Anu Alanen

Sinusitis in the common cold

Abstract Background: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections. Objective: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults. Methods: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed. Results: On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects. Conclusion: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur. (J Allergy Clin Immunol 1998;102:403-8.)

Disc degeneration in young gymnasts A magnetic resonance imaging study

Magnetic resonance imaging (MRI) was performed on 35 young competitive gymnasts and 10 control subjects in order to detect the number of degenerated discs and other lumbar spinal disorders. Lumbar radiographs were obtained from all gymnasts who showed evidence of disc abnormality on MRI. Eleven gymnasts had suf fered from episodes of low back pain during exercises and eight were found to have evidence of back trauma. Only 3 of the 35 gymnasts had MRI evidence of degen erated discs associated with Scheuermanns manifes tations and spondylolysis. Lumbar radiographs con firmed the diagnosis in these three cases. The results indicate that despite the excessive range of motion and strong axial loading of the lumbar spine that are asso ciated with gymnastic maneuvers, incurable primary damage to the intervertebral discs is uncommon in young gymnasts dunng growth.

Disc degeneration in scheuermann disease

Comparison of the radiographic signs of Scheuermann disease and the corresponding disc degeneration on thoracolumbar magnetic resonance (MR) images was made in 21 young patients. Marginal sclerosis, Schmorl nodes and narrowed disc spaces, but not irregular or wedge-shaped end-plates, were significantly associated with disc degeneration. Fifty-five percent of the discs in the patients with Scheuermann disease were abnormal on MRI, compared with 10% in asymptomatic controls. Our study confirms that thoracolumbar disc degeneration is enhanced in 20-year-old patients with low back pain who have radiological evidence of Scheuermann disease.

Radiologic diagnosis of renal colic: the role of plain films, excretory urography and sonography

The accuracy of plain films, excretory urography and ultrasound for the clinical work-up of renal colic for detecting urinary calculi was evaluated prospectively in 49 patients. Excretory urography was the most sensitive and specific test. Plain films and sonography each had a sensitivity of approximately 60%, but combined yielded a sensitivity of 80%; specificity did not improve. A diagnostic algorithm where sonography was performed first followed by an excretory urography in case of a negative sonography was highly sensitive (93%) and rather specific (79%). This algorithm appears also to have a good cost-benefit rate.

Postoperative hematomas after successful lumbar microdiscectomy or percutaneous nucleotomy: a magnetic resonance imaging study.

We evaluated the incidence of postoperative extradural hematomas by means of magnetic resonance imaging (MRI) technique in 44 patients who underwent successful surgery for a virgin lumbar disc herniation. Of these patients, 28 were treated with microdiscectomy and 16 with percutaneous nucleotomy. Postoperative hematoma proved to be a universal MRI finding in the microsurgically treated patients: hematomas were found in all patients in the microdiscectomy group. In 12 (43%) patients the hematoma extended into the dural sack. The incidence of hematomas was significantly (p = 0.001) lower in the patients treated with percutaneous nucleotomy: hematomas were detected in only 10 (63%) of the 16 patients in the nucleotomy group. The hematomas in these patients were also smaller in size and none of them connected with the dural sac. Correlation between the hematomas and clinical findings showed that the presence of a hematoma had no obvious effect on the immediate postoperative recovery of a patient.

Sodium nitroprusside increases human skeletal muscle blood flow, but does not change flow distribution or glucose uptake.

1 The role of blood flow as a determinant of skeletal muscle glucose uptake is at present controversial and results of previous studies are confounded by possible direct effects of vasoactive agents on glucose uptake. Since increase in muscle blood flow can be due to increased flow velocity or recruitment of new capillaries, or both, it would be ideal to determine whether the vasoactive agent affects flow distribution or only increases the mean flow. 2 In the present study blood flow, flow distribution and glucose uptake were measured simultaneously in both legs of 10 healthy men (aged 29 ± 1 years, body mass index 24 ± 1 kg m−2) using positron emission tomography (PET) combined with [15O]H2O and [18F]fluoro‐2‐deoxy‐D‐glucose (FDG). The role of blood flow in muscle glucose uptake was studied by increasing blood flow in one leg with sodium nitroprusside (SNP) and measuring glucose uptake simultaneously in both legs during euglycaemic hyperinsulinaemia (insulin infusion 6 pmol kg−1 min−1). 3 SNP infusion increased skeletal muscle blood flow by 86 % (P < 0·01), but skeletal muscle flow distribution and insulin‐stimulated glucose uptake (61·4 ± 7·5 vs. 67·0 ± 7·5 μmol kg−1 min−1, control vs. SNP infused leg, not significant), as well as flow distribution between different tissues of the femoral region, remained unchanged. The effect of SNP infusion on blood flow and distribution were unchanged during infusion of physiological levels of insulin (duration, 150 min). 4 Despite a significant increase in mean blood flow induced by an intra‐arterial infusion of SNP, glucose uptake and flow distribution remained unchanged in resting muscles of healthy subjects. These findings suggest that SNP, an endothelium‐independent vasodilator, increases non‐nutritive, but not nutritive flow or capillary recruitment.

