Dorsal fractures of the Triquetrum : MRI findings with an emphasis on dorsal carpal ligament injuries

Contexte et but de l'étude: Les fractures du triquetrum sont les deuxièmes fractures des os du carpe en fréquence, après celles du scaphoïde. Elles représentent environ 3.5% de toutes les lésions traumatiques du poignet, et résultent le plus souvent d'une chute de sa hauteur avec réception sur le poignet en hyper-extension. Leur mécanisme physiopathologique reste débattu. La première théorie fut celle de l'avulsion ligamentaire d'un fragment osseux dorsal. Puis, Levy et coll. ainsi que Garcia-Elias ont successivement suggéré que ces fractures résultaient plutôt d'une impaction ulno-carpienne. De nombreux ligaments (intrinsèques et extrinsèques du carpe) s'insèrent sur les versants palmaires et dorsaux du triquetrum. Ces ligaments jouent un rôle essentiel dans le maintien de la stabilité du carpe. Bien que l'arthro-IRM du poignet soit l'examen de référence pour évaluer ces ligaments, Shahabpour et coll. ont récemment démontré leur visibilité en IRM tridimensionnelle (volumique) après injection iv. de produit de contraste (Gadolinium). L'atteinte ligamentaire associée aux fractures dorsales du triquetrum n'a jusqu'à présent jamais été évalué. Ces lésions pourraient avoir un impact sur l'évolution et la prise en charge de ces fractures. Les objectifs de l'étude étaient donc les suivants: premièrement, déterminer l'ensemble des caractéristiques des fractures dorsales du triquetrum en IRM, en mettant l'accent sur les lésions ligamentaires extrinsèques associées; secondairement, discuter les différents mécanismes physiopathologiques (i.e. avulsion ligamentaire ou impaction ulno-carpienne) de ces fractures d'après nos résultats en IRM. Patients et méthodes: Ceci est une étude rétrospective multicentrique (CHUV, Lausanne; Hôpital Cochin, AP-HP, Paris) d'examens IRM et radiographies conventionnelles du poignet. A partir de janvier 2008, nous avons recherché dans les bases de données institutionnelles les patients présentant une fracture du triquetrum et ayant bénéficié d'une IRM volumique du poignet dans un délai de six semaines entre le traumatisme et l'IRM. Les examens IRM ont été effectués sur deux machines à haut champ magnétique (3 Tesla) avec une antenne dédiée et un protocole d'acquisition incluant une séquence tridimensionnelle isotropique (« 3D VIBE ») après injection iv. de produit de contraste (Gadolinium). Ces examens ont été analysés par deux radiologues ostéo-articulaires expérimentés. Les mesures ont été effectuées par un troisième radiologue ostéo-articulaire. En ce qui concerne l'analyse qualitative, le type de fracture du triquetrum (selon la classification de Garcia-Elias), la distribution de l'oedème osseux post- traumatique, ainsi que le nombre et la distribution des lésions ligamentaires extrinsèques associées ont été évalués. Pour l'analyse quantitative, l'index du processus de la styloïde ulnaire (selon la formule de Garcia-Elias), le volume du fragment osseux détaché du triquetrum, et la distance séparant ce fragment osseux du triquetrum ont été mesurés.

Oesophagite à éosinophiles [Eosinophilic esophagitis].

Eosinophilic esophagitis is a recent diagnosis, of growing interest and prevalence. It has to be considered by every physician when facing any adult or pediatric case of dysphagia, food impaction, and symptoms of GERD (gastroesophageal reflux disease) resistant to proton-pump inhibitor treatment. The diagnosis is made by combining clinical symptoms and endoscopic signs, supported by biopsies of the mucosa, which should show more than 15 eosinophils per high power field. The etiology seems to be of allergic origin, and a full immuno-allergic testing should be made. Recommendations for the treatment are to calm down the inflammatory process by proton-pump inhibitors, and to give topical steroids, keeping the systemic treatment for acute severe cases. In cases of esophageal stenoses, dilations can be undertaken, but with a high risk of recurrence.

