Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon.

INTRODUCTION AND OBJECTIVES: This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology. MATERIAL AND METHODS: A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated. RESULTS: Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ±â€¯15° (23-90), a mean total opening angle of 80 ±â€¯26° (30-135), a mean width of 10.3 ±â€¯2.5 mm (6-19) and a mean depth of 4.1 ±â€¯1.5 mm (1-8). Men had higher medial opening angle (60 vs 50°, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001). CONCLUSIONS: Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon. / La evaluación radiográfica de la morfología del surco intertubercular no pronostica cambios intraarticulares en el tendón de la porción larga del bíceps.

INTRODUCTION AND OBJECTIVES: This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology. MATERIAL AND METHODS: A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated. RESULTS: Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53±15o (23 - 90), a mean total opening angle of 80±26o (30 - 135), a mean width of 10.3±2.5mm (6 - 19) and a mean depth of 4.1±1.5mm (1 - 8). Men had higher medial opening angle (60 vs 50o, p=0.044) and wider grooves (11.9 vs 9.7mm, p=0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p <0.001). CONCLUSIONS: Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

Progression of alterations in lipid metabolism in kidney transplant recipients over 5 years of follow-up.

BACKGROUND: Alterations in lipid metabolism frequently affect kidney transplant recipients and contribute to the onset of metabolic and cardiovascular diseases that threaten graft integrity. The purpose of this research study was to investigate the pattern of hyperlipidaemia and its progression, as well as to study potential risk factors in kidney transplant recipients. METHODS: In this study, 119 kidney transplant recipients of both sexes were monitored over a period of 5 years in our posttransplant clinic. During this period, all patients had pretransplant and posttransplant blood tests to measure levels of the following: total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides. Furthermore, the subjects were also weighed and their height measured. Their body mass index was then calculated using the weight (kg)/height (m(2) ) formula. RESULTS: In the 5 years following the transplant, the patients experienced a significant increase in the levels of their biochemical markers as well as in their BMI. Consequently, a greater number suffered from dyslipidaemia, diabetes and hypertension. CONCLUSIONS: Kidney transplants can often trigger hyperlipidaemia, as reflected in higher levels of total cholesterol, low-density lipoproteins and high-density lipoproteins. The results of our study also showed that despite statin therapy, the patients had higher triglyceride levels, which made them more vulnerable to diabetes, hypertension, cardiovascular disease and graft rejection.

Prognostic scores in a gastroenterology intensive care unit.

BACKGROUND: Several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). AIM: To assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. METHODS: Retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. CONCLUSIONS: in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction.

Prognostic Scores in a Gastroenterology Intensive Care Unit

Background: several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. Methods: retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness- of-fit test. Results: overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. Conclusions: in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction(AU)

Fatal mid-gastrointestinal bleeding by cytomegalovirus enteritis in an immunocompetent patient.

Cytomegalovirus (CMV) infections are common in immunocompromised patients but rare in immunocompetent individuals. Gastrointestinal disease is frequent in systemic CMV infections but the small bowel is the least common site of involvement. We present the case of a 66 years-old man, with no evidence of immunological deficiency, hospitalized for unspecific symptoms of diarrhea, fever and abdominal pain, which developed massive mid-gastrointestinal bleeding during hospitalization. Enteroscopy revealed congestive, oedematous mucosa with multiple ulcers in the small bowel. Cytomegalic cells with intranuclear inclusions were found on histologic examination, allowing the diagnosis of CMV infection. Ganciclovir in full therapeutic dose was started and surgery was performed as a last resource treatment, but the patient died. This case highlights the rare condition of massive gastrointestinal bleeding due to CMV disease of the small bowel, the major importance of enteroscopy and pathologic evaluation for diagnosis and the poor prognosis of this situation.

First Report of Pitch Canker on Pines Caused by Fusarium circinatum in Portugal.

In November of 2007, dieback symptoms (basal needle dieback, wilting, and dieback of terminal shoot) were observed on plant groups of Pinus radiata and P. pinaster in a tree nursery located in Anadia in the central region of Portugal (40°26'N, 08°23'W). Two containers with a total of 112 plants per pine species (with and without symptoms) were collected. Small pieces (5 mm long; two from the roots, stem at the soil level, and the aerial part, totaling six pieces) of 20 symptomatic plants were sterilized with 3% sodium hypochlorite, and isolations were performed on potato dextrose agar (PDA) supplemented with 0.5 mg/ml of streptomycin sulfate. A species of Fusarium was isolated from all infected tissues and pure cultures were obtained by single hyphal tip transfers on PDA and Spezieller Nährstoffarmer agar and incubated at 25°C for 10 days with a 12-h photoperiod. The species was identified as Fusarium circinatum Nirenberg & O'Donnell (= F. subglutinans Wollenweb & Reinking) on the basis of morphological and cultural characteristics (2). They produced white, aerial mycelia, violet pigment, typically three-septate macroconidia with slightly curved walls, single-celled microconidia, and characteristic sterile, coiled hyphae. Microconidia were ovoid or allantoid and born in false heads on aerial polyphialides. The identification was confirmed by PCR with specific primers CIRC1A/CIRC4A, resulting in a 360-bp DNA fragment of the two nuclear ribosomal intergenic spacer regions (3). Pathogenicity tests were performed by inoculating 5- and 9-month-old P. pinaster and P. radiata seedlings, respectively. Plants belonging to P. pinea species (8-month-old), the second most important pine in the country, were also included in the tests. Small strips of bark (10 × 1 mm) were cut from the stems and similar-sized pieces of PDA colonized by two isolates of F. circinatum were placed in contact with the open wounds and covered with Parafilm. Ten seedlings for each pine species, isolate, and control (with sterile PDA) were provided in a total of 90 plants. First symptoms, basal needle and shoot dieback, were observed in P. radiata 8 days after inoculation. One month later, all P. radiata and 70% of the P. pinaster plants were dead. In all P. pinea plants, needles turned red along the main stem, from center to periphery, but only 2% of these plants presented wilting of the terminal shoot after 1 month. No symptoms were observed on control seedlings. F. circinatum was reisolated from symptomatic plants of the three species tested. To our knowledge, this is the first report of F. circinatum in Portugal. Pitch canker, caused by Gibberella circinata (anamorph F. circinatum), is one of the most aggressive pathogens on several pine species in the world (1). In 2005, the fungus was detected in the European continent affecting P. radiata and P. pinaster in northern Spain. References: (1) E. Landeras et al. Plant Dis. 89:1015, 2005. (2) H. I. Niremberg and K. O'Donnell. Mycologia 90:434, 1998. (3) W. Schweigkofler et al. Appl. Environ. Microbiol. 70:3512, 2004.

Double pylorus with bleeding gastric ulcer – a rare event / No disponible

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Successful endoscopic banding after cyanoacrylate failure for active bleeding duodenal varix

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Desgarro esofágico espontáneo extenso con hemorragia digestiva alta tratado con la aplicación de un endoclip / Spontaneous extensive esophageal tear with upper digestive haemorrhage treated by endoclip application

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