Interviewing principles for the psychiatrically aware sports medicine physician

This article describes how sports medicine physicians can best approach the diagnoses of mental illness in athletes. Examples of psychiatric problems common to athletes, their incidences in the population, and diagnostic tips to ferret them out are given. Vignettes of well-known athletes who have had these problems are included. Each highlights how the lack of diagnostic awareness of mental health issues in the athletic community and the stigma of "mental illness" prevented the athlete from getting treatment sooner.     

X-ray imaging physics for nuclear medicine technologists. Part 1: Basic principles of x-ray production

The purpose is to review in a 4-part series: (i) the basic principles of x-ray production, (ii) x-ray interactions and data capture/conversion, (iii) acquisition/creation of the CT image, and (iv) operational details of a modern multislice CT scanner integrated with a PET scanner. Advances in PET technology have lead to widespread applications in diagnostic imaging and oncologic staging of disease. Combined PET/CT scanners provide the high-resolution anatomic imaging capability of CT with the metabolic and physiologic information by PET, to offer a significant increase in information content useful for the diagnostician and radiation oncologist, neurosurgeon, or other physician needing both anatomic detail and knowledge of disease extent. Nuclear medicine technologists at the forefront of PET should therefore have a good understanding of x-ray imaging physics and basic CT scanner operation, as covered by this 4-part series. After reading the first article on x-ray production, the nuclear medicine technologist will be familiar with (a) the physical characteristics of x-rays relative to other electromagnetic radiations, including gamma-rays in terms of energy, wavelength, and frequency; (b) methods of x-ray production and the characteristics of the output x-ray spectrum; (c) components necessary to produce x-rays, including the x-ray tube/x-ray generator and the parameters that control x-ray quality (energy) and quantity; (d) x-ray production limitations caused by heating and the impact on image acquisition and clinical throughput; and (e) a glossary of terms to assist in the understanding of this information.     

Low-velocity knee dislocation with sports injuries. Treatment principles

Knowing that the injured MCL and PCL can heal and that the injured ACL and lateral side, predictably, will not heal are the bases for the treatment approach to these injuries. (1) Allow MCL healing nonoperatively. (2) Allow PCL healing to occur as long as PCL laxity is 2+ or less (reconstruct the PCL acutely if posterior drawer is > 2+ initially). (3) Initially delay ACL treatment and reconstruct later, if needed posterior drawer. (4) Perform acute lateral side repair to reattach structures to their distally torn site.     

Orofacial injuries from sport: preventive measures for sports medicine

Individuals worldwide are participating in an expanding arena of vigorous physical activities as well as competitive sports at all levels. The healthful benefits of such activities are unfortunately associated with injury risks that include orofacial soft- and hard-tissue trauma. This article describes the scope and emergency management of sports-related orofacial traumatic injuries that may be encountered by physicians in the field of sports medicine. Since most of these injuries are preventable with the use of protective equipment, specific recommendations are provided for the use of properly fitted mouthguards.     

The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity

The two major imaging modalities used for assessment of soft tissue injuries are ultrasound and MRI. Although ultrasound of the extremities is used only to a limited extent in the United States, it is widely used in many other countries for evaluation of extremity injuries. This article first considers the advantages and disadvantages of MRI and ultrasound. Understanding these differences will help the reader understand the role of ultrasound as compared with MRI in evaluating upper extremity injuries. The uses of ultrasound for evaluating sports medicine injuries in specific regions of the upper extremity are then reviewed. Where the data are available, the reported accuracy of ultrasound is compared with MRI for each type of injury.     

