Simple X-ray Research Articles

Postoperative Satisfaction in Nasal Bone Fracture Patients Who Had Rhinoplasty.

Nasal bone fracture is the most common type of facial bone fracture. There are 2 main reduction methods for treating nasal bone fractures: open reduction and closed reduction. A secondary operation was required when there was a deviation of shape after the operation, so there have been many studies conducted on patient satisfaction after reduction. However, there was few study on the satisfaction of nasal bone fracture patients with rhinoplasty depending on treatment modality. This study focused on the characteristics of nasal bone fracture rhinoplasty patients and on the satisfaction of patients who had previous rhinoplasty and their satisfaction after closed fracture reduction. The 22 patients, who had previously undergone augmentation rhinoplasty using silicone implants, visited Sanggye Paik Hospital from 2009 to 2014 for isolated nasal bone fractures. A satisfaction survey was conducted by telephone. The patients were asked of their subjective satisfaction after rhinoplasty, after the nasal bone fracture, and after the closed or open reduction. The satisfaction scores were recorded on a 5-point numerical scale. As the control group, 149 nasal bone fracture patients who were operated in the year 2013 were selected, and a phone survey was performed. Also, all facial three-dimensional computed tomography scans were reviewed to analyze characteristics of nasal bone fractures in the previously augmented rhinoplasty patients. Satisfaction and other characteristics of the 2 groups were evaluated with the independent t test and χ test using SPSS software (Version 18.0; SPSS Inc, Chicago, IL). Seven patients of 22 were able to complete the phone questionnaire (31.8%). Six of the 7 participants went through closed reduction and 1 had open reduction. Before plastic surgery, patient satisfaction was 2.333; after rhinoplasty it increased to 3.833. After the nasal bone fracture, patient satisfaction was 2.25, and after the reduction, it improved to 3.167. Of the 149 patients of the control group, 87 were able to complete the phone survey (58.3%). Before the injury, patient satisfaction was 3.512, whereas after the fracture it was 2.314. After closed reduction, the satisfaction was 3.326. There were no statistical significance on before trauma (P value >0.05), before reduction (P value >0.05), after reduction (P value >0.05). The rhinoplasty group and the control group were similar in terms of broad characteristics. However, the rhinoplasty group demonstrated a lower diagnostic rate by simple x-ray (40.9%) than the control group (68.5%), a difference that was statistically significant (P value = 0.012). Because there was no significant difference between 2 groups, the closed reduction method is more helpful in patients without deviation, exposure, or destruction of the implant. Also, in rhinoplasty patients who have sustained nasal trauma, the authors suggest facial three-dimensional computed tomography to prevent misdiagnosis.

The influence of age on positions of the conus medullaris, Tuffier's line, dural sac, and sacrococcygeal membrane in infants, children, adolescents, and young adults.

The purpose of this study was to analyze the distances between the conus medullaris and the Tuffier's line, and between the dural sac and the sacrococcygeal membrane (SCM) in the same pediatric population. Spinal magnetic resonance images and simple X-ray images of 350 patients aged from 1 month to 20 years were reviewed. Positions of the conus medullaris, Tuffier's line, the dural sac, and the SCM were identified. Each position was recorded in relation to the corresponding vertebral body segments. The distances between the conus medullaris and Tuffier's line, and between the dural sac and the SCM, were measured and then assessed according to age using an analysis of variance and a linear regression analysis. The median levels of the conus medullaris and Tuffier's line were in the lower third of L1 [the first lumbar vertebral body] and the middle third of L5, respectively. The levels of the conus medullaris and Tuffier's line were lower in younger populations. The distance between the conus medullaris and Tuffier's line ranged from 1.5 to 4.75 vertebral body height. However, a narrow range of 1.5-2.5 vertebral height was observed only in children younger than 2 years. The level of the dural sac did not differ greatly by age, but the upper limit of the SCM was lower in older populations. The distance between the dural sac and the upper limit of the SCM increased with age. In children, there is a distance of 1.5-4.75 vertebral body height between the conus medullaris and the Tuffier's line. However, these distances were narrower among younger populations. The distance between the dural sac and the upper limit of the SCM increased with age.

