Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation.

The risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions. A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large (n = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant (P < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study.

Statistical Shape Modeling of Skeletal Anatomy for Sex Discrimination: Their Training Size, Sexual Dimorphism, and Asymmetry.

Purpose: Statistical shape modeling provides a powerful tool for describing and analyzing human anatomy. By linearly combining the variance of the shape of a population of a given anatomical entity, statistical shape models (SSMs) identify its main modes of variation and may approximate the total variance of that population to a selected threshold, while reducing its dimensionality. Even though SSMs have been used for over two decades, they lack in characterization of their goodness of prediction, in particular when defining whether these models are actually representative for a given population. Methods: The current paper presents, to the authors' knowledge, the most extent lower limb anatomy shape model considering the pelvis, femur, patella, tibia, fibula, talus, and calcaneum to date. The present study includes the segmented training shapes (n = 542) obtained from 271 lower limb CT scans. The different models were evaluated in terms of accuracy, compactness, generalizability as well as specificity. Results: The size of training samples needed in each model so that it can be considered population covering was estimated to approximate around 200 samples, based on the generalizability properties of the different models. Simultaneously differences in gender and patterns in left-right asymmetry were identified and characterized. Size was found to be the most pronounced sexual discriminator whereas intra-individual variations in asymmetry were most pronounced at the insertion site of muscles. Conclusion: For models aimed at population covering descriptive studies, the number of training samples required should amount a sizeable 200 samples. The geometric morphometric method for sex discrimination scored excellent, however, it did not largely outperformed traditional methods based on discrete measures.

Tuberculous epididymitis associated with abdominal lymphadenopathy (2004:1b).

Although the predominant form of tuberculosis is pulmonary disease, an increasing number of cases with extra-pulmonary involvement have been reported. The diagnosis of extra-pulmonary tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory findings. Abdominal lymph node involvement may be present alone or in combination with involvement of the gastrointestinal tract, peritoneum, and solid viscera. Tuberculous epididymitis occurs sporadically and represents a specific secondary subacute or chronic inflammatory process involving the epididymis. We present the imaging findings in a patient with tuberculous epididymitis associated with abdominal tuberculous lymphadenopathy.

Tuberculosis of the central nervous system: overview of neuroradiological findings.

This article presents the range of manifestations of tuberculosis (TB) of the craniospinal axis. Central nervous system (CNS) infection with Mycobacterium tuberculosis occurs either in a diffuse form as basal exudative leptomeningitis or in a localized form as tuberculoma, abscess, or cerebritis. In addition to an extensive review of computed tomography and magnetic resonance features, the pathogenesis and the relevant clinical setting are discussed. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. Contrast-enhanced MR imaging is generally considered as the modality of choice in the detection and assessment of CNS tuberculosis.

Leiomyoma of the right common iliac vein presenting as a duodenal tumour.

A case of vascular leiomyoma originating from the wall of the right common iliac vein is presented. Clinical and radiological features suggested a well circumscribed tumour arising from the duodenal wall. Laparotomy revealed a tumour without connection to the duodenum, but attached to the right iliac vein. The tumour was totally resected, including partial resection of the common iliac vein. Pathology showed a smooth muscle tumour with histological features of benignity. Six months after surgery the patient is asymptomatic.

Psychomotor and cognitive performance in nonapneic snorers: preliminary findings.

Snoring is a common phenomenon and a primary symptom in obstructive sleep apnea syndrome, a sleep-related breathing disorder in which neuropsychological function is reported to be impaired. The first purpose of the present study was to compare cognitive and motor function in 25 heavy nonapneic snorers and 26 sleep apneics. As the basis for impairments in heavy nonapneic snorers is still unclear, the influence of nighttime breathing disturbances and morning alertness, respectively, on daytime performance was evaluated too. Nonapneic snorers exhibit more slow wave sleep and tend to have fewer changes in sleep stage than sleep apnea patients, but values for other sleep variables are similar. Snorers also show comparable alertness. Deficits in immediate visual memory and in visuospatial reasoning are not found. However, there are some indications that snorers show decreased manual dexterity and eye-hand coordination for the nonpreferred hand and that they have deficits in focused attention. In addition, snorers may show difficulties in finger-tapping speed. These performance measures tend to be associated with reduced morning alertness, except for the score on focused attention which has a tendency to be related to the nocturnal breathing disturbances.

Neuropsychological functioning and determinants of morning alertness in patients with obstructive sleep apnea syndrome.

Neuropsychological functioning is reported to be impaired in patients suffering from obstructive sleep apnea syndrome (OSAS). This syndrome is characterized by nocturnal respiratory disturbances, blood oxygen desaturations, sleep fragmentation, and excessive daytime sleepiness. Opinions are divided concerning the exact relationship between the observed cognitive deficits, nocturnal hypoxia, sleep disruption, and impaired daytime alertness. In the present study, morning neuropsychological function of 26 moderate to severe middle-aged sleep apneics is compared to that of 22 primary insomniacs. There were no performance differences on a range of neuropsychological tests among the two patient groups. In addition, the data suggest that morning alertness impairment, which is closely associated with a lack of slow wave sleep (SWS) and rapid eye movement (REM) sleep, is of major importance in inducing poorer cognitive performance in patients with moderate to severe sleep apnea.

Antagonizing the effects of experimentally induced sleep disturbance in healthy volunteers by lormetazepam and zolpidem.

