In Vivo Measurement of Brain Tumor Elasticity Using Intraoperative Shear Wave Elastography.

Purpose: Objective Shear wave elastography (SWE) enabled living tissue assessment of stiffness. This is routinely used for breast, thyroid and liver diseases, but there is currently no data for the brain. We aim to characterize elasticity of normal brain parenchyma and brain tumors using SWE. Materials and Methods: Patients with scheduled brain tumor removal were included in this study. In addition to standard ultrasonography, intraoperative SWE using an ultrafast ultrasonic device was used to measure the elasticity of each tumor and its surrounding normal brain. Data were collected by an investigator blinded to the diagnosis. Descriptive statistics, box plot analysis as well as intraoperator and interoperator reproducibility analysis were also performed. Results: 63 patients were included and classified into four main types of tumor: meningiomas, low-grade gliomas, high-grade gliomas and metastasis. Young's Modulus measured by SWE has given new insight to differentiate brain tumors: 33.1 ±â€Š5.9 kPa, 23.7 ±â€Š4.9 kPa, 11.4 ±â€Š3.6 kPa and 16.7 ±â€Š2.5 kPa, respectively, for the four subgroups. Normal brain tissue has been characterized by a reproducible mean stiffness of 7.3 ±â€Š2.1 kPa. Moreover, low-grade glioma stiffness is different from high-grade glioma stiffness (p = 0.01) and normal brain stiffness is very different from low-grade gliomas stiffness (p < 0.01). Conclusion: This study demonstrates that there are significant differences in elasticity among the most common types of brain tumors. With intraoperative SWE, neurosurgeons may have innovative information to predict diagnosis and guide their resection.

Estrogen deficiency reduces the expression of estrogen receptor-beta in Wistar rats` periodontal tissues.

OBJECTIVE: To assess the effect of ovariectomy on the expression of estrogen receptor-beta (ER-beta) in periodontal ligament and alveolar bone. METHODS: This animal study was conducted at King Fahad Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from March to October 2012. Thirty 12-week-old female Wistar rats were divided into 2 groups (15 each): ovariectomized (OVX) and sham-operated. Levels of estrogen and progesterone in the sera were measured using the enzyme linked immunosorbent assay (ELISA). To detect the expression of ER-beta, immunostaining was performed on the tibia, alveolar bone, and periodontal ligament specimens followed by quantitative histomorphometric analysis. RESULTS: Estrogen (p=0.001) and progesterone (p=0.007) levels were significantly decreased in the OVX rats compared to their controls. Histologically, the thickness and area percentage of the tibia and alveolar bone trabeculae were significantly reduced in OVX rats compared to the controls (p=0.001). The periodontal ligament fibers in the control group exhibited well-organized and appropriately oriented fibers, while in the OVX group they appeared disrupted with loss of orientation. The ER-beta expression in the OVX rats was significantly decreased in the periodontal tissues (p=0.005) and tibia (p=0.008). CONCLUSION: Estrogen deficiency resulted in a significant decrease in the expression of ER-beta in both tibia and periodontal tissues.

Short-term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes.

BACKGROUND: Periodontitis is a major cause of tooth loss among adults. Several studies have shown a possible systemic impact of periodontal infection, including poor glycemic control in patients with diabetes. Recently, photodynamic therapy (PDT) was used to successfully treat periodontal infection. PDT provides a broad spectrum antimicrobial efficacy with no local or systemic side effects. The objective of this study was to examine the effect of the adjunctive use of PDT on periodontal status and glycemic control of patients with diabetes and periodontitis. METHODS: Forty-five patients with type 2 diabetes and moderate to severe chronic periodontitis were selected and randomly assigned to one of the following three treatment modalities (15 subjects each): scaling and root planing (SRP) only, SRP plus systemic doxycycline, and SRP plus PDT. The plaque and bleeding scores, probing depth, clinical attachment level, and glycosylated hemoglobin (HbA1c) level were recorded at baseline and 3 months after periodontal treatment. Descriptive statistics, the paired t test, and analysis of variance (ANOVA) were used for data analysis. RESULTS: Statistically significant differences in the mean probing depth, clinical attachment level, plaque deposit, and bleeding on probing were found between baseline and 12 weeks post-treatment for all groups. No significant differences in periodontal parameters and glucose levels were detected among the three groups. Reduction in the mean HbA1c level after treatment was observed in all groups but was only significant for the SRP plus doxycycline group. CONCLUSION: The results of the present study indicate that PDT does not benefit conventional non-surgical periodontal therapy in patients with diabetes.

Fractures of the adult distal humerus. Elbow function after internal fixation.

We reviewed 57 adult patients at an average of 37 months after early internal fixation for displaced fractures of the distal humerus. Two-thirds had intercondylar (Müller type C) fractures, and one-third had articular comminution (type C3). A chevron olecranon osteotomy was used, with early active movement after fixation. Results were good or excellent in 76% with an average range of movement of 115 degrees. Early stable fixation by an experienced surgeon is recommended for these fractures.

Treatment of burns casualties after fire at Bradford City football ground.

On 11 May 1985 the main stand of Bradford City Football Club caught fire. Within four minutes the stand was alight from end to end. Fifty three people were burnt to death and about 250 injured; 83 required admission to hospital, and 55 of these were treated by primary excision of their burns and skin grafting. In such disasters the help of staff from other hospitals and areas is essential. Patients should be assessed to see whether they have burns that will ultimately be fatal; if they have they should not be sent to regional burns units, where they would take up beds that could be used for patients with treatable burns. All districts should ensure that their plans for accidents in which burns injuries predominate are adequate.

Methods of fixation of olecranon fractures. An experimental mechanical study.

This study was designed to compare the rigidity of the more commonly used techniques of internal fixation of fractures of the olecranon. Cadaveric elbow joints were mounted in a jig and controlled osteotomies performed to simulate transverse, oblique or comminuted fractures. Five techniques of internal fixation were tested by measuring movement at the fracture site after applying a bending moment to the ulna. At transverse osteotomies tension-band wiring with two tightening knots allowed least movement even at high loads. Intramedullary cancellous screw fixation gave erratic results; adding a tension band with a single know was little better. In oblique osteotomies, no statistically significant difference was shown between one-third tubular plate fixation and double-knot wiring. Comminuted osteotomies were held most rigidly by contoured one-third tubular plate fixation.

Elbow function following tension band fixation of displaced fractures of the olecranon.

Fifty-two patients were reviewed following displaced fractures of the olecranon fixed by the tension band technique. Symptoms, range of movement and strength in flexion and extension were assessed, together with the accuracy of reduction. Eighty-five per cent of patients regained very good function. The results confirm that tension band fixation can yield excellent functional results whatever the degree and severity of fracture of the olecranon. The wires must be totally buried to allow full excursion of the triceps tendon.