颈椎创伤早期基本治疗原则

随着对颈椎创伤的认识和继续教育不断发展,我国各级医院对颈椎创伤的诊治水平有了显著地提高.但由于各级医护人员认识水平的差异,导致颈椎损伤早期治疗原则方面,还存在诸多不足.特别是颈椎损伤合并脑外伤或其他脏器严重损伤时,临床漏诊、误诊现象还很常见.笔者将概述颈椎损伤早期基本治疗原则,重点强调颈椎损伤后评估要点、制定最优治疗策略、手术技巧、术后护理和功能锻炼的基本原则等,以期为广大脊柱外科医师提供一个较为全面、实用的诊治指导.     

Renovascular hypertension: nuclear medicine techniques.

Angiotensin converting enzyme inhibition (ACEI) renography is the only imaging examination that tests directly for the presence of renovascular hypertension (RVH); other imaging examinations test for the presence of renal artery stenosis (RAS). The goals of ACEI renography are two-fold: 1) to detect those patients with hypertension who have renal artery stenosis as the cause of their hypertension and who would benefit from revascularization, and 2) to determine which hypertensive patients do not have renovascular hypertension and obviate the expense and risk of angiography and, potentially, revascularization. This review summarizes general components of renal scintigraphy (pretest voiding, hydration, patient position, relative uptake, time to peak height of the renogram curve, 20 min/max ratio, postvoid images, quality control) as well as those components specific to ACEI renography (choice of radiopharmaceutical, choice of ACE inhibitor, angiotensin II receptor blockers, diuretics, parenchymal mean transit time, monitoring of blood pressure, 1 versus 2 day protocols and omission of the baseline study). ACEI renography is highly accurate in patients with suspected RVH who have normal or near normal renal function. In this patient population, the sensitivity and specificity of ACEI renography for renovascular hypertension exceed 90%; angiography as an initial approach is not cost effective. Data from 10 studies evaluating cure or improvement in blood pressure in 291 patients undergoing revascularization showed the mean positive predictive value of ACEI renography to be 92%. When azotemic patients present with suspected RVH, as many as 50% of patients may have an intermediate probability ACEI renogram and the sensitivity of detecting RVH falls to approximately 80% even when intermediate and high probability tests are combined.     

Audit of knee injuries seen in a sports medicine clinic.

In order to assess the management of knee injuries in a sports medicine clinic, an audit was performed of all new patients who attended the clinic over a 12-month period. Of the 167 new patients seen, 76 (46%) had sustained knee injuries. Of these, 43 (57%) were treated in the sports medicine clinic and 33 (43%) were referred for arthroscopic assessment. The maximum waiting time from the time of referral was 3 weeks, with 85% of patients seen within 1 week and 92% within 2 weeks. Arthroscopy was performed on 28 (85%) of the 33 patients referred, and the positive correlation between the sports clinic diagnosis and the arthroscopic diagnosis was 64%. Of the 33 patients referred for arthroscopy, 28 (85%) had sustained acute knee injuries while five (15%) had been treated at other hospitals before referral to the sports medicine clinic. A National Health Service sports medicine clinic is an effective means of treating knee injuries, provided that access to arthroscopy is readily available.     

A profile of Australian football injuries presenting to sports medicine clinics

Most of the published data describing Australian football injuries is from hospital emergency departments and elite injury surveillance studies. There is a lack of good information about injuries to players at the lower levels of participation and those not severe enough to warrant hospital treatment. This study describes the profile of Australian football injuries that present to sports medicine clinics for treatment. New sports injury cases, presenting to five metropolitan Melbourne sports medicine clinics during a 12 month period in 1996-1997, were recorded through the Sports Medicine Injury Surveillance project. Both the patient and treating health professional provided personal and injury details. Australian football accounted for 29% of the 6479 recorded injury cases. The majority of injured players were male (99%) and from adult, community leagues (78%); the mean age was 23 years. Competition accounted for 78% of injuries and 72% of injured players presented for treatment to a sports physician/medical practitioner. Body contact accounted for half of all injuries and the most common injuries were medial ligament sprains of the knee (7%), lateral ligament sprains of the ankle (6%) and anterior cruciate ligament injuries (4%). In conclusion, sports medicine clinics treat a wide variety of football injuries and appear to be a good source of data about injuries to non-elite participants.     