The effects on sleep of two well known hypnotics, lormetazepam and zolpidem, during experimentally induced environmental noise were compared with placebo. In a double-blind, crossover study, 12 normal volunteers were subjected to prerecorded traffic noise with a mean noise level of 52 dB(A) and peaks to 77 dB(A) continuously for 8 hours in bed. Both hypnotics increased total sleep time, predominantly stage 2 sleep. A significant decrease in the number of sleep stage transitions, arousals, and awakenings longer than 3 minutes was found only with lormetazepam. No significant effects on rapid eye movement (REM) and slow wave sleep were observed. Latencies to persistent sleep and REM sleep onset were not different for either active treatment compared with placebo. Only after lormetazepam was performance on the morning reaction time test significantly affected. However, no differences were found in the subjective sleep quality and alertness ratings. Changes in the distribution of sleep stages throughout the night were related to the elimination half-life characteristics of the hypnotics, but few trends were detected. Both the protective properties against environmental noise of the hypnotics studied and the validity of the model of induced sleep disturbance in evaluating hypnotic agents are discussed.

Effects of bretazenil vs. zolpidem and placebo on experimentally induced sleep disturbance in healthy volunteers.

The effects of bretazenil 0.25 and 0.5 mg, a partial agonist at the benzodiazepine receptor, on sleep electroencephalogram (EEG), subjective sleep quality and morning psychomotor performance were compared to zolpidem 10 mg and placebo using noise as an experimental sleep disturbing factor in a single dose, double-blind, crossover study. Twelve healthy volunteers were subjected to prerecorded traffic noise with a mean sound level of 52 dB(A) during eight hours in bed. Significant effects of noise were found on sleep electroencephalogram (EEG) parameters (rapid eye movement [REM] sleep, stage 2 sleep and number of arousals), and subjective sleep quality assessments, but not on psychomotor performance (choice reaction time, digit span memory, and symbol digit substitution). Both drugs reduced the number of shifts between sleep stages and the number of arousals and increased REM sleep latency. Only after 0.5 mg bretazenil, stage 2 sleep increased and REM sleep decreased. Both doses of bretazenil significantly affected performance in the symbol digit substitution test. Sleep quality improved under drug treatments compared to placebo. The results suggest that experimental sleep disturbance can be a valuable tool in the investigation of potential sleep promoting compounds.

Trazodone in benzodiazepine dependence.

BACKGROUND: The authors set forth to test the usefulness of trazodone as an alternative anxiolytic in benzodiazepine-dependent patients. METHOD: Ten benzodiazepine-dependent patients according to DSM-III-R were hospitalized during a 2-4 week period and treated with trazodone (100 mg t.i.d.) while their benzodiazepine intake was progressively tapered; they left the hospital on a regimen of only a 300-mg daily dose of trazodone and were followed as outpatients at monthly intervals. The dose of trazodone was individually adapted according to condition. RESULTS: Very limited withdrawal phenomena occurred during the benzodiazepine taper period; during the 1-year follow-up, all patients remained off benzodiazepines and showed no evidence of abuse of trazodone. The dose of trazodone was significantly reduced to 185 mg (p = .003); the ratings of anxiety and depressive symptoms also significantly improved during follow-up: from 12.3 to 5.4 on the Hamilton Rating Scale for Anxiety (p = .002) and from 11.6 to 4.8 on the Hamilton Rating Scale for Depression (p = .002). CONCLUSION: These findings suggest the usefulness of trazodone as an alternative anxiolytic in patients at risk for benzodiazepine abuse.

Explorative single-blind study on the sedative and hypnotic effects of buspirone in anxiety patients.

In this single-blind study the sedative and hypnotic properties of buspirone, a nonbenzodiazepine anxiolytic, were investigated in 8 anxious outpatients. Polysomnographic recordings were gathered during baseline, at the start of active medication, after 3 weeks of treatment and one night after discontinuing treatment. Daytime alertness was measured using the Multiple Sleep Latency Test and performance tests. The effects of buspirone on sleep structure were minimal and of no clinical consequence. Subjectively, the patients reported improved sleep quality. There were no effects on daytime alertness at the beginning, after 3 weeks or at sudden discontinuation of the medication. It is concluded that buspirone does not have a sedative or hypnotic effect in anxiety patients.

Psychological correlates of the dexamethasone suppression test response and of the shortened REM sleep latency in depressed outpatients.

The overlap between REM sleep latency and DST response was investigated in a group of 117 mildly depressed outpatients. No significant correlation between these two biological markers could be evidenced. The MMPI profile of the DST suppressors was clearly different from the non-suppressors' profile indicating a more severe clinical condition at that moment. REM sleep latency did not contribute to the psychological and clinical subtyping of this depressive sample.

Insomnia. From a single entity to a complex concept.

This paper presents a summary of 106 patients monitored at the Sleep/Wake Disorders Center of the University Hospital in Antwerp. Diagnostic assessment is based upon information from history, physical and psychiatric examination, sleep logs, psychological tests and polysomnographic workups, including at least 2 consecutive nights. A major conclusion is that complete understanding of sleep problems needs a multifactorial approach. This not only leads to a more accurate description of the disorder, but also to rational, specific and individualized treatment strategies.

[Tracheostomy in the sleep apnea syndrome]. / Tracheostomie in slaap-apnea syndroom.

Two cases of sleep apnea syndrome treated by tracheostomy are described. Indications and rationale for tracheostomy are outlined. The hasard of preoperative premedication or the use of mild sedatives is stressed.

The effect of pentylenetetrazol on the levels of dopamine-beta-hydroxylase in the cerebrospinal fluid of rabbits: a dose-dependent relationship.

The effect of various doses of pentylenetetrazol (PTZ) on the levels of dopamine-beta-hydroxylase (D beta H) and acetylcholinesterase (AChE) in the CSF of rabbits was studied. The drug augments in a dose-dependent manner the D beta H activity but causes only a small and dose-independent increase in AChE. This suggests that PTZ-induced convulsions are associated with an increase in central noradrenergic activity but not by an increase in central cholinergic activity.