Radiological Examination (radiological + examination)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case

B. García
García B, Peñarrocha M, Peñarrocha MA, von Arx T. Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case. International Endodontic Journal, 43, 1054,1061, 2010. Abstract Aim, To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. Summary, A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA®. An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. Key learning points ,,When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. ,,Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. ,,The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case. [source]

Fibrocartilaginous mesenchymoma of the distal femur: Case report and literature review

Gokhan Gedikoglu
A case of a 9-year-old boy with fibrocartilaginous mesenchymoma located in the distal femur is presented. Fibrocartilaginous mesenchymoma is a rare tumor. There have been 17 cases reported since 1984. The presenting complaint was pain and local discomfort. Radiological examination showed lytic and sclerotic lesions located in the distal femur. Magnetic resonance imaging showed that there was no soft tissue expansion. Differential diagnosis included fibrocartilaginous dyplasia, dedifferentiated chondrosarcoma, desmoplastic fibroma, fibrosarcoma and low-grade osteosarcoma. The diagnosis of the tumor in a state hospital would not have been possible. Wide resection of the tumor and resection arthrodesis with an intramedullary nail has yielded good results. The patient has been disease free for 4 years. Pathological diagnosis of this very rare tumor may be challenging; the treatment should be wide resection of the tumor. [source]

Pulmonary interstitial glycogenosis in identical twins

W. Onland MD
Abstract We present the clinical, radiological, and pathological findings of open lung biopsies from monozygotic prematurely born male twins with respiratory distress at ages 6 and 8 weeks postnatally. Radiological examination showed a reticular nodular interstititial pattern on chest radiography. High-resolution computed tomography (HRCT) revealed ground-glass opacification and thickened interstitial septae in both infants. Lung biopsies showed a similar histology. There was diffuse interstitial thickening of the alveolar septa by mesenchymal cells, without prominent hyperplasia of type 2 pneumocytes, and without airspace exudates. Sections were periodic acid-Schiff (PAS)-positive within the cytoplasm of interstitial cells, indicating the presence of glycogen. Thus the diagnosis of pulmonary interstitial glycogenosis was made. Both infants were treated with glucocorticoids and had a favorable outcome. We speculate that pulmonary interstitial glycogenosis could be a histopathological form of chronic lung disease (CLD) of infancy. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source]

Juvenile elastoma: A forme fruste of the Buschke,Ollendorff syndrome?

Christopher CI Foo
SUMMARY We describe an Asian child with juvenile elastoma who presented to us at 9 years of age with flesh-coloured nodules on his thigh. Histologically, H&E sections were normal, but elastin stains showed collections of increased and thickened elastic fibres consistent with juvenile elastoma. Radiological examination did not demonstrate osteopoikilosis. However, we postulate that he may represent a forme fruste of the Buschke,Ollendorff syndrome or early presentation prior to the subsequent development of osteopoikilosis. [source]

