Basis Of Clinical Examination Research Articles

Conservative Management of Osteoporotic Vertebral Fractures: A Prospective Study of Thirty Patients.

IntroductionOsteoporotic vertebral fractures relate to poorer quality of life and higher long-term mortality. In a resource-poor setup, conservative management assumes great importance as primary means of treatment. We assess the clinico-pathological epidemiology of osteoporotic vertebral fractures and prospectively evaluate the effectiveness of conservative management in their treatment.Materials & Methods Thirty consecutive patients, diagnosed with osteoporotic vertebral fracture, underwent the predetermined protocol of conservative treatment (bed rest, titrated analgesia, antiosteoporosis pharmacotherapy, bracing, and supervised physical therapy) after assessment of basic demographic data and clinical examination. They were evaluated every three months for nine months, using visual analog scale (VAS) for backpain, Oswestry Disability Index (ODI), and radiological and hematological parameters.Results The mean age of the patients was 66.9 +/-7.6 years and the female: male ratio was 14:1. All (100%) women were postmenopausal and the mean time since menopause was 16.75 +/- 8.12 years. The presenting complaints were backpain (100%) and deformity (53.33%). Neurodeficit was noted in one (3.33%) patient. Higher age was correlated to greater vertebral collapse (p=0.001) and higher kyphotic angle (p=0.002). At nine months after treatment, there was a significant decrease in the VAS score (p<0.0001) and the ODI score (p<0.0001), with the final VAS score improving by 49.25% and the ODI score improving by 47.23% from the baseline. There was progressive increase in vertebral collapse (p=0.0474) with no change in kyphotic or scoliotic angles. With treatment there was a consistent increase in serum calcium (p<0.0001), phosphorous (p<0.0001), and vitamin D3 (p<0.0001) levels, and decrease in parathyroid hormone levels (p<0.0001).Conclusions A multidisciplinary conservative treatment is effective as the primary treatment for patients with osteoporotic vertebral fractures. It alleviates pain, decreases disability, reduces morbidity, and is effective in preventing further progression of the disease process clinically, radiologically, and hematologically.

A New Classification for the Varus Knee

BackgroundA new classification for osteoarthritis of the knee associated with varus deformity is presented. This classification is derived from the combination of conventional radiographs, stress radiographs (when needed), and clinical examination. MethodsThis study included the analysis of coronal alignment on full-leg standing radiographs of 526 patients awaiting knee arthroplasty for varus deformity in a single institution. Various mechanical and anatomic angles were measured, and these findings were combined with a basic clinical examination of patients. The radiographs were measured on 2 separate occasions to determine the intraobserver reliability. Cross-sectional studies such as computed tomography or magnetic resonance imaging were used to further refine observations about different wear patterns. ResultsVarus deformity can either be intra-articular or extra-articular. Intra-articular deformities can be correctable or fixed. In fixed deformities, the status of the lateral ligament is taken into account. Extra-articular deformity can be metaphyseal or diaphyseal, and the possibility for intra-articular correction will depend on the degree of deformity and its distance from the joint. ConclusionThis new classification allows for better definition of varus deformity, which can help surgeons during preoperative planning, particularly with their choice of implant and potentially the degree of constraint. The classification can also be a tool for further prospective studies about varus deformity.

Clinical manual assessment of the wrist

Although hand therapists often evaluate patients with wrist pain, novice and experienced clinicians alike would benefit from a systematic assessment to efficiently identify the source of dysfunction and initiate an appropriate treatment plan. This article proposes a systematic approach for clinical evaluation of the wrist by describing the basic clinical examination (BCE) process and interpreting the findings in terms of common pathology. The BCE will enable the hand therapist to identify conditions that are contraindicated for conservative care and require further physician intervention, determine a working diagnosis for most musculoskeletal problems, and determine the appropriate extra tests to confirm the working diagnosis and/or rule out differential diagnoses. By combining findings from the patient's history, BCE, and special testing, hand therapists can efficiently determine the underlying pathology and provide appropriate treatment that can optimize clinical outcomes.

