Does the ILMA make sense in HEMS?

As first reported by Brain(1) by the early 1980s, the laryngeal mask airway (LMA) represented a new approach to airway management. The LMA has been used to facilitate tracheal intubation by a variety of methods. In fact, the LMA has been used to intubate the patient with difficult tracheal access. A recent addition to this technique, the intubating laryngeal mask airway (ILMA), shown in Figure 1, first was proposed by Brain and coworkers in 1995.(1,2) Fig. 1. Components of the intubating laryngeal mask airway. An endotracheal tube may be passed through the airway tube. The ILMA incorporates the standard LMA cuff in sizes 3, 4, or 5, along with a metal airway tube and handle. The handle allows users to manipulate the device within the patient's airway. The airway tube component has a wider internal diameter and is shorter than the standard LMA tube. A silicone rubber bite block surrounds the upper portion of the stem.     

Calcifications in the cuff: take it or leave it?

Objectives

The aim of this study was to evaluate whether removing the calcifications in the rotator cuff tendons during surgical subacromial decompression improves outcome in patients with calcific tendonitis.

Methods

Two groups of 20 patients with a subacromial impingement syndrome and cuff calcifications were operated on. In group A, patients had an anterolateral acromioplasty according to Neer with excision of calcifications. In group B, the same procedure was performed without additional excision of calcifications. After a minimum follow‐up of 3 years the patients were assessed with the disabilities of arm, shoulder and hand score (DASH), the visual analogue scale (VAS) for pain, measurements of range of motion (ROM) in all planes, and satisfaction with treatment.

Results

The results for the DASH score, ROM, VAS and satisfaction with treatement showed no significant difference between the two groups.

Conclusion

The results of our study suggest that removal of calcific deposits with anterolateral acromioplasty does not influence patient outcome. Further prospective studies are needed to determine the optimal surgical treatment for calcific tendonitis.Calcific tendonitis of the shoulder is a common and painful disorder and is characterised by calcifications in the tendons of the rotator cuff (fig 1​1).). The incidence in the healthy population is 2.7%, rising to 6.8% in patients with shoulder pain.^1,2 The predominant age is 30–60 years and women are affected slightly more often than men. The calcifications are most often seen in the tendon of the supraspinatus muscle.¹ Risk factors for shoulder pain due to problems of the rotator cuff include overhead activities and sports.^3,4 The treatment of choice is primarily conservative. This includes rest, physiotherapy, non‐steroidal anti‐inflammatory drugs and at a later stage a subacromial infiltration with corticosteroids. When conservative treatment fails, surgery can be recommended. In most studies on surgical treatment of calcific tendonitis, removal of the calcifications in combination with a subacromial decompression is only recommended when there are signs of subacromial irritation.^{5,6,7,8,9,10,11} However, it has also been advocated that a subacromial decompression alone might be sufficient, stating that the calcifications will dissolve as a matter of natural course.¹² The aim of this study was to evaluate whether it is beneficial for patient outcome to remove the calcifications of the tendons of the rotator cuff when performing a subacromial decompression.Open in a separate windowFigure 1 Example of a calcification in the rotator cuff on an x ray of the shoulder.     

Trends in utilization: has extremity MR imaging replaced diagnostic arthroscopy?

Objective To examine the relative change in utilization of magnetic resonance (MR) imaging of the extremities versus diagnostic and therapeutic arthroscopy.Design and patients Using the 1993, 1996, and 1999 nationwide Medicare Part B databases, utilization rates (per 100,000) were determined for upper and lower extremity MR imaging, diagnostic arthroscopy and therapeutic arthroscopy using CPT-4 codes. Utilization of extremity MR imaging was compared with that of diagnostic and therapeutic arthroscopy in 10 geographic regions of the United States and tracked over time.Results Combined lower and upper extremity MR imaging utilization per 100,000 increased from 393 to 1,056 in 1999 (+168.7%). Utilization of diagnostic arthroscopy of the extremities decreased from 18 in 1993 to 8 in 1999 (–55.6%); therapeutic arthroscopy rates increased from 461 in 1993 to 636 in 1999 (+40.0%). Specifically, from 1993 to 1999, utilization of lower extremity MR imaging increased from 270 to 661 (+144.8%). Utilization of diagnostic arthroscopy of the knee over the same time period decreased from 11 to 5 (–54.5%); therapeutic arthroscopy increased from 394 to 501 (+27.2%). Similarly, utilization rates for upper extremity MR imaging increased from 123 to 395 (+221.1%). Utilization of diagnostic arthroscopy of the shoulder over the same time period decreased from 7 to 2 (–71.4%); therapeutic arthroscopy increased from 44 to 104 (+136.4%). No specific geographic trends were ascertained.Conclusion The utilization of MR imaging of the extremities has markedly increased from 1993 to 1999. During the same time period the utilization of diagnostic arthroscopy has decreased and that of therapeutic arthroscopy has increased. These findings support the hypothesis that there is increased reliance of clinical practitioners on the diagnostic information provided by MR imaging in preoperative clinical decision-making.     

