Specific Clinical Examination Research Articles

Clinicopathological analysis of small intestinal metastasis from extra-abdominal/extra-pelvic malignancy.

The metastatic tumors in the small intestine secondary to extra-abdominal/extra-pelvic malignancy are extremely rare. However, the small intestine metastases are extremely prone to misdiagnosis and missed diagnosis due to the lack of specific clinical manifestations and examination methods, thus delaying its treatment. Therefore, in order to improve clinical diagnosis and treatment capabilities, it is necessary to summarize its clinical pathological characteristics and prognosis. To summarize the clinicopathological characteristics of patients with small intestinal metastases from extra-abdominal/extra-pelvic malignancy, and to improve the clinical capability of diagnosis and treatment for rare metastatic tumors in the small intestine. The clinical data of patients with small intestinal metastases from extra-abdominal/extra-pelvic malignancy were retrieved and summarized, who admitted to and treated in the Air Force Medical Center, Chinese People's Liberation Army. Then descriptive statistics were performed on the general conditions, primary tumors, secondary tumors in the small intestine, diagnosis and treatment processes, and prognosis. Totally 11 patients (9 males and 2 females) were enrolled in this study, including 8 cases (72.3%) of primary lung cancer, 1 case (9.1%) of malignant lymphoma of the thyroid, 1 case (9.1%) of cutaneous malignant melanoma, and 1 case (9.1%) of testicular cancer. The median age at the diagnosis of primary tumors was 57.9 years old, the median age at the diagnosis of metastatic tumors in the small intestine was 58.81 years old, and the average duration from initial diagnosis of primary tumors to definite diagnosis of small intestinal metastases was 9 months (0-36 months). Moreover, small intestinal metastases was identified at the diagnosis of primary tumors in 4 cases. The small intestinal metastases were distributed in the jejunum and ileum, with such clinical manifestations as hematochezia (5, 45.4%) and abdominal pain, vomiting and other obstruction (4, 36.4%). In addition, 2 patients had no obvious symptoms at the diagnosis of small intestinal metastases, and 5 patients underwent radical resection of small intestinal malignancies and recovered well after surgery. A total of 3 patients did not receive subsequent treatment due to advanced conditions. Small intestinal metastases of extra-abdominal/extra-pelvic malignancy is rare with high malignancy and great difficulty in diagnosis and treatment. Clinically, patients with extra-abdominal/extra-pelvic malignancy should be alert to the occurrence of this disease, and their prognosis may be improved through active surgery combined with standard targeted therapy.

Utilização de plantas medicinais no tratamento da obesidade, diabetes mellitus tipo 2 e hipertensão arterial sistêmica em duas Unidades de Saúde da Família

The use of medicinal plants has been a great ally of Nutrition professionals, corroborating as an alternative therapy in Chronic Communicable Diseases (CNCDs), the treatment of type 2 diabetes mellitus, hypertension and obesity. plants with obesity or type 2 diabetes mellitus or systemic arterial hypertension, by plants of specific clinical examinations in two Family Health Units (AlmaF's), in the municipality of Cruzeiro de Almas, Bahia. in 13 families, the most representative being Asteraceae (2 ssp.), Lamiaceae (2 ssp.), Lauraceae (2 ssp.). The most evident species were lemon balm (Melissa officinalis), lemongrass (Cymbopogon citratus), followed by moringa (Moringa oleifera) and chayote (Sechium edule), which had a use value greater than or equal to 0.13, being cited as auxiliaries for HAS and DM2. As for the way of preparation, 73% of the food, 73% of the plants, use these medicinal infusion plants. Thus, it is important to study medicinal plants and their nutritional potential, allowing to know their mechanisms of action and how they can be applied.

Longitudinal change of energy expenditure, body composition and dietary habits in Progressive Supranuclear Palsy patients.

