CT detection of sacral osteomyelitis associated with pelvic abscesses

In three patients the diagnosis of sacral osteomyelitis was made when CT demonstrated intraosseous (two) and intraforaminal (one) gas. Two of the three patients also had radionuclide bone scans, one of which was unremarkable. In the other case, radionuclide scintigraphy greatly underestimated the extent of the disease process when compared with CT. All three patients had contiguous pelvic abscesses as a cause of the osteomyelitis. Although there was a high clinical suspicion for an intraabdominal process, the diagnosis of superimposed osteomyelitis of the sacrum was unsuspected. The detection of intraosseous gas is a pathognomonic, albeit uncommon, manifestation of osteomyelitis. Although the radionuclide bone scan is the method of choice for detecting osteomyelitis, CT should be used as a complementary study in certain patients.     

Total and free tissue factor pathway inhibitor in pregnancy hypertension.

OBJECTIVE: To clarify the role played by tissue factor pathway inhibitor (TFPI) in pregnancy hypertension. METHODS: Using enzyme-linked immunosorbent assays, hemostatic measurements were obtained for women with pre-eclampsia (n=51), nonproteinuric hypertension of pregnancy (n=62), postpartum pre-eclampsia 24 h after childbirth (n=31), and no hypertension (healthy pregnant controls, n=100). RESULTS: There was a significant increase in circulating free TFPI levels in women with pre-eclampsia (9.7+/-6.2 ng/mL) or nonproteinuric hypertension of pregnancy (8.3+/-5.3 ng/mL) compared with healthy controls (5.3+/-2.1 ng/mL). In women with pre-eclampsia the levels remained elevated after placental delivery (10.6+/-4.0 ng/mL). Free protein S levels were significantly higher in women with pre-eclampsia (40.0%+/-10.7%), nonproteinuric hypertension of pregnancy (37.1%+/-12.5%), or postpartum pre-eclampsia (39.3%+/-9.1%) than in healthy pregnant controls (32.2%+/-8.5%). CONCLUSION: Increased levels of the physiologically active free forms of TFPI and free protein S, 2 coagulation inhibitors, may protect women with pregnancy-induced hypertension from the risks of hemostatic activation.     

Duodenal output of lactoferrin in normal subjects and correlation to output of amylase, bicarbonate, and total bile acids

Nineteen normal subjects were studied before and after pancreatic stimulation. Duodenal flow was quantitated by means of a dilution indicator technique, and the secretion pattern of lactoferrin, amylase, total bile acids, and bicarbonate was studied. Output of lactoferrin in the duodenum was increased both after stimulation with a test meal and after hormonal stimulation by cholecystokinin alone or cholecystokinin in combination with secretin. Output of lactoferrin was not affected by stimulation by secretin alone. Lactoferrin was secreted in parallel with amylase and bile acids. The results indicate that the origin of lactoferrin in duodenum can be bile or pancreatic juice, or a combination of these.     

INFANTILE MYOFIBROMATOSIS WITH HEMANGIOPERICYTOMA-LIKE FEATURES OF THE TONGUE: A Case Study Including Ultrastructure

We report a case of an infantile myofibromatosis with hemangiopericytoma-like features arising in the tongue of a 5-month-old female infant. Many authors now classify neoplasms as infantile myofibromatosis that were previously called infantile hemangiopericytoma. The ultrastructural features of our tumor illustrate its biphasic nature and provide a possible explanation for its histogenesis. Infantile myofibromatosis, including those diagnosed as infantile hemangiopericytomas, rarely arise in any intraoral location. Despite the generally good prognosis associated with these neoplasms, complete surgical excision is recommended to avoid recurrences.     

Predictive model of coronary heart disease in Egypt (a disease with multiple risk factors)

As a multifactorial disease and with the need of primordial prevention coronary heart disease (CHT), a risk scoring system for the prediction of CHD was devised at Community Medicine Department Ain Shams University, Cairo, EGYPT. In this matched case-control study of 119 cases and 121 age and sex matched controls, current cigarette smoking, lack of siesta, hypertension, diabetes mellitus, low occupational physical activity, hypercholesterolemia, marital status, urban residence, level of education, work index, coffee consumption, positive family history, BMI, elevated W/H ratio, low HDL and elevated TC/HDL were studied for association with CHD. The additive risk scoring system based on the results of conditional multiple logistic regression identified the first six factors with statistical weights of 1, 5, 10, 6, 6, 11, respectively. On back validation receiver operating characteristic (ROC) curve, a total score of 17 was found to be the cut off point above which there was increased risk of CHD. The overall predictive accuracy of this system--equivalent to the area under the ROC curve--was 0.873. Future studies need to assess the risk scoring system in population based studies.     

Incidence of non-AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus-infected patients.

PURPOSE: To determine incidence of non-AIDS-defining cancers (NADC) in HIV-infected patients before (P1) and during (P2) the use of highly active antiretroviral therapy (HAART) relative to that observed in the French general population (FGP) of the same age and sex. PATIENTS AND METHODS: Sex- and age-adjusted NADC standardized incidence ratios (SIR), with FGP as reference, were estimated in 1992 to 1995 (P1) and in 1996 to 1999 (P2) in a French Hospital Database on HIV prospective hospital cohort study. RESULTS: NADCs were diagnosed in 260 patients during P1 and 391 patients during P2 among the 77,025 patients included in the database between January 1, 1992, and December 31, 1999. Estimated incidence of all cancers was higher in HIV-infected men than in FGP during both periods (P1 SIR = 2.36 and P2 SIR = 1.91). No excess of cancers was observed among HIV-infected women in either period. Incidence of all cancers did not change from P1 to P2 in either sex (SIR = 0.96 for men and 1.00 for women). In contrast, incidence of Hodgkin's disease (HD) was higher than in FGP in both sexes and both periods and increased in P2 as compared with P1; incidence of lung cancer was higher in both sexes during P2. CONCLUSION: Relative to FGP, the overall incidence of NADCs was increased in HIV-infected men but not in women and did not differ between P1 and P2. Only HD was much more common in HIV infection, and the potential role of HAART on HD cannot be excluded.     

Interpretation of Emergency Department radiographs: a comparison of emergency medicine physicians with radiologists, residents with faculty, and film with digital display

OBJECTIVE: We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation. MATERIALS AND METHODS: A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area. CONCLUSION: We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.