Mechanical factors explain development of cam-type deformity.

OBJECTIVE: A cam-type deformity drastically increases the risk of hip osteoarthritis (OA). Since this type of skeletal anomaly is more prevalent among young active adults, it is hypothesized that the loading conditions experienced during certain types of vigorous physical activities stimulates formation of cam-type deformity. We further hypothesize that the growth plate shape modulates the influence of mechanical factors on the development of cam-type deformity. DESIGN: We used finite element (FE) models of the proximal femur with an open growth plate to study whether mechanical factors could explain the development of cam-type deformity in adolescents. Four different loading conditions (representing different types of physical activities) and three different levels of growth plate extension towards the femoral neck were considered. Mechanical stimuli at the tissue level were calculated by means of the osteogenic index (OI) for all loading conditions and growth plate shape variations. RESULTS: Loading conditions and growth plate shape influence the distribution of OI in hips with an open growth plate, thereby driving the development of cam-type deformity. In particular, specific types of loads experienced during physical activities and a larger growth plate extension towards the femoral neck increase the chance of cam-type deformity. CONCLUSIONS: Specific loading patterns seem to stimulate the development of cam-type deformity by modifying the distribution of the mechanical stimulus. This is in line with recent clinical studies and reveals mechanobiological mechanisms that trigger the development of cam-type deformity. Avoiding these loading patterns during skeletal growth might be a potential preventative strategy for future hip OA.

Testicular plasmacytoma, an unusal testicular tumor.

We report the case of a 78-year-old man with recent diagnosis of Kahler disease and a non-tender swollen left hemiscrotum. Ultrasound findings showed an intratesticular, hypervascular hypoechoic lesion. MRI imaging demonstrated general appearance of a malignant lesion. Specific characteristics however, could not be withheld on MRI. Orchidectomy was performed and plasmacytoma was demonstrated at pathological examination. Although plasmacytoma of the testis is extremely rare, it should be included in the differential diagnosis taking into account the ultrasound and MRI appearances, especially in elderly patients with known Kahler disease.

Spontaneous rupture: a rare complication of hepatic hemangiomas.

Hepatic lesions are one of the possible visceral causes of spontaneous hemoperitoneum. Hepatic hemangiomas are congenital vascular malformations and are the most common benign tumours of the liver. Most cases are asymptomatic. Although they seldom rupture, it is important to diagnose them as their global mortality rate is high. An accurate diagnosis of a hemangioma as cause of a hemoperitoneum would result in correct clinical decision making and treatment.

Is diltiazem effective in treating the symptoms of (tardive) dyskinesia in chronic psychiatric inpatients? A negative, double-blind, placebo-controlled trial.

Calcium channel blockers, antiarrhythmic drugs, such as verapamil and diltiazem, may decrease the symptoms of tardive dyskinesia. The efficacy and safety of administering 60 mg diltiazem hydrochloride, four times daily for a period of 3 weeks, was studied in a random, double-blind, crossover trial in which the drug was compared with placebo in 17 neuroleptic-treated, chronic psychiatric inpatients of both genders with (tardive) dyskinesia. The severity of the dyskinesia was assessed using the Abnormal Involuntary Movement Scale. Neither diltiazem nor placebo produced a significant decrease in the severity of the dyskinesia. Diltiazem did not influence the psychiatric state of the patients, nor did it have a significant effect on either the blood pressure or electrocardiographic parameters. No significant adverse drug reactions were elicited.

Endobronchial tuberculosis: report of three cases.

Three patients are presented who had had a chronic cough for several months, a normal physical examination and a negative chest X-ray. Fiberoptic bronchoscopic examination revealed ulcerohaemorrhagic and/or stenotic lesions which proved to be of tuberculous origin. In one case there was a life-threatening haemoptysis, and a pneumonectomy was performed.

Isolated paratracheal mass of tuberculous origin in an adult patient.