Clinical Assessment, Management and Histo-Pathological Study of Orbital Tumours – A Prospective Clinical Study

Aim of this study is to assess and categorize , the clinico-pathological distribution, management, surgical approaches followed in various types of orbital tumours which were encountered in our practice from October 1994 to till date(January 2016) Materials and methods consisted of 30 patients, with orbital swellings, who visited the outpatient department of Kempegowda Institute of Medical Sciences,- Bangalore and Rajarajeshwari Medical College- Bangalore, where the author has worked in the capacities of Assistant Professor, and Associate Professor respectively. Majority of the cases visited his outpatient department, in Vidya Eye Hospital, Bangalore, where the author is the proprietor. Basic clinical examination was done in each case. Later, investigated by radiography, CT-Scan, MRI to assess, the characteristics and extension of the tumour, to extraorbital areas. Suitable orbitotomy procedures were chosen depending upon the cases. The tumours removed thus were subjected for histo-pathological examination. The conclusion was drawn based on our clinical experience in managing these cases

Echocardiographic screening in children and teenagers to be admitted to sports activities

Children and teenagers are a group in which congenital heart disease (CHD) is most commonly considered as a contraindication to sports activities. In this connection, 440 athletes aged 15.6±1.8 years, who had been going for sports for 6.4±2.5 years and who had undergone echocardiography, were examined. The rate of congenital heart disease according to the preliminary diagnoses was 77 (17.5%), that after echocardiographic verification was 238 (54.1%) (p<0.0000). Training volume and intensity limitations were recommended in 114 (47.9%) athletes because of cardiac morphological and functional changes. These changes contradicting sports activities were not found in 124 (52.1%) athletes. Conclusions. 1. EchoCG screening for congenital heart disease is required to define contraindications to sports activities, for it is impossible to establish its diagnosis only on the basis of clinical examination and ECG. 2. The mere fact of CHD is not a contraindication to athletic activities; is necessary to evaluate hemodynamic disorders associated with this pathology. 3. Abnormally located chordae and trabeculae are neither followed by any complications and nor a contradiction to sports activities.

Hip Instability following DHS Fixation Surgery for Unstable Four Part Per-Trochanteric Fracture Femur

Background: In an ageing population, with resultant osteoporosis hip fractures are common indication for per-trochanteric fracture hip repairs. Various modalities of surgical treatment basically emphasis fracture reduction, fracture immobilization, and rehabilitation as a guide to treatment. Subluxation or dislocation following operative treatment of four part unstable per-trochanteric fracture with Sliding Hip Screw is rare and occasional cases have been reported. Material and Methods: An observational prospective study carried out at tertiary care hospital from Jan 1997 – Dec 2014. Our operative experience of total 510 patients of which 480 underwent DHS fixation surgery for unstable four part per-trochanteric fracture showed 6 cases of instability as subluxation and dislocation. Results: We report 6 cases out of 480 DHS fixation showing instability in 3 cases and subluxation and dislocation in 3 cases after 6 weeks of follow-up. These patients were offered arthroplasty and the follow-up results were evaluated after 8 months. Among 6 cases, four had instability after six weeks and remaining two developed dislocation after eight months which were associated with infection. 1 patient refused further investigations &amp; treatment, 3 other died with due course of time, 1 lost to follow -up and One patient with infection underwent excision arthroplasty. Conclusion: Hip instability following DHS fixation surgery for four part Per-trochanteric fracture femur is a rare complication. Cause of this complication could be mechanical factors (excessive collapse, rotational torque) and infection (superficial or deep) may serve as a contributing factor. Diagnosis was done mainly on the basis of clinical examination and investigations such as X-rays, USG and blood tests. Treatment for such complications consists of Hip arthroplasty. These complications can be prevented with the use of TFN or cemented bipolar prosthesis primarily for treating these type of fractures. Keywords: Intertrochanteric fracture, hip instability, surgical fixation

Mean platelet volume in patients with retinal artery occlusion.