The Patientʼs Perception of Eosinophilic Esophagitis Related Symptoms: a Qualitative Content Analysis

Background and Aims: The international EEsAI study group is currently developing an activity index for Eosinophilic Esophagitis (EoE). A potential discrepancy between patient and physician reported EoE symptoms has not been assessed yet. Therefore, we aimed to evaluate patient reported items describing their EoE activity and to compare these with the physicianʼs perception. Methods: A questionnaire was sent to 100 EoE patients in Switzerland. EoE-related symptoms dependent and independent of food intake were reported by patients. Results were analyzed using a qualitative content analysis and compared with symptoms reported by international EoE experts in Delphi rounds. Results: The questionnaire response rate was 64/100. The following items were developed by combining categories based on patients answers: food-consistency related dysphagia, frequency and severity of dysphagia, food impaction, strategies to avoid food impaction, food allergy, drinking-related retrosternal pain. The following food categories associated with dysphagia were identified: meat, rice, dry bread, French fries, raw, fibrous foods, others. Sports and psychological stress were identified as triggers for non-food intake related EoE symptoms. A good correlation was found between patient and physicianʼs reported EoE related symptoms. Conclusions: There is a good correlation between patient reported symptoms and the physicianʼs perception of clinical items as reported by international EoE experts. These patient reported outcomes will now be incorporated into the EEsAI questionnaire that measures EoE activity.

Hevosen mahalaukun impaktiot : kirjallisuuskatsaus ja kokomuksia potilastapauksista

Summary: Gastric impaction in horses - review of literature and clinical case experiences

Pycnodysostosis. A report of 3 clinical cases

Pycnodysostosis is a rare clinical entity, first described in 1962 by Maroteaux and Lamy. It is a genetic disorder, usually diagnosed at an early age. However, the diagnosis is sometimes late, made as a result of bone fracture, given the severe bone fragility resulting from increased bone density. Oral and maxillofacial manifestations of this disease are very clear. The head is usually large, the nose beaked, the mandibular angle obtuse, and both maxilla and mandible hypoplastic. Dental abnormalities and impaction are observed, as well as alterations in eruption and frequent dental crowding. The differential diagnosis is established with osteopetrosis, cleidocranial dysplasia and idiopathic acro-osteolysis. This article reviews the clinical and radiographic characteristics of pycnodysostosis based on three clinical cases of patients with this disease.

Pediatric and adult eosinophilic esophagitis: similarities and differences.

Early in the 1990s, several case series described adults suffering from dysphagia and children with refractory reflux symptoms, both accompanied by an eosinophil-predominant infiltration, thereby conclusively distinguishing it from gastroesophageal reflux disease. Eosinophilic esophagitis (EoE) was recognized as its own entity in the adult and in the pediatric literature. In the last decade, evidence has accumulated that EoE represents a T-helper (Th)2-type inflammatory disease. Remodeling of the esophagus is a hallmark of EoE, leading to esophageal dysfunction and bolus impaction. Familial occurrence and disease association with single-nucleotide polymorphisms underscore the influence of genetics in this disease. Eosinophilic esophagitis may affect individuals at any age, although the clinical presentation is highly age dependent. There is a significant allergic bias in the EoE population, with the majority of patients having concurrent allergic rhinitis, asthma, eczema, and/or a history of atopy. One noteworthy difference is that in children, EoE seems to be primarily a food antigen-driven disease, whereas in adults, mainly aeroallergen sensitization has been observed. Treatment modalities for EoE include the 3Ds: drugs, diet, and dilation. The crucial question of whether adult and pediatric EoE are different phenotypes of one single entity or whether we are confronted with two different diseases is still open. Here, we review similarities and differences between EoE in adults and children.

Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings.

