Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?

Background: Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence.

Objective: To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque.

Methods: A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer.

Results: The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002).

Conclusions: The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS.

     

Arthroscopic shoulder capsulorraphy: does it work?

The purpose of this project was to answer the question, "Can shoulder instability be dealt with safely and effectively arthroscopically?" This study, which began in December 1982 and concluded in February 1985, involved 12 patients, 3 females and 9 males whose ages ranged from 14 to 40 years. Followup ranged from 31 to 63 months, the average being 44.8 months. The arthroscopic procedure was based on the use of a tool designed to capture the capsule, thus allowing placement of either one or two low profile extraarticular staples in the capsule. Two cases were failures. The remaining 10 patients were pleased with their operation. Based on the classification of Rowe et al., functional results were six excellent, two good, two fair, and two poor. The six patients with excellent results had shoulders of normal appearance. They were fully active and had neither pain nor limitation of motion. All six patients had negative apprehension signs. The two patients with good results had similar outcomes, but they had occasional morning stiffness and intermittent mild pain, as well as a 10 degrees limitation of external rotation in both adduction and abduction. One patient who had a fair result had a positive apprehension sign and occasional pain with quick motion. The other patient with a fair result was hampered by more significant pain on an intermittent basis, yet the pain was not a constant issue. None of these patients had radiographic evidence of increased degenerative changes of the shoulder or staple migration. There were two complications and two failures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Qualitative radiology assessment of tumor response: does it measure up?

Our purpose was to assess whether a simpler qualitative evaluation of tumor response by computed tomography is as reproducible and predictive of clinical outcome as the Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) methods. This study was a two-reader retrospective evaluation in which qualitative assessment resulted in agreement in 21 of 23 patients with metastatic colorectal carcinoma (91.3%, kappa=0.78; 95% CI, 0.51–1.00). Hepatic metastases were classified as increased, decreased, or unchanged, compared with agreement in 20 of 23 patients (87.0%) for RECIST (kappa=0.62; 95% CI, 0.23–1.00) and WHO (kappa=0.67; 95% CI, 0.34–1.00) methods. Patients were placed into partial response, stable disease, and disease progression categories. Time to progression of disease was better predicted qualitatively than by RECIST or WHO. Our pilot data suggest that our qualitative scoring system is more reproducible and predictive of patient clinical outcome than the RECIST and WHO methods.     

Does overtraining exist? An analysis of overreaching and overtraining research

Athletes experience minor fatigue and acute reductions in performance as a consequence of the normal training process. When the balance between training stress and recovery is disproportionate, it is thought that overreaching and possibly overtraining may develop. However, the majority of research that has been conducted in this area has investigated overreached and not overtrained athletes. Overreaching occurs as a result of intensified training and is often considered a normal outcome for elite athletes due to the relatively short time needed for recovery (approximately 2 weeks) and the possibility of a supercompensatory effect. As the time needed to recover from the overtraining syndrome is considered to be much longer (months to years), it may not be appropriate to compare the two states. It is presently not possible to discern acute fatigue and decreased performance experienced from isolated training sessions, from the states of overreaching and overtraining. This is partially the result of a lack of diagnostic tools, variability of results of research studies, a lack of well controlled studies and individual responses to training.The general lack of research in the area in combination with very few well controlled investigations means that it is very difficult to gain insight into the incidence, markers and possible causes of overtraining. There is currently no evidence aside from anecdotal information to suggest that overreaching precedes overtraining and that symptoms of overtraining are more severe than overreaching. It is indeed possible that the two states show different defining characteristics and the overtraining continuum may be an oversimplification. Critical analysis of relevant research suggests that overreaching and overtraining investigations should be interpreted with caution before recommendations for markers of overreaching and overtraining can be proposed. Systematically controlled and monitored studies are needed to determine if overtraining is distinguishable from overreaching, what the best indicators of these states are and the underlying mechanisms that cause fatigue and performance decrements. The available scientific and anecdotal evidence supports the existence of the overtraining syndrome; however, more research is required to state with certainty that the syndrome exists.     

The medical and ethical aspects of photography in the sexual assault examination: why does it offend?

This paper reviews the literature in respect to the photo-colposcopic examination of anogenital injury in the sexually assaulted child, considered to be the 'gold standard' of examination, and how this compares with gross visualisation, still the standard procedure in adult examinations. It then examines the claim that, because the presence of injury does not provide a distinction between consensual and non-consensual intercourse in adults, photo-documentation is unnecessary medically and constitutes an invasive procedure which is ethically unacceptable. The paper questions whether the unwillingness of forensic physicians to extend photo-colposcopy to the examination of adult victims is related more to political and gender issues than to claims made on ethical and medical grounds, and concludes that any move to ban anogenital photography in adult forensic examinations (currently under consideration in the author's own jurisdiction) would possibly constitute an interference with independent clinical judgment and an incursion into the patient's right to evidence-based medicine.     

Neurobiology of suicide: do biomarkers exist?

