology does not affect the final outcome, but less favorable long-term results were found in the steroid-induced AVN patients. CONCLUSIONS: Despite the previously reported, less favorable results, THA is a good option for the younger population, even with AVN, especially in bilateral disease. Etiology did not affect the final outcome. However, patients with steroid-induced AVN should be informed that although their final functional results will equal those of other groups, the longevity of the implants is limited.     

Ocular growth in premature infants conceived by in vitro fertilization versus natural conception

PURPOSE: To evaluate the possible effect of in vitro fertilization (IVF) on early development of the eye in premature infants. METHODS: Biometric and keratometric values, intraocular pressure, and retinal vascular status were assessed in a cohort of 133 premature infants. These values were compared between premature infants conceived by IVF or naturally, and the relationship between these parameters and postconceptional age and weight at examination were evaluated. RESULTS: The sample consisted of 133 premature infants, 62 (46.6%) born by IVF and 71 (53.4%) by natural conception. Postconceptional age at examination was 28 to 46 weeks. In both groups, axial length, anterior chamber depth, and corneal radius correlated with the postconceptional age and weight at examination and followed a linear growth pattern. Lens thickness changed very slightly. The rate of retinal vascularization correlated with the postconceptional age as well. No correlation was found between intraocular pressure and corrected age or weight at examination. There was no difference between the study and control groups in any of the biometric or keratometric parameters or in intraocular pressure, according to two-way analysis of variance. CONCLUSIONS: IVF apparently does not affect early ocular growth, intraocular pressure, changes in corneal curvature, or retinal vascularization in premature infants. These findings may aid ophthalmologists in assessing ocular dimensions in this patient population.     

Ocular injury in children from exploding microwaved eggs

PURPOSE: To report an ocular injury caused by exploding microwave-cooked eggs. DESIGN: Case reports. METHODS: Two children exposed to exploding microwaved eggs were examined for facial burns and ocular trauma. RESULTS: One patient sustained mild corneal epithelial damage in both eyes and eyelid burn, which were treated conservatively. The other, injured in the same event, had symblepharon and moderate keratopathy requiring intensive lysis. CONCLUSIONS: Physicians should be alerted to the potential risk of vision-threatening ocular injury from exploding microwaved foods, and the public should be educated not to cook eggs in microwave ovens.     

P53 alteration in oral tongue cancer is not significantly associated with age at diagnosis or tobacco exposure

AIMS AND BACKGROUND: The tumor suppressor gene P53 is mutated in almost half of head and neck cancers. The current work assessed the prognostic significance of P53 alteration in patients with squamous cell carcinoma of the oral tongue treated with a curative intent, its association with age at diagnosis (using 45 years as a cut point), and risk exposure as defined by tobacco and/or alcohol consumption. METHODS: P53 alteration was determined immunohistochemically in 45 patients with tongue cancer treated with a curative intent. RESULTS: P53 alteration occurred in 20 of 45 tumors (44%) and was more common among younger patients (58% versus 36% for younger versus older patients, respectively) and those lacking tobacco/alcohol exposure (53% versus 40% for "no-risk" and "risk" groups, respectively), but the differences were not statistically significant. With a median follow-up of 56 months, 5-year progression-free survival rates were 48% and 66% in patients with and without P53 detection, respectively (P = 0.22). CONCLUSIONS: Despite a trend of a younger age at diagnosis in P53-altered tumors, results did not reach statistically significant differences. A trend of a worse clinical outcome with P53 alteration was noted.     

Improvement of extrapyramidal symptoms following dehydroepiandrosterone (DHEA) administration in antipsychotic treated schizophrenia patients: a randomized, double-blind placebo controlled trial

Recent investigation in schizophrenia indicated dehydroepiandrosterone (DHEA) levels to be inversely correlated with extrapyramidal symptomatology (EPS). This study thus investigates the effect of DHEA administration on medication-induced EPS. Inpatients with schizophrenia or schizoaffective disorder were randomized in double-blind fashion to receive either 100 mg DHEA or placebo in addition to a constant dosage of antipsychotic medication. Parkinsonism showed a favorable effect of DHEA with a significant time effect (p < 0.0001), as well as a significant group by time interaction (p < 0.05) and with no change noted on akathisia. Change of DHEA blood levels was negatively associated with change of Parkinsonism (p < 0.05) as well as with change of total EPS ratings (p < 0.05). DHEA appears to demonstrate a significant effect on EPS, with improvement observed particularly in Parkinsonian symptoms.     

Factor VIII efficient and specific non-covalent binding to PEGylated liposomes enables prolongation of its circulation time and haemostatic efficacy

Haemophilia A is a bleeding disorder caused by the lack of factor VIII (FVIII). We report the prolongation of exogenous FVIII circulation time and haemostatic efficacy by its formulation with PEGylated liposomes (PEGLip). FVIII binds non-covalently but with high affinity in a specific mode with the external surface of PEGLip neither losing its activity nor its binding to von Willebrand Factor. Experiments in haemophilic and non-haemophilic mice indicate that the circulation time and clotting efficacy of PEGLip-formulated exogenous FVIII (PEGLip-FVIII) are significantly enhanced over those of free FVIII. The data support the feasibility of using PEGLip-FVIII to extend the duration of haemostatic efficacy in the treatment of haemophilia A.     

Unitary hypothesis for multiple triggers of the pain and strain of migraine

Migraine headache is triggered by and associated with a variety of hormonal, emotional, nutritional, and physiological changes. The perception of migraine headache is formed when nociceptive signals originating in the meninges are conveyed to the somatosensory cortex through the trigeminal ganglion, medullary dorsal horn, and thalamus. Is there a common descending pathway accounting for the activation of meningeal nociceptors by different migraine triggers? We propose that different migraine triggers activate a wide variety of brain areas that impinge on parasympathetic neurons innervating the meninges. According to this hypothesis, migraine triggers such as perfume, stress, or awakening activate multiple hypothalamic, limbic, and cortical areas, all of which contain neurons that project to the preganglionic parasympathetic neurons in the superior salivatory nucleus (SSN). The SSN, in turn, activates postganglionic parasympathetic neurons in the sphenopalatine ganglion, resulting in vasodilation and local release of inflammatory molecules that activate meningeal nociceptors. Are there ascending pathways through which the trigeminovascular system can induce the wide variety of migraine symptoms? We propose that trigeminovascular projections from the medullary dorsal horn to selective areas in the midbrain, hypothalamus, amygdala, and basal forebrain are functionally positioned to produce migraine symptoms such as irritability, loss of appetite, fatigue, depression, or the quest for solitude. Bidirectional trafficking by which the trigeminovascular system can activate the same brain areas that have triggered its own activity in the first place provides an attractive network of perpetual feedback that drives a migraine attack for many hours and even days.