Treatment options for unstable trochanteric fractures: Screw or helical proximalfemoral nail

Purpose: To compare treatment outcome of screw proximal femoral nail (PFN) system with that of ahelical PFN.Methods: The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2 & 31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2 & A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk independently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN.Results: Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening >1 cm but <2 cm, while in helical PFN group 1 patient had superficial wound infection.Conclusion: Both screw and helical PFN are very effective implants in osteoporotic and unstabletrochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.     

Can diffusion tensor metrics help in preoperative grading of diffusely infiltrating astrocytomas? A retrospective study of 36 cases

Introduction  

Diffusion weighted imaging and diffusion tensor imaging (DTI) give information about the amount and directionality of water diffusion occurring in a given tissue. Here we study the role of diffusion tensor metrics including fractional anisotropy (FA) and spherical anisotropy (CS) in preoperative grading of diffusely infiltrating astrocytomas.     

Contrast-enhanced MR imaging of the liver: Comparison between Gd-BOPTA and mangafodipir

The purpose of the study was to evaluate the MR contrast agents gadolinium benzyloxypropionictetro-acetate (Gd-BOPTA) and Mangafodipir for liver enhancement and the lesion-liver contrast on T1W spin-echo (SE) and gradient-recalled-echo (GRE) images. Fifty-one patients (three groups of 17 patients each) with known or suspected liver lesions were evaluated with T1W SE (300/12) and GRE (77-80/2.3-2.5/80°) images before and after intravenous (IV) Gd-BOPTA (0.1 or 0.05 mmol/kg) or Mangafodipir (5 μmol/kg) in phase II to III clinical trials. Quantitative analysis by calculating liver signal-to-noise ratio (SNR), lesion-liver contrast-to-noise ratio (CNR), and spleen-liver CNR was performed. Liver SNR and spleen-liver CNR were always significantly increased postcontrast. SNR was highest after application of 0.1 mmol/kg Gd-BOPTA (51.3 ± 3.6, P < .05). CNR was highest after Mangafodipir (?22.6 ± 2.7), but this was not significantly different from others (P = .07). Overall, GRE images were superior to SE images for SNR and CNR. Mangafodipir and Gd-BOPTA (0.1 mmol/kg) provide equal liver enhancement and lesion conspicuity postcontrast. By all criteria, contrast-enhanced T1-weighted GRE were comparable to SE images.     

A multicenter clinical trial of gadolite oral suspension as a contrast agent for MRI

The purpose of this study was to assess the effectiveness and safety of Gadolite Oral Suspension as a gastrointestinal (GI) contrast agent for MRI in a phase II and two phase III multicenter clinical trials. Gadolite was administered to 306 patients with known or suspected abdominal and/or pelvic disease. MRI with T1- and T2-weighted sequences was performed before and after ingestion. Efficacy was evaluated by having two masked readers rate the certainty of their MR diagnosis (0 = uncertain, 1 = probable, 2 = definite) on randomly presented pre- and post-Gadolite Oral Suspension enhanced images. Principal investigators also evaluated the images and established the final diagnosis. Vital signs, clinical chemistries, and adverse events were documented. Blood and urine samples were analyzed for gadolinium content to determine whether Gadolite Oral Suspension was absorbed systemically. Certainty in MR diagnosis increased significantly (P < .001) for both blinded readers between pre- and post-Gadolite images (.49–1.18 for reader 1; .46–1.53 for reader 2). Sensitivity, specificity, and accuracy also increased for both masked readers. No gadolinium was detected in blood or urine samples. There were no serious adverse events and no apparent drug-related trends in mean vital signs or laboratory values. Gadolite is a highly effective, safe, and well tolerated contrast agent for clinical use with MRI.     

Comparison of 3% sorbitol vs psyllium fibre as oral contrast agents in MR enterography

Objective:

To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE).

Methods:

This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n = 20; psyllium, n = 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg⁻¹ psyllium prior to imaging. Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student''s t-test and Mann–Whitney U-test.

Results:

Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p = 0.338–0.908) and quantitative assessments (p = 0.083–0.856). The mean bowel distension achieved was 20.1 ± 2.2 mm for sorbitol and 19.8 ± 2.5 mm for psyllium (p = 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups.

Conclusion:

Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies.