Implant-supported fixed prostheses in the edentulous maxilla

A 2-year clinical, radiological follow-up of treatment with non-submerged ITI implants
Abstract Objectives: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. Material and method:, Twenty-five patients (mean age 64 years) with edentulous upper jaws received five,seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. Results: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45,7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. Conclusion: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla. Résumé Le but de cette étude a été d'évaluer le taux de survie d'implants dentaires ITI vis solides non-enfouis avec une surface TPS (titane plasma-spray) au niveau du maxillaire édenté après une ou deux années de mise en charge. Vingt-cinq patients d'un âge moyen de 64 ans avec des mâchoires supérieures édentées ont reçu de cinq à sept implants et, après un temps de guérison moyen de 6,9 mois, des prothèses fixées vissées à ces implants (ISFP). Un total de 146 implants TPS ITI vis pleines ont été insérés. Le diamètre de 56% des implants étaient plus petits (3,3 mm) que le reste des implants qui avaient un diamètre standard (4,1 mm). La longueur des implants variait de 6 à 16 mm. La quantité osseuse de la majorité des patients était faible et la qualité osseuse pauvre. Des paramètres cliniques ont été enregistrés lors de l'examen initial et après deux années. Des examens radiographiques ont également été effectués à ces moments. Le niveau osseux marginal moyen lors de l'examen initial a été mesuréà un point 4,52 mm (de 1,45 à 7,70 mm : SD 1,2 mm) en apical du point de référence. La perte osseuse moyenne entre l'examen de départ et un an après la mise en charge était de 0,24 mm (SD 0,9; p=0,0002) et entre la première et la deuxième année de 0,15 mm (SD 0,4; p<0,001). Cinq implants ont échoué, dont quatre avant la mise en charge. Un implant a échoué peu de temps après le placement du bridge. Le taux de survie cumulatif après une ou deux années était de 96,6%. Les implants ITI TPS vis pleines avec des prothèses fixées avaient des taux de survie excellents et représentaient un traitement alternatif de qualité pour les patients édentés du maxillaire supérieur. Zusammenfassung Ziele: Die Ueberlebensrate von transmukosalen dentalen ITI-Vollschraubenimplantaten mit einer rauen Oberfläche (titanplasmabeschichtet, TPS) im zahnlosen Oberkiefer nach 1 und 2 Jahren Belastung auszuwerten. Material und Methoden: Fünfundzwanzig Patienten (mittleres Alter 64 Jahre) mit zahnlosen Oberkiefern erhielten 5,7 Implantate und nach einer mittleren Einheilzeit von 6.9 Monaten wurden verschraubte festsitzende implantatgetragene Rekonstruktionen (ISFPs) eingesetzt. Insgesamt wurden 146 ITI-Vollschraubenimplantate eingesetzt. Der Durchmesser von 56% dieser Implantate war kleiner (3.3 mm) als der Standard (4.1 mm) und der Durchmesser der restlichen 44% war Standard. Bei der Mehrzahl der Patienten war die Knochenmenge gering und die Knochenqualität schlecht. Die klinischen Parameter wurden bei der Ausgangsuntersuchung und bei den zwei Nachuntersuchungen in jährlichen Abständen aufgenommen. Bei diesen Untersuchungen wurden auch radiologische Auswertungen durchgeführt. Resultate: Das marginale Knochenniveau zum Zeitpunkt der Ausgangsuntersuchung wurde an einem Punkt 4.52 mm (Bandbreite 1.45,7.70, SD 1.2) apikal des Referenzpunktes gemessen. Der mittlere Knochenverlust von der Ausgangsuntersuchung bis 1 Jahr nach Belastung betrug 0.24 mm (SD 0.9, P=0.002) und zwischen 1 und 2 Jahren nach Belastung betrug er 0.15 mm (SD 0.4, P>0.001). Fünf Implantate zeigten Misserfolge, vier davon waren Frühmisserfolge vor Belastung. Ein Implantat versagte kurz nach der Eingliederung der Brücke. Die kummulative Ueberlebensrate nach 1 und 2 Jahren betrug 96.6%. Schlussfolgerung: ITI TPS Vollschraubenimplantate in Kombination mit festsitzenden Rekonstruktion zeigten erfolgreiche Ueberlebensraten und scheinen eine überlebensfähige Behandlungsalternative im zahnlosen Oberkiefer darzustellen. Resumen Objetivos: Evaluar el índice de supervivencia de implantes ITI roscados macizos no sumergidos con una superficie rugosa (pulverizada con plasma de titanio, TPS) en el maxilar edéntulo tras 1 o 2 años de carga. Material y Métodos: Veinticinco pacientes (edad media 64 años) con maxilares superiores edéntulos recibieron 5,7 implantes y, tras un periodo de cicatrización medio de 6.9 meses, una prótesis fija atornillada implantosoportada (ISFPs). Se insertaron un total de 146 implantes ITI roscados macizos. El diámetro del 56% de los implantes fue menor (3.3 mm) que el estándar (4.1 mm) y el diámetro del resto (44%) fue estándar. La cantidad de hueso de la mayoría de los pacientes fue baja y la calidad de hueso baja. Los parámetros clínicos se registraron al inicio y en los exámenes anuales de seguimiento. También se realizaron exámenes radiológicos y valoraciones en estos momentos. Resultados: El nivel medio de hueso marginal al inicio se midió en un punto 4.52 (rango 1.45,7.70, SD 1.2) apical al punto de referencia. La pérdida de hueso desde el inicio hasta 1 año de carga fue de 0.24 mm (SD 0.9, P=0.002) y de 1 año a 2 años de carga fue de 0.15 mm (SD 0.4, P<0.001). Cinco implantes fracasaron al poco de instalar los puentes. El índice acumulativo de supervivencia fue del 95%. Conclusión: Los implantes roscados macizos ITI TPS en combinación con prótesis fijas tuvieron unos índices de supervivencia exitosos y se encontró que eran una alternativa de tratamiento viable en el maxilar edéntulo. [source]

