The Role of Venom Haemorrhagin in Spontaneous Bleeding in Bothrops jararaca Envenoming

Thirty-eight patients bitten by Bothrops jararaca were investigated. Twenty-six had signs of local or systemic haemorrhage. Twenty-two of these had incoagulable blood, and these patients were found to have low fibrinogen levels (mean 0.17 ± 0.03 g/1), thrombocytopenia, very high thrombin-antithrombin III complex (850 ± 184 pg/1) and D-dimer (170 ± 44 μg/ml) antigen levels. Serum venom haemorrhagin levels were significantly higher in patients with clinical signs of haemorrhage (36.4 ± 6.4 ng/ml) than those without (11.7 ± 3.7 ng/ml; p <0.002). Twelve out of 13 patients with thrombocytopenia were bleeding. High levels of thrombomodulin (22.3 ± 1.5 ng/ml) and haemorrhagin (35.7 ± 7.7 ng/ml) were detected in these 12 patients, suggesting vascular endothelial damage. Haemorrhagin levels also correlated inversely with platelet count in these patients. It was concluded that thrombocytopenia is one of the main causes of bleeding inB. jararaca victims, possibly as a result of venom haemorrhagin activity.

Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy

Background

The majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise to minimally invasive parathyroidectomy (MIP), with lower complication rates in comparison with bilateral neck exploration. Misdiagnosis and undertreatment of multiglandular disease, leading to potentially higher recurrence rates, remains a concern. This study evaluated risks of long‐term (1 year or more) recurrence following ‘targeted’ MIP in PHPT.

Methods

Multiple databases were searched for studies published between January 2004 and March 2017, looking at long‐term outcomes (1 year or more) following targeted MIP for PHPT. English‐language studies, with at least 50 patients and a mean follow‐up of 1 year, were included.

Results

A total of 5282 patients from 14 studies were included. Overall mean recurrence and cure rates were 1·6 (range 0–3·5) and 96·9 (95·5–100) per cent respectively. Mean follow‐up was 33·5 (1–145) months. When intraoperative parathyroid hormone (PTH) measurements were not done, cure rates were higher (99·3 per cent versus 98·1 per cent with use of intraoperative PTH measurement; P < 0·001) and recurrence rates lower (0·2 versus 1·5 per cent respectively; P < 0·001).

Conclusion

Targeted MIP for a presumed single overactive adenoma was associated with very low recurrence rates, without the need for intraoperative PTH measurement when preoperative imaging studies were concordant. Targeted MIP should be encouraged.

The plasmonic properties of gold nanoparticle clusters formed via applying an AC electric field

An external electric AC field with a field strength ranging from 10 V mm-1 to 30 V mm-1 and a frequency ranging from 0.1 kHz to 1 MHz was applied to suspensions of gold nanoparticles (Au NPs) to control their plasmonic properties. Apparent differences in the UV-vis spectra of the Au NPs were observed between the spectra with and without the field application. The characteristic red color of the Au NP suspension darkened; this suggested that the application of the AC field caused the aggregation of the Au NPs. In addition, the sizes of the Au NP clusters in suspension formed by the AC field application depended on the frequency of the applied field. The surface-enhanced Raman scattering (SERS) effects of Au NP clusters were examined by comparing the difference in Raman intensities obtained at 30 V mm-1 and in a frequency range of 0.1 kHz to 1 MHz. The application of a low-frequency field at 0.1 kHz caused a rapid aggregation of the Au NPs, resulting in low Raman intensities of the probe molecules. Conversely, high-frequency applications between 1 kHz and 1 MHz successfully enhanced the Raman intensities of the molecules in suspension. The strong correlation of the optical/sensing properties with the Au NP clustering states reveals that the application of an AC electric field is a powerful tool for control over the plasmonic properties.

Medial and lateral laxity in knees with advanced medial osteoarthritis

OBJECTIVE

An increase in coronal laxity is recognized as a risk factor for progression of knee osteoarthritis (OA). The purpose of this study was to evaluate coronal laxity, which was defined as the angular motion from the neutral, unloaded (baseline) position to the loaded position, in patients with advanced medial knee OA.

METHOD

Preoperative coronal laxity was assessed using radiographs in patients with medial knee OA undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. A consecutive series of 211 knees with OA and 40 normal control knees were examined. A knee with OA was defined as clinically "balanced" when the difference between medial and lateral laxity was 3° or less. Values are expressed as median [25^th, 75^th percentile].

