Hemodynamic-volumetric monitoring

Maintenance of adequate cardiac preload is of paramount importance in the treatment of patients undergoing major surgical surgery and in the critically ill setting. The end point is to maintain the organ perfusion through volume replacement and therapy to optimize cardiac output, oxygen deliver. Various methods have been introduced into clinical practice to estimate cardiac preload. In the last 10 years the transpulmonary indicator dilution technique showed to be accurate as hemodynamic-volumetric monitoring. We briefly review the intra thoracic blood volume index as a preload index and the fluid responsiveness indexes, stroke volume variation and pulse pressure variation, available as novel parameters at the bed-side.The optimization of fluid balance and vasoactive drugs administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system where intravascular volume management is a primary objective.     

Upper thoracic-spine disc degeneration in patients with cervical pain

Objective To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established.Design and patients One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6±14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion.Results Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2–3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7–T1, T1–2, T2–3 and T3–4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patients gender or age. Degenerative cervical disc disease was closely related together (P<0.001), but not with any thoracic disc.Conclusion A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms.This paper was presented at the 9th Scientific Meeting and Exhibition of the International Society for Magnetic Resonance in Medicine and the 18th Annual Meeting and Exhibition of the European Society for Magnetic Resonance in Medicine and Biology, which were held jointly in Glasgow, Scotland, UK, April 2001.     

The evaluation of renal osteodystrophy with cortical quantitative ultrasound at various bone sites

BACKGROUND: In this study we evaluated bone abnormalities of patients with chronic renal failure (CRF) by cortical quantitative bone ultrasound (QUS) measurements at different bone sites because these abnormalities may be of variable etiology and may start before symptoms or radiological changes are manifested. METHODS: Of fifteen patients with chronic renal failure, seven had moderate-severe disease and eight had been on chronic hemodialysis from 5 to 17 years, with renal osteodystrophy (ROD) confirmed by bone biopsies. Twelve normal subjects of similar age and gender volunteered for the control group. RESULTS: Patients and controls differed in creatinine clearance, in serum phosphate levels and in serum total alkaline phosphatase. Mean intact-PTH levels differed significantly amongst the three groups of subjects. All patients with ROD had intact-PTH higher than 200 pg/mL. The cortical ultrasound parameter, speed of sound (SOS), was slower in patients with more severe renal failure at all bone sites measured. The group with ROD had significantly lower cortical ultrasound values than the other patients and the control group at all sites. SOS values at the proximal phalanx, distal radius and midtibial sites were positively and significantly correlated. Cortical ultrasound measurements at the radial site correlated with midtibial and phalangeal sites but the correlation between midtibial and phalangeal sites did not reach significance. IPTH levels correlated negatively and significantly with cortical QUS values at all sites being the correlations higher at phalangeal and radial sites than at the midtibial region. CONCLUSIONS: The differences in cortical ultrasound observed indicate the potential clinical application of this methodology to evaluate bone abnormalities in chronic renal failure, especially in patients on chronic hemodialysis.     

Ergonomics aspect and musculoskeletal symptoms in a transport sector

The aim of the present study was to identify the tasks ranked as the most stressful and to investigate the ocurrence of musculoskeletal symptoms among workers employed by a patient transport sector. The RPE (Rating of Perceived Exertion) scale of Borg was used to determine the rating of perceived physical exertion on the musculoskeletal system. Measures of musculoskeletal disorders was obtained using a modified version of the Nordic Questionnaire. The workers felt that all of the tasks related to patient transfer require intense physical exertion, with scores from 16.8 to 13.8. The workers reported high musculoskeletal complaints in several body regions, with highest prevalence in the low back.     

Rectal cancer masquerading as an amoeboma: case report and review of the literature

Despite the prevalence of amoebiasis in many parts of the world, amoebomas are relatively uncommon. Amoebomas within the colorectum are indistinguishable from carcinomas either macroscopically or by barium enema examination and the presence of both conditions is much rarer still. Herein, we describe such a case and review the possible reasons for their coexistence.