Clinical risk factors have a low predictive value on suicide. This may explain the increasing interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. This review aims to present the current neurobiological findings that have been shown to be implicated in suicide completers and to discuss how postmortem studies may be useful in characterizing these individuals. Data on the role of the main neurobiological systems in suicidality, such as the neurotransmitter families, hypothalamic–pituitary–adrenal axis, neurotrophic factors, and polyamines, are exposed at the different biochemical, genetic, and epigenetic levels. Some neuroanatomic and neuropathological aspects as well as their in vivo morphological and functional neuroimaging correlates are also described. Except for the serotoninergic system, particularly with respect to the polymorphism of the gene coding for the serotonin transporter (5-HTTLPR) and brain-derived neurotrophic factor, data did not converge to produce a univocal consensus. The possible limitations of currently published studies are discussed, as well as the scope for long-term prospective studies.     

Accidental anal intercourse: does it really happen?

A postal survey was conducted of members of the Association of Forensic Physicians (UK) to determine whether accidental anal intercourse occurs in heterosexual relationships and, if so, whether intoxication by alcohol or drugs and sexual inexperience were likely to be causative factors. Of the 512 (47.9%) replies, there were 498 individuals who had had a previous heterosexual relationship and may have experienced accidental anal intercourse. Of these, there were 26 (7.2%) males and 14 (10.4%) females who reported at least one lifetime episode of accidental anal intercourse. Amongst those with a history of accidental anal intercourse, 79% reported that they were sexually experienced at the time and 83% reported that their partners were sexually experienced. Personal intoxication by alcohol or drugs at the time of accidental anal intercourse was reported by 43%, with 41% reporting that their partners were intoxicated.     

Waiting for radiation therapy: does it matter?

The aim of this study was to determine the direct and indirect effects of prolonged waiting times for radiation therapy. We used the Medline, CancerNet and EMBASE databases to search the international research using the keywords radiotherapy, waiting times and delay. The negative effects of prolonged waiting times for radiation therapy can be broken down into direct and indirect effects. Direct effects include tumour control factors and patient factors. Indirect effects include changes in referral patterns and change in management of tumours. The precise effects of prolonged waiting times for radiation therapy are difficult to define. Evidence exists for some tumour sites, such as postoperative head and neck, small-cell lung cancer and high-grade cerebral gliomas, that tumour control might be adversely affected. The effect on other tumour sites is less established. Patient factors are likely to be consistent across all tumour types and indirect effects are hard to quantify.     

Prognostic implications of visceral obesity on gastric adenocarcinoma: does it really matter?

PurposeTo evaluate the association of visceral adiposity measured on computed tomography (CT) in preoperative period with lymph node (LN) metastasis and overall survival in gastric adenocarcinoma patients.MethodsPreoperative CT scans of 246 gastric adenocarcinoma patients who did not receive neoadjuvant chemoradiotherapy were evaluated. Visceral fat area (VFA), subcutaneous fat area (SFA) and Total fat area (TFA), VFA/TFA ratio were quantified by CT. VFA/TFA > 29% was defined as visceral obesity. The differentiation, t-stage, n-stage and the number of harvested-metastatic LNs were noted. The maximum thickness of tumor and localization were recorded from CT. Chi-square, Student's t-test, multiple Cox regression, Spearman's correlation coefficient, and Kaplan-Meier algorithm were performed.ResultsThe overall survival (OS) rates and N-stage were not different significantly between viscerally obese and non-obese group (p = 0.994, p = 0.325). The number of metastatic LNs were weakly inversely correlated with VFA (r = −0.144, p = 0.024). Univariate analysis revealed no significant association between visceral obesity and OS or LN metastasis (p = 0.377, p = 0.736). In multivariate analyses, OS was significantly associated with poorly differentiation (HR = 1.72, 95% CI =1.04–2.84, p = 0.035), higher pathologic T and N stage (T4 vs T1 + T2 HR = 2.67, 95% CI =1.18–6.04, p = 0.019; T3 vs T1 + T2 HR = 1.98, 95% CI = 0.90–4.33, p = 0.089; N3b vs N0 HR = 2.97, 95% CI1.45–6.0, p = 0.003; N3 (3a+ 3b) vs N0 HR = 2.24 95% CI =1.15–4.36, p = 0.018).ConclusionVisceral obesity may not be a prognostic factor in resectable gastric adenocarcinoma patients.     

Sonoelastographic strain ratio: how does the position of reference fat influence it?

Purpose

The purpose of this study was to evaluate how the reference fat position influenced the calculation of the sonoelastographic strain ratio.

Methods

Three hundred fifty-eight breast masses (256 benign lesions and 102 malignant lesions) in 300 women (mean age 47.4 years; age range 17–82 years) who had been scheduled for a percutaneous needle biopsy or surgical excision were examined using B-mode ultrasonography and elastography. The sonoelastographic strain ratio was calculated twice per lesion; once by dividing the strain value of the fat near the mass by that of the mass (FLR 1) and once by dividing the strain value of the subcutaneous fat by that of the mass (FLR 2).

Results

Most (91.9 %) showed a difference of less than 0.5 between FLR 1 and FLR 2 values. Regardless of the position of reference fat, there was no statistically significant difference between the FLR 1 and FLR 2 values (p value = 0.077 and 0.0825, respectively). According to the pathology of the lesion, a difference between FLR 1 and FLR 2 less than 0.5 occurred in 95.3 % of the benign lesions and 84 % of the malignant lesions (p < 0.001).

Conclusions

The sonoelastographic strain ratio was not significantly affected by the position of reference fat.