BACKGROUND: Some patients with a phenotypic appearance of eosinophilic oesophagitis (EoE) respond histologically to PPI, and are described as having PPI-responsive oesophageal eosinophilia (PPI-REE). It is unclear if PPI-REE is a GERD-related phenomenon, a subtype of EoE, or a completely unique entity. AIM: To compare demographic, clinical and histological features of EoE and PPI-REE. METHODS: Two databases were reviewed from the Walter Reed and Swiss EoE databases. Patients were stratified into two groups, EoE and PPI-REE, based on recent EoE consensus guidelines. Response to PPI was defined as achieving less than 15 eos/hpf and a 50% decrease from baseline following at least a 6-week course of treatment. RESULTS: One hundred and three patients were identified (63 EoE and 40 PPI-REE; mean age 40.2 years, 75% male and 89% Caucasian). The two cohorts had similar dysphagia (97% vs. 100%, P = 0.520), food impaction (43% vs. 35%, P = 0.536), and heartburn (33% vs. 32%, P = 1.000) and a similar duration of symptoms (6.0 years vs. 5.8 years, P = 0.850). Endoscopic features were also similar between EoE and PPI-REE; rings (68% vs. 68%, P = 1.000), furrows (70% vs. 70%, P = 1.000), plaques (19% vs. 10%, P = 0.272), strictures (49% vs. 30%, P = 0.066). EoE and PPI-REE were similar in the number of proximal (39 eos/hpf vs. 38 eos/hpf, P = 0.919) and distal eosinophils (50 vs. 43 eos/hpf, P = 0.285). CONCLUSIONS: EoE and PPI-responsive oesophageal eosinophilia are similar in clinical, histological and endoscopic features and therefore are indistinguishable without a PPI trial. Further studies are needed to determine why a subset of patients with oesophageal eosinophilia respond to PPI.

Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results: The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease-including pericoronitis- was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology

Bilateral Killian-Jamieson diverticula demonstrated by videofluoroscopic swallowing study: case report

The authors report the case of a 56-year-old male patient complaining of dysphagia for solids and food impaction, submitted to videofluoroscopic swallowing study that demonstrated the presence of two esophageal diverticula. The videofluoroscopic swallowing study was critical in the identification and diagnosis of the diverticula, an esophageal cause of dysphagia.

Sharp mandibular bone irregularities after lower third molar extraction: Incidence, clinical features and risk factors

Objectives: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. Study Design: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. Results: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group. Conclusions: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic

Caracterização do MP10 e MP2,5 e distribuição por tamanho de cloreto, nitrato e sulfato em atmosfera urbana e rural de Londrina

Samplings of atmospheric particulate matter (PM) were carried out between the months of March and April of 2007, simultaneously in two areas of Londrina, an urban (Historical Museum) and other rural (Farm School-UEL). PM was collected using the cascade impactor consisting of four impaction stages (0.25 to 10 μm). The results indicated that the fine fraction (PM2.5) represented a significant portion of the mass of PM10 (70 and 67% in the urban and rural places, respectively). Cl-, NO3- and SO4(2-) were determined by ion chromatography and the size distribution is presented. Natural and anthropogenic sources were suggested to the ionic components in the fine and coarse mode of PM.

Primary and Revision Hip Replacement. A University Hospital Database and Registry Study

Large-headed total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) with metal-on-metal (MoM) bearings became popular during the last decade. Recently, it has become evident that the large-head MoM hip implants are associated with increased revision rates despite their theoretical advantages. The purpose of this study was to evaluate the early results of primary MoM hip replacements and of acetabular revisions. I analyzed retrospectively the results of four MoM implant designs and the survival rate of acetabular revisions with impaction bone grafting, as documented in the Turku University Hospital database. Further, I evaluated the correlation between femoral head size and dislocation rate, and used the Finnish Arthroplasty Register data to compare the survival of three large-head MoM THAs to analogous HRAs. The early results for the Magnum M2A–ReCap THA were good. A larger head size decreased the risk of dislocation. Articular surface replacement (ASR) THA yielded inferior results compared to analogous HRA. For two other designs the results were similar. The R3–Synergy THA yielded inferior results compared to the reference implants. The survival of acetabular reconstructions with impaction bone grafting was inferior compared to previous reports. In conclusion, the early results of the Biomet ReCap–Magnum design were promising, and large head sizes decreased the dislocation rate. The survival of different MoM hip implant designs varied. The survival of new designs and techniques may be inferior to those reported by the clinics where implants are developed. An important caveat is that early promising results of new devices may rapidly worsen. New implants need to be introduced in a controlled fashion to the market; here, arthroplasty registers are a valuable tool that needs to be used.

