High-frequency ultrasonographic examination of the finger pulley system.

OBJECTIVE: The purpose of this study was to determine the ability of high-frequency ultrasonography to provide for direct evaluation of the annular and cruciform finger pulley system. METHODS: In the first part of the work, a cadaveric study was performed to outline the normal anatomy of the annular and cruciform finger pulley system. Eighteen cadaveric hands were cut (n = 10) or dissected (n = 8). Two musculoskeletal radiologists retrospectively reviewed in consensus the photographs of anatomic sections and dissections. This cadaveric study gave the 2 readers the opportunity to learn the normal anatomy of the finger pulley system. In the second part of the work, the annular and cruciform finger pulley system of 20 hands of volunteers was evaluated by ultrasonography with a 17-MHz linear transducer. Images were retrospectively analyzed by means of consensus of the 2 radiologists with respect to the visibility of each finger pulley. RESULTS: For annular (A) pulleys, high frequency ultrasonography showed A1, A2, A3, and A4 in 100%, 100%, 65%, and 100% of cases, respectively. For cruciform (C) pulleys, high-frequency ultrasonography showed only C1 in 45% of cases. Direct visualization of A5, C2, and C3 was not possible. CONCLUSIONS: High-frequency ultrasonography allows excellent depiction of finger pulleys except for annular pulley A5 and cruciform pulleys C2 and C3.     

Transgenic expression of tpr-met oncogene leads to development of mammary hyperplasia and tumors.

Receptor tyrosine kinases are important in cell signal transduction and proliferation. Abnormal expression of tyrosine kinases often leads to malignant transformation. C-met is a tyrosine kinase receptor and its ligand is hepatocyte growth factor (HGF). HGF/c-met plays diverse role in regulation of cell growth, shape and movement. Constitutively activated met, such as tpr-met, is a potent oncogene in vitro, but its carcinogenic role in vivo remains unclear. Our study demonstrates that expression of tpr-met leads to development of mammary tumors and other malignancies in transgenic mice, and suggests that deregulated met expression may be involved in mammary carcinogenesis.     

Familial Nephropathic Non-neuropathic Amyloidosis: Clinical Features, Immunohistochemistry and Chemistry

Classification of familial amyloidosis by the chemical natureof the fibrillar protein has become possible. Most such amyloidogenicproteins so far recognized are variant transthyretins, but twokindreds with the same apolipoprotein AI modification have beenreported. We describe the clinical features of another suchfamily in whom petechial skin rash appeared to be a marker forthe disease, which was non-neuropathic and of the Ostertag-type.Immunohistochemistry showed the protein to be apolipoproteinAI, but allele-specific DNA amplification indicated that itwas not the Arg²⁶ variant previously identified.     

Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis

Purpose

We performed a systematic review and meta-analysis of studies investigating the passive leg raising (PLR)-induced changes in cardiac output (CO) and in arterial pulse pressure (PP) as predictors of fluid responsiveness in adults.

Methods

MEDLINE, EMBASE and Cochrane Database were screened for relevant original and review articles. The meta-analysis determined the pooled area under the ROC curve, the sensitivity, specificity and threshold for the PLR test when assessed with CO and PP.

Results

Twenty-one studies (991 adult patients, 995 fluid challenges) were included. CO was measured by echocardiography in six studies, calibrated pulse contour analysis in six studies, bioreactance in four studies, oesophageal Doppler in three studies, transpulmonary thermodilution or pulmonary artery catheter in one study and suprasternal Doppler in one study. The pooled correlation between the PLR-induced and the fluid-induced changes in CO was 0.76 (0.73–0.80). For the PLR-induced changes in CO, the pooled sensitivity was 0.85 (0.81–0.88) and the pooled specificity was 0.91 (0.88–0.93). The area under the ROC curve was 0.95 ± 0.01. The best threshold was a PLR-induced increase in CO ≥10 ± 2 %. For the PLR-induced changes in PP (8 studies, 432 fluid challenges), the pooled sensitivity was 0.56 (0.49–0.53), the pooled specificity was 0.83 (0.77–0.88) and the pooled area under the ROC curve was 0.77 ± 0.05. Sensitivity and subgroup analysis were consistent with the primary analysis.

Conclusions

PLR-induced changes in CO very reliably predict the response of CO to volume expansion in adults with acute circulatory failure. When PLR effects are assessed by changes in PP, the specificity of the PLR test remains acceptable but its sensitivity is poor.

     

Expert Consensus on the Management of Patients with Postmenopausal Osteoporosis in the Spanish Healthcare System

Introduction

The management of postmenopausal osteoporosis (PMO) in routine clinical practice differs considerably from guideline recommendations. The objective of our study was to reach a consensus on the management of PMO, considering prevention, diagnosis, treatment and follow-up, according to expert opinion in Spain.

Methods

A two-round Delphi technique was conducted, including 38 experts. The questionnaire contained 35 sections, each one including 1–10 questions (n = 308) based on a literature review and contributions from the scientific steering committee. Each question was scored by experts from the current (1 = no occurrence, 9 = occurrence in all cases), wish (1 = total rejection; 9 = wish) and prediction (1 = no occurrence at all; 9 = occurs with maximum probability) perspectives. Consensus (wish and prediction perspectives) was considered when ≥75% of experts scored 7–9 (agreement) or 1–3 (disagreement).

Results

Overall, consensus was achieved on 75% of questions. While protocols of clinical management and consultation/referral should be followed, their implementation is unlikely. Furthermore, the medical specialties currently involved in PMO management are poorly defined. PMO patients without fracture should be managed (prevention, diagnosis, treatment and follow-up) in both primary care and rheumatology settings; however, experts predicted that only treatment and follow-up will be assumed by these specialties. A multidisciplinary team should be involved in patients with fracture. No assessment tools are usually applied, and prediction indicated that they will not be used.

Conclusion

Efforts should be focused on questions with high divergence between wishes and predictions, defining actions that will improve PMO management. Collaboration between scientific societies and health authorities to address the identified opportunities of improvement is proposed.

Funding

Amgen S.A.

     

Medical waste management

The author describes the treatment systems which should be applied, particularly when dealing with groups III and IV as explained in the previous article, in order to counteract their noxious effects on persons and the environment. Some treatment systems are compared and the author explains how to treat radioactive wastes, residues and sterilization, microwaves and the incineration of sanitary residues.