The role of anterior cruciate ligament reconstruction in the older patients, 55 years or above

Anterior cruciate ligament (ACL) deficiency can result in symptomatic functional instability of the knee regardless of the patient’s age. We reviewed a single surgeon database of 908 ACL reconstructions carried out in the last 20 years for symptomatic instability. 14 patients were identified who were 55 years or above at surgery (mean: 60 years, range 55–75 years). Patients were evaluated clinically and with clinical outcome scoring and KT-1000 arthrometry assessment. 12 patients (86%) were available to attend for follow-up at a mean 9 years after ACL reconstruction. The median pre-injury Tegner score was 5.5 (range 1–7) and the median pre-operative Lysholm score was 33 (range 15–67). Initially, one patient had a good result but subsequently the patient undergone total knee replacement 5 years after ACL reconstruction. For the remainder, at the most recent review, the median Lysholm score had improved to 79 (range 43–100, P < 0.05) although it had deteriorated from the maximum achieved post-op score of 85.5 (range 53–100, P < 0.05); and the Tegner score had declined to 3 (range 1–5, P < 0.05). KT-1000 testing demonstrated a mean side-to-side difference improvement in laxity from 4.6 ± 1.3 mm (range 3–7) to 1.5 ± 1.2 mm (range 0–4, P < 0.05) and >2 mm difference in only one knee (for which it was known that the graft had failed at 11 years after ACL reconstruction). At review, the same knee was the only one that demonstrated a pivot shift. ACL reconstruction with autograft in the above-55 patient with minimal osteoarthritis is a safe procedure that returns stability to the knee and permits a return to a reasonable level of activity.     

The role of imaging in skull base osteomyelitis — Reviewed

PurposeSkull base osteomyelitis (SBO) is difficult to diagnose due to a wide array of clinical presentations. It can be life threatening if not treated promptly.The objective of this study is to identify the various neck spaces involved in skull base osteomyelitis, correlate them with the possible source of infection and identify the related complications.MethodsEighty nine consecutive either culture proven cases of skull base osteomyelitis, or culture negative cases with inflammation on histopathology responding to antibiotic therapy, presenting at a single non-government hospital in south India between January 2016 and December 2018 were included in this study. Images were reviewed by two radiologists and imaging findings were documented by consensus.ResultsInvolvement of the parotid space, retromastoid space and (temporomandibular) TM joint was associated with otogenic source of infection (p value < 0.05); while, retropharyngeal/prevertebral involvement was associated with sphenoid and nasopharyngeal sources (p value < 0.05). Complications such as cavernous sinus thrombosis (p value = 0.023) and ICA involvement (p value = 0.014) were more commonly seen with central skull base osteomyelitis. Abscess formation was seen in all three groups of patients without a significant difference between the groups.ConclusionImaging plays an important role in determining the possible source of infection by identifying the involved neck spaces and this in turn can guide the clinician to a site for biopsy. Complications related to SBO can also be identified on imaging and can guide appropriate management.     

The role of diffusion – Weighted MRI in evaluation of prostate cancer

The aim of work

To illustrate the role of T2WI combined with diffusion WI (DWI) in the evaluation of patients with prostate cancer.

Patients and methods

This prospective study included 36 patients (mean age 61) with clinical suspicion of prostate cancer using surface coil at 1.5 T MR Unit. Axial, coronal, and sagittal high resolution (HR) T2WI were performed, DWI was applied using a single-shot echo-planar imaging sequence in axial orientation. Regions of interest were drawn on ADC maps on the site of visible restricted diffusion as well as the normal tissue, then the ADC value was calculated. Considering histopathological diagnosis the standard of reference, the results of T2WI alone were compared with those of combined T2WI and DWI.

Results

In this prospective study, 36 men were examined and T2WI, DWI, ADC map and ADC values were measured. T2 low SI was detected in the peripheral zone of the prostate of 36 patients, and restricted diffusion in 31 patients.

Conclusion

Our study indicates that the addition of the ADC map and DWI to T2WI provide significantly more accurate results for prostate cancer detection and staging.     

Prevention of violence in prison – The role of health care professionals

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach.Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings.In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations.     

Effect of 8 months of whole-body vibration training on quality of life in elderly women

Whole-body vibration (WBV) training in elderly may improve muscle strength, muscle power and postural control. However, knowledge about the effect of WBV training in elderly on measures of health as a multidimensional construct (health-related quality of life, HRQoL) is scarce. The present study aimed to determine the effects of WBV training on HRQoL in elderly women. A total of 37 women (aged 82.4 ± 5.7 years) were recruited and were assigned to either the WBV group or to the control (CON) group. After 8 months of training, the WBV group showed non-significant changes on HRQoL and additional health-related outcomes (fall risk, life satisfaction or cognitive status). Our findings are in disagreement with previous studies of shorter duration (6 weeks), which reported positive significant changes in HRQoL in elderly people. Discrepancies among studies may be partly attributed to methodological differences, but the existence of publication bias in previous studies cannot be discarded.     

