Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report

Double dislocations of the thumb are rare injuries. Those reported in the English literature have all been treated operatively except one. We report the second case of a double dislocation of a thumb involving the metacarpophalangeal joint and carpometacarpal joint treated nonoperatively. Two-year results reveal a stable, pain free thumb with no evidence of arthritis or subluxation. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.     

Muscle Force and Force Control After Weight Loss in Obese and Morbidly Obese Men

BACKGROUND: Decrease in fat mass and fat-free mass have been observed with weight loss induced by a dietary intervention or surgery. There are concerns that fat-free mass decrease could have some negative functional consequences. The aim of this study was to examine how weight loss affects strength and force control in obese and morbidly obese men. METHODS: Weight loss was obtained in obese individuals by a hypocaloric diet program until resistance to lose fat and in morbidly obese individuals by bariatric surgery. Maximal force was measured for upper and lower limb and the ability to maintain 15% and 40% of that force. These measures were taken at baseline, in those dieting once resistant to weight loss and 1 year after surgery for those operated on. Normal weight individuals used for control were evaluated twice (6 to 12 months apart). RESULTS: At baseline, there was no significant difference between groups for maximal forces and capabilities to maintain force levels. Weight loss averaged 11.1% of the initial body weight after dieting and 46.3% 1 year after surgery. At the same time, there was for the lower limb a loss of 10.1% in maximal force after dieting and 33.5% after surgery. For the upper limb, there was no change in maximal force after dieting whereas a decrease of 14.4% was observed after surgery. When transformed in force related to body weight, there was no change in relative force for the lower limb after dieting whereas an increased relative force after surgery. There was no significant difference for the ability for maintaining force levels. CONCLUSION: Despite a large force loss, particularly for the lower limbs in morbidly obese individuals after surgery, this loss is relatively well tolerated because the relation between force and body weight is even improved and the ability to maintain that force is preserved.     

1,4-Dihydroindeno[1,2-c]pyrazoles with acetylenic side chains as novel and potent multitargeted receptor tyrosine kinase inhibitors with low affinity for the hERG ion channel

The synthesis of a novel series of 1,4-dihydroindeno[1,2-c]pyrazoles with acetylene-type side chains is described. Optimization of those compounds as KDR kinase inhibitors identified 8, which displayed an oral activity in an estradiol-induced murine uterine edema model (ED50 = 3 mg/kg) superior to Sutent (ED50 = 9 mg/kg) and showed potent antitumor efficacy in an MX-1 human breast carcinoma xenograft tumor growth model (tumor growth inhibition = 90% at 25 mg/kg.day po). The compound was docked into a homology model of the homo-tetrameric pore domain of the hERG potassium channel to identify strategies to improve its cardiac safety profile. Systematic interruption of key binding interactions between 8 and Phe656, Tyr652, and Ser624 yielded 90, which only showed an IC50 of 11.6 microM in the hERG patch clamp assay. The selectivity profile for 8 and 90 revealed that both compounds are multitargeted receptor tyrosine kinase inhibitors with low nanomolar potencies against the members of the VEGFR and PDGFR kinase subfamilies.     

Evaluation of Adult Congenital Heart Disease by Cardiac Magnetic Resonance Imaging

Cardiovascular magnetic resonance (CMR) imaging plays an essential role in the evaluation and follow‐up of adult congenital heart disease (ACHD), providing safe, high‐resolution imaging of some of the most complex anatomies encountered. Unlimited by acoustic windows and capable of tissue characterization, CMR is devoid of ionizing radiation and provides superior three‐dimensional spatial resolution to transthoracic echocardiography and superior temporal resolution to computed tomography, making it the gold standard for various cardiac and great vessel imaging indications in ACHD. In this state‐of‐the art review, we provide an overview of CMR examination methods and detail the various approaches and classical findings in the more common forms of ACHD. Although this review touches upon technical aspects of CMR imaging in ACHD, it is primarily geared toward the adult congenital caregiver (i.e., clinical, interventional, or surgical), highlighting relevant practical considerations. To enhance the clinical utility of this review, numerous examples with intraoperative correlates are provided to highlight our imaging approaches for various defects. As CMR image acquisition may be time consuming and requires patient collaboration (e.g., intermittent breath holding), a systemic approach is required to maximize efficiency. A thorough knowledge of ACHD anatomy and natural history is essential in maximizing image interpretation. Proficient scanning is further enabled by clearly outlined study objectives with prior documentation of interventional and surgical procedures, where applicable.     

Is psychiatric emergency service (PES) use increasing over time?