Lamina Fenestration Technique for Treatment of Thoracic Ossified Ligamentum Flavum: 2-Year Follow-Up Result.

Background The incidence of thoracic ossification of ligamentum flavum (OLF) is increasing, and the available surgical techniques were invasive. Study Aims To evaluate the surgical outcome and prognostic factors in relation to clinicoradiologic variables with a novel minimally invasive lamina fenestration technique in patients with thoracic OLF. Patients and Methods Between July 2005 and November 2010, 27 levels with 50 lesions in 17 patients were treated with the lamina fenestration technique for the decompression of thoracic OLF. This technique creates a keyhole in the lamina, preserving lower lamina bone, facet joint, and ligamentum flavum. Patient outcome was analyzed using the Japanese Orthopaedic Association (JOA) score and progression of kyphosis on simple X-ray. Results All patients were successfully treated with the laminar fenestration technique. There was one dural tear but no neural complication or injury. Mean length of follow-up was 49 months. Mean JOA score improved from 4.88 to 7 (p = 0.000). Six patients had an excellent surgical outcome; 10 had a good surgical outcome according to JOA scoring. Conclusion The lamina fenestration technique for the treatment of thoracic OLF had a successful outcome with few complications. This technique can be a minimally invasive surgical option for the treatment of thoracic OLF.

Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up

To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC). Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3years (range, 45-75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at twomonths and at a mean follow-up of 31months (range, 24-39). Early and late follow-up CT scans were available for 21/30 shoulders. Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p < 0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p < 0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p < 0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05). The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth. The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.

Diagnostic imaging of injuries caused by venomous and traumatogenic catfish

Injuries caused by fish are common in marine and freshwater environments. Catfish of the Ariidae and Pimelodidae families cause about 80% of those injuries. One of the complications of injuries caused by fish is the retention of fragments of the stinger in the wounds. Here we report five cases (of a total of 127 injuries caused by catfish in the Brazilian coast) in which the retained fragments were detected by radiological examination. Retained fragments should be considered in patients stung by catfish. A simple X-ray is sufficient to detect fragments of stingers in the wounds.

Flexible Field Emitter for X-ray Generation by Implanting CNTs into Nickel Foil.

This paper reports a novel implanting micromachining technology. By using this method, for the first time, we could implant nano-scale materials into milli-scale metal substrates at room temperature. Ni-based flexible carbon nanotube (CNT) field emitters were fabricated by the novel micromachining method. By embedding CNT roots into Ni foil using polymer matrix as transfer media, effective direct contact between Ni and CNTs was achieved. As a result, our novel emitter shows relatively good field emission properties such as low turn-on field and good stability. Moreover, the emitter was highly flexible with preservation of the field emission properties. The excellent field emission characteristics attributed to the direct contact and the strong interactions between CNTs and the substrate. To check the practical application of the novel emitter, a simple X-ray imaging system was set up by modifying a traditional tube. The gray shadow that appears on the sensitive film after being exposed to the radiation confirms the successful generation of X-ray.

Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification

BackgroundThere is no consensus on the most appropriate technique to diagnose vascular calcification in chronic kidney disease. This is primarily because of the absence of direct comparisons of predictive values of the various calcification scores, especially outside the coronary vascular beds, to detect clinical outcomes. MethodsWe included 93 haemodialysis patients and performed 6 vascular calcification scores: two scores utilised simple X-rays of abdominal aorta and peripheral vessels. CT scans of the thoracic, upper abdominal and lower abdominal aorta were performed to calculate the aortic calcification index and CT of the pelvis for calcification of iliac vessels. Patients were followed for 63months (mean 46.8months) for first major cardiovascular events and mortality. ResultsNineteen cardiovascular events and 28 deaths occurred. Calcification was detected more sensitively in central and peripheral beds using CT scans compared to X-rays (p<0.001). CT scans detected calcification more frequently in distal than proximal vascular beds (p<0.001). Calcification of the pelvic vessels and lower abdominal aorta were most predictive of events including pre-existing cardiovascular disease O.R. 6.5 (95% C.I. 2–22; p=0.001) and O.R. 3 (95% C.I. 1.1–9; p=0.035); new major cardiovascular events H.R. 4.2 (95% C.I. 1.5–11; p=0.006) and H.R. 2 (95% C.I. 0.8–5.3; p=0.1) as well as mortality H.R. 2.8 (95% C.I. 1.3–6; p=0.01) and H.R. 2.2 (95% C.I. 1.04–5; p=0.04) respectively. ConclusionsCT based techniques are more sensitive than plain X-rays at detecting peripheral and aortic vascular calcifications. Distal CT scans of the aorta and pelvic vessels have the highest predictive value for cardiovascular events and mortality.

That bird is not Genyornis

An emu-like bird painted in a western Arnhem Land rock shelter has been interpreted as a probable painting of Genyornis newtoni, one of Australia’s extinct megafaunal species. Support for this argument was based on the anatomical features and posture of the painting, its apparent age and the opinion of a palaeontologist. In this paper, I will argue that the painting does not represent Genyornis, but is a stylised representation of an emu (Dromaius novaehollandiae), or perhaps a bustard (Ardeotis australis), and the same artist has painted an equally stylised painting of a magpie goose (Anseranus semipalmata) or another bird adjacent to the emu. Furthermore, the alleged Genyornis painting is relatively recent in the chronological art sequence for Arnhem Land, having been painted in a Simple X-ray style of the Estuarine Period, with an age likely to be between 1,500 and 8,000 years BP.

Multiple Epidermal Cysts in the Volar Skin of the Thumb

Epidermal cysts most commonly occur in hair-bearing areas, such as the scalp, face, neck, trunk, and scrotum, where many pilosebaceous glands are present [1,2]. Epidermal cysts do not commonly develop in the palmoplantar skin due to the absence of pilosebaceous glands. The etiology of epidermal cysts on the palms and soles may not involve inflammation of the hair follicle, but the traumatic implantation of epidermal elements [1,3]. In this report, we describe a case of multiple epidermal cysts that developed in the volar skin of the thumb. A 53-year-old man visited our outpatient plastic surgery clinic, presenting with a slow-growing protruding mass on the left thumb (Fig. 1). He was a carpenter by occupation, and the mass developed after recurrent mechanical trauma by hammering for several decades. The 2.5×2-cm mass was located on the volar side of the distal phalanx of the left thumb. Upon physical examination, the mass was movable, without tenderness, redness, or a sense of warmth. We performed a simple X-ray of the hand to evaluate potential bony abnormalities and ultrasonography to determine the characteristics of the mass. The simple X-ray showed a normal bony appearance without bony erosion due to mass effect. We also found three subcutaneous low echoic masses on ultrasonography (Fig. 2). The overlying skin was incised horizontally and four masses were resected (Fig. 3). Mild adhesion was noted between the masses and the surrounding tissue, which was completely resected. The light microscopic examination of hematoxylin-eosin-stained sections was performed for all masses, which were diagnosed as epidermal cysts by a pathologist (Fig. 4). The wound was closed directly and followed up for two weeks. No complications, such as dehiscence, necrosis, hematoma, tingling sensation or hypoesthesia, or motility dysfunction occurred. Fig. 1 A 2.5×2-cm protruding subcutaneous mass on the left thumb without an abnormal skin lesion. Fig. 2 Three lobulated heterogeneous hypoechoic masses were seen on ultrasonography. The size of the largest mass was 1.3×0.6×1.2 cm and the other two small masses measured 0.5×0.5 cm each. Fig. 3 During the operation, a total of four masses were removed without any remnants. Fig. 4 A postoperative biopsy showed keratin material (KM) surrounded by stratified squamous epithelium (SE) and a granular cell layer adjacent to the keratin-containing cyst lumen. The result was compatible with an epidermal cyst. H&E stain. (A) ×40. ... Epidermal cysts usually result from inflammation around pilosebaceous follicles [4]. However, no pilosebaceous follicles are present in the skin of the palm and the sole of the foot. Epidermal cysts in the palmoplantar skin have been assumed to result from the implantation of epidermal fragments due to a penetrating injury or another form of epidermal trauma [1,5]. Recently, some palmoplantar epidermal cysts have been reported to be caused by human papilloma virus (HPV) infection [4,5]. The pathophysiology of the epidermal cyst in this patient was presumed to be the implantation of an epidermal fragment, since the patient in this case had a history of recurrent occupational mechanical trauma [1,3]. We did not test for HPV infection because the patient did not present any symptoms or signs thereof. Epidermal cysts in the palmoplantar skin are easily confused with warts or calluses. Surgeons should be aware of the possibility of epidermal cysts in palmoplantar skin and be able to diagnose them correctly and design an appropriate treatment strategy.