The role of bone scan in the diagnosis of Jaffé-Lichtenstein-Uehlinger syndrome

The case of a 12-year-old girl with Jaffé-Lichtenstein-Uehlinger syndrome is presented. A bone scan pattern exhibits clinical symptoms, X ray images and histological findings are described in a case of polyostotic form of the fibrous dysplasia. A biopsy with histology was performed in consideration of bone scan findings and a confirmed final diagnosis.     

Fast or slow start? The role of running strategies in triathlon

ObjectivesTo investigate the impact of fast-start, steady or slow-start strategies of the running fraction in sprint triathlon on oxygen consumption, perception of fatigue and blood lactate.DesignThirteen male triathletes (age; 36.4 ± 10.8 yy, height 174.8 ± 7.9 cm, body mass 70.6 ± 11.1 kg; V’O_2max 62.4 ± 8.9 ml min^?1 kg^?1; mean ± SD) attended the laboratory five times in order to complete two incremental tests and three subsequent cycle-run sessions.MethodsThree experimental randomized sessions with different effort distribution were compared. The intensities of the 1st running kilometer were set at 95%, 100% and 105% of the second ventilatory threshold for slow, continuous and fast start protocol respectively. Measurement of ventilatory variables, blood lactate and ratings of perceived exertion were collected throughout all sessions.ResultsA meaningful difference was found between the slow versus fast start protocol in V’O₂ (SE = 0.58, P = 0.0005), BLa^? (SE = 0.21, P = 0.0097), HR (SE = 1.23, P = 0.0011) and RPE (SE = 2.83, P = 0.0047) values. No differences in-between protocols were found at the end of the running bout whatever the condition.ConclusionsDifferences in physiological parameters were found between protocols during the first kilometer, not at the end of exercise. The fast start appears to be more correct and useful for performance in racing setting and may be used as a strategy without impacting the remaining running bout in ecological setting.     

Imaging features of sporadic breast cancer in women under 40 years old: 97 cases

Objectives

To evaluate characteristic features of mammography, ultrasound and magnetic resonance imaging (MRI) of sporadic breast cancer in women <40 years and to determine correlations with pathological and biological factors.

Methods

A retrospective review of radiological, clinicopathological and biological features of sporadic breast cancers for women under 40 years at our institution between 2007-2012 covering 91 patients. Mammography was available for 97 lesions, ultrasound for 94 and MRI for 38.

Results

The most common imaging features were masses, nearly all classified BI-RADS 4 or 5. On mammography microcalcifications alone accounted for 31 %, all suspicious. There were 42.6 % luminal B, 24.5 % luminal A, 19.1 % HER2-enriched and 10.6 % triple-negative (TN) tumours by immunohistochemistry. HER2 overexpression was correlated with the presence of calcifications at mammography (P?=?0.03). TN cancers more often had an oval shape and abrupt interface at ultrasound and rim enhancement on MRI. MRI features were suspicious for all cancers and rim enhancement of a mass was a significant predictor of triple-negative tumours (P?=?0.01).

Conclusions

The imaging characteristics of cancers in patients under 40 years without proven gene mutations do not differ from their older counterparts, but appear correlated to phenotypic profiles, which have a different distribution in young women compared to the general population.

Key Points

? Young women have more luminal B/HER2+ phenotypes than older women. ? The appearance of cancers is correlated with their biological profiles. ? Sporadic breast cancer imaging in young women is generally classified BI-RADS 4/5. ? Triple-negative cancers can be misinterpreted as benign, requiring thorough imaging analysis.     

The role of the Pauli principle in the elastic scattering of α + O16 clusters

This work is mainly concerned with an applicability of the orthogonality condition model (OCM); which represents simply the effect of the Pauli principle in the strongly overlapping region in the interaction between α-particles and O¹⁶ nuclei for E_α = 20–32 MeV. The angular distributions are analysed. Good agreements are obtained especially at backward angles. The connection between the complex OCM and the effective surface potential model has been made confirming that the Pauli principle plays an important role in the scattering of α particles on O¹⁶.     

The number of Japanese radiologic technologists will be increased in 40 years

It is essential to predict the long-term supply and demand for the number of radiologic technologists as medical resources. However, it is difficult to predict the number of Japanese radiologic technologists due to complex and intertwining factors. Our purpose in this study was to predict the future number of radiologic technologists using the concept of system dynamics (SD), and to clarify the effects of relevant factors. In order to estimate the number of Japanese radiologic technologists, we constructed a flow diagram using the concept of SD. We simulated the number of radiologic technologists for the following 4 cases: maintaining the status quo, a change in the pass rate for the national examination, a change in the post-graduate employment rate, and a change in the rate of continuing education. The result for the predicted number of radiologic technologists was 50,509 in 20 years, which is 4,394 (9.5 %) more than the present number, and 50,166 in 40 years, which is 4,051 (8.8 %) more than the present number. For the factors influencing the number of technologists, the influence of the pass rate on the national examination and that of the rate for post-graduate employment was larger than that of the rate of continuing education in graduate school. The number of Japanese radiologic technologists will increase until 2033 and decrease until 2042, and it does not change after 2042 in case of maintaining the status quo. Implementing the concept of SD allowed us easily to clarify the factors influencing the predicted number of radiologic technologists.     