Telethermographic evaluation of NSAIDs in the treatment of sports injuries

In a multicenter double-blind clinical trial, forty-five athletes, 39 males and 6 females, mean age 20.87 yr (SD 4.48), affected by sports injuries were treated with diclofenac, suprofen, or placebo, orally administered for a period of 1 wk. An objective examination like telethermography was performed with the clinical evaluations (pain on movement or at pressure, motility, and swelling) before and after the treatment period, in all patients. Moreover, at the end of the trial both investigator and patient gave their global judgement of efficacy. The statistical analysis showed a significant superiority of diclofenac sodium versus suprofen and placebo both in patients' and in investigators' global evaluations (P less than 0.05--Kruskal-Wallis tests). This superiority appeared particularly clear in the telethermographic evaluation (P less than 0.05), which is more objective than the clinical one, attesting to the usefulness of the early administration of anti-inflammatory drugs in management of sports injuries. Furthermore, a correlation analysis showed that telethermography is a good technique in controlling the recovery process.     

Guidelines for rehabilitation of sports injuries

Rehabilitation involves a functional progression through a systematic program of physical reconditioning involving the re-establishment of intact articulations and muscles, pain-free joints and muscles, joint flexibility, muscular strength, muscular endurance, muscular speed, integrated and coordinated movement (skill patterns), and cardiovascular endurance. Specific demands must be imposed upon the body to bring about redevelopment of each phase. A proper diagnosis prior to beginning, and constant monitoring of the patient's progress during, rehabilitation are necessary so that the demands of the therapeutic regimen can be adjusted according to the patient's progress. The DAPRE technique objectifies isotonic and loaded isometric strength development and therefore stimulates greater strength gains during rehabilitation than other techniques do.     

Differentiation of tumor sensitivity to photodynamic therapy and early evaluation of treatment effect by nuclear medicine techniques

Objective

Our final goal is to develop an appropriate method using nuclear medicine technique for monitoring the effect and prediction of Photodynamic Therapy (PDT) on tumors. The aim of this study is to evaluate the effect of PDT on tumor cells in vitro using ¹⁸F-FDG and ^99mTc-MIBI as tracers.

Methods

Five tumor cell lines (A431, DU145, H1650, LS180, SHIN3) with varied characteristics were irradiated after incubating for 24 h with several doses of Photofrin (PF). Singlet oxygen was monitored by the near-IR emission detection system during irradiation and generated ¹O₂ was calculated. PDT effects were rapidly evaluated by nuclear medicine techniques (uptake of ¹⁸F-FDG and ^99mTc-MIBI) and traditional methods for cell viability (MTT and trypan blue assays) at 3 h after PDT. Intracellular PF concentration was measured by absorption spectrometer and cell protein content was measured by the Lowry method. ¹⁸F-FDG uptake, ^99mTc-MIBI uptake, singlet oxygen, and intracellular PF concentration were standardized by protein content. Decrease % of ¹⁸F-FDG and ^99mTc-MIBI, MTT, and trypan blue was normalized to the control group.

Results

Decrease % of ¹⁸F-FDG was exponentially related to decrease % of MTT (R ² = 0.650, P < 0.01) while decrease % of ^99mTc-MIBI was linearly related to that of MTT (R ² = 0.719, P < 0.01). The decrease % of MTT was more sensitive than that of trypan blue. However, neither ¹O₂ nor PF uptake was correlated with sensitivity to PDT. In addition, ¹⁸F-FDG uptake before PDT was linearly related to decrease % of MTT (R ² = 0.800, P < 0.05).

Conclusions

Our findings in in vitro studies suggest that ^99mTc-MIBI is better than ¹⁸F-FDG for early evaluation of PDT effect, but ¹⁸F-FDG uptake may be used to predict PDT sensitivity before therapy.