Sickle Cell Trait and the Athlete

KEY POINTS.Sickle cell trait is an inherited condition of the oxy-gencarrying protein,hemoglobin,in red blood cells.This genetictraitis generally benign,but during max-imal exercise,the oxygen levels in muscles can de-crease sufficiently to cause some of the red cells tochange fromthe normal disk shape to a crescent orsickle shape.These sickled red cells can block bloodvessels in muscles,kidneys,and other organs andcan pose a grave risk for some athletes exercising all-out..Inthe past61/2y…     

Are the osseous and tendinous-cartilaginous tibial tuberosity-trochlear groove distances the same on CT and MRI?

Objective

To verify whether the tibial tuberosity-trochlear groove distance (TT-TG) and the tendinous-cartilaginous TT-TG (the distance between the patellar tendon and trochlear groove: PT-TG) are identical using computed tomography (CT) and magnetic resonance imaging (MRI) techniques.

Subjects and methods

The TT-TG and PT-TG distances were measured on the same knee samples by three observers (two measurements per observer) using CT and MRI scans collected retrospectively. The reproducibility of the measurements was assessed using the interclass correlation coefficient (ICC). The means and standard deviations of four measurements were calculated for each patient. A paired t-test was used to assess differences between measurements.

Results

Fifty knee samples (32 with patellar instability and 18 with other conditions) were evaluated. The inter- and intraobserver reliability was excellent for all four measurements (>0.8). On average, the TT-TG distance on MRI was 3.1–3.6 mm smaller than that on CT, and the PT-TG distance on MRI was 1.0–3.4 mm larger than the TT-TG distance on MRI.

Conclusion

The osseous TT-TG and tendinous-cartilaginous PT-TG distances determined by CT and MRI were not identical.

     

Alcoholism and the Armanni–Ebstein lesion

The Armanni–Ebstein lesion is a histological change in the kidney consisting of sub-nuclear vacuolation of the proximal tubules. It has been most associated with diabetic ketoacidosis. The vacuoles have been reported to contain glycogen. More recent studies show them to contain fat. Recent papers have associated the Armanni–Ebstein lesion with non-diabetic ketoacidosis. We present 11 cases of alcoholic ketoacidosis where the Armanni–Ebstein lesion was identified. None had a history of diabetes mellitus and none showed any changes of diabetic nephropathy. All 11 cases had raised acetone levels (3–67 mg/100 mL (mean 17.9 mg/100 mL and median value of 16 mg/100 mL). In addition a case of isopropanol poisoning was found to have the Armanni–Ebstein lesion. Isopropanol is converted to acetone but is not associated with acidosis. These results indicate that the Armanni–Ebstein lesion is not specific to diabetes mellitus.     

Ossification and pseudoepiphysis formation in the “nonepiphyseal” end of bones of the hands and feet

Metacarpals, metatarsals, and phalanges were studied to assess the developmental morphology of secondary ossification in the nonepiphyseal ends of these bones as well as the formation of the pseudoepiphysis as an epiphyseal ossification variant. Both direct ossification extension from the metaphysis into the epiphysis and pseudoepiphysis formation preceded, and continued to be more mature than, formation and expansion of the classic epiphyseal (secondary) ossification center at the opposite end of each specific bone. Direct metaphyseal to epiphyseal ossification usually started centrally and expanded hemispherically, replacing both physeal and epiphyseal cartilage simultaneously. In contrast, when remnants of physis were retained, while juxtaposed epiphyseal cartilage was replaced, a pseudoepiphysis formed. There were three basic patterns of pseudoepiphysis formation. First, a central osseous bridge extended from the metaphysis across the physis into the epiphysis and subsequently expanded to create a mushroom-like osseous structure. In the second pattern a peripheral osseous bridge formed, creating either an osseous ring or an eccentric bridge between the metaphysis and the epiphysis. In the third pattern, multiple bridging occurred. In each situation the associated remnant physis lacked typical cell columns and was incapable of significantly contributing to the postnatal longitudinal growth of the involved bone. Pseudoepiphyses were well formed by 4–5 years and coalesced with the rest of the bone months of years before skeletal maturation was attained at the opposite epiphyseal end, which ossified in the typical pattern (i.e., formation of a secondary center de novo completely within the cartilaginous epiphysis). This process may also affect the development and appearance of ossification within the longitudinal epiphyseal bracket (delta phalanx).     

