Tetanus, pneumonia, and malaria in a tsunami victim in Banda Aceh, Indonesia

On December 26, 2004, a tsunami from the Indian Ocean struck the coastal city of Banda Aceh, Sumatra, Indonesia. This case report describes a 24-year-old woman who presented to the Dr. Zainoel Abidin Hospital in Banda Aceh on January 8, 2005, with a tsunami-related illness. The patient was initially treated for tetanus and aspiration pneumonia with a guarded prognosis. Her recovery was complicated by malaria and recurrent pneumonia. Treatment was hampered by a shortage of medication and equipment, damage to the hospital, and a filthy environment. Morphine, diazepam, and ketamine infusions were used to good effect. This case highlights some of the logistical problems of treating multiple tetanus patients in an austere environment.     

Rights, roles, and relationships in radiology

Traditionally, radiologists report their findings to the referring physician. When a patient who understands the reason for the diagnostic examination asks the radiologist to disclose the results, in most cases the radiologist should not decline but should answer truthfully.     

Food restriction, performance, biochemical, psychological, and endocrine changes in judo athletes

In order to test the hypothesis that dietary restriction may have a negative influence on physiological and psychological adaptation to a judo competition, we examined the effects of weight loss induced by restricting energy and fluid intake on the physiology, psychology, and physical performance of judo athletes. Twenty male judoka were randomly assigned to one of two groups (Group A: called diet, n = 10; height 174.8 +/- 1.9 cm, body weight 75.9 +/- 3.1 kg; they were asked to lose approximately 5 % of their body weight through self-determined means during the week before the competition; Group B: called control, n = 10; height 176.4 +/- 1.1 cm, body weight 73.3 +/- 6.3 kg maintained their body weight during the week before the competition). A battery of tests was performed during a baseline period (T1), on the morning of a simulated competition (T2) and 10 min after the end of the competition (T3). The test battery included assessment for body composition, performance tests, evaluation of mood, determination of metabolic and hormonal responses. Dietary data were collected using a 7-day diet record. The nutrient analysis indicated that all the athletes followed a low carbohydrate diet whatever the period of the investigation. For the Group A, the food restriction (- 4 MJ per day) resulted in significant decreases of the body weight and altered the mood by increasing Fatigue, Tension and decreasing Vigour. Dietary restriction had also a significant influence on metabolic and endocrine parameters and was associated with poor performance. After the competition, significant decreases of the levels in testosterone, T/C ratio, alkali reserve, and free fatty acid were observed in both groups, whereas the plasma concentrations in insulin, ammonia, urea, and uric acid were increased. In conclusion, our results suggest that the combination of energy restriction and intense exercise training, which causes weight reduction before a competition, adversely affects the physiology and psychology of judo athletes and impairs physical performance before the competition. Our data are the first to demonstrate that a competition including five 5-min bouts induced the same changes of physiological and psychological variables and performance whatever the dietary intake (dietary restriction or not) during the seven days before the competition.     

Gunshot suicides in Victoria, Australia, 1988

A study of the 96 gunshot suicides in Victoria, Australia, in 1988 is presented. Only three of the cases were women, all of whom had a psychiatric history. The suicides were commonly associated with physical or mental ill health, the break up of relationships or contact with police. There was often a history of alcohol related problems and 31% showed evidence of drinking before suicide. The suicides tended to occur without witnesses (90%), at home (73%), often in the bedroom (32%). Handguns were used much less commonly than in other countries, although the distribution of entry wounds was similar. The change of gun ownership laws which occurred in 1988 may be expected to alter the incidence of gunshot suicide in future years.     

Hyperthermic-related challenges in aquatics, athletics, football, tennis and triathlon

Although many elite sporting events occur in climate-controlled venues, some athletes train and compete in environments that can potentially pose a risk to the athlete's health. In particular, athletes in aquatics, track and field, tennis, football and triathlon can be exposed to extreme heat during competition or while training. The International Federations responsible for these sports are aware of these health risks and have implemented measures to help protect the health of their athletes. This review paper outlines the sport-specific environmental health risks and the safety standards implemented to safeguard athlete health.     

