Sir Leslie Herron,K.B.E., C.M.G., K.St.J., Q.C., LL.B.

We are indebted to Sir Bernard Sugerman, Immediate Past President of the Court of Appeal of the N.S.W. Supreme Court, and a Past President of the Academy, for this appreciation of our former Patron.     

M.R.I. spectrum of intrinsic spinal cord lesions.

We report our experience of 42 patients undergoing magnetic resonance imaging (MRI) studies demonstrating intrinsic lesions of the spinal cord, excluding those secondary to spondylosis, trauma or congenital malformations. Histological confirmation of the radiological diagnosis was obtained in 15 (36%). MRI is more sensitive than either myelography or CT. MRI identified a previously non-visualised lesion in 17 of 30 cases. In a further 13 cases, MRI contributed by identifying associated features such as cysts and haemorrhage which have aided in the diagnosis and management of the patients. The last 12 cases, which were patients with multiple sclerosis, had MRI as the only neuroradiological examination. These illustrate a range of appearances. The overlap of imaging appearances of the various pathologies implies that a useful diagnosis and differential can only be offered by considering the MRI appearances of a lesion, with its associated features, with the clinical presentation, and with other imaging modalities where appropriate.     

Deterrents to R.T. continuing education.

Constant changes in medicine and technology make continuing education (CE) vitally important for radiologic technologists. Understanding what deters radiographers from participating in CE may help improve CE programs. This article reports on a survey of deterrents to CE participation among radiographers. Results revealed that cost was the leading deterrent, followed closely by work constraints. In addition, certificate-level radiographers found lack of quality to be a significantly higher deterrent than did radiographers with an associate degree.     

250,000 R.T.s

The ranks of R.T.s continue to grow and the demographics continue to evolve. The Registry is proud to say, "ARRT, a quarter of a million registered technologists, strong and growing!"     

Cervical myelopathy in C.P.P.D. deposition disease

Cervical Myelopathy is a rare manifestation of calcium pyrophosphate dihydrate (C.P.P.D.) deposition disease. A case is presented where radiographically noncalcified extradural masses containing C.P.P.D. crystals were present at the C7 level, producing cord compression and neurological symptoms. These masses are thought to represent para-articular deposits related to the adjacent facet joints.     

U.S. Army dental emergency rates in Bosnia.

OBJECTIVE: Our objective is to report on overall dental emergency rates and rates by dental classification of a U.S. Army peacekeeping operation longer than 6 months in the year 2000. MATERIALS AND METHODS: This study was a retrospective cohort analysis of dental emergencies experienced by soldiers of the 3rd Armored Cavalry Regiment as a part of Stabilization Force VII. Before the deployment, all soldiers received dental examinations and the necessary dental treatment to make them class 1 or 2. A dental emergency was identified from field treatment records when a soldier presented to the clinic for a "sick call," emergency, or trauma visit. RESULTS: Retrospective review of the records identified 211 dental emergencies. Class 1 soldiers experienced 75 dental emergencies and class 2 soldiers experienced 136 emergencies. 3rd Armored Cavalry Regiment soldiers spent an average of 201.95 days deployed. The overall emergency rate was 156 dental emergencies per 1,000 soldiers per year. Class 1 and 2 rates were 121 and 185 dental emergencies per 1,000 troops per year, respectively. CONCLUSIONS: The results tend to confirm that dental emergencies continue to be a threat to overall readiness in deployed environments. Military planners need to ensure that the dental component of future forces are sufficient to care for the expected emergencies.     

British pilot study of exercise therapy. I. Middle-aged men.

The physiological and biochemical effects of a carefully graduated course of vigorous gymnasium training with two or three weekly exercise sessions lasting only 15 minutes have been studied in middle-aged London business men. Activity diaries and psychological questionnaires indicated that these men had a positive attitude to exercise which was probably greater than average. The gymnasium exercises caused a large oxygen debt and considerable rises in plasma catecholamines and lactate levels. A close correlation was found between the pulse rate during exercise and the Borg scale of perceived exertion, so that both could be used to ensure that short periods of exercise were sufficiently vigorous to produce a training effect, and protect against over-exertion. The acceptability of this particular exercise regime was shown by the low fall-out and injury rate. It is suggested that this exercise training programme possesses many features which are advantageous if increased physical activity is to be more widely used as a method of reducing some of the risk factors in coronary heart disease.     

