Wrist Pain in a Gymnast

A group of experts met to discuss a case from the University of California, Los Angeles, School of Medicine.     

Cme credit quiz no. 23

A group of experts met to discuss a case from the University of California, Los Angeles, School of Medicine.     

Use of personal digital assistants for retrieval of medical images and data on high-resolution flat panel displays.

For its new acute care hospital, the University of California at Los Angeles is evaluating innovative technology involving high-resolution flat panel display devices configured as "network appliances" that can be wall mounted for use in the retrieval and display of medical images and data. Physicians and healthcare providers can log on with wireless handheld computers, which can serve as an identification device as well as a navigational tool for selecting patient records and data. These data are displayed and manipulated on the flat panel display without the need for a keyboard or mouse. A prototype was developed with commercially available image display software, which was modified to allow the remote control of software functions from a handheld device through an infrared communication port. The system also allows navigation through the patient data in a World Wide Web-based electronic patient record. This prototype illustrates the evolution of radiologic facilities toward "shareable" high-quality display devices that allow more convenient and cost-effective access to medical images and related data in complex clinical environments, resulting in a paradigm shift in data navigation and accessibility. Copyright RSNA, 2003.     

Tibial Pain in an Amenorrheic Runner

A group of experts met to discuss a case from the University of California, Los Angeles, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.     

Peroneal Nerve Palsy Induced by Cryotherapy

A group of experts from the University of California, Los Angeles, met to discuss a case from another institution. This case conference is part of a series featuring a variety of sports medicine topics.     

Clinical cardiac PET: Quo vadis?

Operated for the U.S. Department of Energy by the University of California under contract DE-AC03-76-SF00012. This work was supported in part by the Director of the Office of Energy Research, Office of Health and Environmental Research, Washington D.C., by research grants HL 29845 and HL 33177, National Institutes of Health, Bethesda, MD and by an Investigative Group Award by the Greater Los Angeles Affiliate of the American Heart Association, Los Angeles, Calif.     

Sportsmedicine Cold War?

Three years before the Los Angeles Olympic Games. Michael Yessis, PhD. believes the United States has as much chance of garnering the lion's share of the medals as Albania or Zambia. The professor of physical education at California State University, Fullerton, and publisher o f the Soviet Sports Review told McGraw-Hill World News reporter Paul Addison that he is not a pessimist or communist. He just doesn't expect any nation to match the excellence of the scientifically trained Soviet athletes. Yessis writes here for a change in attitude toward learning from the Russians.     

Families overcoming under stress: implementing family-centered prevention for military families facing wartime deployments and combat operational stress

The toll of multiple and prolonged deployments on families has become clearer in recent years as military families have seen an increase in childhood anxiety, parental psychological distress, and marital discord. Families overcoming under stress (FOCUS), a family-centered evidence-informed resiliency training program developed at University of California, Los Angeles and Harvard Medical School, is being implemented at military installations through an initiative from Navy Bureau of Medicine and Surgery. The research foundation for FOCUS includes evidence-based preventive interventions that were adapted to meet the specific needs of military families facing combat operational stress associated with wartime deployments. Using a family narrative approach, FOCUS includes a customized approach utilizing core intervention components, including psychoeducation, emotional regulation skills, goal setting and problem solving skills, traumatic stress reminder management techniques, and family communication skills. The purpose of this study is to describe the development and implementation of FOCUS for military families. A case example is also presented.     

Tetrahydrogestrinone: The discovery of a designer steroid

The use of steroids and other pharmaceuticals to gain a competitive edge in athletics has been present in the sports world for a long time. Over the past several years, scientific advances in the detection of sports doping agents and improved collaboration between sports organizations have enhanced the monitoring of fair athletic play. Many have suspected the illegal development of designer steroids by rogue scientists to avoid detection by the standard sports doping drug screen. In 2003, the Olympic Analytical Laboratory at the University of California, Los Angeles discovered the first designer steroid, tetrahydrogestrinone (THG), by using liquid chromatography with tandem mass spectrometry. Over the past year, the THG story continues to shock the sports world with its potential to discredit or terminate several high-profile athletic careers. While confirming the existence of designer steroids is credit to the sports antidoping movement, antidoping agencies will need to continue to invest in research and depend on honest athletic participants to maintain fairness and safety in sports.     

Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results

BACKGROUND: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. HYPOTHESIS: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. RESULTS: The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. CONCLUSION: Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. CLINICAL RELEVANCE: Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.     