Intra and intersession repeatability and reliability of the S-Plate® pressure platform

AimThe aim of this study was to assess the repeatability and reliability of the S-Plate® pressure platform in a group of healthy subjects.Material and methodsForty subjects, free from physical conditions that would affect normal gait, walked along a five-meter corridor while data were recorded from the pressure platform. A total of 10 steps (five each side) were obtained as well as five static trials; the same measurements were repeated one week later. Peak and mean plantar pressures and contact area were recorded for both dynamic and static trials. Additionally, weight supported on each limb was documented during static trials. To assess intrasession and intersession repeatability and reliability, the intraclass correlation coefficients (ICCs) and coefficient of variation (CoV) were calculated.ResultsTaking the ICC values into account, every static and dynamic variable analysed showed moderate to excellent reliability and the CoV values were all below 12%.ConclusionMeasurements of either static or dynamic plantar pressure variables with the S-Plate® pressure platform show good repeatability and reliability, and so it is useful for comparing steps within and between sessions.     

Gorham–Stout disease: the experience of the Rizzoli Institute and review of the literature

Gorham–Stout disease (also known as “disappearing bone disease”) was first described by Jackson in 1838, but was properly defined by Gorham and Stout in a series of 24 patients in 1954–1955. It is a rare disease of unknown etiology (about 200 cases reported in the literature) characterized by spontaneous progressive resorption of bone without malignant proliferation of vascular structures. The diagnosis is one of exclusion and it is based on combined histological, radiological, and clinical features. Benign vascular proliferation with fatty bone marrow and thinning of bony trabeculae is a typical histological feature. Standard radiographs of disappearing bone disease show progressive bony resorption with adjacent soft tissue involvement. Most cases of Gorham–Stout disease resolve spontaneously, but prognosis remains unpredictable. This study reports 13 cases of Gorham–Stout disease treated in our institution from 1968 to 2008. The aim of the work was to review our series and the literature on this rare disease, as well as to evaluate whether or not an optimal treatment can be identified and recommended.     

MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist’s experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength.     

TICI and Age: What's the Score?

BACKGROUND AND PURPOSE:Previous studies have suggested that advanced age predicts worse outcome following mechanical thrombectomy. We assessed outcomes from 2 recent large prospective studies to determine the association among TICI, age, and outcome.MATERIALS AND METHODS:Data from the Solitaire FR Thrombectomy for Acute Revascularization (STAR) trial, an international multicenter prospective single-arm thrombectomy study and the Solitaire arm of the Solitaire FR With the Intention For Thrombectomy (SWIFT) trial were pooled. TICI was determined by core laboratory review. Good outcome was defined as an mRS score of 0–2 at 90 days. We analyzed the association among clinical outcome, successful-versus-unsuccessful reperfusion (TICI 2b–3 versus TICI 0–2a), and age (dichotomized across the median).RESULTS:Two hundred sixty-nine of 291 patients treated with Solitaire in the STAR and SWIFT data bases for whom TICI and 90-day outcome data were available were included. The median age was 70 years (interquartile range, 60–76 years) with an age range of 25–88 years. The mean age of patients 70 years of age or younger was 59 years, and it was 77 years for patients older than 70 years. There was no significant difference between baseline NIHSS scores or procedure time metrics. Hemorrhage and device-related complications were more common in the younger age group but did not reach statistical significance. In absolute terms, the rate of good outcome was higher in the younger population (64% versus 44%, P < .001). However, the magnitude of benefit from successful reperfusion was higher in the 70 years of age and older group (OR, 4.82; 95% CI, 1.32–17.63 versus OR 7.32; 95% CI, 1.73–30.99).CONCLUSIONS:Successful reperfusion is the strongest predictor of good outcome following mechanical thrombectomy, and the magnitude of benefit is highest in the patient population older than 70 years of age.