Teollinen öljyn erotus koalesenssisuodatuksella väliaineessa

Koalesenssi on ilmiö, jossa dispergoidun faasin pisarat pyrkivät muodostamaan suurempia pisaroita kunnes erotettava faasi muodostuu. Koalesenssi tapahtuu kolmessa päävaiheessa, jotka ovat lähestyminen, kiinnittyminen ja irrotus. Lähestymiseen vaikuttavat mekanismit ovat muuan muassa sieppaus, diffuusio, törmäysvaikutus, sedimentaatio, sähköiset repul-siovoimat ja van der Waalsin voimat. Kiinnittymisvaiheessa dispergoidun faasin pisarat syrjäyttävät väliaineen nestekalvon samalla kostuttaen väliaineen pinnan. Irrotusvaiheessa pisaran hydrodynaaminen voima voittaa pisaran ja väliaineen välisen adheesiovoiman. Koalesenssin tehokkuuteen vaikuttavat useat eri parametrit kuten virtausnopeus, pedin ominaisuudet, väliaineen ominaisuudet sekä emulsion ominaisuudet. Nämä kaikki asiat tulee ottaa huomioon koalesenssisuodatuksen suunnittelussa. Koalesenssisuodatus lukeutuu syväsuodatusmenetelmiin, jotka on ollut käytössä jo yli 100 vuotta. Koalesenssisuodatusmenetelmä on tehokas menetelmä pienten pisaroiden erottami-seen. Menetelmää käytetään esimerkiksi öljyisten jätevesien puhdistuksessa. Teollisen öljyn syväsuodatuksen etuihin kuuluu muun muassa sen kompakti koko, alhaisemmat käyt-tökustannukset, korkea erotusaste, kyky erotella pienetkin pisarat sekä helppo operointi, automatisointi ja huolto. Suurin haittapuoli on kuitenkin väliaineen tukkeutuminen, joten prosessi vaatii puhdistuksen tai väliaineen uusimisen. Tämän kandidaatintyön tarkoituksena oli koota kirjallisuustyö öljyn koalesenssisuodatuk-sesta. Työssä kartoitettiin koalesenssisuodatuksen lähtökohdat, teoria, tärkeimmät teolli-suuden sovellukset sekä väliaineet.

Use of erythromycin for the treatment of severe chronic constipation in children

The efficacy of erythromycin was assessed in the treatment of 14 children aged 4 to 13 years with refractory chronic constipation, and presenting megarectum and fecal impaction. A double-blind, placebo- controlled, crossover study was conducted at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital. The patients were randomized to receive placebo for 4 weeks followed by erythromycin estolate, 20 mg kg-1 day-1, divided into four oral doses for another 4 weeks, or vice versa. Patient outcome was assessed according to a clinical score from 12 (most severe clinical condition) to 0 (complete recovery). At enrollment in the study and on the occasion of follow-up medical visits at two-week intervals, patient score and laxative requirements were recorded. During the first 30 days, the mean ± SD clinical score for the erythromycin group (N = 6) decreased from 8.2 ± 2.3 to 2.2 ± 1.0 while the score for the placebo group (N = 8) decreased from 7.8 ± 2.1 to 2.9 ± 2.8. During the second crossover phase, the score for patients on erythromycin ranged from 2.9 ± 2.8 to 2.4 ± 2.1 and the score for the patients on placebo worsened from 2.2 ± 1.0 to 4.3 ± 2.3. There was a significant improvement in score when patients were on erythromycin (P < 0.01). Mean laxative requirement was lower when patients ingested erythromycin (P < 0.05). No erythromycin-related side effects occurred. Erythromycin was useful in this group of severely constipated children. A larger trial is needed to fully ascertain the prokinetic efficacy of this drug as an adjunct in the treatment of severe constipation in children.