Visual contrast sensitivity of U.S. Navy jet pilots.

Good visual contrast sensitivity (CS) is often described as a visual capability important for success as a military aviator and so has been suggested as a physical standard for personnel selection and retention. To evaluate this idea, we measured the CS of 135 U.S. Navy fighter pilots ranging in age from 24 to 44 years (mean = 30.20, S.D. = 4.06) and compared these to the CS of non-aviators. We obtained the non-aviator data from published studies of other investigators who used similar procedures with the same widely used, commercially available apparatus (Nicolet CST 2000). In addition to this comparison, we correlated the pilots' CS with their air-to-air target detection distances measured during air combat maneuver training and to their night carrier landing performance scores. The major findings were: 1) The mean CS of the aviators and the non-aviators were within +/- 1.0 S.D. of each other in most instances, and those few instances where a greater difference was found were parsimoniously explained by methodological and procedural factors; 2) sensitivities to different spatial frequencies were highly correlated among themselves, indicating much redundancy among the measurements; 3) there was no evidence of a relationship between CS and air-to-air target detection distances or night carrier landing performance.     

Dietary supplement use in U.S. Army Special Operations candidates.

We administered a dietary supplement survey to 2,215 males (mean age, 25 years; range, 18-47 years) entering U.S. Army Special Forces and Ranger training schools. The survey contained questions on demographics and health as well as the use of vitamin, mineral, protein, pro-performance, and other cofactor supplements; answers were made on a five-point frequency scale. Eighty-five percent of the men reported past or present use of a supplement, 64% reported current use, and 35% reported daily use. Individuals using a supplement at least occasionally were significantly less likely to smoke (p < 0.05) and more likely to exercise on a daily basis. Recent U.S. Department of Agriculture survey data (1994) reported that 39% of males 20 to 39 years old used a dietary supplement at least occasionally. Our data indicate that the rate of supplement use in this study group was much higher than in the general population of young men. This observation supports the need to study more extensively the use and benefits or potential harm of dietary supplementation by otherwise healthy individuals.     

Hip arthroscopy. The supine position.

Hip arthroscopy is an effective technique. It can be performed successfully either supine or in the lateral position, but there appear to be modest advantages of the supine approach. Arthroscopy offers a less invasive alternative to arthrotomy for traditionally recognized forms of hip pathology, such as loose bodies or impinging osteophytes. Arthroscopy also offers a method of treatment for many conditions (including labral tears, acute articular injuries, and damage to the ligamentum teres) that previously went unrecognized and untreated. In the past, these patients were simply resigned to living within the constraints of their symptoms. Several dictums about hip arthroscopy must be acknowledged. First, the key to a successful outcome lies in proper patient selection. A technically well-executed procedure will fail when performed for the wrong reason, or when the outcome fails to meet the patient's expectations. Second, the patient must be properly positioned for the procedure to go well. Poor positioning will assure a difficult procedure. Third, simply gaining access to the hip joint is not an outstanding technical accomplishment. The paramount issue is accessing the joint in as atraumatic a fashion as possible. Due to its constrained architecture and dense soft tissue envelope, the potential for inadvertent iatrogenic scope trauma is significant and, perhaps unavoidable to some extent. Therefore, every reasonable step should be taken to keep this concern to a minimum. Perform the procedure as carefully as possible and be certain that it is being performed for the right reason. After accessing the joint, the techniques of operative arthroscopy for the hip employ existing strategies established in other joints. Because of the restraints imposed by the hip, however, technical deficiencies may be more apparent.     

Open shoulder instability surgery. Complications.

Surgical stabilization of the shoulder can be a challenging procedure. Complications can and do occur, even in the hands of the most experienced surgeons. Emphasis must be placed on proper diagnosis, appropriate technique, and an understanding of potential complications to maximize the likelihood of a successful surgical outcome. The authors hope that this review helps to outline the complications that can occur with open instability surgery. Only by understanding the complications associated with the procedures performed can surgeons hope to decrease the frequency of their occurrence.     