Fine needle aspiration cytology in the diagnosis of bone lesions

U. Handa
Objective:, Fine needle aspiration cytology (FNAC) in combination with radiological examination has recently gained clinical recognition for evaluating skeletal lesions. We evaluated our experience with the use of FNA in diagnosing bone lesions with emphasis on areas of difficulty and limitations. Materials and Methods:, Over a period of 5 years FNA was performed in 66 cases of bone lesions. Aspirations were done by cytopathologists using 22-gauge needle. Out of 66 cases unsatisfactory aspirate was obtained in 12 cases. Cytohistological correlation was available in 19 cases. Results:, Adequate aspirates were categorized into neoplastic (27 cases) and non-neoplastic (27 cases) lesions. Of the 27neoplastic aspirates, 20 were malignant (12 primary, 8 metastatic deposits) and 7 were benign. In the malignant group osteosarcoma was correctly diagnosed in 3 cases while other 3 were labeled as sarcoma NOS because of lack of osteoid. Metastatic deposits were sub-typed in 6 cases; from renal cell carcinoma (3 cases), proststic adenocarcinoma, follicular carcinoma thyroid, and squamous cell carcinoma. Neoplastic group comprised of 6 cases of cysts and 21 cases of chronic osteomyelitis. Thirteen cases were diagnosed as tuberculous osteomyelitis. Conclusions:, FNA is a frequent indication in metastases in the bone where distinct cytologic features can even identify an unknown primary. However, diagnosis of primary tumours of the bone is limited by precise subtyping of the tumours. FNA has emerged as a cost effective tool for initial diagnosis of both neoplastic and non-neoplastic lesions of the bone. [source]

Bifid mandibular condyle: a case report

Nur Hersek
Abstract,,, A case of left bifid mandibular condyle (BMC) is reported in a 36-year-old female. The patient had a history of trauma in childhood. From the radiological examination, the left condyle was seen to have two anterioposteriorly situated heads. BMC is an extremely rare condition, where the condyle is duplicated or lobulated. The literature on BMC is reviewed, and possible cause of trauma and consequences of the anomaly are discussed. [source]

Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A

HAEMOPHILIA, Issue 6 2006
Summary., We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis. [source]

False gingival enlargement as a diagnostic problem: a case report

L Kesi
Abstract:, The aim of the case report was to describe gingival enlargement in a patient who came to the Department of Oral Medicine and Periodontology at Ni, Dental Clinic. After anamnesis had been taken, and following clinical examination, laboratory blood analysis, radiological examination and pathological examination, it was established that gingival enlargement was a consequence of medicament injection. We are of the opinion that gingival enlargement was a consequence of sclerotic agent injection. [source]

A pre-Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

Y. S. ErdalArticle first published online: 16 AUG 200
Abstract In this study, the skeleton of an approximately 15-year-old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non-gummatous osteomyelitis on almost every post-cranial bone. Because of the sub-periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Rheumatic disease in the Australian Aborigine of Cape York Peninsula: a 1965 study

William Alexander DOUGLAS
Abstract Aim:, To study the prevalence of rheumatic disorders in two Aboriginal populations on the western coast of Cape York Peninsula. Methods:, Physical and radiological examination of 217 adult Aborigines at Aurukun Aboriginal Mission and 71 Aboriginal adults at Weipa Mission. The study was performed in October 1965. Results:, Mild to moderate degenerative arthritis was not uncommon in the populations examined. However, generalised or nodal osteoarthritis was not seen. One young woman had definite sero-positive rheumatoid arthritis. This woman's appearance suggested some Torres Strait Islander influence. No case of gouty arthritis or classical ankylosing spondylitis was encountered. An incidental finding of retrospective interest was that the calculated body mass index showed that the majority of adults were underweight by Caucasian standards. Conclusions:, These findings are of historic interest given the health impacts of social, cultural and environmental circumstances of Aborigines currently reported. [source]

Dendritic cell immunotherapy for patients with metastatic renal cell carcinoma: University of Tokyo experience

