Gallstones and biliary sludge in Greek patients with complete high spinal cord injury: an ultrasonographical evaluation.

INTRODUCTION: We used ultrasonography to detect the presence of biliary sludge or gallstones in Greek patients with complete high spinal cord injury (SCI) above the seventh thoracic segment (T7), within the first six months from injury onset, in order to evaluate the effects of neurological instability and dysfunction of the sympathetic nervous system (SNS) on the gallbladder function in the early post-SCI phase. METHODS: We evaluated 78 asymptomatic patients (57 males, 21 females; mean age 34.8 (range 19-56) years) with complete high SCI located above the T7 segment, and 78 healthy subjects (59 males, 19 females; mean age 35.2 (range 21-59) years) matched for age, gender and race, for a total period of 39 months. All the participants underwent ultrasonographical examination of the gallbladder and common bile duct within the first six months from the injury, in order to investigate the development of biliary sludge and gallstones. RESULTS: The incidence of biliary sludge was significantly higher in patients with SCI compared with the control group. The incidence of biliary sludge and gallstones was also significantly higher in patients with SCI patients in comparison with the healthy subjects. In male SCI patients, the incidence of biliary sludge was significantly increased in comparison with healthy subjects. No significant difference was revealed between the two groups in detection of gallstones. CONCLUSION: Our study indicates that the detection of gallbladder sludge and gallstones are significantly higher in Greek patients with complete high SCI above the T7 segment, as compared with healthy control subjects within the first six months of the injury onset. The complete disruption of the SNS and the neurological instability in the early post-SCI phase is probably responsible for the biliary sludge and gallstone formation. Our results suggest that ultrasonography should be performed in these patients at the first 3-6 months from the injury for the early diagnosis of the lithogenic bile.

Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis.

OBJECTIVE: We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults. MATERIALS AND METHODS: Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated. RESULTS: Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%). CONCLUSION: A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.

Clinical practice guidelines proposed by the Hellenic Foundation of Osteoporosis for the management of osteoporosis based on DXA results.

In recent years guidelines for the testing and treatment of osteoporotic patients have been published by recognised organisations, including the World Health Organisation (WHO), the National Osteoporosis Foundation (NOF) and the International Osteoporosis Foundation (IOF). Dual Energy X-ray Absorptiometry (DXA) has been considered the technique of choice because of its excellent precision and ability to predict osteoporotic fractures. Last December, based on the Appraisal of the Guidelines for Research and Evaluation (AGREE), the Hellenic Foundation of Osteoporosis, in collaboration with other scientific societies, provided guidelines for the use of DXA for the diagnosis, monitoring and treatment of osteoporosis and Quality Assurance (QA) of these systems. According to these guidelines, the adequacy of the present number of DXA units in Greece was assessed. There are 367 DXA units in Greece, and almost 50% are located in the capital city, Athens, where 34.1% of the population lives. The distribution of DXA devices per resident in the Greek provinces (except Attica) is between 4.2 units/100,000 heads (Ionian Islands) and 1.6 units/100,000 heads (Sterea Hellas). These guidelines have resulted in a suggestive yearly repeat of the measurements, to ensure the precision of the method, but mainly for reasons of compliance. Finally, these guidelines are viewed as a work in progress and will be updated periodically in response to advances in this field.