Chronic Lunate Dislocation: An Unusual Cause of Carpal Tunnel Syndrome—Avoiding Diagnostic Pitfalls and Synopsis of Management Options

ABSTRACT Carpal tunnel syndrome (CTS) represents the most common compressive neuropathy of the upper limb (1). There are a myriad of causes of CTS, of which carpal fractures and dislocations are known aetiologies. Volar lunate dislocations are the most common carpal dislocations described (1). Approximately 25% of perilunate dislocations are missed on initial presentation, resulting in delayed diagnosis and likely poorer outcomes (1-3). A case of chronic lunate dislocation presenting as CTS is presented here to highlight diagnostic pitfalls and management options.

Gross and histopathological pitfalls found in the examination of 3338 cattle brains submitted to the BSE surveillance program in Brazil / Ciladas macroscópicas e histopatológicas encontradas no exame de 3338 encéfalos de bovinos submetidos ao programa de vigilância da EEB no Brasil

This study stems from the findings during the gross and histopathological exam of 3,338 cattle brains as part of the bovine spongiform encephalopathy (BSE) active surveillance program of the Brazilian Ministry of Agriculture, Livestock, and Supply from 2001 to 2005. The work was carried out in the Veterinary Pathology Laboratory of the Federal University of Santa Maria which at the time (2001-2007) was the national reference laboratory for the diagnosis of BSE and other transmissible spongiform encephalopathies. Both gross and histopathological aspects are described. Several gross aspects were annotated: anatomic normal structures not commonly recognized (non-lesions), lesions of no clinical significance, postmortem changes and artifacts; all these can amount to important pitfalls that distract the pathologist during the routine gross examination of the central nervous system (CNS). Accordingly, equivalent pitfalls were described in the histological examination. Non-lesions observed were the pineal body, embryo remnants such as the external germinal layer of the cerebellum, subependymal plates, and clusters of neuroblasts in the basal ganglia; or circumventricular structures such as area postrema, subcomisural organ, and melanosis in the leptomeninges and vessel walls. Lesions with little or no clinical importance included age-related changes as lipofuscin, hemosiderin, mineralization and hyalinization of vessel walls within the brain and meninges. Corpora amylacea and corpora arenacea were detected respectively in astrocyte processes and the pineal body. Cytoplasmic neuronal vacuolization was observed in the red nucleus and habenular nucleus. Sarcocystis sp. without a correspondent inflammatory reaction was rarely observed. Included within findings with no clinical manifestation were axonal spheroids and perivascular mononuclear cuffings. Changes in the CNS due to killing, sampling and fixation methods can obscure or distract from the more critical lesions. The ones related to the process of killing included hemorrhages caused in cattle destroyed by a captive bolt. Artifacts related to sampling and handling of CNS tissue consisted of inclusion of bone sand in the neural tissue from sawing the calvarium; dark neurons produced by excessive handling of the brain, and micro-organisms that contaminated the tissues during sampling or histological processing. Postmortem autolytic or putrefactive changes observed included vacuolar changes in the myelin sheath, clear halos surrounding neurons and oligodendrocytes, clusters of putrefaction bacilli within vessels or dispersed throughout the brain tissue associated or not to clear halos. One interesting, and somewhat frequent, postmortem autolytic change found in the bovine brain was the partial dissolution of the granule cell layer (GCL) of the cerebellum, also referred to as conglutination of the GCL or as the French denomination "état glace". Due to the shortage of comprehensive publications in the subject, this review is intended to address the main pitfalls that can be observed in the brain of cattle hoping to help other pathologists avoiding misinterpret them.(AU)