Alterations in metabolic status, body composition, and food intake are present in all neurodegenerative diseases. Aim of this study was to detect the progression of these changes in Progressive Supranuclear Palsy (PSP). We conducted a longitudinal study of 15 patients with PSP. The assessments were performed at baseline (T0) and after 7(IQR = 5) months of follow-up (T1). We collected anthropometric measures including body weight, height, body mass index and waist circumference, metabolic parameters through indirect calorimeters, body composition using bioimpedance analysis, and dietary habits with a validated questionnaire. PSP-rating scale (PSP-rs) was used to evaluate disease severity and dysphagia. The majority of patients (66.66%) presented PSP-Richardson Syndrome and 33.33% the other variant syndromes of the disease. At T1 there was a decrease in intake of total daily calories (p < 0.001), proteins (p < 0.001), fibers (p = 0.001), calcium (p = 0.008), iron (p < 0.001), zinc (0.034), vitamin E (p = 0.006) and folates (p = 0.038) compared to T0. No other changes were found. As for T1 data, no significant differences were shown according to disease phenotypes or the presence of clinically significant dysphagia for solids. Within a mid-term follow up, PSP patients presented reduced caloric and proteins intake regardless the presence of dysphagia. The PSP-rs is likely not adequate to assess dysphagia, which should be investigated by specific clinical scales or instrumental examinations. With the goal of maintaining adequate nutritional status, the administration of protein and vitamin supplements should be considered even in the absence of dysphagia evidenced by the rating scales.

Lesões compressivas no sistema nervoso central em caprinos e ovinos: estudo retrospectivo de 11 casos no bioma amazônico

ABSTRACT: This paper describes, within the framework of a retrospective study, the epidemiological and clinicopathological findings in goats and sheep with compressive lesions of the central nervous system (CNS) in Pará. This study included eight sheep and three goats from 2005 to 2022 by reviewing the clinical files of animals with CNS compressive lesions managed by the team of the Carlos Tokarnia Veterinary Hospital of the Institute of Veterinary Medicine of the Federal University of Pará. The animals with clinical signs were subjected to a general and specific clinical examination of the nervous system. All animals included in the study were necropsied, and the clinical signs were found to vary according to the location of the lesion. At necropsy, changes such as an abscess with osteomyelitis of the vertebral body with pathologic fracture and spinal cord compression, submeningeal abscess in the skull floor, subarachnoid hematoma, and congenital bone changes causing spinal cord compression and ankylosing spondylitis were noted. These findings indicate that a comprehensive clinical examination of the CNS in conjunction with necropsy findings is essential to characterize the clinical picture, localize the lesion, and determine the cause of the disease. The most affected medullary segment was between T3 and L3. Therefore, these diseases should be included in the list of differential diagnoses in farm animals with nervous system symptoms.

Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability

ObjectiveTo compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability.MethodsSixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded.ResultsSymphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23.ConclusionDedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability.Clinical relevance statementFor diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients.Key Points• Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography.• Additional fluoroscopy may be important for therapeutic injections.• The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.

Carotid and femoral bruits as cardiovascular risk indicators in a middle-aged Finnish population: A 20-year prospective study.

Effective treatment and prevention of cardiovascular (CV) diseases requires reliable methods of assessing individual CV event risk. Although standardized risk calculators like Systematic Coronary Risk Evaluation (SCORE) are sufficient in most instances, sometimes more specific clinical examination is needed to determine the most optimal intervention and its intensity. To study whether carotid and femoral bruits provide prognostic information on CV events, CV mortality and all-cause mortality beyond traditional CV risk factors. 1045 subjects (49.8% men), aged 51.3 ± 5.97 years were clinically examined in the beginning of 1990's. The subjects were followed for over 20 years and data on CV events and causes of deaths was collected. During the follow-up period, 241 (23.1%) of the subjects died and 82 (34.6%) of the deaths were of CV origin. Carotid bruits were a significant risk factor for CV deaths only if subjects with previous CV events were included. After adjusting for age, sex, systolic blood pressure, smoking, diabetes, LDL cholesterol, coronary artery disease and stroke, carotid bruits posed a hazard ratio (HR) (95% confidence interval) of 4.15 (2.39-8.52) p<0.001 for CV deaths. After excluding subjects with previous CV events (after which n = 941) neither carotid nor femoral bruits were statistically associated with CV events or all-cause mortality. Adding carotid or femoral bruits in the baseline risk model with traditional CV risk factors did not improve C-statistic, reclassification, or discrimination of the subjects. Carotid and femoral bruits do not provide clinically useful information in a pure primary prevention setting. Carotid bruits might be useful in evaluating the overall CV risk in a population where recurrent CV events may occur.

