Predicting complete finger extension in Dupuytren's disease.

Multiple studies have reported the effectiveness of treatment on contracture reduction in Dupuytren's disease. However, very few studies have attempted to quantify to which extent patient and disease characteristics influence the chance of achieving a straight finger after surgery. Therefore, the aim of this study is to explore to which extent pre-operative patient and disease characteristics can reliably predict a straight finger after surgery for Dupuytren's disease. In total, 812 and 281 patients, who underwent a limited fasciectomy or needle fasciotomy, respectively, were included in the final analyses. Analysis was performed using a logistic modeling framework. For both treatments, the combination of the extension deficit at baseline; which finger is most affected, which joint is most affected, and the number of affected fingers provided reliable predictions. Classical patient characteristics, such as age and sex, had no additional predictive value. The models presented in this study provide reliable predictions and could be helpful in informing patients and managing their expectations.

Predictors of positive CT scans in the trauma patient with minor head injury.

Routine cerebral CT scanning of patients with minor head injuries has been advocated as a screening procedure for hospital admission. The purpose of this study was to determine whether there were characteristics of the trauma patient with a minor head injury. Glasgow Coma Scale (GCS) of 13-15, that would predict a positive cerebral CT scan. An analysis of 200 patients with potential head injuries transported to our regional trauma center was performed. The following characteristics were analyzed as possible predictors: scene GCS (SC-GCS), emergency room GCS (ER-GCS), a change in GCS from scene to emergency room, loss of consciousness (LOC), and focal neurological deficit. Forty-eight per cent (96/200) of the patients underwent CT scanning of the head. CT scans were positive in 4 per cent (8/200) of the total group and 8.3 per cent (8/96) of those who underwent CT scanning. In the patients without LOC and ER-GCS of 13-15, all CT scans were negative (95% confidence interval 0.0% to 3.4%). In the 93 patients with LOC, eight patients had a positive scan (P < 0.001). Of the nine patients who sustained a skull fracture, five had a positive CT (55.6%; 95% confidence interval 21.2% to 86.3%) (P < 0.0001). Of all the patients with positive CT scans, two underwent emergent craniotomy: one for a depressed skull fracture with underlying contusion, the other for a temporal bone fracture and an epidural hematoma. Both patients had LOC and SC-GCS and ER-GCS of 15.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurotoxicity of iohexol: a new nonionic contrast medium.

The neurotoxicity of iohexol was evaluated and compared with the neurotoxicity of sodium diatrizoate, meglumine iothalamate, and metrizamide. Direct neurotoxicity was evaluated with in vitro rat hippocampal slices, and angiographic neurotoxicity was studied in a cat's spinal cord following thoracic aortography. In the experiments with the hippocampal slices, the ionic agents, sodium diatrizoate and meglumine iothalamate, and metrizamide caused early excitatory changes in electrical activity and later inhibition, but iohexol caused only inhibition. In the experiments with the cat's spinal cord, the ionic contrast materials produced an increase in the ventral root reflexes, and iohexol and metrizamide produced no significant effect. These results indicate that iohexol is less neurotoxic than metrizamide and the ionic contrast materials and may be a very useful angiographic and/or myelographic contrast agent.