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Tuberculous osteomyelitis/arthritis of the first costoclavicular joint and sternum

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World Journal of Radiology 2014年第12期6卷 928-931页

作者： Prasan Patel Robin R Gray Faculty of Medicine Health Science Centre Foothills Campus University of Calgary Department of Diagnostic Imaging Foothills Medical Centre

A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography(CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acidfact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

关键词： Infectious diseases Tuberculosis Sternum Osteomyelitis Radiology Medicine in developing countries

Fifth metatarsal fractures and current treatment

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World Journal of Orthopedics 2016年第12期7卷 793-800页

作者： Julia Bowes Richard Buckley Department of Surgery Division of OrthopedicsWalter Mackenzie CentreUniversity of Alberta Department of Surgery Section of OrthopedicsFoothills Medical CentreUniversity of Calgary

Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

关键词： Metatarsal fractures Fifth metatarsal Jones fracture Operative care Athlete

Contrast-enhanced ultrasound of focal liver masses

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Hepatoma Research 2020年第9期6卷 10-20页

作者： Stephanie R.Wilson Christina Merrill Department of Radiology University of CalgaryCalgary T2N 2T9Canada Department of Radiology Foothills Medical CentreCalgary T2N 2T9Canada.

Non-invasive imaging is the current method of choice for the characterization of frequently discovered focal liver *** historically,contrast-enhanced computed tomography(CT)and magnetic resonance(MR)scans have been selected for this purpose,contrast-enhanced ultrasound(CEUS)now offers a less expensive and safer method to acquire the same *** with the intravenous injection of a microbubble contrast agent,CEUS provides some unique advantages that make it a valuable addition to an imaging *** is performed in dynamic real-time,providing superior temporal resolution compared to other modalities and allowing detection of enhancement regardless of its timing or *** is performed with a purely intravascular contrast agent,providing accurate depiction of the presence of microbubbles in the circulation in all phases of *** compares with CT and MR contrast agents,which have a well-recognized interstitial *** discordant imaging may occur especially in the portal venous phase,when CT and MR may show pseudoenhancement from interstitial contrast,while CEUS will accurately show washout in malignant ***,the contrast specific software used to perform CEUS has an excellent subtraction technique,which produces a contrast only image with high sensitivity to enhancement in thin septations and small *** makes a positive contribution to liver mass characterization in any situation.

关键词： Contrast-enhanced ultrasound liver cancer diagnosis

Esthesioneuroblastoma Masquerading as Chronic Rhinosinusitis

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Case Reports in Clinical Medicine 2015年第9期4卷 303-308页

作者： Sylvia G. McCulloch Harold Y. Lau Yves Starreveld John T. Lysack Desiree Hao Department of Internal Medicine Faculty of Medicine University of Calgary Calgary Canada Tom Baker Cancer Center/University of Calgary Calgary Canada Division of Neurosurgery Foothills Medical Centre Calgary Canada Clinical Neurosciences and Surgery University of Calgary Department of Diagnostic Imaging Foothills Medical Centre Calgary Canada

Background: Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Case presentation: A 52-year-old, previously healthy, Caucasian female presented to the emergency room with two months of nasal congestion and a spontaneous, protracted nosebleed that required a nasal clamp to settle. In the following months she had another episode of epistaxis in addition to fatigue, headaches, anosmia, difficulty breathing, worsening vision, weight loss and behavioral changes. Subsequent investigations led to the diagnosis of esthesioneuroblastoma. Conclusion: When patients present with recurrent epistaxis or chronic rhinosinusitis that does not respond to a reasonable course of medical therapy and/or have atypical associated symptoms, further investigations should be considered. The presences of red flags, such as weight loss, severe headaches, vision changes or bizarre behavior are also clues that alternate diagnoses and further additional workup should be considered.