Diagnosis and treatment of solid pseudopapillary neoplasm of the pancreas in children: A report of 18 cases.

PurposeTo explore the incidence, imaging and treatment of solid pseudopapillary tumor of pancreas in children, and Summarize the experience of treatment.MethodsThe clinical data of 18 children with a solid pseudopapillary tumor of the pancreas treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The age range was 8–16 years old, the average age was 11.67 years old, and the median age was 11.5 years old, namely, three boys with an average age of 10 years old and 15 girls with an average age of 12 years old. In total, two cases were admitted to the hospital because of trauma, seven cases were found in physical examination, and nine cases were admitted with the abdominal pain as the main complaint. Enhanced CT examination was performed before operation, nuclear magnetic resonance examination and abdominal ultrasound examination were performed in some children, and plain CT scan was performed after operation.ResultsSolid pseudopapillary tumor of the pancreas can occur in all parts of the pancreas, especially in the body and tail of the pancreas. Among the 18 cases, SPN occurred in the head of pancreas in 5 cases (27.78%), the neck of pancreas in 2 cases (11.11%), and the body and tail of pancreas in 11 cases (61.11%). All the 18 children were treated by operation. among them, 4 cases underwent choledochal pancreatico duodenectomy (1 case), 4 cases underwent pancreaticoduodenectomy combined with splenectomy (3 cases), 6 cases underwent spleen-preserving pancreatectomy / tail pancreatectomy (1 case), 3 cases underwent enucleation of pancreatic tumor due to exogenous growth, 1 case underwent laparoscopic partial pancreatectomy and pancreaticoenterostomy. Laparotomy was performed in 12 cases and endoscopic surgery in 6 cases. Postoperative pathology confirmed solid pseudopapillary tumor of the pancreas. None of the patients received radiotherapy and chemotherapy after operation and were followed up for 6 months to 2 years. There was no recurrence, metastasis or pancreatic dysfunction.ConclusionSolid pseudopapillary tumor of pancreas in children is a rare, low-grade malignant solid tumor with no specific clinical manifestations and laboratory examinations. Preoperative diagnosis mainly depends on enhanced CT. Surgical resection of tumor is a reliable treatment, and the specific operation is mainly based on the experience of the chief surgeon, the location of the tumor and the invasion of surrounding tissue. At present, there is no evidence of the effectiveness of other treatment options, and surgical resection of the tumor has a good prognosis.

Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

Maigne Syndrome - A potentially treatable yet underdiagnosed cause of low back pain: A review.

First discussed by Dr. Robert Maigne in the late 1980s, Maigne Syndrome is an often unrecognized and treatable cause of low back pain. It can be separated into two distinct entities. The central variant is a result of nerve afferent input secondary to changes of facet joint arthropathy at the thoracolumbar junction. The peripheral variant is a result of impingement of the medial branch of the superior cluneal nerve, which arises from the posterior rami of the lower thoracic and upper lumbar nerve roots, and results in similar clinical symptoms and signs. To review the current literature for a comprehensive description of Maigne Syndrome, its diagnosis and management. Evidence was gathered using two main medical databases, namely PubMed and Google Scholar. Search terms included 'Maigne's Syndrome', 'Maigne facet', 'thoracolumbar junction syndrome', 'cluneal nerve entrapment', 'posterior iliac crest trigger point', 'pseudosciatica', as well as various permutations of these terms. The initial search generated 52 articles. These were screened, and duplicate and irrelevant articles were removed. Using the remaining articles, and with evaluation of their cited references, we selected 28 articles for review. Most of these consisted of case reports, many of which were published in rehabilitation, chiropractic and medical journals. The papers explored topics such as anatomy, cluneal nerve imaging, and treatment of nerve entrapment and facet related back pain syndromes, and have been included in this review, which is, to the best our knowledge, the most comprehensive description of Maigne Syndrome to date. The keys to the diagnosis of Maigne Syndrome include an awareness of the mechanical causes of back dominant pain, an understanding of the relevant anatomy, a specific clinical examination, and focused radiological guided anesthetic blocks. Treatment is available, and as in all back-pain etiologies, is most effective in the early stages of the disease.