Age-related, regional, hemispheric, and medial-lateral differences in myelin integrity in vivo in the normal adult brain

BACKGROUND AND PURPOSE: Clinical validation of magnetization transfer (MT) imaging is important for investigating clinical disease and organization of normal brain function. We determined whether an in vivo quantitative measure sensitive to white matter is distributed in functionally important ways. METHODS: Axial 1.5-T MR images with and those without MT were obtained. MT ratios (MTRs) were computed for 33 regions of interest (ROIs) in 27 healthy adults (aged 18-69 years) without evidence of cognitive or radiographic abnormalities. Three tests of reliability yielded coefficients above 0.97. MTRs for the whole brain, groups of structures, and individual ROIs were calculated. Low standard errors confirmed the consistency of the technique. RESULTS: Age, education, sex, and hand dominance were not correlated with whole-brain MTR (mean = 37.35, SD = 1.25), but age was associated with the cerebellum and some lobes at a trend level. MTRs were as follows, in descending order: corpus callosum, cingulate, white matter, brain stem, subcortical nuclei, and cerebellum. MTRs were selectively higher in the prefrontal lobe versus the posterior frontal lobe and in the lateral temporal lobe versus medial temporal lobe. MTR was higher in the left hemisphere than in the right hemisphere for the whole brain, frontal and temporal lobes, and lenticular nuclei. CONCLUSION: MT imaging showed selective age, medial-lateral, and hemispheric differences, giving evidence of normal aging effects on the white matter in the absence of T2- weighted hyperintensities. These differences support neurocognitive theories of the organization of brain function. MT imaging appears to be a robust technique for use in cognitive neuroscience.     

Changes in blood platelet function, coagulation, and fibrinolytic activity in response to moderate, exhaustive, and prolonged exercise

In a group of 47 healthy men aged 25-55, the influence of moderate, exhaustive, and prolonged exercise on blood platelet function, coagulation, and fibrinolytic activity was evaluated. Static exertion of short duration and moderate intensity did not cause significant alterations in any of the indices analyzed. Prolonged exercise (60 min) performed on a bicycle ergometer in aerobic conditions led to strong activation of the fibrinolytic system [euglobulin lysis time (ELT) fell from 208 to 88 min] and a slight increase in platelet count (PC) but did not cause significant changes in platelet factor 4 (PF 4) and platelet aggregate ratio, recalcification (RT), and prothrombin time (PT). Repeated bouts of maximum exercise leading to considerable acidosis (pH = 7.22; BE = -13.3) caused a significant increase in blood platelet count and an increase in PF 4 release. These changes were accompanied by strong intensification in fibrinolytic activity (over 63% reduction of ELT and a marked increase of fibrin/fibrinogen degradation products). In some individuals, unfavorable hemostatic changes were observed following intensive exercise. It is concluded that more attention should be given in future to the problem of verification of preventive and rehabilitative training programs from the point of view of exercise-induced hemostatic changes.     

Curriculum in radiology for residents: what, why, how, when, and where

Developing a curriculum in chest radiology should follow the same general principles that are used when developing a curriculum in any subspecialty area of radiology. A curriculum is more than a "list of topics" with which a resident should be familiar after 4 years of training. It includes objectives and goals, content, faculty, methods, and evaluation. Numerous resources are available for those who are charged with developing a curriculum in chest radiology. In addition to faculty members in the department, whose input during development can ensure successful implementation of the curriculum, organizations (i.e., ACR, APDR, STR) already have begun to develop "model" curricula. Attending the annual meeting of the Association of American Medical Colleges is a way to meet and hear from professionals who develop and oversee curriculum development at their medical schools, and another important resource available at some medical schools is the Office of Medical Education. The faculty within such offices are uniquely qualified to assist with curriculum and faculty development, especially for those areas in which radiology faculty traditionally are less experienced, such as development of valid and reliable assessment forms and construction of behaviorally based objectives.     

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention

Epicondylar injuries in sports with overhead or repetitive arm actions are frequent and often severe. Acute injury that results in inflammation should be termed epicondylitis and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon. Epicondylalgia refers to elbow pain at either the medial or lateral epicondyl of the elbow related to tendinopathy of the common flexor or extensor tendon origins at these points. Pain is usually associated with gripping, resisted wrist extension and certain movements such as in tennis and golf, hence the common terms 'tennis elbow' (lateral epicondylsis) and 'golf elbow' (medial epicondylossi). A variety of assessment and diagnostic tools are available to aid the clinician in their comprehensive evaluation of the patient to ensure correct diagnosis and the appropriate conservative or surgical management strategy. Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. Medical practitioners should have a good understanding of the mechanisms of injury in order to help treat and prevent the re-occurrence of injuries. More emphasis by medical and sport science personnel working with coaches and athletes needs to be placed on prevention of elbow injury in sport through improved joint strength, biomechanically sound sport technique and use of appropriate sport equipment.     

Osteoarthritis in other joints (hip, elbow, foot, ankle, toes, wrist) after sports injuries

Osteoarthritis of nonknee joints, although less common than knee osteoarthritis, remains a significant and disabling condition for many present and former athletes. These injuries can be caused by repeated loads or following a specific traumatic event. The resulting pain and loss of motion can limit function and ability. Arthroscopic techniques in many cases enable surgeons to symptomatically treat limitations of range of motion and pain, prolonging active careers. Joint replacement remains the ultimate solution for hip osteoarthritis, and may be a viable option in ankle osteoarthritis.