Computer assisted evaluation of wound healing in chronic ulcers

The aim of this work was to present an efficient and objective method of wound healing assessment based on serial measurements of ulcer dimensions and calculation of wound margin advancement towards the center of the lesion. The method is implemented via computer software, which permits clinicians to perform necessary computations. The proposed method of wound assessment integrates pieces of work that have been published in the past into a user-friendly environment. The high accuracy of computations may help clinicians to make objective decisions in the management of difficult to heal ulcers.     

Low-Back Pain in Morbidly Obese Patients and the Effect of Weight Loss Following Surgery

Background: Although low-back pain (LBP) is a common health problem and a source of significant discomfort, disability and work absences, its incidence, severity and outcome have not been extensively investigated in morbidly obese patients undergoing bariatric surgery. Methods: 50 morbidly obese candidates for vertical banded gastroplasty (VBG) were asked to fill in a questionnaire, to assess the incidence and severity of any existing LBP symptoms. 50 non-obese patients, admitted to our surgical unit for management of several benign conditions, were also asked to fill in the same questionnaire and served as controls. 24 months after VBG, the morbidly obese patients were again evaluated for their LBP symptoms. Results: LBP was identified in 29 morbidly obese patients (58%) preoperatively and in only 12 (24%) of the lean controls (P<0.01). 2 years after VBG, with a significant excess weight loss (P<0.0001), only 10 patients continued to have LBP but less frequently and requiring reduced doses of medications compared with the preoperative condition. In the remaining 19 patients with preoperative positive LBP history, the postoperative weight loss was associated with complete resolution of the symptoms. Conclusion: The frequency of LBP is significantly higher in morbidly obese patients than in lean subjects. Surgical weight reduction results in significant improvement and even disappearance of this obesity co-morbidity.     

Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients

The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 ± 16 years and mean duration of PD 3.1 ± 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was −1.04 ± 1.68, the lumbar spine Z-score was −0.31 ± 1.68, the femoral neck T-score was −1.38 ± 1.39, and the femoral neck Z score was −0.66 ± 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time × dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca × PO₄ had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca × P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass—19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients.     

Eosinophilic pleural effusion, peripheral eosinophilia, pleural thickening, and hepatosplenomegaly in sarcoidosis

In this atypical case of sarcoidosis with an unusual combination of clinical and laboratory findings, a 32-year-old male presented with a 3-month history of thoracic pain complicated with dyspnea. Laboratory tests, chest radiography, and CT scans of the chest and abdomen revealed eosinophilia of pleural effusion and blood, pleural thickening, hepatosplenomegaly, and bronchiolitis obliterans. In cases such as this, in which pleural fluid eosinophilia is accompanied by peripheral eosinophilia and splenohepatomegaly, underlying malignancies such as Hodgkin lymphoma should be ruled out. A biopsy of the mediastinal lymph nodes suggested noncaseating epithelioid granulomas, characteristic of sarcoidosis. The patient underwent prednisolone therapy for 1 year and is doing well 2 years after initial diagnosis.     

QRS dispersion: an electrocardiographic index of systolic left ventricular dysfunction in patients with left bundle branch block

The presence of complete left bundle branch block (LBBB) in patients with congestive heart failure has been proposed to be a factor that negatively affects left ventricular (LV) systolic function. The aim of this study was to evaluate the relative predictive value of QRS dispersion (QRSD) and QRS duration (QRSd) in relation to systolic performance of the left ventricle. The ejection fraction of 130 consecutive patients with LBBB was evaluated by standard echocardiographic methods, whereas QRSd and QRSD were measured. It was demonstrated that QRSD in patients with complete LBBB is strongly related to LV contractility. We, therefore, suggest that this simple electrocardiographic index may serve as a useful screening test for detection of patients with LV systolic dysfunction.     