Vertebroplasty Injections Using High Viscosity Cement: a Cadaveric Study

Introduction Vertebral compression fracture (VCF) is a unique type of fractures involving the body of vertebrae. It is associated with a significant decline in functionality and poor quality of life. Osteoporosis, or decreased bone density, is one of the leading causes of VCF. It is commonly seen amongst elderly, especially in post-menopausal women. Vertebroplasty (VP) is a minimally invasive percutaneous technique that involves injecting cement into a pathologic vertebral body, with the aim of pain relief and deformity correction. It is considered the best next line of management when conservative management fails to control symptoms. Although considered minimally invasive, VP has ~1 to 5% risk of clinically evident complications. Where, cement extravasation is the most commonly reported in the literature. Cement viscosity is considered the single most important predictor of the risk of extravasation. Unfortunately, injecting high viscosity cement is difficult to utilize in real practice. We invented a new device capable of injecting high viscosity with ease and at a distance to avoid radiation. The aim of this study is to confirm the efficacy and safety of the new device on cadaveric vertebrae. Materials and Methods For this prospective case-control cohort study, 126 osteoporotic vertebral bodies were harvested form 14 fresh whole human cadavers. DEXA scan and simple X-rays were performed on all specimens to confirm the diagnosis of osteoporosis, and to rule out any pre-existing fractures. A total of 80 vertebral were included in the study. Computer-randomization software was used to allocate specimens over two main groups, Conventional VP and New Device. Both groups were further subdivided into two subgroups, High-Viscosity and Low-Viscosity. A custom device was used on each vertebra to induce a compression fracture. All augmentations were done following the same method commonly practiced in clinical treatment. X-ray radiographs were used to measure and compare cement distribution within the body between groups. Results Injecting high viscosity cement was associated with a lower leakage volume compared with low viscosity cement, with a mean of 0.06cc for the Conventional VP and 0.08cc with the New Device. High viscosity cement was associated with no leakage into the spinal canal. It was also associated with a low incidence of vascular extravasation ( p &lt; 0.001). The mean volume of cement leakage in the low viscosity group was 0.23cc and 0.15cc, for the Conventional VP and New Device respectively. In both groups, the most common site for leakage was the vertebral end plate, which was exhibited more in the low viscosity group (71.5%) compared with the high viscosity group (42.5%). The preset target amount of cement to be injected was reached in 99% of the time when injecting high viscosity cement with the New Device, compared with 62% using the Conventional VP. In both groups, there was no correlation between the amount of cement injected and the amount of leakage. Conclusion The new device is capable of injecting high viscosity cement easily, with a lower incidence of cement leakage. It also minimized the risk of radiation exposure to the surgeon.

Experimental Endoscopic Angular Domains of Transnasal and Transoral Routes to the Craniovertebral Junction: Light and Shade.