The clinical outcome after acute ischemic stroke is generally worse in the elderly compared with nonelderly populations.^1,2 Poorer outcomes are to be expected in the elderly population in all disease states; however, the effect of a therapy may still afford a similar magnitude of benefit.³ Results from the Third International Stroke Trial suggest that the therapeutic effect of IV-tPA is similar or even better in the elderly population.^4,5 With regard to stroke therapy, recanalization has been definitively related to good clinical outcomes.^6–8 However, it has been reported in multiple studies that despite similar rates of recanalization, the elderly have higher mortality rates and poorer outcomes than younger patients following intra-arterial treatment.^7,9–13 These studies were mostly retrospective, single-center series or used older generation devices with suboptimal reperfusion rates.^7,9–13 Recent clinical studies demonstrating the value of mechanical thrombectomy for acute ischemic stroke (AIS) did not include a significant number of elderly patients.^14–17 We performed a post hoc analysis of 2 prospective core lab–reviewed studies assessing mechanical thrombectomy by using new-generation devices (stent retrievers) for AIS to determine whether the benefit of reperfusion was constant across age groups, including the older population.     

Does supplementation of CT and MRI with gallium-67 SPECT improve the differentiation between benign and malignant tumors of the head and neck?

The objective of our study is to determine whether 67Ga SPECT can supplement CT and/or MRI diagnostic information by visual comparison of the two separate data sets in patients with head and neck tumors. METHODS: A total of 50 patients with head and neck tumors (benign: 19, malignant: 31) were entered in the study. Three board-certified radiologists who had practical experience in interpreting both head and neck CT/MRI and 67Ga SPECT images, participated as readers. All of the CT and/or MR images of each patient were shown to each reader first, who after they had finished interpreting them were shown the 67Ga SPECT images. They were asked to score each image on a 7-point scale for the likelihood of the presence or absence of malignancy. Histological or cytological evaluation was done in all cases, and the radiologic studies were correlated with these findings. RESULTS: Improvement of all three readers' performance was from 70.7% to 83.3% in the mean accuracy and from 0.790 to 0.921 in the mean Az value (p = 0.033, 0.163, 0.105 in the Az values) after they were shown the 67Ga SPECT images. CONCLUSIONS: 67Ga SPECT should substantially increase confidence in the diagnosis of head and neck tumors when CT and/or MRI do not permit differentiation between benign and malignant disease.     

Protective equipment and the prevention of concussion - what is the evidence?

The complex nature of the evaluation and management of concussion lends to controversy, and the immediate and long-term implications still are being investigated. Various types of protective equipment have been used as a means to prevent concussions, and protective equipment is being used more frequently in different sports. Recent investigations have suggested that a protective, but not preventive, effect may be afforded by mouthguard use in rugby players, headgear use in soccer players, and customized mandibular orthotic use in football players. The use of faceshields has not shown a proven benefit in preventing the incidence of sport-related concussion in ice hockey or field hockey participants. Further studies are needed to clarify the role of protective equipment in the prevention of sport-related concussion.     

The distribution of the HLA-DQα alleles and genotypes in the Finnish population as determined by the use of DNA amplification and allele specific oligonucleotides

Summary Allele and genotype frequencies for the HLA-130 locus were determined for use in forensic analyses and paternity tests in Finland. The polymerase chain reaction (PCR) and the reverse dot blot format were employed to detect 6 different HLA-DQ alleles. All 6 HLA-DQ alleles were detected among the 112 unrelated individuals with allele frequencies ranging from 5.8% to 32.6%. The distribution of the observed genotypes is in Hardy-Weinberg equilibrium. Additionally, this Finnish population sample is statistically similar to 2 other Caucasian sample populations. The power of discrimination of this system in the Finnish population sample is 0.92, suggesting this method may prove suitable for identification purposes.     

Formation and decay of the E1′ center and of its precursor

The E₁′ center has been used for ESR dating of quartz with assuming that the signal intensity increases with natural radiation dose as those of other ESR signals do. However, this simple assumption is not necessarily correct. Formation and decay of the E₁′ center are closely related with its precursor, diamagnetic oxygen vacancies. Gamma ray of large dose (>100 kGy) creates oxygen vacancies giving little dose rate effect, which, therefore, might be useful for dating of granites and high dose dosimetry.     

Mapping the war: gender,health, and the medical profession in France and Germany, 1914–1918

This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial ‘map’ which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war’s impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?