[An atypical presentation of tuberculosis]. / Een atypische presentatie van tuberculose.

BACKGROUND: In 2020 there were 623 known TB infections in the Netherlands according to the Dutch ministry of health (RIVM). About 4% were located in bones and joints. The incidence of Multi Drug Resistant (MDR) TB in The Netherlands is about 1%. CASE: We describe the case of a 46-year-old female with a painful and swelling of the mid phalangeal bone of the fourth left digit. Quantiferon was positive and PCR of the biopsy for Mycobacterium tuberculosis complex (MTC) in Ziehl-Neelsen staining confirmed tuberculous osteomyelitis. The strain was resistant for rifampicin, isoniazid, ethambutol and pyrazinamid classifying it as MDR. Treatment in a specialized center with second line drugs was indicated due to rare resistance. CONCLUSION: Tuberculosis may manifest anywhere throughout the body, also as an (atypical) swelling of the hand. The golden diagnostic standard for bone and joint TB is biopsy with Ziehl-Neelsen staining.

Sensitive capacitive pressure sensors based on graphene membrane arrays.

The high flexibility, impermeability and strength of graphene membranes are key properties that can enable the next generation of nanomechanical sensors. However, for capacitive pressure sensors, the sensitivity offered by a single suspended graphene membrane is too small to compete with commercial sensors. Here, we realize highly sensitive capacitive pressure sensors consisting of arrays of nearly ten thousand small, freestanding double-layer graphene membranes. We fabricate large arrays of small-diameter membranes using a procedure that maintains the superior material and mechanical properties of graphene, even after high-temperature annealing. These sensors are readout using a low-cost battery-powered circuit board, with a responsivity of up to 47.8 aF Pa-1 mm-2, thereby outperforming the commercial sensors.

RETROSPECTIVE STUDY OF SURGICAL TREATMENT OF REFRACTIVE OSTEOMYELITIS AND INFECTIOUS ARTHRITIS IN THE FLIPPERS OF SEALS IN THE NETHERLANDS.

Amputation surgery in pinniped rehabilitation centers is a feasible procedure when animals are presented with open fractures, osteomyelitis, and/or infectious arthritis of the flippers that appear to be refractory to medical treatment. From 2011 to 2017, the Sealcentre Pieterburen in The Netherlands admitted 3,775 seals for rehabilitation. Of these, 37 individuals presented clinical and radiologic signs of bone abnormalities indicative of osteomyelitis or infectious arthritis refractory to medical treatment. Seven cases resulted in euthanasia, and 30 cases underwent amputation surgery. The surgical procedure involved amputation of part of a flipper (24; two animals twice) or of a complete flipper (eight). All procedures were done under general anesthesia except one that was performed with local anesthesia, and all 30 animals were released. In two cases, the osteomyelitis presented with the rare Totenlade phenomenon, a sequestrum surrounded by new periosteal bone formation. The purpose of this retrospective study was to evaluate the outcome of the operative treatment of osteomyelitis and infectious arthritis in the flippers of harbor (Phoca vitulina) and grey seals (Halichoerus grypus) during this 6-yr period.

A Comparison of Image Quality and Radiation Exposure Between the Mini C-Arm and the Standard C-Arm.

Background: The use of intraoperative fluoroscopy has become mandatory in osseous hand surgery. Due to its overall practicality, the mini C-arm has gained popularity among hand surgeons over the standard C-arm. This study compares image quality and radiation exposure for patient and staff between the mini C-arm and the standard C-arm, both with flat panel technology. Methods: An observer-based subjective image quality study was performed using a contrast detail (CD) phantom. Five independent observers were asked to determine the smallest circles discernable to them. The results were plotted in a graph, forming a CD curve. From each curve, an image quality figure (IQF) was derived. A lower IQF equates to a better image quality. The patients' entrance skin dose was measured, and to obtain more information about the staff exposure dose, a perspex hand phantom was used. The scatter radiation was measured at various distances and angles relative to a central point on the detector. Results: The IQF was significantly lower for the mini C-arm resulting in a better image quality. The patients' entrance dose was 10 times higher for the mini C-arm as compared with the standard C-arm, and the scatter radiation threefold. Conclusions: Due to its improved image quality and overall practicality, the mini C-arm is recommended for hand surgical procedures. To ensure that the surgeons' radiation exposure is not exceeding the safety limits, monitoring radiation exposure using mini C-arms with flat panel technology during surgery should be done in a future clinical study.

Radiation Exposure to Surgeon and Assistant During Flat Panel Mini C-Arm Fluoroscopy in Hand and Wrist Surgical Procedures.

PURPOSE: During mini C-arm fluoroscopy, both the patient and surgical team are exposed to scatter radiation. The objective of this study was to quantify body, thyroid, and hand radiation exposure to surgeon and assistant during intraoperative use of flat panel mini C-arm fluoroscopy in hand and wrist surgical procedures. METHODS: Over 5 months, the surgeon's and assistant's radiation exposure was recorded during all osseous hand and wrist surgical procedures. Whole-body and thyroid radiation exposure were measured with 2 types of dosimeters: a photon thermoluminescence detector and a RaySafe i2 real-time dosimeter. Ring dosimeters were used to quantify hand radiation exposure. RESULTS: Mini C-arm fluoroscopy was used in 94 surgical procedures. Total fluoroscopy time was 1,996 seconds and varied between surgical procedures (range, 1-152 seconds; median, 11 seconds). No thermoluminescence detector photon dosimeter exceeded the threshold limit of 0.1 mSv. The RaySafe i2 real-time dosimeters recorded a cumulated dose of 0.029 mSv for the body and 0.012 mSv for the thyroid position of the surgeon. The assistant received a cumulated dose of 0.011 mSv for the body and 0.011 mSv for the thyroid position. The ring dosimeters showed a cumulated dosage of 1.28 mSv for the surgeon and 0.20 mSv for the assistant. CONCLUSIONS: Our results show that the surgeon's and assistant's body, thyroid, and hands were exposed to acceptable levels of scatter radiation during intraoperative use of the flat panel mini C-arm. The surgeon received the highest radiation exposure: 2.9% of the yearly radiation limits for the body, 0.05% for the thyroid position, and 2.56% for the hands. The assistant was exposed to less scatter radiation: 1.1% for the body, 0.04% for the thyroid, and 0.4% for the hands. CLINICAL RELEVANCE: This study quantified radiation levels to which surgeon and assistant are exposed during mini C-arm fluoroscopy in hand and wrist surgical procedures.