Stress fracture of the ulnar diaphysis in a recreational golfer

PURPOSE To report a very rare presentation of a stress fracture in a golfer: a stress fracture of the ulnar diaphysis. CASE SUMMARY A 44-year-old woman had a 4-week history of a sore left wrist. She had been playing golf daily and had had no sudden trauma. Extensor tendinitis was suspected. Symptomatic treatment was given. Radiographs showed a spiculated periosteal reaction of the distal ulnar diaphysis with no signs of fracture or bone destruction. The suggestion of a malignant lesion was raised. Magnetic resonance imaging showed a healing ulnar fracture and edema of the interosseous membrane. DISCUSSION In golfers, stress fractures may be seen in ribs laterally and in tibias. We believe supination together with overuse of the hand flexor muscles caused the stress fracture presented, which has not previously been reported in golfers. RELEVANCE Physicians should be aware of the potential for ulnar stress fracture in golfers with wrist pain.

Central nervous system involvement in gyrate atrophy of the choroid and retina with hyperornithinaemia

In gyrate atrophy of the choroid and retina with hyperornithinaemia (GA), a genetically determined deficiency of ornithine {3}d-aminotransferase activity leads to high ornithine concentrations in body fluids. GA is characterized by centripetally progressing retinal and choroidal destruction and selective atrophy with tubular aggregates in type II skeletal muscle fibres. These findings have been suggested to be mediated by hyperornithinaemia-induced deficiency of high-energy creatine phosphate. As abnormal brain magnetic resonance images and electroencephalograms are found in another disorder of creatine metabolism, guanidinoacetate methyltransferase deficiency, we investigated the central nervous system involvement in GA, which seems to be associated with a milder degree of phosphocreatine deficiency. We compared 23 untreated GA patients with age-matched healthy controls, and with 9 patients who had received creatine or creatine precursor supplementation daily for several years. The mean age of the patients (32±18 years) was similar to that of the controls (36±22 years). The MRI or EEG findings of the patients on creatine supplementation did not differ from those of the untreated group. Brain MRI revealed degenerative lesions in the white matter in 50% of the GA patients, and 70% of the patients had premature atrophic changes, with a striking increase in the number of Virchows spaces. Of the patients whose EEG was recorded, 58% had abnormal slow background activity, focal lesions or high-amplitude β rhythm (>50μV). The EEG findings were not associated with the MRI changes or with the age or the sex of the patients. Early degenerative and atrophic brain changes and abnormal EEG are thus features of GA, in addition to the well-characterized eye and muscle manifestations.

Sonography of the achilles tendon in hypercholesterolaemia

Abstract. Objectives. Tendon xanthomas cause thickening of the tendon and are an important sign in monogenic familial hypercholesterolaemia (FH). The aim of our study was to investigate the usefulness of achilles tendon sonography in detecting FH patients. Special attention was paid to structural abnormalities of the achilles tendon.

Artifacts in MR Imaging Caused by Small Quantities of Powdered Iron

The MR image artifacts caused by minute metallic particles were investigated by imaging small powdered iron quantities from 0.01 mg to 1.7 mg in water phantoms. Images with T1-weighted GRE 3-D and T2-weighted SE 2-D sequences were reconstructed with 5 MR imagers: at 0.04 T, 0.1 T (2 scanners), 1.0 T and 1.5 T. In GRE 3-D images the artifacts were round, clearly demarcated black areas, whereas in SE 2-D images artifact areas were elliptic and surrounded by a bright irregular rim with ghost veils in the direction of frequency encoding. The area of the artifact increased slightly up to 0.1 mg of iron, but grew clearly with larger samples. It appeared to behave independently on the MR imager system for all iron samples. This study shows that even microscopic magnetic particles cause a notable distortion in the MR image independently of the MR equipment used.