Preoperative imaging in adult-to-adult living related liver transplant donors: what surgeons want to know

Because of an overwhelming demand for cadaveric livers in the United States that far outstrips supply, living related liver transplantation is increasingly being performed to help treat a cohort of patients with severe end-stage liver disease. This procedure demands careful preoperative evaluation to minimize morbidity to the healthy donor and recipient, however. As a part of the workup, radiologic assessment of the donor hepatic vascular and biliary anatomy, hepatic volume, and hepatic parenchyma (with regard to focal and diffuse liver disease) is essential. In this pictorial essay, the experience of a group of investigators at the University of California at Los Angeles is reviewed, and the essential radiologic components of the preoperative evaluation of hepatic vascular and biliary anatomy, hepatic parenchyma, and lobar volume are described. The roles of high-field magnetic resonance (MR) imaging, MR angiography, MR cholangiopancreatography, multidetector-row computed tomography (CT) angiography, and CT cholangiography in the workup are discussed.     

The influence of mental skills on motivation and psychosocial characteristics

The purpose of this observational, cross-sectional study was to assess psychosocial characteristics and intrinsic motivation in a convenience sample of Army soldiers with different mental skills profiles. Participants were recruited immediately before or immediately following regular training activities. Anonymous surveys were completed and collected in the training area. Instruments used in this study included the Ottawa Mental Skills Assessment Tool-3 Revised for Soldiers; Rosenberg Self-esteem Scale; Depression Anxiety Stress Scale-21; University of California, Los Angeles, Loneliness Scale; Beck Hopelessness Scale; Intrinsic Motivation Inventory; and an anger measure. Soldiers with strong mental skill profiles were more intrinsically motivated and psychosocially healthier than their peers with weaker mental skill profiles. It is recommended that a proactive approach to psychological health promotion practices in soldiers be sought rather than reactive treatment plans to psychological sequelae. Future research must examine the role of psychosocial fitness and adaptability to enhance mental skills fitness.     

Medical image security in a HIPAA mandated PACS environment.

Medical image security is an important issue when digital images and their pertinent patient information are transmitted across public networks. Mandates for ensuring health data security have been issued by the federal government such as Health Insurance Portability and Accountability Act (HIPAA), where healthcare institutions are obliged to take appropriate measures to ensure that patient information is only provided to people who have a professional need. Guidelines, such as digital imaging and communication in medicine (DICOM) standards that deal with security issues, continue to be published by organizing bodies in healthcare. However, there are many differences in implementation especially for an integrated system like picture archiving and communication system (PACS), and the infrastructure to deploy these security standards is often lacking. Over the past 6 years, members in the Image Processing and Informatics Laboratory, Childrens Hospital, Los Angeles/University of Southern California, have actively researched image security issues related to PACS and teleradiology. The paper summarizes our previous work and presents an approach to further research on the digital envelope (DE) concept that provides image integrity and security assurance in addition to conventional network security protection. The DE, including the digital signature (DS) of the image as well as encrypted patient information from the DICOM image header, can be embedded in the background area of the image as an invisible permanent watermark. The paper outlines the systematic development, evaluation and deployment of the DE method in a PACS environment. We have also proposed a dedicated PACS security server that will act as an image authority to check and certify the image origin and integrity upon request by a user, and meanwhile act also as a secure DICOM gateway to the outside connections and a PACS operation monitor for HIPAA supporting information.     

Radiology film-management systems at Los Angeles County-University of Southern California Medical Center.

An accurate and efficient x-ray film-retrieval service was needed in the radiology department at Los Angeles County-University of Southern California Medical Center. In July 1986, the radiology department implemented the radiology film-management system in concert with the surgery department. The centralized radiology film files were replaced by service bins, each containing all inpatient films for a specified surgical service. Physician waiting time, clerical work load, and the number of lost and misplaced films have been reduced, and cost savings to date is $840,000. By mid-1988, the system had been expanded to accommodate more than 90% of radiology users.     

关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳

目的观察关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳的临床疗效。方法选择21例肩关节前方不稳的患者,关节镜下锚钉修复盂唇损伤,同时修复合并出现的上盂唇前后(SLAP)损伤,较大的Hill-sachs损伤。采用UCLA功能评分标准和SST评分进行疗效的评估,记录术前和终末随访的得分。结果术后患者随访12~45个月,平均随访27个月。SST得分术前为(6.72±2.38)分,术后终末随访评分为(11.24±1.46)分,同术前比较差异有统计学意义(P<0.01)。术前UCLA平均得分为(19.55±5.02)分,术后终末随访评分为(33.19±4.61)分,与术前比较差异有统计学意义(P<0.01)。结论关节镜下Bankart修复治疗训练伤所致肩关节前方不稳疗效满意,可以很好恢复肩关节功能。     

Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy

Twenty-five athletes (26 shoulders) who underwent an inferior capsular shift procedure for multidirectional glenohumeral instability based on isolated capsular and ligamentous redundancy were evaluated at a median of 54 months (range, 25 to 113) after the operation. Twenty-one athletes (84%) returned to their preinjury activity level at a median of 5 months after surgery. Of 21 athletes involved in sports using overhead motions, 16 (76%) returned to their previous sport after the operation, and 12 (57%) were still active in this sport at the preinjury level at follow-up. According to the Rowe score, 23 shoulders (88%) were excellent or good. The University of California at Los Angeles score for 24 shoulders (92%) was excellent or good. The operations on two shoulders (8%) failed. One patient had a spontaneous redislocation, and one had recurrent subluxations. Nine contralateral shoulders had a history of significant instability; four of these had undergone Bankart repair. We concluded that athletes who have multidirectional instability based on isolated capsular and ligamentous redundancy can be successfully treated by an inferior capsular shift preserving the subscapularis tendon insertion. We found a high rate of return to demanding upper extremity sports in our patients, range of motion was restored in the majority of shoulders, and the failure rate after a median of 54 months was acceptable.     

Improvements in prostate brachytherapy dosimetry due to seed stranding

PURPOSE: Prostate brachytherapy with suture embedded seeds has emerged as a popular technique to reduce seed migration and to improve dosimetry. Various trials have shown improved dosimetry with seed fixity, whereas others have shown no benefit and possible detriment to suture embedded seeds. In order to contribute to the understanding of whether seed stranding improves dosimetry, we present retrospective data from our institution. METHODS AND MATERIALS: We analyzed 80 patients treated between April 29, 2001 and June 19, 2006, receiving I-125 monotherapy for prostate cancer. Brachytherapy patients at the University of California, Los Angeles (UCLA) were initially treated using a transperineal approach with loose seeds. Subsequent to October 26, 2002, all patients were implanted using suture embedded seeds. Dosimetric quantifiers were calculated based on a CT obtained 1-month postimplantation. RESULTS: Dosimetry of patients treated with stranded seeds showed significant improvement. Specifically, the V100 (volume of the prostate receiving 100% of the prescribed dose) improved from 88% to 92% (p<0.05), and the D90 (maximum dose received by 90% of the prostate) improved from 143 to 155 Gy (p<0.05). CONCLUSIONS: At UCLA, the use of suture embedded seeds resulted in a significant improvement in our dosimetric quantifiers. Based upon other published studies, this improvement in dosimetry may translate into improved patient outcomes.     

Planning an airport disaster drill.

The authors have prepared this paper to serve as a guide for planning airport disaster drills, particularly at the major air carrier airports. Their recommendations are subject to change according to the needs of the individual airport and the particular circumstances that may be present. Basically, the recommendations are founded on the experience gained by participation in planning and carrying out five separate emergency or disaster drills (Oakland International Airport 1, San Francisco International Airport 2, Los Angeles International Airport 2). The authors also have been involved in a total of three additional disaster drills in California and have been involved in one way or another in an additional 19 airport disaster drills throughout the United States. The presentation is divided into segments according to activity. However, it should be noted that there is a cohesiveness necessary for disaster planning if the drill is to be successful.     

Arthroscopic laser-assisted capsular shift in the treatment of patients with multidirectional shoulder instability

BACKGROUND: In recent years, various investigators have begun using lasers in the treatment of shoulder instability. HYPOTHESIS: Arthroscopic laser-assisted capsular shift is an effective treatment for patients with multidirectional shoulder instability. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively identified 28 patients (30 shoulders) with multidirectional shoulder instability who were unresponsive to nonoperative management and who had undergone the laser-assisted capsular shift procedure. Twenty-five patients (27 shoulders) with an average follow-up of 28 months were available for review. All patients underwent a physical examination and completed a general questionnaire; the University of California, Los Angeles, shoulder rating scale; the Western Ontario Shoulder Instability Index; and the Short-Form 36 quality of life index. RESULTS: In 22 shoulders, results of the procedure were considered a success because the patients had no recurrent symptoms and at latest follow-up had required no further operative intervention. In five shoulders, results were considered a failure because of recurrent pain or instability and the need for an open capsular shift procedure. With recurrent instability as a measure of failure, the overall success rate was 81.5%. CONCLUSIONS: Our results with laser-assisted capsular shift are comparable with the results of other open and arthroscopic techniques in relieving pain and returning athletes to their premorbid function.