We investigate on the surgical reliability of nasal palatine line for the transnasal approach and introduce a conceptually analogue radiological line as a reliable predictor of the maximal superior extension of the transoral approach. We have also compared radiological and surgical lines to find possible radiological references points to predict preoperatively the maximal extent of superior dissection for the transoral approach. After comparing the surgical exposition angle and the working channel volume of both the approaches in our previous article, now we compare the radiological (theoretical) with the "surgical" (effective) Nasopalatine line and the latter with the recently introduced Nasal Axial Line. We conceived a radiological line with a similar significance for the transoral approach and we called it Mandibulopalatine line; then we compared the radiological with the "surgical" one. Endoscopy represents both an alternative and a useful complement to the standard microsurgical approach to the anterior craniovertebral junction (CVJ). Both the surgical routes have a limitation caused by the hard palate. Ten fresh nonperfused cadavers were studied. Transnasal and transoral linear and angled exposure of the CVJ were evaluated by means of X-ray and CT scan in the sagittal plane. The angular difference between the radiological and surgical transoral endoscopic lines was significantly smaller compared with the difference between the radiological and surgical transnasal lines. Finally we found how to calculate preoperatively the "surgical" (effective) Mandibulopalatine line by a simple lateral preoperative radiological study of the CVJ. Naso-axial line is confirmed to be a reliable preoperative predictor of the maximal extent of inferior dissection for transnasal approach. Surgical Palatine Inferior dental Arch line will draw the maximal extent of superior dissection for the transoral approach with simple lateral head X-ray examination by open mouth. 3.

Miniature lightweight X-ray optics (MiXO) for surface elemental composition mapping of asteroids and comets

The compositions of diverse planetary bodies are of fundamental interest to planetary science, providing clues to the formation and evolutionary history of the target bodies and the Solar system as a whole. Utilizing the X-ray fluorescence unique to each atomic element, X-ray imaging spectroscopy is a powerful diagnostic tool of the chemical and mineralogical compositions of diverse planetary bodies. Until now the mass and volume of focusing X-ray optics have been too large for resource-limited in-situ missions, so near-target X-ray observations of planetary bodies have been limited to simple collimator-type X-ray instruments. We introduce a new Miniature lightweight Wolter-I focusing X-ray Optics (MiXO) using metal-ceramic hybrid X-ray mirrors based on electroformed nickel replication and plasma thermal spray processes. MiXO can enable compact, powerful imaging X-ray telescopes suitable for future planetary missions. We illustrate the need for focusing X-ray optics in observing relatively small planetary bodies such as asteroids and comet nuclei. We present a few example configurations of MiXO telescopes and demonstrate their superior performance in comparison to an alternative approach, micro-pore optics, which is being employed for the first planetary focusing X-ray telescope, the Mercury Imaging X-ray Spectrometer-T (MIXS-T) onboard Bepicolumbo. X-ray imaging spectroscopy using MiXO will open a large new discovery space in planetary science and will greatly enhance our understanding of the nature and origin of diverse planetary bodies.

MC2: MAPPING THE DARK MATTER DISTRIBUTION OF THE “TOOTHBRUSH” CLUSTER RX J0603.3+4214 WITH HUBBLE SPACE TELESCOPE AND SUBARU WEAK LENSING*

ABSTRACT The galaxy cluster RX J0603.3+4214 at z = 0.225 is one of the rarest clusters boasting an extremely large (∼2 Mpc) radio relic. Because of the remarkable morphology of the relic, the cluster is nicknamed the “Toothbrush Cluster.” Although the cluster's underlying mass distribution is one of the critical pieces of information needed to reconstruct the merger scenario responsible for the puzzling radio relic morphology, its proximity to the Galactic plane b ∼ 10° has imposed significant observational challenges. We present a high-resolution weak-lensing study of the cluster with Subaru/Suprime Cam and Hubble Space Telescope imaging data. Our mass reconstruction reveals that the cluster is composed of complicated dark matter substructures closely tracing the galaxy distribution, in contrast, however, with the relatively simple binary X-ray morphology. Nevertheless, we find that the cluster mass is still dominated by the two most massive clumps aligned north–south with a ∼3:1 mass ratio ( M 200 = 6.29 &minus; 1.62 &plus; 2.24 &times; 10 14 M &CircleDot; ?> and 1.98 &minus; 0.74 &plus; 1.24 &times; 10 14 M &CircleDot; ?> for the northern and southern clumps, respectively). The southern mass peak is ∼2′ offset toward the south with respect to the corresponding X-ray peak, which has a “bullet”-like morphology pointing south. Comparison of the current weak-lensing result with the X-ray, galaxy, and radio relic suggests that perhaps the dominant mechanism responsible for the observed relic may be a high-speed collision of the two most massive subclusters, although the peculiarity of the morphology necessitates involvement of additional subclusters. Careful numerical simulations should follow in order to obtain more complete understanding of the merger scenario utilizing all existing observations.