Os resultados deste estudo foram obtidos pelo exame macroscópico e histopatológico de 3.338 cérebros de bovinos examinados durante o programa de vigilância ativa da encefalopatia espongiforme bovina (BSE) do Ministério da Agricultura, Pecuária e Abastecimento (MAPA), de 2001 a 2005. O trabalho foi realizado no Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM) que, de 2001 a 2007, foi o laboratório nacional de referência para o diagnóstico da BSE e de outras encefalopatias espongiformes transmissíveis. Macroscopicamente, foram descritas estruturas anatômicas normais (não-lesões), mas que são, com frequência, interpretadas como lesões; lesões sem significado clínico; alterações pós-mortais e artefatos. Esses achados podem confundir e desviar a atenção do patologista durante o exame de rotina do sistema nervoso central (SNC). Da mesma forma, estruturas equivalentes foram descritas no exame histológico. As não-lesões observadas foram corpo pineal, remanescentes embrionários, como a camada germinativa externa do cerebelo, placas subependimárias e aglomerados de neuroblastos nos gânglios da base; ou estruturas circunventriculares, como área de postrema, órgão subcomissural e melanose em leptomeninges e paredes dos vasos. Lesões com pouca ou nenhuma importância relacionadas ao envelhecimento incluíram lipofuscina, hemossiderina, mineralização, hialinização das paredes dos vasos do encéfalo e das meninges. Corpora amylacea foram detectados em processos astrocíticos e corpora arenacea, no corpo pineal. Adicionalmente, foi observada vacuolização no citoplasma de neurônios do núcleo vermelho e do núcleo habenular. Sarcocystis sp. sem reação inflamatória correspondente foi raramente observado. Incluídos nos achados sem manifestação clínica estavam esferóides axonais e manguitos mononucleares perivasculares. Alterações no SNC causadas pelo método de abate, amostragem e fixação podem simular ou obscurecer lesões mais importantes. Aquelas relacionadas ao método de abate incluíram hemorragias causadas em bovinos dessensibilizados pelo dardo cativo ou por punção por faca da medula na articulação atlanto-occipital. Artefatos relacionados à amostragem e manuseio de tecido do SNC consistiram na inclusão de pó de osso no tecido neural em consequência do uso de serra para abrir a caixa craniana; neurônios escuros produzidos pelo manuseio excessivo do cérebro e micro-organismos que contaminaram os tecidos durante a amostragem ou processamento histológico. Alterações autolíticas pós-mortais ou de putrefação incluíram vacuolizações na bainha de mielina, halos claros em torno dos neurônios e oligodendrócitos, aglomerados de bacilos de putrefação dentro dos vasos ou dispersos em todo o tecido cerebral, relacionados ou não a halos claros. Uma alteração autolítica pós-mortal intrigante e relativamente frequente encontrada foi a dissolução parcial da camada de células granulares (CCG) do cerebelo, também referida como conglutinação da CCG ou "état glacé". Devido à escassez de publicações abrangentes neste assunto, esta revisão pretende abordar as principais ciladas que possam aparecer no cérebro de bovinos, na esperança de ajudar outros patologistas a evitar interpretá-las erroneamente.(AU)

Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest / Armadilhas e artefatos na interpretação de PET/CT na oncologia torácica

Abstract PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of 18F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation.

Resumo PET/CT é amplamente utilizada para avaliação de pacientes com neoplasias torácicas. Altos níveis de captação de 18F-fluordesoxiglicose (FDG) são geralmente vistos em neoplasias, mas também podem ser fisiológicos, decorrentes de artefatos ou ocorrerem em condições benignas, como lesões infecciosas, inflamatórias e iatrogênicas. Por outro lado, alguns tumores malignos podem não captar FDG, como o adenocarcinoma in situ (anteriormente denominado de carcinoma bronquioloalveolar) e tumores carcinoides. Os autores ilustram as principais armadilhas e artefatos na interpretação dos exames torácicos de PET/CT oncológicos, com estratégias para evitar erros de interpretação.

A Review On Fusion Imaging In Maxillo Facial Region - A Deliberation Of Undeniable Creative Power

From advances in X-ray film and cassettes to the launch of computers and digital images, diagnostic imaging has never stopped reinventing its technology to improve patient care. Today, diagnostic imaging is on the cusp of meteoric growth in an arena known as fusion imaging. This technology melds two independent imaging modalities---- typically a procedure that demonstrates an organ’s function with one that potray the organ’s anatomy---- to produce a diagnostically and clinically superior study

Pitfalls and optimal approaches to diagnose melioidosis

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

Pitfalls and optimal approaches to diagnose melioidosis

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

Surgical Strategies for Successful Minimally Invasive Transforaminal Lumbar Interbody Fusion