The aim of this study was to investigate the mean platelet volume (MPV) of patients with retinal artery occlusion (RAO). Thirty-seven patients diagnosed with RAO and 32 control subjects were included in this retrospective study. Retinal artery occlusion was diagnosed on the basis of clinical examination and fundus fluorescein angiography. All participants underwent complete ocular examination, and MPV, hematocrit, hemoglobin, and platelet counts were recorded. RAO patient data were compared with those of the control subjects. Patients with RAO had significantly higher MPV values (7.96 ± 1.2 fL) compared with control subjects (7.33 ± 0.7 fL, p<0.001). No significant difference was found with regard to platelet count between the RAO group and the control group (262 ± 70.1 × 109/L and 251 ± 56.6 × 109/L, respectively, p=0.50). MPV was an independent predictor of RAO [odds ratio (OR)=0.50; 95% confidence interval (CI)=0.28-0.89; p=0.019). Our results demonstrated that MPV values were significantly higher in patients with RAO, suggesting that larger platelets may contribute to the pathogenesis of the RAOs.

Acute hemorrhagic edema: Rare variety of leukocytoclastic vasculitis

A 12-month-old boy presented with swelling all over body, reddish brown lesions over both lower extremities, and mild fever. On examination, pallor was present, vitals were stable, and child appeared well-except for edema and rashes. Pitting edema was present over all extremities and periorbital region. There was no edema over scrotum and abdominal wall. Skin examination showed erythematous, palpable, purpuric lesions (0.5–3 cm in diameter) over buttocks and lower limbs sparing trunk, face, and upper limbs. All other systems were within normal limits. Skin biopsy showed the features suggestive of leukocytoclastic vasculitis. Diagnosis of acute hemorrhagic edema was made on the basis of clinical examination and skin biopsy. The child responded to steroids.

OSSICULAR STATUS IN CHOLESTEATOMA : A DEPARTMENTAL EXPERIENCE IN A STATE MEDICAL COLLEGE OF WESTBENGAL.

Introduction: Chronic otitis media is a long standing infection of part or whole of middle ear cleft. Its active squamosal variant (cholesteatoma) is most dangerous due to its bone eroding property.&#x0D; Aims &amp; Objective: Background knowledge of ossicular status in cholesteatoma will help us in determining the type of reconstruction needed during the surgery.&#x0D; Material &amp; methods: 60 cases of cholesteama, irrespective of age and sex [diagnosed on the basis of clinical examination , audiological and radiological evaluation] were selected during the study period of two years and their ossicular status were recorded intra-operatively.&#x0D; Results &amp; analysis: Ossicles and their parts getting involved in cholesteatoma cases , in decreasing order are :&#x0D; Lenticular process (in total 50 cases)&gt;Long process of incus (in total 49 cases) &gt; stapes super-structure(in total 29 cases) &gt; body of incus(in total 26 cases)&gt; head of malleus(in total 23 cases)&gt; handle of malleus(in total 10 cases).&#x0D; Ossicular chain defeact in decreasing order are : M-I-S- &gt; M+I-S- &gt; M-I-S+ &gt; M+I-S+.&#x0D; Conclusion: In our study it was found that incus is the most vulnerable ossicle to get involved in cases of active squamosal variety of chronic otitis media where as malleus appeared to be the least susceptible one.

The use of instrumented gait analysis for individually tailored interdisciplinary interventions in children with cerebral palsy: a randomised controlled trial protocol.