RESULTS

The laxity was 4° [3, 5] from the baseline on the medial side and 3° [2, 4] on the lateral side. The distribution of medial and lateral laxity indicated that 90% (189/211) of patients fell within 3°. The equivalence test showed that the medial and lateral laxity was similar, with an equivalence margin of 3° (P < 0.001). In the control knees, the laxity was 3° [2, 4] from the baseline on the medial side and 2° [2, 4] on the lateral side. The differences between the knees with advanced OA and the controls were significant (P = 0.005, medial; P = 0.006, lateral).

CONCLUSION

This study showed that a clinically balanced knee was maintained even in patients with advanced medial knee OA.

Ultrasound-Guided Fine-Needle Aspiration Biopsy for Breast Tumors: Needle Guide versus Freehand Technique

Background

We retrospectively studied whether a needle guide is necessary when performing ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in patients with breast tumors.

Methods

A total of 47 patients (50 lesions) with breast tumors underwent US-FNAB with a needle guide and 127 patients (143 lesions) underwent the procedure without a needle guide (freehand biopsy). The diagnoses obtained by US-FNAB were compared with the surgical findings.

Results

The sensitivity of freehand biopsy for tumors <3 cm in diameter was significantly higher than that of the needle guide technique.

Conclusions

We recommend performing US-FNAB without a needle guide (freehand biopsy) in order to maximize the correct preoperative diagnosis rate, especially in patients with tumors <3 cm in diameter.

Thyroid Cancer in Uremic Patients

Background

The combination of thyroid cancer and secondary uremic hyperparathyroidism has thus far been reported in only 25 cases.

Methods

Here we report our experience of 19 patients with secondary hyperparathyroidism who underwent parathyroidectomy.

Results

Thyroid nodules were present in five patients (26.3%), including one with a benign nodule and four with papillary thyroid cancer (21.1%).

Conclusion

Our experience suggests that, in order to make a correct diagnosis, clinicians should consider the possibility of thyroid cancer in uremic patients with secondary hyperparathyroidism.

Accessory Breast Cancer: A Case Report and Review of the Japanese Literature

The case of a 31-year-old woman with accessory breast cancer in the left axilla is described. She had noticed a swelling in the left axilla during her three pregnancies. The preoperative diagnosis of accessory breast cancer was made on the basis of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) and clinical history. She was treated by wide local resection and regional lymph node dissection. Although cancer originating from accessory breast tissue has been reported very rarely, knowledge of this disorder may facilitate the correct diagnosis of axillary tumors. US-FNAB is a useful and simple technique for the tissue diagnosis of axillary tumors.

Intrathyroid Thyroglossal Duct Cyst Simulating a Thyroid Nodule

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.

Risk assessment of the onset of Osgood-Schlatter disease using kinetic analysis of various motions in sports

BACKGROUND

Some studies have listed motions that may cause Osgood-Schlatter disease, but none have quantitatively assessed the load on the tibial tubercle by such motions.

PURPOSES

To quantitatively identify the load on the tibial tubercle through a biomechanical approach using various motions that may cause Osgood-Schlatter disease, and to compare the load between different motions.

METHODS

Eight healthy male subjects were included. They conducted 4 types of kicks with a soccer ball, 2 types of runs, 2 types of squats, 2 types of jump landings, 2 types of stops, 1 type of turn, and 1 type of cutting motion. The angular impulse was calculated for knee extension moments ≥1.0 Nm/kg, ≥1.5 Nm/kg, ≥2.0 Nm/kg, and ≥2.5 Nm/kg. After analysis of variance, the post-hoc test was used to perform pairwise comparisons between all groups.

RESULTS/CONCLUSIONS

The motion with the highest mean angular impulse of knee extension moment ≥1.0 Nm/kg was the single-leg landing after a jump, and that with the second highest mean was the cutting motion. At ≥1.5 Nm/kg, ≥2.0 Nm/kg, and ≥2.5 Nm/kg, the cutting motion was the highest, followed by the jump with a single-leg landing. They have a large load, and are associated with a higher risk of developing Osgood-Schlatter disease. The mean angular impulse of the 2 types of runs was small at all the indicators.

CLINICAL RELEVANCE

Motions with a high risk of developing Osgood-Schlatter disease and low-risk motions can be assessed in further detail if future studies can quantify the load and number of repetitions that may cause Osgood-Schlatter disease while considering age and the development stage. Scheduled training regimens that balance load on the tibial tubercle with low-load motions after a training day of many load-intensive motions may prevent athletes from developing Osgood-Schlatter disease and increase their participation in sports.