STUDY DESIGN: Literature review. OBJECTIVES: The aim of this study was to demonstrate surgical strategies for successful minimally invasive transforaminal lumbar interbody fusion (TLIF). SUMMARY OF LITERATURE REVIEW: Although many studies have reported the benefits and disadvantages of minimally invasive TLIF, few have described surgical strategies to improve the success rate or to reduce complications. MATERIALS AND METHODS: We searched for studies reporting the clinical and radiological outcomes of minimally invasive TLIF, and analyzed the optimal indications, technical pitfalls, and tips for successful surgical outcomes. RESULTS: The ideal candidate for minimally invasive TLIF is a patient with single or 2-level low-grade adult degenerative or isthmic spondylolisthesis. Incomplete decompression, dura tearing, nerve root injury, and implant-related complications were found to be the most commonly reported adverse events, especially in the early periods of a surgeon's experience. Precise positioning for skin incision and tube insertion, complete neural decompression, proper interbody preparation for bone graft and cage insertion, and the correct placement of percutaneous pedicle screws are critical strategies for successful surgical outcomes. Fully understanding the surgical pitfalls and tips described in this review is also important to avoid potential complications. CONCLUSIONS: It is imperative not only to carry out a comprehensive preoperative evaluation and proper patient selection, but also to perform meticulous surgical procedures with thoughtful considerations of potential pitfalls, in order to improve the success rate and to reduce the complications of minimally invasive TLIF.

Artifacts and pitfalls in shoulder magnetic resonance imaging / Artefatos e armadilhas na ressonância magnética do ombro

AbstractMagnetic resonance imaging has revolutionized the diagnosis of shoulder lesions, in many cases becoming the method of choice. However, anatomical variations, artifacts and the particularity of the method may be a source of pitfalls, especially for less experienced radiologists. In order to avoid false-positive and false-negative results, the authors carried out a compilation of imaging findings that may simulate injury. It is the authors’ intention to provide a useful, consistent and comprehensive reference for both beginner residents and skilled radiologists who work with musculoskeletal magnetic resonance imaging, allowing for them to develop more precise reports and helping them to avoid making mistakes.

ResumoA ressonância magnética revolucionou o diagnóstico de lesões do ombro, tornando-se, em muitos casos, o método de escolha. No entanto, as variações anatômicas, artefatos e particularidade do método podem ser fonte de armadilhas, especialmente para radiologistas menos experientes. Para evitar resultados falso-positivos e falso-negativos, foi realizada uma compilação de achados de imagem que podem simular lesões. Pretendemos ser uma referência útil, consistente e abrangente para os residentes iniciantes e radiologistas qualificados que trabalham com ressonância magnética musculoesquelética, a fim de desenvolver relatórios mais precisos e ajudá-los a evitar erros.

Hurthle cells in fine needle aspiration cytology of the thyroid: a potential diagnostic dilemma?

Hurthle cells are not uncommonly encountered in thyroid fine needle aspiration cytology (FNAC) smears. They are easily recognized by their distinct cytomorphology in cytological preparations, i.e. large, polygonal cells displaying uniform, rounded nuclei, often prominent nucleoli and abundant granular cytoplasm. Hurthle cells can be seen in both non-neoplastic and neoplastic thyroid lesions which can pose diagnostic dilemma to cytopathologists, especially when the lesions are focally sampled. We describe a case of solitary thyroid nodule in a 46-year-old male, whose aspirates comprised predominantly of Hurthle cells exhibiting nuclear features suspicious of papillary carcinoma, which turned out to be Hurthle cell carcinoma on subsequent histological sections. The potential diagnostic pitfalls of Hurthle cell lesions and associated conditions in thyroid FNA are discussed. The presence of Hurthle cell change in a wide variety of thyroid lesions can be diagnostically challenging. However, accurate diagnosis can still be made with careful observation of the predominant cell population, nuclear features and whether there is abundant colloid or lymphocytes in the background.

Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Colorectal carcinoma is a common lethal disease with signs and symptoms that may be nonspecific. Computed tomography (CT) of the abdomen and pelvis with or without contrast is frequently performed for various general abdominal complaints, but unlike CT colonography, the large bowel may not be optimally prepared for evaluation. As such, careful and diligent assessment of the non-prepared colon in all CT images of the abdomen and pelvis is important, as it ensures that incidental colorectal malignancy is not missed, especially in older patients. This article gives an overview of multidetector CT imaging signs and subtle clues to aid in the diagnosis of colorectal carcinoma, as well as their pitfalls.

Fine-needle aspiration cytology of pleomorphic adenoma: cytologic variations and diagnostic pitfalls: a report of two cases.

