Cross-Calibration of Prodigy and Horizon A Densitometers and Precision of the Horizon A Densitometer

We performed this study to enable a reliable transition for clinical study participants and patients from a GE Lunar Prodigy to a Hologic Horizon A dual-energy X-ray absorptiometry (DXA) scanner and to assess the reproducibility of measurements made on the new DXA scanner. Forty-five older adults had one spine, hip, and total body scan on a Prodigy dual-energy X-ray absorptiometry (DXA) scanner and 2 spine, hip, and total body scans, with repositioning, on a new Hologic Horizon A DXA scanner. Linear regression models were used to derive cross calibration equations for each measure on the 2 scanners. Precision (group root-mean-square average coefficient of variation) of bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine (L1-L4), and total body fat, bone, and lean mass, appendicular lean mass, and trabecular bone score (TBS) was assessed using the International Society of Clinical Densitometry's (ISCD's) Advanced Precision Calculation Tool. Correlation coefficients for the BMD and body composition measures on the 2 scanners ranged from 0.94 to 0.99 (p<0.001). When compared with values on the Prodigy, mean BMD on the Horizon A was lower at each skeletal site (0.136 g/cm² lower at the femoral neck and 0.169 g/cm² lower at the lumbar spine (L1-4)), fat mass was 0.47 kg lower, and lean mass was 4.50 kg higher. Precision of the Horizon A scans was 1.60% for total hip, 1.94% for femoral neck, and 1.25% for spine (L1-4) BMD. Precision of TBS was 1.67%. Precision of total body fat mass was 2.16%, total body lean mass was 1.26%, appendicular lean mass was 1.97%, and total body bone mass was 1.12%. The differences in BMD and body composition values on the 2 scanners illustrate the importance of cross-calibration to account for these differences when transitioning clinical study participants and patients from one scanner to another.     

A study on the association between serum amyloid A and sperm concentration

Our aim was to compare peripheral blood and seminal fluid serum amyloid A (SAA) protein levels in men classified on the basis of sperm concentration and investigate whether SAA protein is an important marker of male infertility. A total of 74 first‐attempt IVF male partners of infertile couples classified as azoospermic (n = 25), oligozoospermic (n = 25) and normozoospermic group (n = 24) were recruited for this cross‐sectional study. There was no difference with respect to age, BMI, infertility period and smoking ratio. No difference in haematologic parameters including white blood cell count, neutrophil ratio, lymphocyte ratio, neutrophil‐to‐lymphocyte ratio and blood SAA level was found between the groups. Seminal fluid SAA level was 17.85 ± 2.21 ng ml^?1 in azoospermics, 16.13 ± 3.58 ng ml^?1 in oligozoospermics and 15.67 ± 4.77 ng ml^?1 in normozoospermics, showing no significant difference. Seminal SAA level was found to be not correlated with blood SAA levels. Therefore, we could not find any associations between these parameters at all. However, further studies with more participants are needed to address the exact action of SAA on spermatogenesis.     

A mucinous cystadenocarcinoma of the pancreas. A clinical and histopathological contribution

Two cases of pancreatic cystadenocarcinoma, a very rare pathology, are reported. The authors treat the anatomopathological classification and they underline the diagnosis especially with reference to the new methods of cytologic study. Finally they consider the surgical approach that must be radical because of the potential malignancy of this kind of tumor whose prognosis is quite good with a lasting long-term survival.     

Maternal Vitamin A Nutriture and the Vitamin A Content of Human Milk

Because of the many functions of vitamin A inhuman physiology, deficiency or excess of the vitamin inlactating women or their infants can adversely affecttheir health. Infants are born with low body stores of vitamin A, and rely on vitamin A inmilk to meet their needs. The vitamin A content of milkis related to maternal vitamin A status and maternaldietary vitamin A intake during lactation. Low-income lactating women in non-industrialized countrieshave lower milk vitamin A concentrations than lactatingwomen in industrialized countries. Supplementation oflactating women in non-industrialized countries with vitamin A or beta-carotene has resulted inincreased milk vitamin A concentrations. However, theoptimal timing and dose for sustaining adequate levelsof vitamin A in milk throughout the lactation period has not been determined. Furtherresearch is needed to understand factors affecting thetransfer of vitamin A to milk, and to evaluate variousstrategies for improving the vitamin A status of mothers and infants.     

A gun-shot lesion of the internal carotid. A clinical case and review of the literature

The authors report a case with penetrating zone II neck wound and internal carotid artery injury. Optimal evaluation and management with vascular injury remains controversial. A review of retrospective studies reported in the literature has demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. Not unexpectedly, the results of carotid artery repair in neurologically stable patients have been excellent, in front of the results of revascularization in patients with equivocal or less-severe neurologic deficits.     