Takeshi Azuma
Abstract Background : Dendritic cells (DC) are the most potent antigen-presenting cells and induce host antitumor immunity through the T-cell response. A clinical study of immunotherapy using cultured DC loaded with tumor antigen, for patients with metastatic renal cell carcinoma (RCC) was performed. Methods : Dendritic cells were generated by culturing monocytes from peripheral blood for 7 days in the presence of granulocyte,macrophage colony-stimulating factor and interleukin-4. On day 6 the DC were pulsed with lysate from autologous tumor as the antigen and with keyhole limpet hemocyanin (KLH) as immunomodulator. The patients were given four doses of lysate-pulsed DC by intradermal injection with a 2-week interval between doses. Clinical effect and immune response were, respectively, evaluated by radiological examination and delayed-type hypersensitivity (DTH) test. Results : Three patients were enrolled and the immunotherapy was well tolerated without significant toxicity. The vaccination induced a positive DTH reaction to tumor lysate in two patients and to KLH in all patients. Clinical responses consisted of one case of no change and two cases of progression of disease. However, we did not see a significant reduction of tumor volume in any case. Conclusion : Dendritic cell vaccination can safely induce an immunological response against RCC. Further trials are needed to fully evaluate its efficacy. [source]

Evidence-based medicine: Review of guidelines and trials in the prevention of secondary stroke,

David J. Likosky MD
Abstract Transient ischemic attack (TIA) carries a substantial short-term risk for stroke, which is a leading cause of disability and death in the United States. Despite the existing evidence-based guidelines for secondary prevention of stroke, variability in the assessment, diagnostic testing, and treatment of patients with TIA in actual clinical practice remains. Identification of stroke etiology via radiological examination is of paramount importance for the appropriate treatment of patients after TIA or stroke. Management of ischemic stroke or TIA includes lifestyle modifications, reduction of modifiable risk factors (eg, hypertension, diabetes, and elevated cholesterol), and appropriate therapeutic treatments. Antiplatelet therapy is the cornerstone of secondary prevention of stroke; guidelines for its use for noncardioembolic cases have been developed from a solid evidence base. Additional therapeutic approaches include HMG-CoA reductase inhibitors (statins), antihypertensives, and anticoagulants. The results of ongoing large trials will further clarify the role of specific antiplatelet agents for the secondary prevention of stroke in patients with noncardioembolic ischemic stroke or TIA. Journal of Hospital Medicine 2008;3(4 Suppl):S6,S19. © 2008 Society of Hospital Medicine. [source]

Clinical and radiological follow-up results of patients with untreated TMJ closed lock

summary, The purpose of this study was to compare clinical and radiological findings of untreated closed lock patients at least 22 months after initial diagnosis. Ten patients with closed lock in at least one joint who had received no treatment were included in the study. Clinically maximum mouth opening, joint pain and joint sounds were recorded. Radiologically position of the disc, disc morphology, bone degeneration and presence of fluid were determined on magnetic resonance imaging. Clinical and radiological examinations were repeated 2,5 years after initial examinations. Results were statistically compared using either the non-parametric McNemar test or the Wilcoxon signed-rank test. There were significant improvements in both mouth opening capacity and prevalence of joint pain, while no significant change in radiological examination. The results of this study suggested that closed lock patients undergo active adaptation in clinical symptoms. [source]

Radiological trace of mandibular primary growth center in postnatal human mandibles

Young Joon Lee
Abstract The mandibular primary growth center (MdPGC) of human fetus was conspicuously defined in the soft X-ray view of fetal mandibles. As the peripheral adaptive growth of mandible advances during the postnatal period, the MdPGC image became overshadowed by condensed cortical bones in soft X-ray view. In this study, we traced a sclerotic sequela of MdPGC during the postnatal period. Panoramic radiograms of 200 adults and soft X-ray views of 30 dried adult mandibles were analyzed by statistical methods. The former clearly showed an MdPGC below the middle portion of apices of canine and first premolar, which was distinguishable from mental foramen, and the latter also showed the MdPGC at the same area as a radiating and condensed radiopaque image, measuring 0.5,1.0 cm in diameter. This MdPGC position was seldom changed in the elderly people, even in the edentulous mandibles. Additionally, in the radiological examination, the benign tumors including odontogenic cysts hardly involved the MdPGC, while the malignant tumors of both primary and metastatic cancer frequently destroyed the MdPGC. Anat Rec Part A, 2006. © 2006 Wiley,Liss, Inc. [source]