The Effect of the Rapid Antigen Test for Influenza on Clinical Practice in the Emergency Department: A Comparison of Periods before and After the 2009 H1N1 Influenza Pandemic

Introduction. The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). In this study, we investigated the effect of the RAT for influenza on clinical practice in an emergency department.Methods. A retrospective chart review was conducted considering two periods, namely before and after the 2009 influenza pandemic. The rate of antibiotic administration, the use of blood sample tests, the use of simple chest X-rays, the rate of antibiotic administration according to the result of the RAT, and the duration of ER stay in the case of influenza-like illnesses were investigated for the two study periods considered.Results. The use of the RAT increased from 23.9% to 39.8% in influenza-like pediatric patients (p<0.05) and from 4.9% to 67.6% in adult patients (p<0.001). After the 2009 influenza pandemic, the number of cases of antibiotic administration, blood sample test and simple chest X-ray decreased by 19.0%, 46.2%, and 27.4%, respectively, in pediatric patients with the use of RAT. Among RAT-positive patients, after the 2009 influenza pandemic, none of the pediatric patients and only 3 of the adult patients (17.6%) were administered antibiotics. The duration of ER stay was longer in patients who underwent RAT than in those who did not.Conclusion. The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses. However, the use of RAT has not contributed to a decrease in the duration of ER stay.

Exogenous Lipoid Pneumonia: Dramatic Clinical and Radiological Improvement After Multiple Segmental Bronchoalveolar Lavages

Dear Editor, Hydrocarbon compounds such as petroleum jelly and mineral oil can cause lower respiratory disease named exogenous lipoid pneumonia because of high viscosity and surface tension (1). Acute exogenous lipoid pneumonia occurs after exposure to large amounts of mineral oils. The acute form in children is mostly a consequence of accidental poisoning. (2). Consolidation, nodular lesions, reticular and alveolar-interstitial patterns are the most common findings in the chest X-rays. Lower lobes or right middle lobe commonly get involved, but multifocal and bilateral lesions are shown too (3). The diagnosis of exogenous lipid pneumonia is made by a positive history of mineral oil exposure and radiologic findings in favor of the disease and revealing lipid-laden macrophages on bronchoalveolar lavages (BALs) or sputum specimen. Multiple BALs can remove Lipid-laden macrophages as a leading cause of fibrosis in the alveoli and interstitium (3, 4). We present a rare case of exogenous lipoid pneumonia in a 2.5-year old boy with a history of mineral oil aspiration who admitted to the pediatric intensive care unit because of cyanosis and severe respiratory distress. On physical examination he presented with tachycardia (190 min), tachypnea (80 min), O2 saturation 50%, numerous crackles on auscultation of both lungs. Laboratory findings were leukocytosis with a left shift and increased CRP. A chest X-ray showed diffuse opacities with an alveolar pattern in both lungs (Figure 1). CT scans of the chest revealed bilateral diffuse severe pneumonitis with ground glass and alveolar appearance and crazy paving (Figure 2). Bronchoscopy was done. Mucopurulent secretions aspirated then rinsed with saline. After staining the BAL fluid with Sudan III many lipid laden macrophages (grade IV/IV) were seen. Multiple segmental BAL was done weekly, after that BAL fluid became nearly clear and cell counts reached near the normal range values. CT scan which was done after the forth therapeutic BAL, showed dramatic improvement in both lungs (Figure 3). The patient discharged after one month hospitalization and recommended to return to follow up. Figure 1. Simple Anteroposterior Chest X-Ray Demonstrating Bilateral Opacities, Mostly in the Lower Lobes Figure 2. High-Resolution Computed Tomography Scan of the Chest Demonstrating Alveolar Infiltrate, Mostly in the Lung Bases Figure 3. High-Resolution Computed Tomography Scan of the Chest Showing Dramatic Improvement in Both Lungs After Multiple Segmental BAL The best way to remove the oil is multiple BALs especially in the most severely involved segments (3). According to several surveys, multiple BALs is an effective therapeutic strategy with few risks, and better improvement in the clinical and radiological signs (5). The present study indicates that therapeutic multiple segmental BAL is a successful method in removing intra-alveolar mineral oil with significant resolution of clinical, radiological and laboratory findings.

