Subject(s)
Low Back Pain , Medical Audit , Acute Disease , Denmark , Diagnosis, Differential , Family Practice/standards , Humans , Low Back Pain/diagnosis , Low Back Pain/surgery , Low Back Pain/therapy , Patient Admission , Referral and Consultation/standards , Surveys and Questionnaires , Waiting ListsABSTRACT
This study assessed the effect on clinical decision making and the possible prognostic significance of the 24-hour Tl-201 image in patients undergoing Tl-201-MIBI dual-isotope myocardial scintigraphy. The records of all patients who underwent 24-hour Tl-201 imaging as part of their myocardial perfusion study from 1994 to 1996 were reviewed. Follow-up evaluations were obtained from the referring physician or by direct patient contact. Fifty-six patients underwent a total of 57 studies; four patients were lost to follow-up. Of the 53 studies evaluated, 29 showed no change between the standard rest images and the 24-hour images; these patients were reported to have myocardial scar. Of these 29 patients, 25 were treated medically without further evaluation; 24 of these 25 patients remained stable. Four of the 29 patients had further evaluation; 2 patients had coronary artery bypass graft, 1 had a stent placed, and 1 remained stable. Twenty-four patients showed definite improvement or normalization of their study results by 24 hours; they were reported as ischemic. Of these 24 patients, 11 were treated medically without further evaluation; 9 remained stable, whereas 2 had adverse events. The remaining 13 patients required further evaluation; 4 remained stable, whereas 9 had adverse events (4 = increasing angina; 1 = stent; 1 = rotoblator; 2 = percutaneous transluminal coronary angioplasty; 1 = death). Twenty-four-hour imaging contributes to clinical decision making and may identify a subset of patients at risk for subsequent complications.
Subject(s)
Coronary Disease/diagnostic imaging , Heart/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Thallium Radioisotopes , Aged , Coronary Circulation , Dipyridamole , Exercise Test , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Tomography, Emission-Computed, Single-PhotonABSTRACT
Patients with rheumatoid arthritis are at greater risk of developing joint infections than any other group of patients. Diagnosis is often delayed because of the difficulties in distinguishing between a flare-up and a septic affection of the joint. A case of septic arthritis with multiple joint involvement and lethal outcome despite extensive antibiotic treatment and successive surgical procedures is presented. The patient developed osteomyelitis and multiple organ failure. In order to reduce morbidity and mortality from septic arthritis, early joint puncture and subsequent antibiotic treatment is essential.
Subject(s)
Arthritis, Infectious/complications , Arthritis, Rheumatoid/complications , Osteomyelitis/microbiology , Spondylitis/microbiology , Staphylococcal Infections/complications , Aged , Anti-Bacterial Agents/administration & dosage , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/microbiology , Fatal Outcome , Humans , Male , Osteomyelitis/diagnostic imaging , Osteomyelitis/drug therapy , Radionuclide Imaging , Spondylitis/diagnostic imaging , Spondylitis/drug therapy , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purificationABSTRACT
Rheumatoid arthritis has a prevalence of between 1% and 2%. The majority of patients face the prospect of surgical treatment of joints, that do not respond to medical treatment. With respect to the extensive development in joint surgery during the last decade, today's recommendations for surgical treatment of the individual joints are surveyed.
Subject(s)
Arthritis, Rheumatoid/surgery , Arthroplasty , Humans , Risk FactorsSubject(s)
Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Auranofin/administration & dosage , Gastrointestinal Diseases/prevention & control , Antirheumatic Agents/adverse effects , Auranofin/adverse effects , Diarrhea/chemically induced , Double-Blind Method , Gastrointestinal Diseases/chemically induced , Humans , Severity of Illness IndexABSTRACT
Scintigraphy using Tc-99m has been shown to be highly sensitive in localizing abnormal parathyroid glands in patients with hyperparathyroidism. False-negative studies most often are attributed to glandular size or location. The authors report a case of negative parathyroid imaging using standard dual-phase technique, which was converted to a positive study by the addition of a pinhole view. During a 1-year period, the authors systematically added an anterior-pinhole image of the neck to all equivocal or negative Tc-99m studies. Five of 19 patient studies were pinhole-image positive and standard-image negative or equivocal. In selected patients undergoing Tc-99m scintigraphy for hyperparathyroidism, the addition of a pinhole view may enhance study sensitivity and the confidence in interpretation.