The role of a consultant radiologist—are patients still in the dark?

Little is known regarding public awareness of the roles and responsibilities of a consultant radiologist. Between 1 April and 20 May 2008, 916 outpatients attending our radiology department completed a questionnaire addressing this issue. We found public perception variable. Thirty-six percent of respondents thought we were responsible for choosing appropriate imaging; only 65% perceived that we reported studies. Another 38% felt that we did not play an important role in their treatment, and 38% considered that we were not part of their medical team. Thirty-two percent of respondents preferred their hospital consultant to give them their imaging results, with 17% preferring this to come from the radiologist. There is significant under-appreciation of the roles and responsibilities of a consultant radiologist. It is important that we educate the public to ensure that future health policy reflects the increasingly central role imaging plays in health-care delivery.     

The value of quantitative MRI using 1.5 T magnet in diagnosis of carpal tunnel syndrome

Objective

The aim of this study was to assess the efficacy of quantitative MRI parameters using 1.5 T magnet in evaluation of MN in CTS.

The role of tumor necrosis factor-α in diffuse axonal injury following fluid-percussive brain injury in rats

The immunolocalization of tumor necrosis factor-α (TNFα) after diffuse axonal injury (DAI) is demonstrated using a midline fluid percussion rat model (moderate brain injury of 1000 mm Hg was generated) and the effects of TNFα on the axolemmal permeability using horseradish peroxidase as a tracer. In addition, the accumulation of β-amyloid precursor protein (β-APP) was investigated, which has recently been shown to be a reliable marker for the diagnosis of DAI in cases with fatal head injury. TNFα levels in brain tissues from the impact site and the cortex including the corpus callosum, gradually increased during the first 1 h, rose to a maximal elevation at 3 h, gradually decreased at 6 h and decreased further at 24 h. Horseradish peroxidase (HRP) tracer experiments revealed that primary axonal damage appeared as early as 15 min after impact but rapidly recovered and that 1 h after impact, secondary axonal damage occurred in the corpus callosum and the brain stem. By immunoelectron microscopy it was seen that β-APP accumulated in the axon from 1 h after impact demonstrating that there was functional axonal damage. TNFα reactions were detected in the lysosomes of microglia 30 min after impact and 1 h after impact these reactions were mainly detected in the glial cells (such as microglia, astrocytes and oligodendrocytes) in the corpus callosum and the brain stem. It is generally accepted that TNFα directly induces primary demyelination and oligodendrocyte apoptosis. Therefore, TNFα conveyed from the microglial cells is one cofactor contributing to the formation of the delayed axonal damage observed at these sites. The present study suggests that TNFα conveyed from the glial cells may contribute to the pathogenic mechanism of DAI formation following fluid percussive brain injury. Received: 27 April 1999 / Received in revised form: 26 July 1999     

Maturity-related developmental inequalities in age-group swimming: The testing of ‘Mat-CAPs’ for their removal

ObjectivesTo (1) examine the association between maturity timing and performance-based selection levels in (N = 708) Australian male 100-m Freestyle swimmers (12–17 years); (2) identify the relationship between maturation status and 100-m Freestyle performance; and (3) determine whether Maturation-based Corrective Adjustment Procedures (Mat-CAPs) could remove maturation-related differences in swimming performance.MethodsIn Part 1, maturity timing category distributions (‘Early’, ‘Early Normative’, ‘Late Normative’ and ‘Late’) for ‘All’, ‘Top 50%’ and ‘25%’ of raw swimming times were examined within and across age-groups. In Part 2, multiple regression analyses quantified the relationship between maturity offset (YPHV) and swimming performance. In Part 3, sample-based maturity timing category distributions were examined based on raw and correctively adjusted swim times for 12–17 year old age-groups.ResultsBased on raw swim times, a high prevalence of ‘Early-maturing’ swimmers, with large effect sizes was identified (e.g., 14 years ‘All’ — χ² (3, 151 = 111.98, p < 0.001; ‘Early’ v ‘Late’ OR = 82.0 95%CI = 4.77, 1409.9); while a complete absence of ‘Late-maturers’ was apparent in the sample (N = 708). When maturity categories were re-defined based on sample mean ± standard deviation, and when using the expected curvilinear trendline identified in Part 2, Mat-CAPs mitigated maturity timing biases across all age-groups and selection levels, and removed the Freestyle performance advantage afforded by advanced maturity timing and status.ConclusionsRemoving the influence of maturation-related developmental differences could help improve youth swimmer participation experiences and improve the accuracy of identifying genuinely skilled age-group swimmers.     

The role of FDG PET in the management of lymphoma: what is the evidence base?

[18F]Fluorodeoxyglucose positron emission tomography (18F-FDG PET) is playing an increasing role in the management of both Hodgkin and non-Hodgkin lymphoma, offering potential advantages in the accuracy of disease assessment at a number of points in the management pathway. This review evaluates the current level of confidence in the use of PET technology in (1) initial staging, (2) the assessment of early response to chemotherapy, (3) the assessment of residual masses at completion of initial treatment, (4) follow-up, and (5) radiotherapy planning.