Advances in knowledge:

This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.MR enterography (MRE) is an imaging technique used to evaluate the small bowel for diagnoses that include inflammatory bowel disease and neoplasms. Sufficiently distending the small bowel with an oral contrast agent (OCA) is critical, as collapsed loops may hide or mimic abnormalities.The OCAs employed in MRE can be classified as positive, negative or biphasic contrast agents according to their signal properties on T₁ and T₂ weighted imaging. Biphasic contrast agents typically provide low signal intensity on T₁ weighted imaging and high signal intensity on T₂ weighted imaging (T2W), and are most commonly used today because of their favourable signal characteristics for detecting bowel pathology. Water is a biphasic contrast agent, but its rapid physiological absorption from the small bowel necessitates the use of additives. These additives are often highly osmolar agents or non-osmotic agents that form hydrogels that trap water molecules in the bowel lumen. Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum.^1,2Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and easy availability, (v) have easy storage and (vi) have no serious adverse side effects.³Currently, VoLumen® (E-Z-EM Inc., Westbury, NY), a biphasic OCA comprising 0.1% w/v ultra-low-dose barium with sorbitol, simethicone and natural gums, is commonly used for MRE examinations in the USA. However, VoLumen is not easily available for sale in Canada, the UK and Europe. Instead, our institution (St Michael''s Hospital, Toronto, ON) used commercially available Metamucil® (Proctor & Gamble, Cincinnati, OH), a non-osmotic bulk fibre laxative containing psyllium seed husk, as a biphasic OCA for routine MRE studies from 5 January 2010 to 20 January 2013. On 21 January 2013, this was switched to the highly osmolar agent, 3% sorbitol, for all routine cases. This switch was prompted after a patient expressed concern about whether psyllium could result in small bowel obstruction.The purpose of our study was to retrospectively compare psyllium and 3% sorbitol as OCAs for MRE using the outcome measure of small bowel distension. On the basis of past literature, we hypothesized that sorbitol would provide better distension than psyllium.⁴     

Temporal variations in basicranium dimorphism of North Indians

In recent years, several investigations have documented notable secular changes in human skull morphology. The present study is the next link in the series, addressing its possible effects in the cranial base in North Indian populations. The present study aims to examine the sexual dimorphism in cranial base of two temporally different samples of North Indian population to provide updated population specific osteometric standards. The contemporary and the subrecent samples are comprised of 158 (M 110; F 48) and 325 adult crania (M 206; F 119), respectively. Five variables of cranial base were measured, and data were subjected to discriminant function analysis using SPSS 16.0. The t-tests between the two temporally different samples showed significant sexual dimorphism and population variation. Contemporary females showed comparatively greater dimensions than subrecent. Contemporary population exhibited less sexual dimorphism than subrecent population. Factors associated with the changes in sexual dimorphism are likely to be a consequence of improved nutrition and population admixture in last 50 years. The accuracy of sex prediction ranged from 48.1 to 70.0 % in contemporary sample and 60.9 % to 77.2 % in subrecent sample. Overall, these findings support the conclusion that sexual dimorphism shows variation within few decades, so sex discriminating osteometric standards must be updated regularly.     

Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. Multicenter phase III clinical trials. Efficacy of early imaging

The efficacy of contrast-enhanced magnetic resonance imaging (MRI) for detecting and characterizing, or excluding, hepatic masses was assessed in 404 patients, following the intravenous administration of mangafodipir trisodium (MnDPDP) injection, a hepatic MRI contrast agent. An initial contrast-enhanced computed tomography (CT) examination was followed by unenhanced MRI, injection of MnDPDP (5 micromol/kg IV), and enhanced MRI at 15 minutes post injection. Agreement of the radiologic diagnoses with the patients' final diagnoses was higher for enhanced MRI and for the combined unenhanced and enhanced MRI evaluations than for unenhanced MRI alone or enhanced CT using the clinical diagnosis as the gold standard. Mangafodipir-enhanced MRI uniquely provided additional diagnostic information in 48% of the patients, and patient management was consequently altered in 6% of the patients. MnDPDP-enhanced MRI was comparable or superior to unenhanced MRI and enhanced CT for the detection, classification, and diagnosis of focal liver lesions in patients with known or suspected focal liver disease.     

Formulation Development and Release Studies of Indomethacin Suppositories

Indomethacin suppositories were prepared by using water-soluble and oil soluble suppository bases, and evaluated for in vitro release by USP I and modified continuous flow through bead bed apparatus. Effect of the Tween 80 (1% and 5%) was further studied on in vitro release of the medicament. Release rate was good in water-soluble suppositories bases in comparison to oil soluble suppositories bases. Release was found to be greater in modified continuous flow through bead bed apparatus. When surfactant was used in low concentration then release rate was much greater, as compared to high concentration. When stability studies were performed on the prepared indomethacin suppositories it was found that suppositories made by water-soluble base had no significant changes while suppositories prepared by oil soluble bases, had some signs of instability.