The contribution of genetic variants of SLC2A1 gene in T2DM and T2DM-nephropathy: association study and meta-analysis.

An association study was conducted to investigate the relation between 14 variants of glucose transporter 1 gene (SLC2A1) and the risk of type 2 diabetes (T2DM) leading to nephropathy. We also performed a meta-analysis of 11 studies investigating association between diabetic nephropathy (DN) and SLC2A1 variants. The cohort included 197 cases (T2DM with nephropathy), 155 diseased controls (T2DM without nephropathy) and 246 healthy controls. The association of variants with disease progression was tested using generalized odds ratio (ORG). The risk of type 2 diabetes leading to nephropathy was estimated by the OR of additive and co-dominant models. The mode of inheritance was assessed using the degree of dominance index (h-index). We synthesized results of 11 studies examining association between 5 SLC2A1 variants and DN. ORG was used to assess the association between variants and DN using random effects models. Significant results were derived for co-dominant model of rs12407920 [OR = 2.01 (1.17-3.45)], rs841847 [OR = 1.73 (1.17-2.56)] and rs841853 [OR = 1.74 (1.18-2.55)] and for additive model of rs3729548 [OR = 0.52 (0.29-0.90)]. The mode of inheritance for rs12407920, rs841847 and rs841853 was 'dominance of each minor allele' and for rs3729548 'non-dominance'. Frequency of one haplotype (C-G-G-A-T-C-C-T-G-T-C-C-A-G) differed significantly between cases and healthy controls [p = .014]. Regarding meta-analysis, rs841853 contributed to an increased risk of DN [(ORG = 1.43 (1.09-1.88); ORG = 1.58 (1.01-2.48)] between diseased controls versus cases and healthy controls versus cases, respectively. Further studies confirm the association of rs12407920, rs841847, rs841853, as well as rs3729548 and the risk of T2DM leading to nephropathy.

Pre- and post-treatment computed tomographic findings of a primary intranasal transmissible venereal tumor in a canine patient.

A two-year-old, female intact, cross-breed dog presented with a two-month history of nasal discharge. Computed tomography (CT) demonstrated obliteration of both nasal cavities by soft tissue density, destruction of the nasal and ethmoidal turbinates, and lysis of the frontal and palatine bones and maxilla. Frontal sinuses and maxillary recesses were obscured by soft tissue/fluid density. Histopathological examination of the mass was diagnostic of transmissible venereal tumor. The dog was clinically normal 3 months after treatment initiation with vincristine sulphate and amoxicillin/clavulanate. Six months after the completion of treatment no mass-like lesion was demonstrated in CT sections. Nasal cavities, maxillary recesses and frontal sinuses were filled with air. The reticular turbinate nasal plexus appeared atrophic with focal loss of the nasal turbinates on both sides. The ethmoidal turbinates were well-defined; however, focal loss of turbinates was also seen. Lysis of the frontal and palatine bones were still evident.

A new CT grading system for hip osteoarthritis.

OBJECTIVES: We have developed a new grading system for hip osteoarthritis using clinical computed tomography (CT). This technique was compared with Kellgren and Lawrence (K&L) grading and minimum joint space width (JSW) measurement in digitally reconstructed radiographs (DRRs) from the same CT data. In this paper we evaluate and compare the accuracy and reliability of these measures in the assessment of radiological disease. DESIGN: CT imaging of hips from 30 female volunteers aged 66 ± 17 years were used in two reproducibility studies, one testing the reliability of the new system, the other testing K&L grading and minimum JSW measurement in DRRs. RESULTS: Intra- and inter-observer reliability was substantial for CT grading according to weighted kappa (0.74 and 0.75 respectively), while intra- and inter-observer reliability was at worst moderate (0.57) and substantial (0.63) respectively for DRR K&L grading. Bland-Altman analysis showed a systematic difference in minimum JSW measurement of 0.82 mm between reviewers, with a least detectable difference of 1.06 mm. The area under the curve from ROC analysis was 0.91 for our CT composite score. CONCLUSIONS: CT grading of hip osteoarthritis (categorised as none, developing and established) has substantial reliability. Sensitivity was increased when CT features of osteoarthritis were assigned a composite score (0 = none to 7 = severest) that also performed well as a diagnostic test, but at the cost of reliability. Having established feasibility and reliability for this new CT system, sensitivity testing and validation against clinical measures of hip osteoarthritis will now be performed.

Evaluating the success of preoperative imaging for diagnosing rotator cuff tears in a regional centre.