A year's trauma admissions and the effect of the weather

PURPOSE OF THE STUDY: To study the admissions to a busy trauma unit on a day-by-day basis over a 1 year period, and to look for any correlation with local weather variation or temporal factors (day of the week, weekends/school holidays, etc.). METHOD: Admissions data for the Trauma Unit at the Leicester Royal Infirmary was collected from an administrative database and ward records for the calendar year of 1998. Admissions were split into four groups: all admissions, adult admissions, admissions for proximal femoral fractures (neck of femur (NOF)) and paediatric admissions. Weather information for the local area was obtained from the Meteorological Office. Details of school holidays were obtained from the local Education Department. The above variables were examined using Poisson regression analysis for their potential importance in explaining day-to-day variation in admission rates for the four groups. RESULTS: For adult and NOF admissions, none of the weather factors appeared to explain variation in incidence, only day of the week appears to be important, with the earlier part of the week yielding a highly statistically significant increase in the relative incidence of trauma admissions. For both paediatric and total admissions, a number of factors appear important, including maximum and minimum temperatures, hours of sunshine, day of the week and month of the year. Daily rainfall, significant weather and whether the day was a school day or school holiday did not appear to be important on univariate analysis. CONCLUSION: Trauma admissions are related to both weather and temporal factors. This may have implications both in terms of prevention and in planning of care provision in trauma units.     

A comparison between the Macintosh and the McCoy laryngoscope blades

The view of the larynx using the Macintosh laryngoscope and the McCoy levering laryngoscope was assessed in 177 adult patients. The view with the McCoy blade in the neutral position and in the position (neutral or elevated) that gave the 'best' view were recorded. The McCoy blade in the neutral position was associated with a lower incidence of grade 1 views and a higher incidence of grade 2 views than the Macintosh blade. There was no difference in the incidence of grade 3 views. When views for each patient using the different blades were compared, the McCoy blade in the neutral position produced a worse view than the Macintosh blade (p < 0.0001). The view obtained with the McCoy blade in its 'best' position and the Macintosh blade were similar. In the 152 patients in whom the vocal cords were seen using the Macintosh blade, the view was worse using the McCoy blade in its 'best' position more often than it was better (p = 0.06). In 25 patients, the vocal cords could not be seen with the Macintosh blade; in these patients the view was better with the McCoy blade (the cords were visible) on 14 occasions and worse in one (p = 0.001). We conclude that the McCoy blade in its neutral position does not behave identically to the Macintosh blade. The McCoy blade is a useful aid to difficult intubation but should not replace the Macintosh blade as the first choice laryngoscope.     

A giant intrathoracic osteolipoma: A case report and review of the literature

IntroductionLipomas are ubiquitous and can occur anywhere in the body. Intrathoracic lipomata are rare benign lesions. However, a complete removal giant intrathoracic osteolipoma is achieved with only 18 cases previous cases described in medical literature from 1960 to 2008.Presentation of caseA 66-year-old female presented to our hospital suffered from mild chest pain and mild shortness of breath for more than 10 days. A subsequent chest X-ray and CT scans revealed a large homogeneous, low-attenuation fat density mass containing an oval calcification area in the center of the mass. Following surgical resection was performed successfully to remove the entire mass, which weighed a total of 1568 g and measured 26 cm × 19 cm × 12 cm in size. The histological analysis confirmed a giant intrathoracic osteolipoma without evidence of malignancy.DiscussionIntrathoracic lipomas are rare, slow-growing benign tumors without any symptom, which originate from the adipose tissue in submesothelial layers of the pleura parietalis, diaphragm, mediastinal and extrapericardial. They may extend into the chest cavity and fully encapsulate in most cases. Chest X-ray and CT and MRI scans are the most helpful tests in the diagnosis of intrathoracic lipomas. Complete enbloc removal of lipoma whenever possible, is the only definitive treatment option and the only way to prevent future recurrences.ConclusionThis case is the largest intrathoracic osteolipoma documented in the modern literature. Complete enbloc removal of lipoma whenever possible, is the only definitive treatment option.     

Trigger fingers requiring simultaneous division of the A1 pulley and the proximal part of the A2 pulley

In a prospective study of 50 adult patients with primary idiopathic trigger finger, four patients (8%) required simultaneous division of the proximal 3 to 4mm of the A2 pulley as well as the A1 pulley in order to completely resolve the triggering. At final follow up at 6 to 12 months, all patients were symptom-free with a full range of motion of the fingers. This entity is discussed.     

Inhalational injury and the larynx: A review

ObjectiveTo review and discuss the existing research on the pathophysiology, impact and management of inhalational injury on the larynx and lower respiratory tract.Data sourcesA literature search was conducted on the PubMed, MedLine, Embase, Web of Science and Google Scholar databases based on the keywords “airway burn”, “inhalational injury” and “larynx”.Review methodsInclusion criteria included English language studies containing original and review data on airway injury. Data was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.ConclusionsAbnormal laryngeal and lower airway findings are common in burns patients and the incidence tends to increase with severity of the burns. Most patients with abnormal findings remain dysphonic decades after the initial injury. Larynx, the inlet to the airway, is exposed to the most intense thermal damage and highest concentration of chemical in inhalational injury. Airway injury is common and may result in long term morbidity. Healing of this tissue architecture is prolonged and different from cutaneous burn. Many patients receive prolonged intubation for medical complications that arise due to the burn injury. The degree of subglottic damage, however, is more extensive and occurs sooner compared with those without inhalational injuries.Implications for practiceWith advances in acute medical and surgical management of burn and inhalational injury, airway injury is an important secondary outcome with lasting impact. Awareness of these potential complications and early involvement of medical and allied health team are important steps in improving patient care. A multi-disciplinary approach to management will optimise the short and long-term morbidity management and ultimately our patients’ quality of life.