Introduction: Fine-needle aspiration cytology (FNAC) of the salivary gland is a sensitive and specific technique used in the diagnosis of lesions of the salivary gland. On FNA, adequately cellular aspirates make distinction easy in most cases. However, sparse cellularity makes diagnosis difficult partly due to lack of observer familiarity with the different patterns. The diagnosis of pleomorphic adenoma (PA) can be made accurately but this common salivary gland neoplasm can be diagnostically challenging, causing pitfalls in cytodiagnosis. Material And Methods: A 26-year-old male presented with a firm, painless, mobile slowly-growing mass in the right preauricular region of three years duration. Fine needle aspiration (FNA) was done. A diagnosis of pleomorphic adenoma suspicious of malignancy was given due to the presence of isolated squamous cells, occasional cluster of basaloid cells, occasional giant cells and hyaline globules. Histology confirmed a pleomorphic adenoma with marked squamous metaplasia and keratin cyst formation without evidence of malignancy. A 52-year-old male presented with a firm, painless, mass in the right preauricular region of five months duration. FNAC smears were cellular and showed a hemorrhagic background. Numerous single anucleate and nucleate squamous cells, myoepithelial cell clusters and epithelial cell aggregates were seen. Few foamy cells, giant cells and hyaline globules were noted. Characteristic metachromatic fibrillary chondromyxoid stroma which is usually seen in pleomorphic adenoma was absent. A diagnosis of pleomorphic adenoma suspicious of malignancy was given. The patient was lost to follow up and hence details regarding the histopathological status of his preauricular swelling were not known. Results: Here we illustrate that PA with squamous metaplasia, basaloid cells and hyaline globules can be misinterpreted as carcinoma on cytology and discuss the various pitfalls of cytology. Conclusion: FNAC is a good pre-operative procedure for the diagnosis of PA. One should be aware of the cytological variations to avoid diagnostic errors. When one is uncertain about classification of a salivary gland tumour the cytopathologist should leave the diagnosis open with a few suggested differential diagnoses rather than issuing a misleading report.

Evaluation of Role of Ultra Sound Guided Fine Needle Aspiration Cytology for Diagnosis of Ovarian Lesions with Particular References to Diagnostic Pitfalls.

Background: Ovarian lesions are quite common among females of all age groups. Ovarian cancers account for 6% of female malignancy. ULTRASONOGRAPHY(USG) can help in proper identification and categorization of these lesions. Fine needle aspiration cytology (FNAC) under USG guidance can be an effective modality for early diagnosis of ovarian masses. Aims And Objectives: To evaluate the role of USG guided FNAC over ovarian space occupying lesions (SOLs) for proper categorization into non-neoplastic, benign & malignant variants and to identify possible underlying causes of cytological misdiagnosis, if any, in comparison to histopathological diagnosis. Materials and Methods: FNAC under USG guidance were performed over one hundred and sixteen cases with radiologically proved ovarian SOLs during a period of five years. Aspirated materials were interpreted as non- neoplastic, benign or malignant lesions. Histopathological study was possible in 47 of these cases. Results: Out of 116 aspirations, non neoplastic, benign and malignant diagnosis were given in 51, 42 &23 cases, respectively. During histopathological correlation 41 out of 47 cases(87.2%) show exact cytohistological parity.Rest six cases with cytological misdiagnosis were discussed in detail. Conclusion: USG guided FNAC can effectively diagnose ovarian lesions in more than 87% cases. Scrutiny about failed diagnosis will help to improve accuracy in future.

Challenges and pitfalls in the diagnosis of hyperprolactinemia / Desafios e armadilhas no diagnóstico da hiperprolactinemia

The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22.

A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve-se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outras doenças, muitos podem apresentar galactorreia ou distúrbios menstruais, bem como anormalidades neurorradiológicas. Finalmente, os médicos devem estar cientes de que incidentalomas hipofisários são encontrados em pelo menos 10% da população adulta. Arq Bras Endocrinol Metab. 2014;58(1):9-22.

Pitfalls in Using Electrophysiological Studies to Diagnose Neuromuscular Disorders

Electrodiagnostic testing is used widely for the full characterization of neuromuscular disorders and for providing unique information on the processes underlying the pathology of peripheral nerves and muscles. However, such testing should be considered as an extension of anamnesis and physical examination, not as pathognomonic of a specific disease entity. There are many pitfalls that could lead to erroneous interpretation of electrophysiological study results when the studies are not performed properly or if they are performed in the presence of anatomical aberrations. The diagnostic reliability of electrodiagnostic studies can be improved and the associated pitfalls overcome if the physician is familiar with all of those possible pitfalls. In this article we discuss the most common and important pitfalls associated with electrodiagnostic medicine.

Congenital lobar emphysema: Pitfalls and management.

Congenital lobar emphysema is a rare entity presenting in the first month of life. It appears with varying degrees of respiratory distress, clinical and radiological evidence of over-aeration of the upper and middle lobes, mediastinal shift and hypoxia. Its early recognition and surgical intervention can be life-saving. Even today, despite advanced diagnostic techniques, pitfalls in diagnosis and management are not uncommon and the condition may be mistaken for pneumothorax or pneumonia. This report elucidates the anesthetic management of three such cases with a review of literature.