Subject(s)
Adenoma/diagnostic imaging , Image Enhancement/methods , Parathyroid Neoplasms/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Adult , False Negative Reactions , Humans , Hyperparathyroidism/diagnostic imaging , Male , Radionuclide Imaging , Radiopharmaceuticals/pharmacokinetics , Sensitivity and Specificity , Technetium Tc 99m Sestamibi/pharmacokineticsSubject(s)
Salivary Duct Calculi/diagnostic imaging , Submandibular Gland Diseases/diagnostic imaging , Submandibular Gland/diagnostic imaging , Thyroid Gland/diagnostic imaging , Aged , Aged, 80 and over , Female , Humans , Iodine Radioisotopes , Radionuclide Imaging , Thyroid Diseases/diagnostic imagingABSTRACT
Surgical synovectomy in the treatment of rheumatoid arthritis has been performed for more than a 100 years, and yet the definite indication has not been made clear. Synovectomy has a convincing, but mostly time-limited effect on pain and articular hydrops, but the radiological progression continues almost undisturbed. Histological evaluation of the regenerating synovial membrane has now shown a tendency towards reversing to baseline within about a year. The difficulties in evaluating the operation are caused by the lack of comparable randomized studies performed on large populations, treated in a double-blind fashion and examined in cooperation between surgeon and rheumatologist.
Subject(s)
Arthritis, Rheumatoid/surgery , Synovectomy , Humans , Postoperative Complications/diagnosis , Synovial Membrane/pathologyABSTRACT
In a randomized, observer-blind trial, 150 men and women, aged 21-64 years, with chronic/subchronic low-back pain, followed one of these three treatment regimens: 1) intensive, dynamic back-muscle exercises; 2) conventional physiotherapy, including isometric exercises for the trunk and leg muscles; and 3) placebo-control treatment involving semihot packs and light traction. Eight treatment sessions were given during the course of 4 weeks, each session lasting 1 hour. The short-term effect was evaluated at the end of the treatment period and 1 month later, and the long-term effect at 6 and 12 months. The evaluations included recording of changes in pain level and assessment of overall treatment effect, which were indicated on visual interval scales. Subgroups of patients could be identified according to their treatment responses: physiotherapy was the superior treatment for the male participants, whereas the intensive back exercises appeared to be most efficient for the female participants. Patients with moderate or hard physical occupations tended toward a better response with physiotherapy, whereas intensive back exercises seemed most effective for those with sedentary/light job functions.
Subject(s)
Exercise Therapy , Low Back Pain/rehabilitation , Physical Therapy Modalities , Adult , Double-Blind Method , Female , Humans , Male , Middle Aged , Pain Measurement , Sex Characteristics , Treatment OutcomeABSTRACT
In dichotic listening tasks, the (dominant) right ear's superiority in processing verbal stimuli has been attributed to its direct anatomic connection with the left dominant hemisphere. The role played by extralinguistic factors, such as attention and functional tuning of the associated cortical structures, has not been carefully examined. This investigation was undertaken to evaluate the effects of the left thalamic electric stimulation on the processing (recognition and recall) of dichotically presented CVC verbal stimuli in a patient being treated for chronic pain. We report the positive effects of electric stimulation (confirmed by increased subcortical metabolic activity using SPECT, a brain imaging technique) on the processing of dichotically presented verbal stimuli.
Subject(s)
Dominance, Cerebral/physiology , Speech Perception/physiology , Thalamic Nuclei/physiopathology , Attention/physiology , Brain Mapping , Dichotic Listening Tests , Electric Stimulation , Humans , Male , Mental Recall/physiology , Middle Aged , Tomography, Emission-Computed , Trigeminal Neuralgia/physiopathologyABSTRACT
Six patients undergoing diagnostic lumbar myelography were studied with respect to plasma and cerebrospinal fluid (CSF) concentrations of two xanthine drugs--enprofylline and theophylline. Three patients received enprofylline and three patients received theophylline, 200 mg t.i.d., and plasma and CSF were sampled on the morning of the third day of treatment. CSF plasma ratios averaged 0.095 with enprofylline (range of 0.094-0.097) and 0.36 with theophylline (range of 0.35-0.37). The different ratios of the two drugs contrast to their similar plasma protein binding, about 50%. Different lipophilicity or differences with regard to transport out of the CSF may explain the discrepancy.