关键词： Esthesioneuroblastoma Sinonasal Neoplasms Sinusitis Epistaxis

Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis： perspectives and approaches

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Neural Regeneration Research 2018年第11期13卷 1871-1874页

作者： Francois Grand'Maison Michael Yeung Sarah A. Morrow Liesly Lee Francois Emond Brian J. Ward Pierre Laneuville Robyn Schecter Neuro Rive-Sud Hospital Charles LeMoyne Greenfield Park Quebec Canada Clinical Neurosciences Foothills Medical Centre Calgary Alberta Canada London Health Sciences Center (LHSC) Western University London Ontario Canada Department of Neurology Sunnybrook Health Sciences Centre Toronto Ontario Canada centre Hospitalier Universitaire de Quebec - hospital de l'Enfant-Jesus Quebec City Quebec Canada Research Institute of the McGill University Health centre Montreal Quebec Canada Department of Medicine McGill University Montreal Quebec Canada Novartis Pharmaceuticals Canada Inc. Dotal Quebec Canada

Multiple sclerosis（MS） is characterized by chronic inflammation in conjunction with neurodegeneration within the central nervous system. Most individuals with MS begin with a relapsing remitting course that later transitions to secondary progressive MS. Currently available disease-modifying therapies（DMTs） for relapsing MS have been demonstrated to reduce disease activity, however most patients require a change in therapy over the course of their disease. Treatment goals include the prevention of relapses and disability accumulation and to achieve this objective requires careful planning. Sequencing of DMTs for individual patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes.

关键词： relapsing multiple sclerosis high efficacy disease-modifying therapies treatment optimization treatment sequencing therapeutic inertia sub-optimal treatment progressive disease immune effects

Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada

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Family Medicine and Community Health 2020年第4期8卷 48-56页

作者： Tanvir C Turin Ruksana Rashid Mahzabin Ferdous Iffat Naeem Nahid Rumana Afsana Rahman Nafiza Rahman Mohammad Lasker Department of Family Medicine Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada Department of Community Health Sciences Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada Sleep Center Foothills Medical CentreCalgaryAlbertaCanada Community Based Citizen Researcher CalgaryAlbertaCanada

Objective The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare(PHC)services in *** A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research *** group discussions were conducted to collect the qualitative data where thematic analysis was *** The focus group discussions were held in various community centres such as individual meeting rooms at public libraries,community halls and so on arranged in collaboration with community organisations while ensuring complete *** Thirty-eight adults,Bangladeshi immigrant men,living in Calgary were selected for this study and participated in six different focus *** sample represents mostly married,educated,Muslim,Bangla speaking,aged over 25 years,full-time or self-employed and living in an urban centre in Canada>5 *** The focus groups have highlighted long wait time as an important *** wait at the emergency room,difficulties to get access to general physicians when feeling sick,slow referral process and long wait at the clinic even after making an appointment impact their daily chores,work and access to *** is another important barrier that impedes effective communication between physicians and immigrant patients,thus the quality of *** with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in ***,no gender-specific barriers unique to men have been identified in this *** The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority *** is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.

关键词： services Canada qualitative

世界腹腔间隙学会腹内高压和腹腔间隙综合征2013版专家共识与诊疗指南

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中华外科杂志 2015年第3期53卷 173-175页

作者： Andrew W.Kirkpatrick Derek J.Roberts Jan De Waele Roman Jaeschke Manu L.N.G.Malbrain Bart De Keulenaer Juan Duchesne Martin Bjorc Ari Leppaniemi Departments of Surgery and Critical Care Medicine and Regional Trauma Services foothills medical centre Calgary Alberta T2N 2T9 Canada

随着人们对腹内压（intra-abdominal pressure,IAP）的重视,大量研究开始关注腹内高压（intraabdominal hypertension,IAH）和腹腔间隙综合征（abdominal compartment syndrome,ACS）.世界腹腔间隙学会（The abdominal compartment society,WSACS）先后在2006年提出了IAH和ACS的专家共识,2007年发表了诊疗指南,2009年明确了疾病相关研究的推荐方向.2013年WSACS发布了新的IAH和ACS专家共识与诊疗指南.该指南由多学科专家共同参与制定,大部分是外科专家和重症监护专家.专家们首先明确24个临床医师关心的IAH和ACS问题,随后进行了系统有序的文献整理.