Does deployment impact the health care use of military families stationed in Okinawa,Japan?

Military families are placed under a great deal of stress while serving in the armed forces. In Okinawa, Japan, marines deploy regularly at 3-month intervals throughout the year, leaving behind 7,924 dependents in a single-parent home environment. The purpose of this study was to investigate the health care needs of families in a deployed and nondeployed status in Okinawa, Japan. Families enrolled were studied over a 6-month period for levels of self-reliance, coherence, social support, well-being, adaptation, coping, anxiety, and health care visits. The tools that were used included the Family Index of Regenerativity and Adaptation-Military tools and the State Trait Anxiety Inventory. There were 299 families enrolled, of which 80% were marine spouses. A total of 28% of those surveyed were regarded as "high risk" based on the responses received on the surveys. Of these 85 families, 35% (n = 30) were nondeployed (ND), and 65% (n = 55) were from the deployed group (p = 0.03). After phone intervention, 40% of the deployed group and 17% of the ND were classified as stable; however, psychiatric consults were accepted by 29% of deployed group spouses compared with 23% of ND spouses who were identified as high-risk families. Typology change over time identified family dysfunction at 1% in the ND group alone. This study sheds new light on the stressors and subsequent health care needs of both deployed and nondeployed families in an isolated overseas duty location.     

Editorial Comment: Advances in MRI and PET of the prostate: concurrence or complementarity?

This Editorial Comment refers to the articles “Diagnostic evaluation of magnetization transfer and diffusion kurtosis imaging for prostate cancer detection in a re-biopsy population” by Barrett T et al., Eur Radiol. 2017 Dec 8 and “18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients” by Selnæs KM et al., Eur Radiol. 2018 Jan 2.     

Alcohol discovered in the urine after death: ante-mortem ingestion or post-mortem artefact?

A study was undertaken of blood and urine alcohol levels in 44 cases where the bodies had been immersed in water, following accidents, for at least one day after death. In no case was there any ante-mortem evidence of ingested alcohol. In 15 cases there was a raised urine alcohol. The average urine-to-blood alcohol ratio in these cases was 0.56:1. This is dramatically less that that seen after ingestion. It is suggested that the alcohol, following its initial post-mortem production in the abdomen, enters the urine by diffusion from surrounding tissues. The presence of alcohol in the urine from bodies that have not been recovered and examined until several days after death cannot always be taken to indicate ante-mortem ingestion. Urine-to-blood alcohol ratios of less than 1:1 are strongly suggestive of post-mortem production.     

Imaging the premature brain: ultrasound or MRI?

Neuroimaging of preterm infants has become part of routine clinical care, but the question is often raised on how often cranial ultrasound should be done and whether every high risk preterm infant should at least have one MRI during the neonatal period. An increasing number of centres perform an MRI either at discharge or around term equivalent age, and a few centres have access to a magnet in or adjacent to the neonatal intensive care unit and are doing sequential MRIs. In this review, we try to discuss when best to perform these two neuroimaging techniques and the additional information each technique may provide.     

Calf injuries in professional football: Treat the patient or the scan? – A case study

ObjectiveTo describe a case of a professional football player with significant imaging findings despite a rather innocuous clinical presentation with gradual onset of calf pain and who was able to continue training and playing with minor medical intervention. To discuss some of the limitations of existing muscle injury grading systems and their potential to cover the full range of injury presentations for calf injuries.DesignCase report.SettingA professional football player was assessed by physical examination, clinical testing and imaging (MRI) after a gradual onset of a calf injury. After returning to training and competition, a follow-up of his symptoms was performed with regular ultrasound imaging assessments.ParticipantA professional football player (35 years, 1.90 m, 88 kg) male, African, striker, playing in the Professional Arabian Gulf League.ConclusionThe discordance between the clinical presentation and the imaging findings resulted in a challenging situation regarding the decision of whether to allow the player to train and compete. In addition, existing muscle injury grading systems do not seem to cover the full range of injuries seen in clinical practice.     

Midcareer Transition in Radiology: Threat or Opportunity?

Midcareer job transitions are occurring for many reasons other than individual radiologists’ professional performance quality, affability, and desire for geographic change. New causes seem to be related to the present health care environment. All radiologists should be aware of this disruptive change to the profession and of the resources available to help job seekers find new positions.