Subject(s)
Theophylline/pharmacokinetics , Xanthines/pharmacokinetics , Adult , Female , Half-Life , Humans , Male , Middle Aged , Theophylline/blood , Theophylline/cerebrospinal fluid , Xanthines/blood , Xanthines/cerebrospinal fluidABSTRACT
Possible differences in spinal stress were evaluated during forward-reaching movements from chairs with, respectively, fixed backward-inclining, forward-inclining, and tiltable seat. Twenty-four healthy subjects, 12 female and 12 male, performed rhythmical sagittal movements with pins over a 40-cm distance. The posture in an upright and in a forward position was described by means of seven variables, measured by an inclinometer. Posture changes between these positions were then compared for the three types of chairs. No significant influence from the chairs on posture changes was observed. Thus, no variation in spinal stress can be anticipated during forward-reaching movements in any of the three types of chair. The discussion also presents a current status regarding tiltable and fixed forward-inclining seats.
Subject(s)
Facility Design and Construction , Interior Design and Furnishings , Movement , Posture , Biomechanical Phenomena , Equipment Design , Female , Humans , Male , Models, Theoretical , Spine/physiologyABSTRACT
A prospective evaluation of 111In-labeled platelet scintigraphy (IPS) for the early diagnosis of acute postoperative renal transplant rejection (TR) was undertaken. The results of IPS were compared with in vitro biochemical tests, the clinical finding of graft tenderness, and combined [99mTc]DTPA and [131I]orthoiodohippurate scintigraphy. With a sensitivity of 0.93 and a specificity of 0.95, IPS provided otherwise unavailable diagnostic information. Furthermore, postoperative IPS was a good predictor of long-term allograft survival.
Subject(s)
Graft Rejection , Indium , Kidney Transplantation , Radioisotopes , Acute Disease , Adolescent , Adult , Blood Platelets , Female , Humans , Kidney/diagnostic imaging , Male , Middle Aged , Postoperative Period , Prospective Studies , Radionuclide ImagingABSTRACT
A study of standing, supported-standing ("riding" on a rounded seat), and sitting postures was carried out on persons simulating assembly work in places with poor leg space. These postures and the upper trapezius muscle load were examined using statometric and electromyographic methods, respectively. While supported-standing or sitting, the lumbar spine moved toward kyphosis, even where there was no backward rotation of the pelvis. In adopting the position for anteriorly placed work, the upper arms were raised 30 degrees forward or more; then, if a greater reach was necessary, the trunk was flexed as well. It is concluded that if leg space is poor, variation between supported-standing and standing should be encouraged, and an ordinary office chair avoided. Working level should be arranged so that it is lower than 5 cm above elbow level if no arm/wrist support is possible.
Subject(s)
Muscles/physiology , Posture , Shoulder , Spine/physiology , Adult , Biomechanical Phenomena , Female , Hip Joint/physiology , Humans , Humerus/physiology , MaleABSTRACT
Eleven (14%( of 80 patients with polymyalgia rheumatica syndrome (PMR-S) recovered spontaneously within one year; two of them had received repeated injections of depot steroids before remission occurred. The remaining 69 patients, including 14 with giant cell arteritis (GCA), were all treated with systemic glucocorticoids for an average of 30 months (range 3-81 months). Nine of the patients developed side effects from the treatment, which in seven cases were severe osteoporosis and spinal compression. None suffered from loss of vision. The patients' mortality rate and causes of death did not differ from those of the population at large. The diagnostic criteria are discussed, with the omission of those applied for exclusion. Use of the common term PMR-S is preferred, as GCA and polymyalgia rheumatica (PMR) are clinically indistinguishable. Systemic glucocorticoids are urgently needed when arteritis or ocular manifestations are detected or even suspected. In uncomplicated cases of PMR we recommend that trials be made with repeated injections of depot steroids. This procedure could also be used in patients suffering from severe subjective recurrences after cessation of treatment with systemic glucocorticoids, thereby reducing the number of cases where steroid treatment is unquestionably maintained for too long.