Microflow imaging: new Doppler technology to detect low-grade inflammation in patients with arthritis

AIM: To assess the efficacy of microvascular imaging in detecting low-grade inflammation in arthritis compared with Power Doppler ultrasound (PDUS). METHOD AND MATERIALS: Patients presenting for ultrasound with arthralgia were assessed with grey-scale, PDUS and Superb Microvascular Imaging (SMI). Videoclips were stored for analysis at a later date. Three musculoskeletal radiologists scored grey-scale changes, signal on PDUS and/or SMI within these joints. If a signal was detected on both PDUS and SMI, the readers graded the conspicuity of vascular signal from the two Doppler techniques using a visual analogue scale. RESULTS: Eighty-three patients were recruited with 134 small joints assessed. Eighty-nine of these demonstrated vascular flow with both PD and SMI, whilst in five no flow was detected. In 40 joints, vascularity was detected with SMI but not with PDUS (p = 0.007). Out of the 89 joints with vascularity on both SMI and PDUS, 23 were rated as being equal; while SMI scored moderately or markedly better in 45 cases (p <0.001). CONCLUSION: SMI is a new Doppler technique that increases conspicuity of Doppler vascularity in symptomatic joints when compared to PDUS. This allows detection of low grade inflammation not visualised with Power Doppler in patients with arthritis. KEY POINTS: • SMI detects vascularity with improved resolution and sensitivity compared to Power Doppler. • SMI can detect low-grade inflammation not seen with Power Doppler. • Earlier detection of active inflammation could have significant impact on treatment paradigms

Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient ischaemic attack (TIA). Sensitivity analyses were performed considering the population type and the use of adjustments. Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block. Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients

TINJAUAN KRIMINOLOGIS TERHADAP TINDAK PIDANA INCEST DENGAN KORBAN ANAK(STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)

ABSTRAKTRI KARUNIA PUTRI AMELIA,TINJAUAN KRIMINOLOGIS TERHADAP 2015 TINDAK PIDANA INCEST DENGAN KORBAN ANAK (STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)Fakultas Hukum Universitas Syiah Kuala(v,54),pp.,bibl(Dr. DAHLAN ALI., S.H., M.Hum., M.Kn.,)Salah satu kejahatan yang sering terjadi adalah tindak pidana perkosaan. Tindak pidana perkosaan merupakan salah satu dari tindak pidana terhadap kesusilaan. Dalam Bab XIV dalam Buku II KUHP memuat kejahatan terhadap kesusilaan yang tersebar pada pasal 281 hingga 303 KUHP. Di dalamnya yang dimaksud dengan kesusilaan sebagian besar berkaitan dengan seksualitas. Salah satu jenis kelainan seksual adalah hubungan seks yang dilakukan secara paksa bersama seseorang yang masih ada hubungan darah yaitu incest, dan yang biasanya menjadi korban ialah anak-anak. Incest sebagaimana dirumuskan dalam kamus besar bahasa Indonesia adalah hubungan seksual antara orang-orang yang bersaudara dekat yang dianggap melanggar adat, hukum dan agama. Sanksi mengenai incest dengan korban anak dapat dilihat dalam Pasal 81 dan Pasal 82 Undang-Undang No. 23 Tahun 2002 Tentang Perlindungan Anak.Penelitian ini bertujuan untuk menjelaskan faktor penyebab terjadinya tindak pidana incest, dan untuk mengetahui upaya yang perlu dilakukan untuk menanggulangi tindak pidana incest di provinsi Aceh.Untuk memperoleh data dalam penelitian skripsi ini, dilakukan penelitian pustaka (library research) dan penelitian lapangan (field research) yang dilaksanakan di Banda Aceh dengan lokasi penelitian pada Lembaga Pemasyarakatan Klas IIA dengan tipe penelitian deskriptif yaitu menganalisis data yang diperoleh dari studi lapangan dan kepustakaan dengan cara menjelaskan dan menggambarkan kenyataan objek. Hasil penelitian menunjukkan bahwa faktor-faktor penyebab terjadinya tindak pidana incest adalah: Faktor rendahnya pendidikan dan ekonomi, Faktor lingkungan atau tempat tinggal, Faktor alkohol, Faktor kurangnya pemahaman terhadap agama, dan Peranan korban. Penanggulangan tindak pidana incest dapat dilakukan dengan cara mengadakan pelayanan emergency call kepada masyarakat, mengadakan pengedukasian bagi para orang tua, dan juga pembinaan mental kepada pelaku dan korban tindak pidana incest.Disarankan kepada pemerintah agar hendaknya memperbanyak wadah tempat pengaduan untuk masyarakat, serta diadakan penyuluhan hukum agar dapat menumbuhkan kesadaran masyarakat untuk benar-benar mentaati hukum. Selain itu disarankan agar sistem pembuktian dalam kasus perkosaan dapat lebih permudah, khususnya incest.Banda Ace

Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging.

Many papers have been published recently on the subject of pseudotumors surrounding metal-on-metal hip resurfacing and replacement prostheses. These pseudotumors are sterile, inflammatory lesions within the periprosthetic tissues and have been variously termed masses, cysts, bursae, collections, or aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL). The prevalence of pseudotumors in patients with a well-functioning metal-on-metal hip prosthesis is not well known. The purpose of this study was to quantify the prevalence of pseudotumors adjacent to well-functioning and painful metal-on-metal hip prostheses, to characterize these lesions with use of magnetic resonance imaging, and to assess the relationship between their presence and acetabular cup position with use of three-dimensional computed tomography

A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty

Background and purpose — Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy. Patients and methods — We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values. Results — The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43–87) and on USS it was 53% (CI: 29–76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39–91) and the specificity was 83% (CI: 36–97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24–71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI

Unusual cause of a painful right testicle in a 16-year-old man: a case report

<p>Abstract</p> <p>Introduction</p> <p>Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall.</p> <p>Case presentation</p> <p>A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 10⁹/L) and C-reactive protein (CRP; 300 mg/L). Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery.</p> <p>Conclusion</p> <p>Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.</p

Stereotactic large-core needle breast biopsy: analysis of pain and discomfort related to the biopsy procedure

The purpose of this study was to determine the significance of variables such as duration of the procedure, type of breast tissue, number of passes, depth of the biopsies, underlying pathology, the operator performing the procedure, and their effect on women’s perception of pain and discomfort during stereotactic large-core needle breast biopsy. One hundred and fifty consecutive patients with a non-palpable suspicious mammographic lesions were included. Between three and nine 14-gauge breast passes were taken using a prone stereotactic table. Following the biopsy procedure, patients were asked to complete a questionnaire. There was no discomfort in lying on the prone table. There is no relation between type of breast lesion and pain, underlying pathology and pain and performing operator and pain. The type of breast tissue is correlated with pain experienced from biopsy (P = 0.0001). We found out that patients with dense breast tissue complain of more pain from biopsy than patients with more involution of breast tissue. The depth of the biopsy correlates with pain from biopsy (P = 0.0028). Deep lesions are more painful than superficial ones. There is a correlation between the number of passes and pain in the neck (P = 0.0188) and shoulder (P = 0.0366). The duration of the procedure is correlated with pain experienced in the neck (P = 0.0116) but not with pain experienced from biopsy