BackgroundChildren with cerebral palsy (CP) often have an altered gait. Orthopaedic surgery, spasticity management, physical therapy and orthotics are used to improve the gait. Interventions are individually tailored and are planned on the basis of clinical examinations and standardised measurements to assess walking (‘care as usual’). However, these measurements do not describe features in the gait that reflect underlying neuro-musculoskeletal impairments. This can be done with 3-dimensional instrumented gait analysis (IGA). The aim of this study is to test the hypothesis that improvements in gait following individually tailored interventions when IGA is used are superior to those following ‘care as usual’.Methods/DesignA prospective, single blind, randomised, parallel group study will be conducted. Children aged 5 to 8 years with spastic CP, classified at Gross Motor Function Classification System levels I or II, will be included. The interventions under investigation are: 1) individually tailored interdisciplinary interventions based on the use of IGA, and 2) ‘care as usual’. The primary outcome is gait measured by the Gait Deviation Index. Secondary outcome measures are: walking performance (1-min walk test) and patient-reported outcomes of functional mobility (Pediatric Evaluation of Disability Inventory), health-related quality of life (The Pediatric Quality of Life Inventory Cerebral Palsy Module) and overall health, pain and participation (The Pediatric Outcome Data Collection Instrument). The primary endpoint for assessing the outcome of the two interventions will be 52 weeks after start of intervention. A follow up will also be performed at 26 weeks; however, exclusively for the patient-reported outcomes.DiscussionTo our knowledge, this is the first randomised controlled trial comparing the effects of an individually tailored interdisciplinary intervention based on the use of IGA versus ‘care as usual’ in children with CP. Consequently, the study will provide novel evidence for the use of IGA.Trial registrationTrial registration: ClinicalTrials.gov NCT02160457. Registered June 2, 2014.

PROGNOSTIC IMPACT OF NEOADJUVANT CHEMOTHERAPY ON JUVENILE NASOPHARYNGEAL CARCINOMA.

ABSTRACT Objective: To study the efficiency of neoadjuvant chemotherapy (NACT) and the impact of CT response on prognosis of juvenile nasopharyngeal carcinoma (NPC). Materials and Methods: From 1995 to 2005, 108 non-metastatic NPC patients younger than 25 years old were treated with NACT at Salah Azaiz Institute.The Median age of patients was 17 year-old and the male/female ratio was 1.6. According to the 2002 TNM staging system, T3-T4 tumors and N3 nodal status rates were 64% and 52%, respectively. All patients had undifferentiated carcinoma and received three cycles of CT combining doxorubicin and cisplatin followed by conventional RT with a total dose of 70 Gy to the primary tumor and the cervical areas initially involved, and 54 Gy to the remaining cervical areas. Tumor response to NACT was assessed after the third cycle on the basis of clinical examination (100%) and CT-scan of the nasopharynx (66%). Response was evaluated according to WHO criteria. Results: The overall CT response rate was 88% at cervical lymph node (complete response (CR): 35%, partial response (PR): 53%) and 83% at primary tumor (CR: 20%, PR: 63%). A complete remission at the end of the treatment program was observed in 91% of cases. Five-year DFS and OS rates were 75% and 81%, respectively. A no response (NR) or progressive disease (PD) after NACT at both cervical nodes and primary tumor had a statistically significant pejorative impact on DFS (p<0.001 and p=0.04, respectively) and OS (p<0.001 and p=0.037). Five-year DFS and OS rates of patients in CR after initial CT at cervical nodes was significantly better than the other patients (PR, NR, or PD) (94% vs. 66% and 94% vs. 73%, respectively). Conclusion: Our results showed that NPC is a very chemosensitive neoplasm and suggest that a regimen of induction CT followed by RT is feasible and can provide excellent antitumor effect in juvenile NPC. The prognosis was influenced by response to initial CT; the DFS and OS were better in patients with a good response to CT. RT dose reduction to good responders could be an interesting therapeutic approach in order to limit long-term sequelae.

Clinico-etiological profile of childhood stroke in a Tertiary Care Hospital in Eastern India.