Lesões compressivas no sistema nervoso central de bovinos: um estudo retrospectivo de 50 casos no bioma amazônico

ABSTRACT: The present study gathered epidemiological and clinical-pathological information about cattle with compressive lesions in the central nervous system (CNS). The retrospective study included observations made in 50 cattle from 1998 to 2021 by reviewing the clinical records of animals with compressive lesions in the CNS treated at the Veterinary Hospital of the Veterinary Medicine Institute of the Federal University of Pará. The animals had clinical signs and were subjected to general and specific clinical examination of the nervous system. Blood samples were collected from 13 animals for complete blood counts, and cerebrospinal fluid (CSF) samples were collected from four animals for physical evaluation. Twenty-nine cattle underwent necropsy. The most affected sites were the T3-L3 (46%, 23/50), C1-C5 (22%, 11/50), C6-T2 (14%, 7/50), sacrococcygeal vertebrae, (4%, 2/50), L4-S2 (2%, 1/50), brain (8%, 4/50) and cerebellum (4%, 2/50). The age of the affected cattle ranged from 20 days to 16 years, with a higher occurrence in animals younger than 12 months (56%, 28/50). More Females were affected (58%, 29/50) than males (42%, 21/50). The clinical signs varied according to the location of the lesion and were mainly represented by ataxia, paresis or paralysis of the limbs, inability to stand and walk, postural changes, hyperesthesia in the extremities, and loss of skin sensitivity at the location of the lesion. The necropsy findings revealed changes such as abscesses in the vertebral body; intervertebral space in the medullary canal, pituitary and cerebellum; granuloma in the arch of the vertebra; fractures of the body of the vertebrae; subarachnoid haematoma; congenital bone alteration causing spinal cord compression; and spondylitis. Detailed anamnesis and clinical examination of the CNS, associated with necropsy findings, were important to determine the cause of the disease, correlate with the clinical picture and locate the affected segments of the CNS in the cattle. It is important to include these diseases in the list of differential diagnoses in cattle with nervous symptoms.

Lesões compressivas no sistema nervoso central de bubalinos

ABSTRACT: This study describes, through a retrospective study, the epidemiological and clinical-pathological findings of compression in the central nervous system (CNS) of buffaloes. The study includes observations made in 15 animals from 1998 to 2021 by reviewing the clinical records of animals with compressive injuries of the CNS treated at the Veterinary Hospital of the Veterinary Medicine Institute of the Federal University of Pará. The animals treated with clinical signs compatible with CNS compressive lesions were subjected to general and specific clinical examinations of the nervous system. Blood samples were collected from four animals for complete blood counts, and cerebrospinal fluid (CSF) samples were collected from three animals for physical evaluation. Thirteen animals were necropsied. The age range of the affected animals ranged from four months to 11 years of age, with a greater frequency over age 12 months (80%, 13/15). The most affected vertebral segment was between T3 and L3 (60%, 9/15), followed by brain injury (20%, 3/15), the L4-S2 segment (13.3%, 2/15) and the C1-C5 segment (6.7%, 1/15). The clinical findings varied according to the location of the lesion. The necropsy findings revealed paraypophyseal abscess in the brainstem and vertebral body, subarachnoid hematoma, lymphoma and vertebral fractures. The performance of a thorough clinical examination of the CNS combined with the necropsy findings was important to characterize the clinical picture and to locate the cause and the affected CNS segments in the buffaloes studied. It is important to include CNS compressive lesions among the neurological diseases of buffaloes.

Хронічний ендометрит та ендометріоз: чи є взаємозв’язок?

Актуальність. Хронічний ендометрит та ендометріоз мають багато спільних рис. Обидва захворювання є тривалими запальними процесами, з неуточненими до кінця етіологічними чинниками та патогенетичними механізмами, які негативно впливають на фертильність та можуть викликати тазовий біль або аномальну маткову кровотечу. Питання ефективної та своєчасної діагностики хронічного ендометриту залишається відкритим через відсутність специфічних клінічних симптомів та даних клінічного огляду. Мета: оцінка сучасних наукових доказів зв'язку між ендометріозом та хронічним ендометритом. Матеріали та методи. Проведено системний пошук наукової медичної інформації в англомовних базах даних: MEDLINE, Scopus, Web of Science, Medline, The Cochrane Library, PubMed. Результати. За даними огляду різних наукових досліджень, що проводились останнім часом, виявлено, що у пацієнток з ендометріозом ризик розвитку хронічного ендометриту статистично значимо вищий у 1,3-2,5 разів, ніж у жінок без ендометріозу. Із застосуванням гістологічного дослідження ендометрію та визначення CD138 хронічний ендометрит було виявлено у 52,94% жінок групи ендометріозу та у 27,02% пацієнток групи без ендометріозу; показник був значно вищим у групі ендометріозу, ніж у контрольній групі (р=0,0311). Більше того, у 76% жінок з ендометріозом виявлені запальні процеси тазових органів (у порівнянні з групою контролю, де запалення виявилось у 38,4% жінок, p&lt;0.0001). Висновки. Пацієнтки з ендометритом демонструють позитивну кореляцію з розвитком ендометріозу. Враховуючи неможливість встановити причинно-наслідковий зв’язок ендометріозу та хронічного ендометриту необхідна розширена діагностика з метою виключення хронічного ендометриту, особливо, якщо жінки мають аномальну маткову кровотечу або хронічні тазові болі. Поєднання гістологічного та імуногістохімічного методів дослідження ендометрію показало свою ефективність у своєчасній діагностиці хронічного ендометриту. Виявлення та адекватне лікування даного стану допоможе уникнути непотрібного оперативного втручання.

Update on the thoracic outlet syndrome and plexus brachial syndrome: Specific clinical examination (for all) and rehabilitation protocol.

The diagnosis of uncomplicated forms of thoracobrachial outlet syndrome (TOS) and brachial plexus stretching syndrome (BPSS) is imprecise due to the lack of clear differentiation between dynamic vascular or neurological compression and brachial plexus stretching without vascular compression. After a review of literature, we propose and describe a simple way for clinical assessment of TOS, BPSS or association of both comprising 1 clinical sign and 2 manoeuvres. This clinical assessment can be performed by the medical doctor, the physiotherapist and the surgeon. The clinical diagnosis is essential because it will dictate the rehabilitation treatment. We propose and describe also a rehabilitation protocol comprising 10 phases with modulation of exercises according to clinical form (TOS, BPSS or association) and/or severity of symptoms. The physiotherapist has a capital role and is the guarantor of the effectiveness of the medical treatment. In France, a training is now available thanks to personal continuous development for diagnosis and treatment of TOS and BPSS. This is essential in order to propose an optimal care to patients.

An exploratory study into the teaching of clinical examination skills in advanced practice.

Clinical examination skills are vital for the accurate assessment and diagnosis of patients. These skills also allow clinicians to differentiate between pathology requiring investigation or treatment and normal anatomy or physiology. This allows clinicians to avoid unnecessary tests and to be able to reassure a patient that their symptoms do not require treatment. However, an incomplete or faulty clinical examination can lead to missed diagnoses and patient harm. Although comprehensive clinical examination skills training is provided in the undergraduate curriculum of medical schools in the UK, little is known in relation to the teaching provided for nurses and allied health professions working in advanced practice roles. This survey sought to explore this phenomenon and uncover clinicians' experiences with regard to being taught a selection of specific clinical examination skills in theory and in practice, those skills being the core system examinations (respiratory, cardiovascular and peripheral vascular, abdominal, central and peripheral nervous systems) and a number of focused examinations (digital rectal and examination, thyroid, breast and genital examination for males and females). The findings demonstrate a concerning variability of educational experiences and a lack of educational coverage of some of the basic clinical examination skills in both theoretical and practical terms. These findings provide an insight into areas of future higher education curricula development as well as workplace mentoring and learning.

CLINICAL CHARACTERISTICS AND EEG FEATURES OF NON-CONVULSIVE STATUS EPILEPTICUS (NCSE) AFTER CARDIOVASCULAR SURGERY

One of the most frequent complications after cardiovascular surgery are different types of epilepsy seizures during coma (GCS &lt;8). Manifestation of coma might be result of hypoxic brain injury. It is very important to make early diagnose of exact type of complications and immediately start appropriate treatment. There are several difficulties in identification of non-convulsive status epilepticus (NCSE) during coma that is why in all of these cases we are using Specific clinical and Electrophysiological examinations. Materials And Methods: There were 42 patients with persistent coma after cardiac surgery under our clinical observation. Aged between 36-82. Patients underwent one of the following surgeries: coronary artery bypass graft surgery (CABG) in 27 patients, valve surgery - in 9 cases. In 6 cases there were used Surgery of ascending aorta and aortal arch. 40 patients have been undergone cardiopulmonary bypass (CPB) during cardiac surgery. Following methods were used: Ÿ Clinical neurological status evaluation Ÿ Computer tomography (CT scan) Ÿ Long-term EEG Results: Non-convulsive status was discovered in 9 cases. Patients with the NCSE were separated into three groups: First, 3 patients with nystagmoid eye jerking and facial muscles twitching. Second: in 4 cases there were twitching of the limb. Third: 2 patients didn't have any movement clinical symptoms. Conclusion: As we see Cardiovascular surgery might cause neurological especially epileptiform type of complications during coma. These types of complications include non-convulsive epileptic status. Each patient needs immediate EEG examination for early diagnose and correct treatment of this condition.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images.

Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = -0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group (P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level III. case-control study.

Loxoscelismo dermonecrotico en bovinos

Fueron atendidos por el Servicio Clínico Ambulatorio de Grandes Animales de la Facultad de Medicina Veterinaria y Zootecnia, Universidad de Córdoba, dos bovinos hembra, ambas de la raza Brahman, una novilla de 15 meses y un peso de 150 Kg y una vaca de 5 años y un peso 400 kg, ambos casos ubicados en el municipio de Cereté, Córdoba. La anamnesis indica que la novilla de 15 meses comenzó mostrando una leve hinchazón cutánea nivel de la región abdominal ventral y pectoral, con un progresivo aumento de volumen del área afectada durante una semana, de igual forma, la vaca de 5 años comenzó con enrojecimiento de la piel de la glándula mamaria y del pezón. Se realizó un examen clínico sistema tegumentario, donde se analizaron las características de la lesión, así como los posibles diagnósticos presuntivos, basado en la forma, ubicación, extensión, humedad y profundidad de la lesión; y de las condiciones epidemiológicas de la zona. En ambos animales, las lesiones fueron en común caracterizadas por una necrosis progresiva, con una zona eritematosa y edematosa, presencia de un punto necrótico central y un halo medial blanquecino y uno más externo violáceo, hiperestesia de la zona. Se concluye la importancia de conocer la epidemiología de las alteraciones dermatológicas en bovinos del Departamento de Córdoba, así como, el buen uso del examen clínico, la caracterización de las lesiones y la presencia de la araña en las explotaciones bovinas donde se presenten casos de dermonecrósis para el correcto diagnóstico de loxoscelismo.

Clinical examination factors that predict delayed recovery in individuals with concussion

BackgroundRisk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis.MethodsThe study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR.Results80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR.ConclusionsThe clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion.