A 40-year-old man presented with a solitary mediastinal (right paratracheal) mass which proved to be due to Mycobacterium tuberculosis. While the incidence of tuberculosis has diminished in our countries, such unusual manifestations of tuberculosis as the present case, are still encountered. Tuberculosis, the "perfect imitator", should be included in the differential diagnosis of a mediastinal mass. Excision for therapeutic, as well as histological and bacteriological diagnostic, purposes should be supplemented by appropriate antituberculous chemotherapy.

Effect of neck position during radionuclide superior cavography. Its value in the diagnosis of superior vena cava obstruction due to retrosternal goiter.

In five patients with substernal goiter, three of whom presented with superior vena cava (SVC) syndrome, and in five normal subjects, radionuclide superior cavography (RNSC) was performed with extension and flexion of the neck during tracer administration (simultaneous bilateral injection of Tc-99m pertechnetate). When the tracer was injected during neck extension, venous flow pattern was abnormal in four of five patients, and transit time (TT) prolonged in three of five patients. In this posture, mean TT +/- 1 standard deviation (SD) was 6.3 +/- 2.6 s (range 3.5 to 9 s) for the five patients and 3.5 +/- 0.7 s (range 2.5 to 4.5 s) for a group of five control subjects. When the tracer was injected during neck flexion, all five patients showed abnormal flow patterns and prolonged TT (mean +/- 1 SD 10.1 +/- 4.1 s; range 4.4 to 16 s), in contrast to the control group where a slight decrease in TT was found (mean +/- 1 SD 3 +/- 0.6 s; range 2 to 3.5 s). In the presence of a substernal goiter, or any mobile mass at the thoracic inlet, impairment of venous flow through the SVC system appears to be a common occurrence, readily detectable by RNSC. RNSC should be performed with neck flexion during tracer injection, since in this posture its ability to detect compromised venous flow through the SVC system is enhanced, even in patients without a clinically apparent SVC syndrome.

[Evaluation of ceftriaxone (R013-9904) in the treatment of septicemia caused by gram-negative bacilli]. / Evaluation de la ceftriaxone (R013-9904) dans le traitement des septicémies à bacilles gram négatifs.

Thirty-four patients admitted for a suspicion of septicaemia were treated with ceftriaxone, a third generation cephalosporin. Ceftriaxone was administered IV at a dose of 2 grams daily, either as a single injection of 2 g or as two injections of 1 g each. 43 organisms were isolated from the blood of the 34 patients: 20 E.coli; 5 Klebsiella; 2 Salmonella; 2 indole positives Proteus; 1 indole negative Proteus; 1 Enterobacter; 2 Acinetobacter; 3 Staphylococcus aureus; 2 Streptococcus; 1 Enterococcus; 1 Meningococcus and 3 anaerobes. The MIC of the enterobacteria for ceftriaxone ranged from less than or equal to 0.097 microgram/ml to 1.56 microgram/ml. Only two staphylococci, one Acinetobacter and the enterococcus were resistant to the drug. Serum assays of ceftriaxone were performed on the second day of treatment for 15 patients. Within the group treated with a single dosis of 2 g per day, the blood levels were: maximal level (10 min, after the injection): 175 to 460 micrograms/ml (average: 315), minimal level (before injection) 12 to 100 micrograms/ml (average 53). Among the patients treated with two doses of 1 g per day, we obtained: maximal levels 121 to 260 micrograms/ml (average 178), minimal levels 31 to 70 micrograms/ml (average 52). A clinically favorable evolution was obtained for 29 patients (85%). In the cases of 4 patients, the antibiotherapy had to be adapted in view of the susceptibility of the organisms isolated. Ceftriaxone was very well tolerated. The only observed secondary effect was a drug fever occurring in 3 patients who remained febrile in spite of a general improvement.

Bronchogenic carcinoma: a rare cause of nontraumatic pneumopericardium.

The history of a 67-year-old woman presenting a sudden nontraumatic pneumopericardium is reported. Investigation revealed that this patient had developed a bronchopericardial fistula secondary to a bronchogenic carcinoma. The clinical diagnosis was confirmed at autopsy. Although it is fairly evident that in this case the pneumopericardium could be related to the bronchogenic carcinoma, only a few reports of such an association have been published in the literature.