Background:The clinical pattern and etiology of stroke may vary over time or with geographical location. In Asian countries, specific etiology and outcome of childhood stroke have been rarely reported.Objective:To determine the clinical and etiological pattern of childhood stroke and their outcome in a Tertiary Care Center.Materials and Methods:This study was conducted in a Tertiary Care Hospital of Kolkata over a period of 3 years. All children from 6 months to 12 years, diagnosed as childhood stroke by radio-imaging were included in our study. Children presenting with paraplegia/paraparesis were excluded. Etiologies were determined on the basis of clinical examination, related blood investigations and radio-imaging findings. Data gathered from the stroke patients were entered into a preformed proforma and appropriate statistical analyses were done.Result:Most commonly found clinical presentation was hemiparesis (70.6%). Next in place was a seizure (61.8%) and alteration of consciousness (58.8%). The most common etiology of childhood stroke in our hospital was found to be an intracranial infection (41.2%), followed by vascular etiology. Stroke was ischemic in nature in 91.2% of cases. Among the clinical features, vomiting, alteration of sensorium, and fever were significantly (P < 0.01) more in infectious cases of stroke, but hemiparesis was significantly (P < 0.05) more common in noninfectious etiology. Most of the cases of noninfectious etiology (95%) completely recovered without any persistent neurodeficit or mortality.Conclusion:Intracranial infection is the commonest etiology of stroke in pediatric patients presenting at our hospital. Commonest type is an ischemic stroke. The most of the patients completely recovered from the acute neurological insult after proper and timely management.

Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model

BackgroundChoroidal naevomelanocytic lesions are often identified as an incidental finding by community optometrists and referred for expert evaluation in hospital eye units or specialist ocular oncology centres. Optimal management strategy...

Associação entre aplasia segmentar de veia safena magna e varizes em membros inferiores avaliada pelo ecocolor Doppler

ResumoContextoHá diferenças individuais no diâmetro da veia safena magna (VSM) em membros normais e doentes; sendo possível a identificação dessas alterações pelo ecocolor Doppler.ObjetivoAvaliar a associação da aplasia segmentar da VSM com a presença de varizes e/ou insuficiência da mesma em membros inferiores, usando o ecocolor Doppler em pacientes com clínica de doença venosa crônica (DVC).Métodos1.408 pacientes com queixas compatíveis de DVC de membros inferiores, sendo 1.286 do sexo feminino, com idade entre 17 e 85 anos, examinados com ecocolor Doppler. Foram incluídos aqueles com classificação CEAP clínica C0 a C4. Pela avaliação clínica, a amostra foi distribuída em grupo A, pacientes com varizes, e grupo B, aqueles sem varizes. O ecocolor Doppler determinou se havia aplasia da VSM pela análise do seu trajeto no compartimento safeno e presença de veias varicosas nos diferentes sítios. Para estatística, foram considerados os testes Qui-quadrado ou Exato de Fisher e uma análise de resíduos em tabelas, com nível de significância de 5%.ResultadosNo grupo A houve 479 (83,9%) de VSM insuficientes, 169 (38,2%) com aplasia e 71 (80,7%) com insuficiência e aplasia associadas. No grupo B, houve 92 (16,1%) de VSM insuficientes, 273 (61,8%) com aplasia e 17 (19,3%) com insuficiência e aplasia associadas.ConclusãoA aplasia segmentar da VSM ocorre mais em membros inferiores que não apresentam varizes e/ou insuficiência da mesma, mas considerando-se a presença da associação de aplasia e insuficiência, houve maior incidência no grupo de membros que apresentavam varizes.

Risk Factors and Current Health-Seeking Patterns of Migrants in Northeastern Mexico: Healthcare Needs for a Socially Vulnerable Population.

This study identified risk factors for health and access to healthcare services of migrants during their journey across Mexico to the United States. Data were collected in shelters located in Monterrey, the largest city of northeastern Mexico, through a basic clinical examination and a survey completed by 75 migrants; 92% of them were undocumented Central Americans. During their transit, they are at a high risk of contracting, developing, and transmitting diseases. The need of working to survive affects health-seeking behavior and a constant fear of being traced keeps migrants away from public health services, which delays diagnosis and treatment of diseases. Negligent lifestyles, such as smoking, drinking (31.8% of men and 11.1% of women), and drug abuse (13% of men and 11% of women), were found. Regarding tuberculosis (TB), undocumented migrants are usually not screened, even though they come from countries with a high TB burden. Besides, they might be overexposed to TB because of their living conditions in overcrowded places with deficient hygiene, protection, and malnutrition (54.7% of the sample). Possible comorbidities like acquired immune deficiency syndrome (AIDS; 4%) and diabetes (2.7%, but probably under-diagnosed) were referred. Migrants have little TB knowledge, which is independent of their level of education or a previous experience of deportation. About one-third of the migrants were totally unfamiliar with TB-related symptoms, while 36% had correct knowledge of basic TB symptoms. We conclude that a shortage of information on the highly vulnerable migratory population combined with a lack of social support and health education among migrants may play a significant role in the spread of communicable diseases. We recommend that health authorities address this urgent, binational, public health concern in order to prevent outbreaks of emerging infections.