To review the diagnostic performance of ultrasonography (US) and magnetic resonance imaging (MRI) for the detection of rotator-cuff tears, we performed a retrospective audit of patients who underwent shoulder arthroscopy at Hinchingbrooke hospital. The diagnostic accuracies of US for full and partial-thickness tears were 82% and 28% respectively. Those of MRI were 82% and 81% respectively. These were lower than expected from the literature. This discrepancy is likely to be the consequence of over-diagnosis in imaging and under-diagnosis at arthroscopy.

Ultrasound evaluation of the distal migration of the long head of biceps tendon following tenotomy in patients undergoing arthroscopic repair of tears of the rotator cuff.

This study evaluates the position of the long head of biceps tendon using ultrasound following simple tenotomy, in patients with arthroscopically repaired rotator cuff tears. In total, 52 patients with a mean age of 60.7 years (45 to 75) underwent arthroscopic repair of the rotator cuff and simple tenotomy of the long head of biceps tendon. At two years post-operatively, ultrasound revealed that the tendon was inside the bicipital groove in 43 patients (82.7%) and outside in nine (17.3%); in six of these it was lying just outside the groove and in the remaining three (5.8%) it was in a remote position with a positive Popeye Sign. A dynamic ultrasound scan revealed that the tenotomised tendons had adhered to the surrounding tissues (autotenodesis).The initial condition of the tendon influenced its final position (p < 0.0005). The presence of a Popeye sign was statistically influenced by the pre-operative co-existence of supraspinatus and subscapularis tears (p < 0.0001). It appears that the natural history of the tenotomised long head of biceps tendon is to tenodese itself inside or just outside the bicipital groove, while its pre-operative condition and coexistent subscapularis tears play a significant role in the occurrence of a Popeye sign.

Acute nontraumatic adult knee pain: the role of MR imaging.

Acute nontraumatic pain in the adult knee can be seen in many settings, such as transient bone marrow oedema syndrome (TBMOS), regional migratory osteoporosis (RMO), spontaneous osteonecrosis (SONK) and insufficiency fractures. Early differentiation among them is crucial to avoid unnecessary treatment. TBMOS and RMO are considered to be self-limiting conditions without longterm sequelae. On the other hand, the clinical course of SONK is thought to be dependent on the size of osteonecrosis. Recent data suggest the term SONK is misleading one and should be replaced. Insufficiency fractures may demonstrate a similar clinical syndrome without a history of a single traumatic injury. The imaging pathway for knee pain has evolved considerably with the advent of magnetic resonance (MR) imaging, which is very sensitive in the early depiction of bone marrow oedema. Therefore, in patients with acute nontraumatic knee pain whose radiographs are negative or inconclusive, MR imaging is the method of choice for further evaluation. This article discusses the potential aetiologies and reviews MR imaging findings of the most common disorders afflicting the subchondral knee-joint area.

Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation.

BACKGROUND: The painful shoulder is a relatively common clinical entity that may be attributed to a variety of pathologies, including partial rotator cuff tears. Conservative treatment or surgical intervention may be offered, depending on the extent of the partial tear and the degree of patient discomfort. PURPOSE: To apply ultrasound (US) imaging in order to evaluate the prevalence of partial rotator cuff tears in patients with painful shoulders. MATERIAL AND METHODS: Fifty-six patients (17 men, 39 women; mean age 53.7 years) were included in the study, with symptomatic impingement syndrome of the shoulder after having failed to respond to conservative treatment. All patients underwent US and magnetic resonance imaging (MRI) scans prior to surgical intervention. RESULTS: Arthroscopy or mini-open surgery revealed 53 cases with partial tears of the rotator cuff and three with extensive tendinopathy. Both imaging modalities detected successfully 44 cases of partial tears of the supraspinatus tendon. US imaging yielded a sensitivity of 95.6%, a specificity of 70%, an accuracy of 91%, and a positive predictive accuracy of 93.6%. The corresponding values for MRI were 97.7%, 63.6%, 91%, and 91.7%, respectively. CONCLUSION: US imaging can be considered almost equally effective in detecting partial tears of the rotator cuff compared to MRI, particularly located in the area of the supraspinatus tendon. MRI may be reserved for doubtful or complex cases, in which delineation of adjacent structures is mandatory prior to surgical intervention.

Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report.

INTRODUCTION: Congenital renal arteriovenous malformations (AVMs) are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma. CASE PRESENTATION: A 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC) of the upper tract, in view of the patient's age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed. CONCLUSION: This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

Snapping knee syndrome in an athlete caused by the semitendinosus and gracilis tendons. A case report.