Cytologic Findings of Cerebrospinal Fluid / 대한세포병리학회지

Cerebrospinal fluid (CSF) cytology is based on the cytopathologic findings of other body fluids. However, CSF's cytologic features are less familiar to physicians than are those of the other body fluid's cytology because of the small number of cases. The low overall diagnostic accuracy and the presence of false positivity still remain as problems. The incidence of lymphoreticular malignancies and metastatic carcinomas are rather higher than that of primary brain tumors. In this review, the characteristic cytologic findings of conventional CSF cytology are reviewed along with a brief note on the technical preparation and diagnostic pitfalls.

Determinations of symptomatical fractured vertebrae in treating osteoporotic vertebral compression fractures with vertebroplasty and pitfalls as well as preventive strategy / 中国矫形外科杂志

[Objective]Osteoporotic vertebral compression fractures(OVCFs)are commonly multiple fractures and this study is aimed to explore how to determine the symptomatical fractured vertebrae as well as the pitfalls in treating OVCFs using percutaneous vertebroplasty(PVP).[Method]Forty-eight OVCFs patients(78 vertebrae)undergoing PVP were retrospectively analyzed.All the patients had anteroposterior and lateral plain X-rays as well as T1W1,T2W1 and fat-compressing(STIR)MR images preoperatively.The symptomatical fractured vertebrae were determined with combination of regional pain、X-rays and MR images.Of all the patients,36 were injected unilaterally while 12 were injected bilaterally.The mean injected volume of PMMA were 3-7 ml.[Result]The back pain of all the patients were relieved to different degrees postoperatively.The back pain completely disappeared in 30 patients while the left back pain was not improved though the right back pain disappeared in 2 patients who were injected via right approach.The back pain almost disappeared but the bilateral rib pain was not improved in 1 patient with T8 vertebral fracture.No severe complications including pulmonary emboli occurred.[Conclusion]The symptomatical fractured vertebrae should be determined comprehensively not only based on preoperative X-rays but also on the MR images,especially fat-compressing MR images.Only when the fractured vertebrae demonstrate low intensity on T1W1 MR image and high-intensity on T2W1 or fat-compressing MR image can we consider them new fractures.Otherwhise,the fractured vertebrae are considered old fractures and they see no necessity to be injected.The injection should reach the most severely fractured part and if necessary the bilateral approaches are considered.PMMA should be injected after the bone cements are solid enough so as not to develop complications such as pulmonary emboli.

Actual Conditions and Pitfalls of Death Statistics Based on the Current Death Registration System in Korea / 한국역학회지

BACKGROUND: Death statistics is the most basic one among health-related statistics. This study was conducted to propose actual data to improve the quality of death statistics through a review of the contents of total registered death reports which are primary sources of death statistics. METHODS: The author reviewed the recent regulations about the death registration and analyzed contents of the total 1,383 death certificates written out from January, 1998 to December, 1999 in a county of Kyungsangnamdo, Korea. RESULTS: The two laws - the Family Registration Act and the Medical Act that mainly control death registration, and the two legal forms - death certificates and death report form that actually used were not accorded. This is a reason why there occurred frequent mistakes in the current death registration. Also, there was no way to correct the incomplete contents of death certificate primarily written by doctors. Among 1,383 death report cases, 83.9% of death was due to illness. The causes of the death were generally incredible; diverse expression even on the same disease, incorrect and inadequate expression, not standardized by standard classification of disease, and unwritten or 'unknown' especially in case of the intermediate underlying and underlying cause. The major place of death was home(67.8%) and medical facilities(22.3%). And, it considered that the welfare facilities should be added as one of the place of death. The proportion of the doctors' diagnosis for death was as high as 96.6%, however, the death certificates issued by a clinic had many problems in aspect of accuracy and completeness. In the time spent for the death report, 98.0% reported within the legal term of one month. CONCLUSIONS: The authors propose the followings to improve the quality of death statistics. First of all, contents of the two laws should be unified. Secondly, concerns and professionalism of the personnel who deal with death registration are should be strengthened. Thirdly, the regular and reinforcing training for the doctors and the officials who issue the death certificates should be emphasized with consistent upgrade of the standard guidelines. Fourthly, the death reporting system should be qualified through the validation of the contents of the death report forms, i.e., checked by medical doctor or medical professionals in the Community Health Center in the process of the receipt, informing, and report.