Contrast-enhanced ultrasonographic characteristics of the diseased canine prostate gland

The work was carried out on a total of 26 male dogs that on the basis of clinical examination, prostate ultrasound and prostate biopsy, were divided prospectively into four groups: (1) normal dogs (control group; n = 8); (2) dogs with benign prostatic hyperplasia (group BPH; n = 8); (3) dogs suffering from prostatitis (group prostatitis; n = 4); (4) dogs with prostatic tumors (group tumors; n = 6). The examination of the prostate by means of contrast medium and dedicated ultrasound system allowed a detailed qualitative and quantitative analysis of prostatic vessels in normal and diseased conditions, enabling the detection and characterization of different disease states, and quantification of parameters such as peak intensity of perfusion (%), arrival time of the contrast medium to its maximum value of video intensity (time to peak [TTP; seconds]), regional blood volume, regional blood flow, and mean transit time (MTT [seconds]). The hemodynamic indices TTP (P < 0.01) and MTT (P < 0.001) of diseased prostate groups were significantly lower than those in the normal prostate group although there were no differences among diseases. Optimal cutoff values were 31 seconds (Sensitivity: 72%; Specificity: 88%) and 47 seconds (Sensitivity: 100%; Specificity: 88%) while area under receiver operating characteristic curves were 0.86 (P < 0.01) and 0.97 (P < 0.01) for TTP and MTT, respectively. The qualitative evaluation of vascular patterns showed differences between normal and diseased prostate glands. The latter were characterized by an alteration of the normal vascular appearance consisting of loss of the subcapsular arterioles and lack of a centripetal vascular pattern. The qualitative aspect of the study highlighted the different vascular architecture between BPH, prostatitis, adenocarcinoma, and lymphoma. This study shows how contrast-enhanced ultrasound represents a valid and noninvasive method for highlighting and characterizing prostatic vasculature. Furthermore, it allows the operator to obtain qualitative and quantitative data that are useful for the diagnosis of selected prostatic diseases. In conclusion, contrast-enhanced ultrasound can be a valuable noninvasive diagnostic tool to improve the diagnostic accuracy of prostate diseases in the dog.

Should routine assessment of anastomotic integrity be undertaken using radiological contrast swallow after oesophagectomy with intra-thoracic anastomosis? Best evidence topic (BET)

Thoracic anastomotic leak is associated with significant postoperative morbidity and mortality. Routine contrast oesophagograms are consequently employed by a number of centres to routinely screen for this complication yet there exists little consensus as to if and when this assessment should occur. We have demonstrated within this BestBET analysis of five level IV case series that routine contrast oesophagograms lack adequate sensitivity or positive predictive value to be effective as screening tools, with leaks often arising clinically prior to scheduled routine assessment. We additionally demonstrate the significant risk of aspiration associated with contrast swallow use. The use of contrast swallow studies as diagnostic tools in patients for whom a leak is considered likely on the basis of clinical examination is nevertheless supported by relatively greater negative predictive values and specificity reported within the literature. There is additional evidence to support the use of CT imaging with oral contrast and endoscopic assessment of the anastomosis as valuable tools to assess for anastomotic integrity.