N.K.Karpinsky--first general-headquarter-doctor

The article is devoted to biographies of the first head of the Department of Anatomy and Physiology of Petersburg Medical-Surgical Academy Professor Nikon Karpovich Karpinsky (1745-1810). Karpinsky contributed to the development of domestic medicine, especially surgery. His first work "The course of surgical dressings" proved it (1776). Multi-faceted medical services Karpinsky successfully combined with various administrative assignments. In 1791 he was appointed as a member of the Medical Board--the highest government body, ruled the Russian medicine, and after its closure in 1804--the chief scientist of the expedition department in the state medical council and a member of the Medical Council. The apotheosis of his administrative career began in 1805 post-general headquarters, a doctor, who commanded all military medicine of the country.     

A comparison between M.R.I. and C.T. in the investigation of neurological deterioration in longstanding spinal trauma.

MRI at 0.3T and CT with myelographic contrast (CTM) were compared in the retrospective evaluation of 35 patients investigated for the development of new neurological symptoms following longstanding spinal cord injury. Compared with MRI, CTM was relatively accurate for the demonstration of spinal cord compression, but failed to identify 23% of patients with spinal cord atrophy, and 43% of patients with post-traumatic syrinx formation. However, 5 patients had unsatisfactory MR imaging, either due to motion or metallic artifact, and in 3 of these, CTM demonstrated a syrinx. Although MRI is the method of choice in the investigation of this problem, CTM may still be required for patients with an unsatisfactory MR examination. Magnetic Resonance (MR) imaging is now an established technique for imaging the spine, with accurate depiction of the spinal cord, as well as the adjacent soft tissues (1, 2). However, the cost of this technique, and its as yet limited availability in Australasia, has resulted in the necessity to demonstrate its superiority over other imaging modalities for any specific clinical problem (3). One of the major areas of impact of MR has been in the investigation of the problem of acute neurological deterioration in patients with past spinal trauma (4, 5, 6). Some of these patients will have treatable causes of deterioration, either a post-traumatic syrinx, or spinal cord compression (6), and MR can be used to image these conditions (7), which, until recently, were investigated with computed tomography with myelographic contrast medium (CTM), (8, 9).(ABSTRACT TRUNCATED AT 250 WORDS)     

Calculation of Clinical r.b.e. Values for Neutrons

Summary

A method is described for calculating r.b.e. values for normal tissues at risk in clinical neutron beam therapy. This is based on the assumption that with high l.e.t. radiations the slope of the cell survival curve is steeper, mainly in the initial or low-dose region. This effect is quantified by using two coefficients, one (ε) to produce a proportionate increase in the initial slope, and a second (η) determining the change in the terminal slope (D₀) of the survival curve.

Analysis of published experimental data shows ε to be a variable quantity, different for different tissues; ε is larger when the survival curve has a large shoulder or slope ratio (ρ). By contrast, η is relatively constant (for a given beam) and less dependent on the tissue or end-point studied.

For low doses, the r.b.e. approaches ε, which can be calculated given η (characteristic of the beam) and ρ (characteristic of the relevant tissue) [ε = η + ρ(η ? 1)]. This provides a useful approximation to the clinical r.b.e. for specific tissues relative to conventionally fractionated low-l.e.t. photons.     

Histiocytosis X. III. Clinical value of serial biopsies.

In a retrospective review of sequential biopsies in 8 cases of histiocytosis X, 2 developed xanthomatous or fibrous lesions, 3 remained unchanged, whereas 3 developed malignant disease, one Hodgkin's disease and 2 malignant histiocytosis. A possible progression from benign, well differentiated to malignant histiocytic lesion is discussed, and the importance of achieving a microscopic diagnosis is emphasized.     

A new generation of U.S. Army flight helmets.