We report a case of symptomatic subluxation of the semitendinosus and gracilis over the posteromedial corner of the tibia manifesting with snapping. This is the first such case recorded in non-Asian population and in a high-demand athlete. Snapping was reproduced on active extension of the knee and at initiation of flexion and could be readily palpated over the posteromedial aspect of the tibia. Dynamic ultrasound, a key diagnostic tool in such conditions, revealed abrupt anterior subluxation of the semitendinosus and gracilis tendons during active terminal extension over the insertion of the semimembranosus as well as areas of tendinopathy corresponding with the site of subluxation. Due to failure of conservative treatment, surgery was undertaken, involving tenotomy and resection of a 10-12 cm segment of the semitendinosus and gracilis. The patient returned to the same level of sporting activities within 4 months and remained symptom-free 18 months post-operatively. The role of eccentric loading of the knee joint, as well as the "protective" role of the accessory tendinous bands and aponeurotic expansions of the semitendinosus and gracilis is discussed.

The use of mirtazapine in a group of 11 patients following poor compliance to selective serotonin reuptake inhibitor treatment due to sexual dysfunction.

Mirtazapine, a noradrenergic and specific serotonergic antidepressant, displays strong serotonin (5-HT)2 blocking properties, which may be related to lack of sexual dysfunction. In our open-label study, after a wash-out period of 4-14 days, mirtazapine (30-45 mg/day) was administered for 6 weeks to six male and five female patients who discontinued treatment with selective serotonin reuptake inhibitors (SSRIs) because of sexual dysfunction. The patients were moderately depressed, with baseline Hamilton Depression Rating Scale (17-item HAMD) scores between 19 and 24, and none of them experienced any sexual dysfunction prior to SSRI treatment. Efficacy was assessed weekly by 17-item HAMD, and adverse events were registered at the same time points. All patients completed the study. After 6 weeks of treatment, the individual 17-item HAMD scores were between 5 and 9, indicating significant improvement in depressive symptoms. None of the patients reported any sexual dysfunction symptoms. Other adverse events, mild and transient in nature, were reported only by three patients (somnolence in two, and weight gain in one patient). In conclusion, treatment with mirtazapine was effective in patients who are unable to tolerate SSRIs because of sexual dysfunction and demonstrated no effect on sexual function.

Ketoprofen versus paracetamol in the treatment of acute migraine.

The efficacy and safety of ketoprofen and paracetamol were compared for the treatment of acute migraine in a randomized, double-blind study of 64 patients. Thirty-four patients received ketoprofen 100 mg intramuscularly, and 30 patients received paracetamol 500 mg intramuscularly. Partial or complete relief of pain and other symptoms was achieved 15 to 20 minutes after administration in the ketoprofen group and within 35 minutes in the paracetamol group. Complete relief of pain was achieved within 30 to 40 minutes after ketoprofen in 28 patients (82.5%) compared to 5 patients (17.5%) in the paracetamol group. Six of the patients treated with ketoprofen needed a second dose for complete relief of pain during the 4-hour follow-up period. Side effects were rare and minimal. Our findings suggest that ketoprofen produced statistically significant benefit in the treatment of acute migraine.

Aristophanes' Wealth: ancient alternative medicine and its modern survival.

The miraculous cure of the blind god Plutos ("Wealth') in Aristophanes' play illuminates some of the reasons why people have sought help in alternative medicine over the ages. Apart from limitations of conventional medicine these factors can be social, political, religious, psychological, and scientific. Alternative medicine may function in a complementary way to the conventional. Nevertheless, an overestimation of its therapeutic potentials by the public can lead to the domination of irrationalism, all in the name of liberation from the shackles of a mechanistic rationalism.

Treatment of acute migraine attack with diclofenac sodium: a double-blind study.

The efficacy of diclofenac sodium, a potent prostaglandin inhibitor, in patients with acute migraine attacks in a double-blind placebo-controlled study involving 86 migraine patients. Forty-six patients with acute migraine attacks were treated with intramuscular injection of 75 mg diclofenac sodium, and another group of forty patients with intramuscular injection of paracetamol. Partial or complete relief of pain and other symptoms of acute migraine attack was achieved within 10 minutes after treatment in the diclofenac sodium group and within 32 minutes in the paracetamol group. Complete relief of attack was achieved within 30 minutes after diclofenac sodium in 40 patients (88%) compared to 7 patients (17.5%) of the paracetamol group (P less than 0.001). Five of the patients treated with diclofenac sodium needed a second injection for complete relief of pain during the 2-to-4 hour follow-up period. Side effects were rare and minimal. In conclusion, diclofenac sodium administered intramuscularly is a very effective drug in treating acute migraine attacks.