Effect of Cyclosporine Therapy With Low Doses of Corticosteroids on Idiopathic Nephrotic Syndrome

Cyclosporine (CyA) has an immunosuppressive effect that might suggest a therapeutic role in idiopathic glomerular conditions. We focused on the optimization of CyA treatment control in patients with idiopathic nephrotic syndrome by using trough‐level CyA measurements (C0) and the 2‐h postdose levels (C2). Twenty‐two patients (14 male, 8 female) with idiopathic nephrotic syndrome and the mean age of 51 ± 18 months (mean [M] ± standard deviation [SD]) were enrolled in our study during a period of 10 months (range: 3–18 months). All of the patients received CyA (2–3 mg/kg) in combination with methylprednisolone. In the present study protocol CyA concentrations (C0, C2), renal function, lipid profile, and degree of proteinuria were determined. The mean proteinuria of our patients before treatment was 11 972 ± 7953 mg/24 H (±SD) and the mean creatinine level (Cr) was 0.99 ± 0.37 mg/dL (±SD). Proteinuria decreased significantly already from the first month of therapy with CyA to 3578 ± 2470 mg/24 H (M± SD), and during the whole study period this reduction was significant (0.56 ± 0.37 gr/24 H (M ± SD), P < 0.05). At the same time renal function preserved, 1.09 ± 0.48 mg/dL (M ± SD). The blood levels of C0 were 135.10 ± 97.36 ng/mL (M ± SD) and the blood levels of C2 were 725 ± 256 ng/mL (M ± SD) at the first month of therapy. At the same time renal function preserved, 1.09 ± 0.48 mg/dL (M ± SD). Total cholesterol levels reduced significantly during study period (276.89 ± 45.57 to 200.67 ± 40.27 mg/dL [M ± SD]). The mean number of antihypertensive medication remained the same. The whole therapeutic protocol did not provoke any kind of side effects and CyA was quite tolerated by our patients. Treatment of idiopathic nephrotic syndrome with low doses of CyA with methylprednisolone leads to remission of proteinuria without deterioration of renal function. Blood levels of C0 for monitoring and treatment of nephrotic syndrome agrees with recent literature, while our study focus on establishing the proper levels of C2 for the treatment of nephrotic syndrome. The efficacy of CyA is combined with safety and tolerance.     

Misleading interpretation of distended post-op bowel images in Helical CT scan

Differential diagnosis of distended post-op colon can be misleading when based solely to imaging findings. A case report of an artefact giving the impression of faecal leak or foreign body (gossypiboma) in Spiral Computerized Tomography after colonic surgery is presented. The patient was managed conservatively due to the lack of clinical evidence of abdominal emergency, A second CT scan twenty days later revealed no findings besides minor colonic diverticulas.     

Concurrent imperforate hymen, transverse vaginal septum, and unicornuate uterus: a case report

A 14-year-old premenarcheal adolescent girl presented with lower abdominal discomfort and urine retention. After clinical and imaging examination, an imperforate hymen and a large hematocolpos along the upper part of the vagina was diagnosed. Incision of the imperforate hymen did not lead to drainage of blood or fluid. A complete transverse vaginal septum in the middle third of the vagina was identified and when incised drained approximately 200 mL of a dense brownish fluid. Laparoscopy showed a small unicornuate uterus, confirmed by hysteroscopy. This is the first case in the literature of concurrent imperforate hymen, transverse complete vaginal septum, and unicornuate uterus, and it highlights the potential of a multifactorial embryologic genetic etiology.     

Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: a randomised, placebo-controlled trial

OBJECTIVE: Functional electrical stimulation (FES) improves exercise capacity and endothelial function in chronic heart failure (CHF) patients. This study evaluates the impact of FES on quality of life and emotional stress in patients with moderate to severe CHF. METHODS: Thirty patients with stable CHF (24 men; NYHA class II-III; left ventricular ejection fraction <35%) were randomly assigned (2:1) to a 6-week FES training program (n=20) or placebo (n=10). Questionnaires addressing quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ), functional and overall], and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory (BDI)], as well as plasma B-type natriuretic peptide (BNP) and 6-min walking distance test (6MWT) were assessed at baseline and after completion of training protocol. RESULTS: A significant improvement in KCCQ functional (F=76.666, p<0.001), KCCQ overall (F =41.508, p<0.001), BDI (F =17.768, p<0.001) and Zung SDS (F =27.098, p<0.001) was observed in the FES group compared to placebo. Patients in the FES group had also a significant increase in 6MWT (F =19.413, p<0.001) and a trend towards reduction in plasma BNP (F =4.252, p=0.053) compared to placebo. CONCLUSION: FES seems to have a beneficial effect on quality of life, exercise capacity and emotional stress in patients with moderate to severe CHF.