Frequency of acute longus colli tendinitis on CT examinations
PURPOSE/OBJECTIVE:We attempted to determine the frequency of acute longus colli tendinitis on diagnostic CT imaging performed at a large multicenter health care system. By correlating with the pre-imaging clinical information, we investigated which patient presentations should lead the radiologist to increased suspicion for this condition. METHODS:Images from a total of 8101 adult CT examinations of the neck and cervical spine performed over a 3-month period were evaluated by researchers independent of the original clinical report. Clinical information available at the time of imaging was reviewed and assigned to one of five categories. Frequency of the condition was calculated by sex and clinical presentation. This retrospective study with waiver of consent and waiver of HIPPA was approved by our IRB. RESULTS:Nine positive scans were found for an overall frequency of 1.1 per 1000 examinations. The frequency was significantly higher (11.4 per thousand) on scans performed of patients presenting without history of recent trauma, concern for tumor, suspected postoperative complication, or clinical signs of infection localized to the neck. Although frequency in males was higher than in females, this did not reach statistical significance. In no positive or negative case was longus colli tendinitis considered in the pre-imaging documentation. CONCLUSIONS:Findings of acute longus colli tendinitis on CT examination generally occur in the absence of prior mention of this condition in the medical record. The radiologist should be particularly alert for this diagnosis when a patient presents with rapid-onset neck pain without a clear history of recent trauma or other etiologies.
Binding of RBP-Jkappa (CSL) protein to the promoter of the Kaposi's sarcoma-associated herpesvirus ORF47 (gL) gene is a critical but not sufficient determinant of transactivation by ORF50 protein
ORF50 protein activates the KSHV lytic cycle. The promoter of an early lytic-cycle gene ORF47, encoding envelope protein gL, is activated by an interaction between ORF50 protein and RBP-Jkappa. In ORF47p only one of two sequences fitting the consensus RBP-Jkappa recognition site strongly binds RBP-Jkappa and confers a response to ORF50 protein. Flanking sequences 5' to the RBP-Jkappa binding site are required to confer a maximal response to ORF50 protein. Not all mutant ORF50 response elements in the ORF47p that are bound by RBP-Jkappa are sufficient to confer maximal ORF50 responsiveness. Four sequences containing an RBP-Jkappa site and flanking sequences characteristic of the ORF50 response element in ORF47p were identified in human DNA. All bound RBP-Jkappa, but only one responded robustly to ORF50 protein. We propose models for the possible function of ancillary sequences flanking the RBP-Jkappa-binding element which are crucial for mediating ORF50 transactivation.
The paradox of the pouch: prompt emptying predicts improved weight loss after laparoscopic Roux-Y gastric bypass
INTRODUCTION: The utility of routine upper gastrointestinal (UGI) evaluations after laparoscopic Roux-Y gastric bypass (LRYGB) has yet to be determined, primarily being used to rule out a gastrojejunal leak. Additional information can be assessed with these studies, including the rate of contrast emptying from the pouch; some patients show no or very slow emptying while others show a faster rate of emptying. No or slow emptying is likely due to anastomotic edema and/or a small initial stomal diameter. The aim of this study is to ascertain whether initial pouch emptying (or lack thereof) predicts postoperative weight loss. METHODS: Between August 2002 and July 2006, 405 LRYGB were performed by a single surgeon using a linear stapler technique. Patient demographics were entered into a longitudinal, prospective database. All patients had an UGI study on postoperative day 1. At 1-year follow-up, 304 patients were available for analysis. The patients were divided into two groups: group A, 188 patients with normal gastric emptying, and group B, 116 patients with very slow or no emptying of contrast. Analysis of covariance (ANCOVA) was used to compare weight loss between the two groups. The following covariates were considered in all analyses: age, sex, length of stay, and operative time. RESULTS: There was a statistically significant difference in weight loss between the two gastric emptying groups adjusting for age, sex, and operative time (p=0.007). Subjects with prompt gastric emptying (group A) showed more weight loss (50.6 kg versus 47.3 kg) and greater body mass index (BMI) loss (mean loss of 18.1 versus mean loss of 16.6 kg/m(2)) when compared with group B patients with slow or no emptying of the gastric pouch. CONCLUSIONS: Many factors (psychosocial, behavioral, hormonal, and anatomical) influence weight loss after LRYGB. Although we are uncertain of the mechanism, patients with normal initial pouch emptying tend to lose more weight than patients who initially exhibit slow or no emptying of the gastric pouch.
Posttraumatic stress disorder: the missed diagnosis
Posttraumatic stress disorder (PTSD) is frequently underdiagnosed in maltreated samples. Protective services information is critical for obtaining complete trauma histories and determining whether to survey PTSD symptoms in maltreated children. In the current study, without protective services information to supplement parent and child report, diagnosing PTSD was missed in a significant proportion of the cases. Collaboration between mental health professionals and protective service workers is critical in determining psychiatric diagnoses and treatment needs of children involved with the child welfare system