Multiple skin ulcers from malignant syphilis

A 38-year-old man presented to our department in April, 2014, with a 1 month history of multiple painful skin ulcers (fi gure) on his face, trunk, and extremities. The eruptions had started as papular and nodular lesions and progressed to pustules and painful ulcers within 2 weeks. He had been diagnosed with pyoderma gangrenosum at his local hospital and treated with methylprednisolone. After 1 week, the lesions had worsened and he had developed fever. He reported having had sex with four women during the past year and denied ever having sex with men. Histological examination of a biopsy sample from an ulcer on his left arm indicated psoriasiform epidermal hyperplasia with central ulceration. In the dermis we noted mixed perivascular infi ltrate with neutrophils, lymphocytes, plasma cells, and histiocytes. Stains for fungi, mycobacteria, and spirochetes were negative. Full blood cell count, CD4 cell count, CD8 cell count, anti-neutrophil cytoplasm antibody test, HIV serotest, and cultures for fungi and bacteria (including Mycobacterium tuberculosis and Neisseria gonorrhoeae) were normal or negative. The erythrocyte sedimentation rate (ESR) was 50 mm/h (normal range 0–20 mm/h). Serum treponema pallidum particle agglutination assay (TPPA) was positive and rapid plasma reagin (RPR) titre was 1:128. On the basis of clinical examination, serum TPPA, RPR, and histological examination, we diagnosed malignant syphilis. We started 2·4 mg intramuscular benzathine penicillin injections, once a week for 3 weeks. 6 months later the ulcers had healed completely, although atrophic scars remained (fi gure); the RPR titer dropped to 1:1 and HIV serotest remained negative. Malignant syphilis is a rare form of destructive secondary syphilis. It usually occurs from 6 weeks to 1 year after primary infection, or earlier in people with HIV. Syphilis is a common sexually transmitted disease in China, with an incidence of 0·03% in 2014. However, malignant syphilis is rare.

Appendicular Mucocele : High Frequency Sonography Imaging A case report and short review of literature

Appendicular mucocele, a cystic mass resulting from a dilated appendiceal lumen caused by abnormal accumulation of mucus that often is not considered when problems of the right quadrant lower abdominal pain are assessed. It is rare entity; occurring in 0.25% of 43,000 appendectomy specimens in one series. A correct preoperative diagnosis is rarely made on the basis of clinical examination. Accurate diagnosis is essential in order to prevent rupture at surgery with development of pseudomyxoma peritonei and predict malignant transformation. We describe high frequency sonography findings that led to the correct preoperative diagnosis confirmed with surgery and histopathological confirmation.

Non-invasive evaluation of the haemodynamic effects of high-dose medetomidine in healthy cats for semen collection.

This study aimed to assess non-invasively the cardiovascular effects of high-dose medetomidine on healthy male cats undergoing semen collection. Haemodynamic evaluations were assessed on the basis of clinical examination, systolic arterial pressure (SAP) and transthoracic echocardiographic examination. Eight client owned, male domestic shorthair cats were sedated with a bolus of medetomidine intramuscularly (IM; 0.13 mg/kg), and semen collection was performed. A second transthoracic echocardiographic examination and SAP measurement were carried out 15 mins after sedation. At the end of the examination, the patients received a bolus of atipamezole (0.3 mg/kg) IM. The cats were deeply sedated, relaxed and laterally recumbent during the entire procedure. No rhythm abnormalities were observed during the examinations and no significant increase in SAP was recorded. Heart rate dropped from 200 ± 33 to 92 ± 13.1 beats per min after sedation. There was a significant increase in left ventricular dimensions and the left atrial area. The parameters of left ventricular systolic function were reduced, as were systemic and pulmonary cardiac outputs. Peak diastolic wave velocities were significantly reduced, while isovolumic contraction and relaxation time of the left ventricle were prolonged. Aortic valve insufficiency was recorded for all cats, while mitral valve insufficiency was noted in five cats. None of the subjects developed systolic anterior motion of the mitral valve. The protocol allowed us to collect good semen samples in healthy cats. However, high-dose medetomidine induces significant haemodynamic effects on the feline heart, mainly due to a reduced heart rate, an increased cardiac preload and impaired systolic function. The animals recovered from the anaesthesia, after antagonist administration, without showing any clinically relevant consequences.