Scintigraphic diagnosis of tricuspid regurgitation

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.     

Size of posterior fossa in Chiari type 1 malformation in adults

Summary The clinical and neuroradiological findings in five patients with Chiari Type 1 malformation presenting symptoms in adult life are presented. New posterior fossa ratio methods have been applied to this material. The posterior cranial fossae are demonstrated to be small, and the most significant deviation from normal gave the ratio h/Tw: posterior fossa height in proportion to Twining's line. The implications of these findings are discussed in relation to the static and dynamic factors that are operating in the development of neurological symptoms in Chiari type 1 malformation. A final discussion is given comparing the Chiari type 1 malformation to meningo-myelocele. The findings using posterior fossa ratio methods may strengthen the indications for suboccipital craniectomy in these patients.     

Neuropsychiatric symptoms in patients with multiple sclerosis

OBJECTIVE: To explore the range of psychiatric symptoms in patients with multiple sclerosis (MS) and their association with neurological disability. METHOD: Patients diagnosed with MS during 1998-2000 in Rogaland and Hordaland counties, western Norway, were included. Psychiatric symptoms were assessed by the Neuropsychiatric Inventory (NPI). Patients with systemic lupus erythematosus (SLE) served as controls. RESULTS: Eighty-six of 93 eligible MS patients were included, and 80% showed at least one psychiatric symptom. The most frequent symptoms were depression (59%), sleep disturbance (48%), irritability/emotional lability (42%), and apathy (31%). Depression was associated with higher disability score. MS patients showed significantly higher NPI irritability score (P = 0.002), appetite disturbance score (P < 0.001), and apathy score (P = 0.01) than SLE patients. CONCLUSION: Neuropsychiatric symptoms occur frequently in patients with MS. Irritability and apathy are independent of disability and chronic disease and represent unique disease manifestations.     

Do all young ischemic stroke patients need long-term secondary preventive medication?

After a mean of 6 years, the frequencies of later vascular events (recurrent ischemic stroke or myocardial infarction) in 232 young ischemic stroke patients (younger than 50 years) with none to five traditional risk factors were 2.1%, 6%, 19%, 26%, 30%, and 67% (p < 0.001). Long-term secondary preventive medication may not be indicated in young ischemic stroke patients with no risk factor.     

Tendon graft fixation in ACL reconstruction: in vitro evaluation of bioabsorbable tenodesis screw

BACKGROUND: Conventional ACL reconstruction requires sufficient tibial bone quality for secure graft fixation. We evaluated the mechanical characteristics of a supplemental tenodesis screw in cadaveric specimens. MATERIAL AND METHODS: One group of 7 specimens from 7-paired tibiae was randomly assigned to undergo tibialis anterior tendon graft-bone tunnel fixation with a bioabsorbable interference screw, using conventional ACL reconstruction techniques. The other group of 7 specimens underwent the same procedure supplemented with a bioabsorbable tenodesis screw. All specimens were subjected to pullout testing on a servo hydraulic device. RESULTS: Specimens in the supplemental fixation group had double the load to failure (tenodesis = 467 (SD 184) N, control group = 223 (SD 66) N, p = 0.02) and were also one-third stiffer (tenodesis = 31 (SD 13) N/mm, control group = 21 (SD 6) N/mm, p = 0.03) than the specimens in the conventional fixation group. INTERPRETATION: Supplemental bioabsorbable tenodesis screw fixation may be advantageous for primary reconstruction in patients with low tibial bone mineral density or during revision procedures. By providing secure soft tissue graft-tibia fixation during the early phase after ACL reconstruction, supplemental tenodesis fixation may enable patients to participate safely in more intense, early rehabilitation.     

Therapeutic modality: rehabilitation of the injured athlete

Traditional therapeutic modalities include cryotherapy, sonotherapy, pulsed electrical stimulation, transcutaneous electrical nerve stimulation, high-volt pulsed current, and iotopheresis. Alternative modalities include acupuncture, magnetic field therapy, biofeedback,and massage. All therapeutic modalities should be considered adjuncts to progressive functional exercise. Controlled studies rarely reach consensus regarding the efficacy of therapeutic modalities,so their use should be individualized to the patient.