Multiple system atrophy as a cause of upper airway obstruction

ANAESTHESIA, Issue 11 2007
Y. S. Lim
Summary A patient presented to the ear, nose and throat department with inspiratory stridor, dysphagia and a sore throat. Clinical and radiological examination was normal. During induction of anaesthesia for a planned microlaryngoscopy, the patient developed complete upper airway obstruction that was overcome by applying positive pressure via a facepiece until awake. He subsequently developed respiratory failure, requiring mechanical ventilatory support. An elective tracheostomy was inserted for his symptoms. Neurological opinion confirmed the diagnosis of multiple system atrophy with akinetic rigid syndrome. We review this obscure condition and how it may occasionally present to anaesthetists. [source]

Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery

Fatih Atug
Authors from the USA describe their experience using robotic-assisted laparoscopic pyeloplasty and stone extraction, and present their technical recommendations. They point out the not unexpected finding that concurrent stone extraction and pyeloplasty was rather longer than in patients having pyeloplasty alone. OBJECTIVE To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4,22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure. [source]

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy, ergotism, treponematosis, sarcoidosis or smallpox?

M. Lefort
Abstract This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20,25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller-Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Primary malignant melanoma of the bladder

Abstract, Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis. [source]

SAPHO syndrome masquerading as metastatic bone disease

NH Theumann
Summary A 46-year-old woman who had had a right mastectomy for breast carcinoma a month before underwent bone scintigraphy. The examination revealed multiple pelvic, vertebral and sternal hot spots suggestive of bone metastases. Standard X-rays and CT confirmed the presence of bony lesions but they were not typical of bone metastases. As the radiographic appearance was reminiscent of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), bone biopsies were performed. Histology showed fibrosis and hyperostosis but no tumour cells. On further questioning, the patient revealed she had had palmar pustulosis and sacroiliitis some years earlier. The purpose of the case report is to show that accurate diagnosis of SAPHO syndrome requires careful clinical and radiological examinations. [source]

Clinical and radiological follow-up results of patients with untreated TMJ closed lock

summary, The purpose of this study was to compare clinical and radiological findings of untreated closed lock patients at least 22 months after initial diagnosis. Ten patients with closed lock in at least one joint who had received no treatment were included in the study. Clinically maximum mouth opening, joint pain and joint sounds were recorded. Radiologically position of the disc, disc morphology, bone degeneration and presence of fluid were determined on magnetic resonance imaging. Clinical and radiological examinations were repeated 2,5 years after initial examinations. Results were statistically compared using either the non-parametric McNemar test or the Wilcoxon signed-rank test. There were significant improvements in both mouth opening capacity and prevalence of joint pain, while no significant change in radiological examination. The results of this study suggested that closed lock patients undergo active adaptation in clinical symptoms. [source]


M. A. Hansen
Purpose For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction. Methodology Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B-Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre- and post-operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients. Results A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow-up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups. Discussion Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end-plate subsidence. [source]

Reliable screening for acute pancreatitis with rapid urine trypsinogen-2 test strip

Dr M.-L.
Background: This study was designed to evaluate the validity of a new rapid urinary trypsinogen-2 test strip (Actim Pancreatitis) for detection of acute pancreatitis in patients with acute abdominal pain. Methods: A total of 525 consecutive patients presenting with abdominal pain at two emergency units was included prospectively and tested with the Actim Pancreatitis test strip. Urine trypsinogen-2 concentrations were also determined by a quantitative method. The diagnosis and assessment of severity of acute pancreatitis was based on raised serum and urinary amylase levels, clinical features and findings on dynamic contrast-enhanced computed tomography. Results: In 45 patients the diagnosis of acute pancreatitis could be established. The Actim Pancreatitis test strip result was positive in 43 of them resulting in a sensitivity of 96 per cent. Thirty-seven false-positive Actim Pancreatitis test strips were obtained in patients with non-pancreatic abdominal pain resulting in a specificity of 92 per cent. Nine patients with severe acute pancreatitis were all detected by the dipstick. Conclusion: A negative Actim Pancreatitis strip result excludes acute pancreatitis with high probability. Positive results indicate the need for further evaluation, i.e. other enzyme measurements and/or radiological examinations. The test is easy and rapid to perform, unequivocal in its interpretation and can be used in healthcare units lacking laboratory facilities. © 2000 British Journal of Surgery Society Ltd [source]