Background  

Several recent studies have reported a significant increase in medical emergency department (ED) use for reasons of mental health. The diagnostic profile of these patients however differs from that usually described for patients visiting the psychiatric emergency service (PES). Few studies have specifically focused upon long-term PES utilization rates. Those that do typically present data from the early 80s, suggesting that deinstitutionalization may be an important contributing factor to the increases found. The aim of this study was to assess PES use using a more recent time frame and, the effects of non-specific factors, such as population growth, on this use.     

Diagnostic et prise en charge de la coagulopathie post-traumatique

Trauma-induced coagulopathy is frequent and complex, and is responsible for an impairment of trauma outcome. Diagnosis of trauma coagulopathy is usually done with standard biology but recently new technics arose and gave us the opportunity to have faster information on coagulopathy with quick INR measure or clot formation study with thrombelastometry. Treatment of the coagulopathy should be done earlier in the course of trauma. Two strategies are possible that include either the association of RBC, platelet and FFP in a predefined ratio, or the use of factor concentrates guided with thrombelastometry. Treatment of favouring factors such as hypothermia, acidosis and hypocalcemia is also mandatory.     

Gated blood-pool SPECT versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction

Background  

We evaluated the accuracy of planar radionuclide angiography and different count-based and space-based electrocardiogram (ECG)-gated blood-pool single-photon emission computed tomography (GBPS) algorithms for assessment of left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) compared with the gold standard of cardiac magnetic resonance imaging (cMRI). The goal is to assess the accuracy of a recently developed GBPS algorithm.     

Increased Plasma Levels of Toxic Pollutants Accompanying Weight Loss Induced by Hypocaloric Diet or by Bariatric Surgery

Background: Weight loss reduces the risk of several diseases. Increases of plasma organochlorine and pesticide compounds, however, have been observed with weight loss induced by a dietary intervention and by a gastroplasty. This increased concentration of toxic pollutants could be a side-effect of weight loss and a risk for health problems. The aim of this study was: 1) to observe if there is a relationship between the plasma concentration of organochlorines and BMI at steady state weight, and 2) to determine, after a bariatric surgical intervention, if the magnitude of the weight loss has a direct effect on this concentration. Methods: Weight loss was obtained in obese individuals by a hypocaloric diet program until resistance and in morbidly obese individuals by a bariatric operation (biliopancreatic diversion - duodenal switch [BPD-DS]). Normal-weight individuals were tested to serve as controls. Blood samples were analyzed for organochlorine and pesticide compounds at baseline in all groups, after resistance to weight loss in obese individuals, and at 3 months and 1 year after surgery in morbidly obese individuals. Results: At steady state weight, organochlorine and pesticide compounds were found in all groups, and the sum of all organochlorine compounds correlated with age and not BMI. Weight loss averaged 12.1% of the initial body weight after dieting and 20.9% at 3 months after surgery, respectively. This weight loss yielded significant increases in total plasma organochlorine concentration (increase of 23.8% for obese and 51.8% for morbidly obese individuals). For morbidly obese individuals, the weight loss at 1 year after surgery (46.3%) yielded a 388.2% increase in total plasma organochlorine concentration. Conclusion: Plasma organochlorine concentration increases with weight loss and is related to the magnitude. Future research will have to determine if: 1) this pollutant concentration remains elevated over time and 2) there are long-term effects of this high concentration on health.     

Effects of methamphetamine dependence and HIV infection on cerebral morphology

OBJECTIVE: The authors examined the separate and combined effects of methamphetamine dependence and HIV infection on brain morphology. METHOD: Morphometric measures obtained from magnetic resonance imaging of methamphetamine-dependent and/or HIV-positive participants and their appropriate age- and education-matched comparison groups were analyzed. Main effects of age, HIV infection, methamphetamine dependence, and the interactions of these factors were examined in analyses of cerebral gray matter structure volumes. RESULTS: Independent of the effect of age, HIV infection was associated with reduced volumes of cortical, limbic, and striatal structures. There was also some evidence of an interaction between age and HIV infection such that older HIV-positive participants suffered disproportionate loss. Methamphetamine dependence was surprisingly associated with basal ganglia and parietal cortex volume increases, and in one of these structures-the nucleus accumbens-there appeared to be a larger effect in younger methamphetamine abusers. Neurocognitive impairment was associated with decreased cortical volumes in HIV-positive participants but with increased cortical volumes in methamphetamine-dependent participants. CONCLUSIONS: These results suggest significant brain structure alterations associated with both HIV infection and methamphetamine dependence. The regional patterns of the changes associated with these factors were distinct but overlapping, and the effects on brain volumes were opposing. Although the results of the present study provide little information about the specific mechanisms leading to the unexpected methamphetamine effects, they may be related to glial activation or neuritic growth, both of which have been associated with methamphetamine exposure in animal studies. These results have implications for the interpretation of brain morphological findings in methamphetamine-dependent, HIV-positive individuals, a group whose numbers are unfortunately increasing.