Justifying CT prior to MRI in cases of suspected occult hip fracture. A proposed diagnostic protocol.

INTRODUCTION: Patients with clinical suspicion of hip fracture, but negative radiographs are suspected of having an occult hip fracture (OHF). Different diagnostic modalities are available for investigating OHF and various protocols have been suggested. MRI has the highest sensitivity and specificity, however availability is limited in many institutes. CT is readily accessible in the large majority of hospitals throughout the world but has lower sensitivity and may miss some fractures. In this article we investigate a protocol that balances these issues providing a practical and cost-effective solution. METHODS: During a four-year period between 2012 and 2016 a strict diagnostic protocol was followed at our Medical Center for patients suspected of OHF. This MRI selective protocol consisted of CT initially being performed and only when negative for fracture, followed by an MRI. Retrospective analysis of all patients who followed the protocol was performed. The patients were divided into two groups: those diagnosed by CT alone and those diagnosed by MRI after having a negative CT scan. Diagnostic performance, time to diagnosis and the cost of this protocol were evaluated. RESULTS: 103 patients were treated under the protocol. In 50 patients (49%) hip fracture was diagnosed by CT alone. In the remaining 53 patients (51%) no definitive diagnosis was reached by CT and MRI was subsequently performed. 12 of these 53 patients (23%) were diagnosed with hip fracture necessitating surgery. In the CT only group mean time from admission to diagnosis was 3 hours, in the CT + MRI group this rose to 40 hours. Cost analysis showed that this protocol was more cost-effective than performing MRI in all patients, saving an estimated 66,805 Euro during the study period. CONCLUSION: The clinical challenge of diagnosing OHF can be minimised by implementing a diagnostic protocol. The protocol should take into consideration the diagnostic sensitivity, availability and cost of different imaging modalities. An MRI selective strategy with initial CT scanning is recommended, as it reduces time to diagnosis and lowers overall costs.

Intraoperative 3-dimensional imaging of scaphoid fracture reduction and fixation.

INTRODUCTION: We examined the clinical benefit of two intraoperative three-dimensional imaging modalities for reduction and fixation of scaphoid fractures. HYPOTHESIS: Our hypothesis was that three dimensional imaging will aid in operative care in comparison with standard fluoroscopy. METHODS: In 25 consecutive patients treated for fractures, after satisfactory reduction and fixation was obtained with a single Kirschner wire using fluoroscopy, intraoperative three-dimensional visualization was performed. The quality of fracture reduction, wire position and extrusion of the wire were examined. RESULTS: In two of the 25 cases, after three-dimensional visualization, malreduction of the fracture was seen and the reduction revised. Artifact and the dependency on technologist performance, limited the use of these modalities to locate the wire accurately. DISCUSSION: Diagnosis of malreduction of a scaphoid fracture is possible with 3-dimensional modalities. Utilization of these systems is still limited by technical factors.

[Effect of spirobramin and prospidin on immunogenesis]. / Vliianie spirobramina i prospidina na immunogenez.

The immunosuppressant effects of the antineoplastic piperazine drugs spirobramine and prospidin in respective doses of 500 and 600 mg/kg (1/2 of the LD50) were studied in experiments on cats. Spirobramine was shown to exert a more pronounced immunoinhibitory action on the primary and secondary immune response induced by sheep red blood cells.

[Effect of carminomycin on the immunological reactivity of the body]. / Vliianie karminomitsina na immunologicheskuiu reaktivnost' organizma.

The morpho-functional state of the muscle lymphoid tissue of mice treated with karmionmycin (LD50, 1.1 mg/kg) was studied experimentally. Development of a number of changes evident of the cell disorganization in the lymphoid tissue was shown. The cytological shifts in the thymus and spleen were reversible, while the destructive period in the strumous gland was more prolonged. The morpho-structural normalization of the spleen did not coincide with reduction of its immunological function. The studies on the karminomycin effect on the kinetics of the primary immune response showed dependence of the antibiotic effect on the temporal ratio between the antigenic stimulus and the drug administration. The antibiotic had no effect on the inductive phase of the primary immune response but significantly suppressed its productive phase. On reproduction of the secondary immune response, a decrease in the content of the antibody-forming cells in the spleen was observed, production of the circulating antibodies remaining unchanged.