Thermal X-ray emission from a baryonic jet: a self-consistent multicolour spectral model

We present a publicly-available spectral model for thermal X-ray emission from a baryonic jet in an X-ray binary system, inspired by the microquasar SS 433. The jet is assumed to be strongly collimated (half-opening angle $\Theta\sim 1\deg$) and mildly relativistic (bulk velocity $\beta=V_{b}/c\sim 0.03-0.3$). Its X-ray spectrum is found by integrating over thin slices of constant temperature, radiating in optically thin coronal regime. The temperature profile along the jet and corresponding differential emission measure distribution are calculated with full account for gas cooling due to expansion and radiative losses. Since the model predicts both the spectral shape and luminosity of the jet's emission, its normalisation is not a free parameter if the source distance is known. We also explore the possibility of using simple X-ray observables (such as flux ratios in different energy bands) to constrain physical parameters of the jet (e.g. gas temperature and density at its base) without broad-band fitting of high-resolution spectra. We demonstrate this approach in application to Chandra HETGS spectra of SS 433 in its 'edge-on' precession phase, when the contribution from non-jet spectral components is expected to be low. Our model provides a reasonable fit to the 1-3 keV data, while some residuals remain at higher energies, which may be partially attributed to a putative reflection component. Besides SS 433, the model might be used for describing jet components in spectra of other Galactic XRBs (e.g. 4U 1630-47), ULXs (e.g. Holmberg II X-1), and candidate SS 433 analogues like S26 in NGC7793 and the radio transient in M82.

Double Dispersive X-Ray Fluorescence (D2XRF) based on an Energy Dispersive pnCCD detector for the detection of platinum in gold

With the aim of improving limits of detection (LOD) of trace elements in a matrix with adjacent fluorescence energies, a simple double dispersive X-ray fluorescence detection system (D2XRF) was constructed to operate at the beamlines BAMline and the mySpot @ BESSY II. This system is based on the combination of a crystal analyzer with an energy resolving single photon counting pnCCD. Without further collimators, the efficient suppression of the background by the pnCCD and the good energy resolution of the crystal results in improved LOD. In first order reflections, an energy resolution of 13eV for Cu Kα was reached, and an energy range of 1keV was covered in one shot.This new system was applied to the detection of platinum (Pt) in gold leaves with a LOD of 0.9mg/kg, which is the lowest attained by totally non-destructive methods nowadays. The presence of Pt in gilded objects from Abydos and Byzantine mosaics provides vital information, as it indicates the alluvial origin of the gold for these examples.

Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline--a longitudinal analysis after using TNFa blockers.

Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)α blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNF α blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNF α therapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNF α blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

IntroductionTreatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. MethodsThis article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. ResultsBased on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022). ConclusionIn this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level of proofLevel II prospective non-randomized comparative study.

Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis

ObjectiveThe aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). Materials and methodsThe DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. ResultsThe DTPER showed a sensitivity of 100% (95% CI: 91.8–100%) and a specificity of 90% (95% CI: 82.4–94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI: 5.5–19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. DiscussionThe DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis).