Incapacitating hypersensitivity to one's own body sounds due to a dehiscence of bone overlying the superior semicircular canal. A case report

We present a case study of a 49-year-old patient with an 8-year history of hypersensitivity to sound produced by intrinsic but not extrinsic sources. Findings that indicated an organic problem were: a supranormal bone conduction threshold of −25 to −15dB HL from 0.25 to 1kHz with an air-bone gap of 15 to 45dB HL, a lower threshold and larger amplitude for vestibular-evoked myogenic potentials, eye movement reactions to sound and trunk pitch sway in response to sound. Results of immitance audiometry and otoacoustic emission testing were within normal limits and indicative of intact middle ear conductance. A high-resolution CT scan of the temporal bone demonstrated a dehiscence of bone overlying the superior semicircular canal. These findings support previous research indicating that auditory energy reaches the cochleo-vestibular receptor systems more easily via transmission through cerebrospinal fluid than through bone. Therefore, a dehiscence of the bone overlying the superior semicircular canal may lead to hypersensitivity to intrinsic sound. We recommend that similar findings in other patients be followed up with an evaluation of middle ear function and the temporal bone with high-resolution CT sca

Individual voxelwise dosimetry of targeted 90Y-labelled substance P radiotherapy for malignant gliomas

Purpose: Substance P is the main ligand of neurokinin type 1 (NK-1) receptors, which are consistently overexpressed in malignant gliomas. The peptidic vector 111In/90Y-DOTAGA-substance P binds to these receptors and can be used for local treatment of brain tumours. Dosimetry for this interstitial brachytherapy has mainly been done using geometrical models; however, they often do not faithfully reproduce the in vivo biodistribution of radiopharmaceuticals, which is indispensable to correlate the deposited energy with clinical response. The aim of this study was to establish a reproducible dosimetry protocol for intratumoural radiopeptide therapy. Methods: For test and therapeutic injections, 2MBq of 111In-substance P and 370-3,330MBq of 90Y-substance P, respectively, were applied in 12 patients with malignant gliomas. Over a period of 24h, serial SPECT scans were performed on a dual-head SPECT camera. The scans were acquired in a double-energy window technique together with 99mTc-ECD in order to co-register the dose distributions with a separately acquired, contrast-enhanced CT scan. Quantitative voxelwise dose distribution maps (in Gy/GBq) were computed from these data using a mono-exponential decay approach. Pre- and post-therapeutic values were compared. Results: Agreement between pre- and post-therapeutic dosimetry was very good and delivered absolute dose values in Gy per injected GBq. In all patients, the pretherapeutic test injection together with the CT overlay technique could predict the precise localisation of dose deposition in an anatomical context. Conclusion: This protocol allows a precise pretherapeutic computation of the expected three-dimensional dose distribution and is clearly superior to the previously used dosimetry based on planar scintigraphic images. It has become an indispensable tool for planning intratumoural radiopeptide therapy in glioma patient

Synthesis, structural analysis, chemical stability, magnetic study and electric percolative effect on composite GdBa2Cu3O7−δ /Sr2GdSbO6.

1 recurso en línea (páginas 33-40).This document reports the synthesis of the materials Sr2GdSbO6 (SGSO) and GdBa2Cu3O7−δ (GBCO), by the reaction method in solid state and GdBa2Cu3O7−δ /Sr2GdSbO6 (GBCO/SGSO) composites in different volumetric proportions. The structural characterization of the synthesized compounds was carried out by means of X-ray diffraction, using the Rietveld refinement method, performing a quantitative analysis of phases in volume. The results obtained confirm that the two materials (GBCO / SGSO) are chemically stable, coexisting in the same volume at 9000 C. It was also found, by means of magnetization measures, that the GBCO contained in each one of the different composites, It keeps superconducting properties, as the transition to the superconducting state was obtained below a temperature of 900 K. The morphological characterization was performed by scanning electron microscopy (SEM) and elemental analysis by means of dispersive energy spectroscopy (EDX) measurements. The electrical study was performed by means of voltage measurements as a function of the current at room temperature and subsequent calculation of the volumetric resistivity. The study of the percolative effect was carried out by calculating the critical volume and the critical exponents in each one of the insulating and conductive phases, using the Kussy model [1] and the semi-classical non-linear response model Random Resistor cum Tuning Bond Network (RRTN)[2], by contrasting critical exponents with those found in the literature.En este trabajo se reporta la síntesis de los materiales Sr2GdSbO6 (SGSO) y GdBa2Cu3O7−δ (GBCO), por el método de reacción en estado sólido y de compósitos GdBa2Cu3O7−δ /Sr2GdSbO6 (GBCO/SGSO) en diferentes proporciones volumétricas. La caracterización estructural de los compuestos sintetizados se realizó por medio de difracción de rayos X, usando el método de refinamiento Rietveld, realizando un análisis cuantitativo de fases en volumen. Los resultados obtenidos permiten confirmar que los dos materiales (GBCO/SGSO) son estables químicamente, coexistiendo en un mismo volumen a 900 C. También se encontró, mediante medidas de magnetización, que el GBCO contenido en cada uno de los diferentes compósitos, conservó sus propiedades superconductoras, ya que se obtuvo la transición al estado superconductor por debajo de una temperatura de 90 K. La caracterización morfológica se realizó mediante medidas de microscopia electrónica de barrido (SEM) y análisis elemental mediante medidas de espectroscopia de energía dispersiva (EDX). El estudio eléctrico se realizó mediante medidas de voltaje en función de la corriente a temperatura ambiente y posterior cálculo de la resistividad volumétrica. El estudio del efecto percolativo se llevó a cabo mediante el cálculo del volumen crítico y de los exponentes críticos en cada una de las fases aislante y conductora, usando el modelo de Kussy [1] y el modelo de respuesta no lineal semi clásica Random Resitor cum Tunelling bond Network (RRTN) [2] contrastando los exponentes críticos, con los encontrados en la literatura.Bibliografía: página 40

Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Arthroscopic rotator cuff repair in the weight-bearing shoulder

BACKGROUND: In wheelchair-dependent individuals, pain often develops because of rotator cuff tendon failure and/or osteoarthritis of the glenohumeral joint. The purposes of this study were to investigate (1) specific rotator cuff tear patterns, (2) structural healing, and (3) clinical outcomes after arthroscopic rotator cuff repair in a cohort of wheelchair-dependent patients. METHODS: Forty-six shoulders with a mean follow-up of 46 months (range, 24-82 months; SD, 13 months) from a consecutive series of 61 shoulders in 56 patients (46 men and 10 women) undergoing arthroscopic rotator cuff repair were available for analysis. Clinical outcome analysis was performed using the Constant-Murley score, the Subjective Shoulder Value, and the American Shoulder and Elbow Surgeons score. The integrity of the repair was analyzed by ultrasound. RESULTS: Of the shoulders, 87% had supraspinatus involvement, 70% had subscapularis involvement, and 57% had an anterosuperior lesion involving both the supraspinatus and subscapularis. Despite an overall structural failure rate of 33%, the patients showed improvements in the Constant-Murley score from 50 points (range, 22-86 points; SD, 16 points) preoperatively to 80 points (range, 40-98 points; SD, 12 points) postoperatively and in the American Shoulder and Elbow Surgeons score from 56 points (range, 20-92 points; SD, 20 points) preoperatively to 92 points (range, 53-100 points; SD, 10 points) postoperatively, with a mean postoperative Subjective Shoulder Value of 84% (range, 25%-100%; SD, 17%). CONCLUSION: Failure of the rotator cuff in weight-bearing shoulders occurs primarily anterosuperiorly. Arthroscopic rotator cuff repair leads to a structural failure rate of 33% but satisfactory functional results with high patient satisfaction at midterm follow-up

The Comprehensive AOCMF classification system : radiological issues and systematic approach

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94); the levels 2 and 3 focus on defining fracture location and morphology within more detailed regions and subregions. Correct imaging acquisition, systematic analysis, and interpretation according to the anatomic and surgical relevant structures in the CMF regions are essential for an accurate, reproducible, and comprehensive diagnosis of CMF fractures using that system. Basic principles for radiographic diagnosis are based on conventional plain films, multidetector computed tomography, and magnetic resonance imaging. In this tutorial, the radiological issues according to each level of the classification are described.8 page(s

Skull base and maxillofacial fractures : two centre study with correlation of clinical findings with a comprehensive craniofacial classification system

PURPOSE: A comprehensive classification based on high resolution computed tomography (CT) of the whole craniofacial region was correlated with clinical findings of combined skull base and maxillofacial fractures. MATERIAL AND METHODS: In a study of two clinical centres, 70 patients with such injuries were admitted at the Universities of Basel (n=29) and Uppsala (n=41). Clinical signs (rhinorrhoea, periorbital haematoma and pneumencephalus) and surgical versus conservative treatment were correlated with a cranio-maxillofacial injury severity score (CMF-ISS) calculated from the classification system. Fracture classifications were decided in consensus on the basis of CT and semiautomatic classification software. The classification system defined 3 fracture types (A, B, C), 3 groups (A1, A2, A3), and 3 subgroups (A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). RESULTS: Of 70 patients, 43 were operated upon and 27 conservatively treated. The operated patients had significantly higher severity scores than non-operated. Patients with or without periorbital haematoma do not differ significantly in the severity score. The severity of the CMF-ISS score was significantly associated (two sample T-test P>0.01) with the occurrence of pneumencephalus, rhinorrhoea and treatment approach. CONCLUSION: Based on our present results, this system seems to be clinical useful for operative decisions and interventions

Globe restriction in a severely myopic patient visualized through oculodynamic magnetic resonance imaging (od-MRI)

Different mechanisms have been hypothesized as contributing to abduction deficit in high myopia: the size of the eye within the orbit, tightness of the medial rectus muscles, decompensation of longstanding esotropia, and inferior displacement of the lateral rectus muscle. Using oculodynamic magnetic resonance imaging, enhanced by computer-aided visualization, we demonstrate globe restriction by the medial orbital wall on abduction in a patient with high myopia

Efectos de la simpatectomía torácica sobre la pletismografía de los miembros superiores en sujetos con hiperhidrosis palmar

Introducción: La simpatectomía es el tratamiento de la hiperhidrosis palmar y consiste en denervación simpática de miembros superiores que produce un efecto en el flujo sanguíneo al impactar la respuesta vasoconstrictora. El cambio en el flujo sanguíneo se puede evaluar a través de la onda fotopletismográfica. Metodología: Se realizaron 2 sesiones (presimpatectomía y postsimpatectomía) de 10 minutos en cada miembro superior en 28 pacientes obteniendo 79 señales fotopletismográficas distribuidas así: 37 presimpatectomía y 42 señales postsimpatectomía. De cada señal se analizó 1.5 minutos donde se tienen 80 ondas de fotopletismografía y se miden 6 variables: 1. Componente AC (componente pulsátil), 2. Componente DC (componente no pulsátil), 3. Relación entre AC/DC (índice de perfusión), 4. Area bajo la curva (AUC), 5. Tiempo entre el inicio de la onda y pico sistólico (T_DA) y 6. Tiempo entre cada onda de pulso (T_DD). Resultados: Aumentó 120% el componente AC y disminuyó 78% en DC del miembro superior derecho (MSD) con 99% de confiabilidad (p<0.001) entre presimpatectomía (n=18) y postsimpatectomía (n=21). AC/DC aumentó 55% con 95% de confiabilidad entre presimpatectomía (n=19) y postsimpatectomía (n=21) en el miembro superior izquierdo (p<0.05). No se encontró diferencia para T_DA, T_DD ni AUC. Discusión y Conclusión: La simpatectomía en pacientes con hiperhidrosis palmar produce un cambio en el flujo sanguíneo de los miembros superiores evidenciado por los cambios en el componente no pulsátil (DC) y pulsátil (AC) que es secundario a la vasodilatación consecuencia del bloqueo simpático por la denervación quirúrgica de los ganglios simpáticos torácicos.Introduction: Sympathectomy is used for the treatment of palmar hyperhidrosis with sympathetic denervation in upper limbs. It has an effect on blood flow because of it’s impact in vasoconstrictor response. The change in blood flow can be evaluated through the photoplethysmographic waveform. Methodology: 2 sessions (preoperative and postoperative) were performed for 10 minutes in each upper limb in 28 patients obtaining 79 photoplethysmographic signals: 37 presympathectomy and 42 postsympathectomy. Each signal was analyzed for 1.5 minutes. We obtained 80 waves and measured 6 variables: 1. AC component (pulsatile component), 2. Component DC (non-pulsatile component), 3. Ratio AC / DC (perfusion index), 4. Area under the curve (AUC), 5. time between the start of the peak systolic wave (T_DA) and 6. Time between pulse wave (T_DD). Results: AC increased 120% and DC decreased 78% of the right upper extremity (RUE) with a 99% confiability (p <0.001) between presympathectomy (n=18) and postsympathectomy (n=21). AC/DC increased 55% with a 95% confiability between presympathectomy (n=19) and post-sympathectomy (n=21) in the left upper extremity (p <0.05). No difference in T_DA, T_DD or AUC was observed. Discussion and Conclusion: Sympathectomy in patients with palmar hyperhidrosis causes a change in blood flow to the upper limbs as evidenced by the changes in non- pulsatile (DC) and pulsatil component (AC). This change may be secondary to vasodilation due to surgical sympathetic denervation of the thoracic sympathetic ganglia