Image Diagnosis in Extensor Tendons Injuries in the Radiocarpal Region in Horses

Background: Soft tissue injuries are common in sport horses, especially those involving tendons, with few current reports in the literature on the diagnosis of extensor injuries, especially with regard to ultrasound characteristics, being essential for the diagnosis of these injuries. The objective of the study is to characterize the clinical signs and the alterations of images, especially ultrasound, in the diagnosis of these lesions of the dorsal radiocarpal region, through case reports of horses seen at the Medical Clinic of Large Animals of the Federal University of Campina Grande (MCLA/UFCG), Patos-PB, Brazil.Cases: The study includes five “vaquejada” competitions horses, of which two were active and the others were away from the sport before the onset of the problem, with injuries to the extensor tendons in the radiocarpal region. Two of the animals had involvement of the common digital extensor muscle tendon (CDEMT), with acute and chronic tenosynovitis, and three with involvement of the extensor carpi radialis muscle tendon (ECRMT), presenting acute tendonitis, septic tenosynovitis and rupture, all of traumatic etiology, except for one whose cause has not been determined. On physical examination, the affected tendon was noticeable in three cases, and two had other injuries associated with the tendons. Bone alteration in the radiographic examination was observed in two cases, however, one of them related to another disease in the radiocarpal palmar region. Ultrasound images, performed in all cases, showed different characteristics and degrees of the involvement of the tendon and its sheath.Discussion: The scarcity of current reports of extensor tendon injuries in horses can be attributed to the fact that they do not suffer as much overload or effect from biomechanics compared to flexor tendons, in addition to being an area of little soft tissue covering these tendons. Although the involvement of the extensor tendons is more frequent in the pelvic limbs, due to lacerations, the occurrence of lesions in the dorsal radiocarpal region may be related to excess flexion, being easily susceptible to trauma to solid objects. The specific clinical examination, associated with a well-explored anamnesis, can allow us to locate the lesion and achieve a presumptive diagnosis. In three cases, tendon injuries were noticeable on inspection and palpation, important points to guide the diagnosis. However, in two cases with associated injuries this perception became difficult. Regardless of the clinical diagnosis, imaging diagnosis in lesions of the locomotor system was essential, as it allowed us to assess bone involvement, accurately determine the location of the lesion, its extent and prognosis, which would not be possible only in the clinic. Through ultrasonography it was possible to classify the lesions into acute (hypoechoic areas) and chronic (hyperechoic areas or with heterogeneous pattern of variable echogenicity), in addition to the thickness and characteristic of the liquid in the tendon sheath, which are also important aspects for lesion classification. Thus, we conclude that the dorsal region at the carpal level is susceptible to trauma and can easily compromise the extensor tendons. And for the diagnosis and adequate conduct, it is necessary to determine ultrasound image regarding the different types of lesions, which is provided in the present study.

Circulating ensembles of tumor-associated cells: A redoubtable new systemic hallmark of cancer.

Circulating ensembles of tumor‐associated cells (C‐ETACs) which comprise tumor emboli, immune cells and fibroblasts pose well‐recognized risks of thrombosis and aggressive metastasis. However, the detection, prevalence and characterization of C‐ETACs have been impaired due to methodological difficulties. Our findings show extensive pan‐cancer prevalence of C‐ETACs on a hitherto unreported scale in cancer patients and virtual undetectability in asymptomatic individuals. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples of 16,134 subjects including 5,509 patients with epithelial malignancies in various organs and 10,625 asymptomatic individuals with age related higher cancer risk. PBMCs were treated with stabilizing reagents to protect and harvest apoptosis‐resistant C‐ETACs, which are defined as cell clusters comprising at least three EpCAM+ and CK+ cells irrespective of leucocyte common antigen (CD45) status. All asymptomatic individuals underwent screening investigations for malignancy including PAP smear, mammography, low‐dose computed tomography, evaluation of cancer antigen 125, cancer antigen 19‐9, alpha fetoprotein, carcinoembryonic antigen, prostate specific antigen (PSA) levels and clinical examination to identify healthy individuals with no indication of cancer. C‐ETACs were detected in 4,944 (89.8%, 95% CI: 89.0–90.7%) out of 5,509 cases of cancer. C‐ETACs were detected in 255 (3%, 95% CI: 2.7–3.4%) of the 8,493 individuals with no abnormal findings in screening. C‐ETACs were detected in 137 (6.4%, 95% CI: 5.4–7.4%) of the 2,132 asymptomatic individuals with abnormal results in one or more screening tests. Our study shows that heterotypic C‐ETACs are ubiquitous in epithelial cancers irrespective of radiological, metastatic or therapy status. C‐ETACs thus qualify to be a systemic hallmark of cancer.