Head injuries are the most common cause of fatal injury in helicopter crashes. For over 80 years, the U.S. Army has used crash investigation studies to redesign flight helmets. This paper describes the evolution of the new fielded U.S. Army helmet, the Sound Protection Helmet No. 4B (SPH-4B), and compares its protective features to its predecessors, especially the SPH-4. A major contribution to the helmet design process was made by the Aviation Life Support Equipment Retrieval Program (ALSERP), a functional program at the U.S. Army Aeromedical Research Laboratory (USAARL). ALSERP has analyzed more than 500 helmets involved in crash events since 1972. Based on these studies of critical safety factors, the Army has developed and deployed the SPH-4B, a new helmet with improved energy absorption, retention, and stability.     

Occupational back disability in U.S. Army personnel.

Musculoskeletal disorders represent a prevalent source of outpatient visits, lost work time, hospitalization, and disability in the military. Recent research has identified patterns among military occupations, gender, and musculoskeletal disability. Although back disorders accounted for a high percentage of all cases, little is known about the relationship between job type and disability in soldiers. The present study analyzed 41,750 disability cases to determine (1) prevalence of work-related back disability diagnoses, (2) specific jobs associated with greater risk of back disability, and (3) association among gender, job type, and disability. The results indicate that (1) lumbosacral strain and intervertebral disc syndrome represent the most prevalent diagnoses for back disability, (2) certain occupations were associated with higher back disability risk, and (3) specific jobs were identified in which females experienced higher rates of back disability than males. The nature of these high-risk jobs, and recent research on work disability factors in U.S. Army soldiers, suggest that a combination of ergonomic and individual/organizational psychosocial factors may play a role in the development, exacerbation, and maintenance of work disability. Future research that identifies specific job factors contributing to increased back disability risk should assist in the development of empirically based work site prevention programs to improve musculoskeletal health and readiness.     

Color vision testing for the U.S. Naval Academy.

Normal color vision is a prerequisite for admission to the United States Naval Academy. The Farnsworth Lantern (FALANT) is the Navy's definitive test for color vision. A FALANT is not available at many locations where candidates are examined, so satisfactory performance on pseudoisochromatic plates has been considered an acceptable alternative. Until recently, the Farnsworth Dichotomous Test Panel D-15 had also been used as an alternative test, but is now considered unacceptable. In the summer of 1991, a large number of candidates reported for induction who were unable to pass the FALANT. Since their screening physical examinations had been reported to show normal color vision, a shadow of doubt was cast upon the ability of the alternative tests to predict performance on the FALANT. Four hundred subjects were then tested on several color vision tests to determine if these tests could predict FALANT success. The results of this study and recommendations are presented.     

Objective symmetry detector method for gammaencephalography. I. Physical characteristics.

A symmetry detector method for gammanecephalography is described. It is based on two detectors, collimated by square tubes with large apertures. Increase ratios and side difference ratios should be used as evaluation parameters in clinical applications and are therefore analysed theoretically and experimentally from measurements on a phantom system. The effect of energy discrimination is analyzed and found to be small over a wide range of the lower discrimination level setting. The chosen performance of the measuring routine used made errors caused by the electronic devices negligible in relation to the loss of precision occurring from counting statistics.     

Racing problems in the U.S.A.

The major problems of racing in the United States at the present time are caused by too much racing. This has led to too few horses and small fields. Consequently many owners and trainers are trying to enter their horses too frequently and to race them when they are not really fit to run. The desire to race horses as frequently as possible has led to constant pressure from horsemen through their organizations for so called "permissive medication". Started in the state of Colorado approximately ten years ago this has grown until finally there are only a few states, notably New York and New Jersey that have resisted the pressure. The drug that gave the opening wedge to permissive medication was phenylbutazone, but this in many states has led to the inclusion of other drugs including analgesics and drugs that veterinarians claim are needed for therapeutic purposes. Some states have endeavoured to control phenylbutazone medication by quantitation and while lower limits cause little difficulty, maximum allowable limits have caused problems and are not practical. While there has been no publicity to my knowledge about frusemide (furosemide, lasix) the abuse of this drug for so called "bleeders" is an example that may seriously interfere with drug detection in urine and its use should be confined to proven "bleeders" (i.e. horses suffering from epistaxis). Pre-race blood testing began roughly ten years ago at the harness tracks and has been resisted by our flat tracks rather successfully up to the present time. The blood testing methods and those used by the same laboratories in post-race urine testing is inadequate and will not detect many illegal drugs.