关键词：腹腔间隙综合征外科专家诊疗指南腹内高压 hypertension 学会世界 2009年

Analyzing hydro abrasive erosion in Kaplan turbine:A case study from India

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Journal of Hydrodynamics 2016年第5期28卷 863-872页

作者： Anant Kr.RAI Arun KUMAR Alternate Hydro Energy centre IIT Roorkee

Sediment flow through hydro turbine causes erosion of hydraulic components resulting in drop of turbine efficiency, parti- cularly in hydropower plants of the Himalayan region. The measurement of erosion and monitoring of sediment flow in turbine are major concerns in erosion study. Attempts have been made to study erosion mainly in Pelton and Francis turbines. In this study, a simple and effective method has been presented to measure erosion in a Kaplan turbine of a run-of-river scheme Chilla hydropower plant in foothills of Himalaya. Recent techniques were used to measure sediment parameters like concentration, size, shape and mineral content. A standard erosion model is applied to estimate the erosion in Kaplan turbine blade, runner chamber and draft tube cone. A calibration factor has been proposed to apply the erosion model for site specific conditions. It has been found that the outer trailing edges of the turbine blade and upper rtmner chamber are most erosion prone zones. Sediment analysis revealed that effective operation can reduce erosion in turbine components. The estimated erosion values from model are found to be consistent with measu- red values. Finally, suggestions for design improvements and effective operation of erosion affected hydropower plants are given.

关键词： turbine sediment erosion measurement IEC 62364 hydropower

Leadless Cardiac Pacemaker: Does Anatomical Position at Implant Affect Long-Term Electrical Performance?

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Journal of Biomedical Science and Engineering 2017年第11期10卷 500-508页

作者： John Ip Abdul R. Safadi Randy Ip Matthew Gaskill Rajesh Banker Derek Exner Srinivas Dukkipati Mayer Rashtian Imran Niazi Cardiac Electrophysiology Department Michigan State University Lansing USA Cardiac Electrophysiology Department Premier Cardiology Inc Newport Beach USA Cardiac Electrophysiology Department Foothills Medical Centre Calgary Canada Cardiac Electrophysiology Department Mount Sinai Hospital New York USA Cardiac Electrophysiology Department Huntington Memorial Hospital Pasadena USA Cardiac Electrophysiology Department Aurora Medical Group Milwaukee USA

Background: The Nanostim {trade mark, serif} Leadless Cardiac Pacemaker (LCP) has been shown to be safe and effective in human clinical trials. Since there is little information on the effect of implant location on LCP performance, the aim of this study was to determine whether anatomic position affects the long-term pacing performance of the LCP. Methods: Patients who enrolled in the Leadless II IDE Clinical Trial and had finished 6 months follow up (n = 479) were selected for the study. The implanting investigators determined the LCP final position under fluoroscope, which was categorized into three groups: RV apex (RVA, n = 174), RV apical septum (RVAS, n = 101), and RV septum (RVS, n = 204) (Figure 1). Data on capture threshold (at a 0.4 ms pulse width), R-wave amplitude and impedance were analyzed at implant, hospital discharge and 2 weeks, 6 weeks, 3 months and 6 months post-implant. Results: At implant, the mean capture thresholds in the RVA, RVAS and RVS were 0.77 ± 0.45, 0.81 ± 0.61 and 0.78 ± 0.59 volts, respectively. R-wave amplitudes were 8.0 ± 3.0 mV, 7.7 ± 2.9 mV and 7.6 ± 2.9 mV, respectively. Impedance values were 727 ± 311, 765 ± 333, and 677 ± 227 respectively. There were no differences among the 3 implant locations in capture threshold or R-wave amplitudes at 6 months (P > 0.06);however, all 3 performance parameters significantly improved over time (P < 0.001). Conclusions: The LCP implant location does not affect capture thresholds or R-wave amplitudes at 6 months, and there is little effect on impedance. Although implant location does not appear to be a predictor of electrical performance, additional long-term data will help guide optimal implant location.

关键词： Pacing Lead Location Leadless Pacing Lead Impedance Pacing Threshold R-Wave Amplitude