The outcome of conservative treatment of fifth metatarsal diaphyseal fractures.

INTRODUCTION: The fifth metatarsal diaphyseal fracture is a common fracture. However, clear consensus about the treatment is lacking. Unlike the avulsion fracture or Jones' fracture, literature available on the treatment and long-term outcome of the diaphyseal fracture is scarce.The purpose of this study is to demonstrate a substantial number of conservatively treated patients with persistent pain and to evaluate metatarsal shortening and displacement within this group. METHODS: In this retrospective study, 106 patients who had experienced a fifth metatarsal diaphyseal fracture were included and evaluated. The minimum follow-up period was three months. FAAM, AOFAS and NRS scores were used as outcome measurements for function and pain. Length and displacement were analysed on plain X-rays. RESULTS: At least 11% of the patients who received conservative treatment for their fifth metatarsal diaphyseal fracture had persistent pain at least 3 months after initiation of conservative treatment. No relationship has been found between the length of the fifth metatarsal and the FAAM (r( Petrisor et al., 2006) 2 = 0,051), AOFAS (r( Petrisor et al., 2006) 2 = 0,009) and NRS (r( Petrisor et al., 2006) 2 = 0,001). Furthermore, there was no association between patients with a shorter fifth metatarsal and FAAM, AOFAS, NRS, displacement and BMI. DISCUSSION AND CONCLUSION: The finding of persistent pain in at least 11% of all patients at long-term follow-up confirms our hypothesis on long-term symptoms. However, the results suggest that these persistent symptoms are not related to metatarsal shortening or displacement.

Mild hydrothermal conditioning prior to torrefaction and slow pyrolysis of low-value biomass.

The aim of this research was to establish whether hydrothermal conditioning and subsequent thermochemical processing via batch torrefaction or slow pyrolysis may improve the fuel quality of grass residues. A comparison in terms of fuel quality was made of the direct thermochemical processing of the feedstock versus hydrothermal conditioning as a pretreatment prior to thermochemical processing. Hydrothermal conditioning reduced ash content, and particularly nitrogen, potassium and chlorine contents in the biomass. The removal of volatile organic matter associated with thermochemical processes can increase the HHV to levels of volatile bituminous coal. However, slow pyrolysis only increased the HHV of biomass provided a low ash content (<6%) feedstock was used. In conclusion, hydrothermal conditioning can have a highly positive influence on the efficiency of thermochemical processes for upgrading low-value (high-ash) biomass to a higher quality fuel.

[Dissection of the carotid artery following blunt trauma: still a pitfall]. / Dissectie van de A. carotis door een stomp trauma: nog altijd een valkuil.

Two young patients, an 18-year-old woman and a 25-year-old man, were admitted to hospital after accidents with a car. They developed very severe complications as a consequence of blunt carotid artery dissection. This diagnosis was delayed in both patients until serious cerebral ischaemia had occurred. Despite current awareness of carotid dissection as a possible result of blunt trauma, this injury is often overlooked. Early diagnosis by means of Doppler ultrasonography and CT-angiography is important in adequate management of this injury and may reduce morbidity and mortality. The treatment of carotid dissection consists of antithrombotic, endovascular or surgical therapy and needs to be individualized.

True myocardial motion tracking.

Myocardial tagging is a powerful tool for the assessment of in-plane cardiac motion. However, for previous myocardial tagging techniques, the imaged slice is fixed with respect to the magnet coordinate system. Thus, images acquired at different heart phases do not always represent the same slice of the myocardium. A new myocardial tagging technique is presented, which takes the through-plane motion into consideration. It involves tagging of the desired myocardial slice and applying a subtraction imaging technique to image just that part of the myocardium. The examination time can be reduced considerably by the acquisition of two one-dimensionally tagged images. To increase the signal-to-noise ratio especially at later heart phases, variable imaging RF excitation flip angles are applied. To reduce motion artifacts a repetitive breathhold scheme was applied. In vivo results demonstrate that the tags can be accurately tracked within the entire heart period with a temporal resolution of 35 ms, even at a top basal level of the heart and right ventricle.