Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic

Thirty-three patients attending the Nottingham Sports Injury Clinic in whom a clinical diagnosis of a stress fracture of the pars interarticularis was made were evaluated with both radiography and bone scintigraphy. This was done in an effort to distinguish a recent stress fracture which would produce a positive scintigram from an established 'incidental' spondylolysis giving a normal scintigram. Nine patients demonstrated abnormal radiography with a normal scintigram. A further nine patients had a positive scintigram. Six were associated with a spondylolysis indicating a recent stress fracture but two had normal radiography suggesting a stress fracture in the 'sub-radiological' phase. One patient had increased uptake in relation to degenerative changes of the lower lumbar facet joints. Oblique views of the scintigram helped in localisation of the abnormal uptake to the pars interarticularis.     

Motivational and social cognitive predictors of doping intentions in elite sports: An integrated approach

Doping use is an important issue in both competitive and non‐competitive sports, and poses potentially irreversible health consequences to users. Scholars increasingly call for theory‐driven studies on the psychosocial processes underlying doping use that will inform subsequent policy‐making and prevention interventions. The aim of the study was to implement an integrative theoretical model to assess the direct and indirect effects of motivational variables, moral orientations, and social cognitions on doping intentions. A randomly selected and representative sample of 750 elite athletes anonymously completed a battery of questionnaires on motivational and moral constructs, and social cognitions related to doping. Hierarchical linear regression analysis and multiple mediation modeling were used. The effects of achievement goals and moral orientations were significantly mediated by attitudinal, normative, and self‐efficacy beliefs, in both lifetime ever and never doping users. Moral orientations indirectly predicted the doping intentions of never users, but did not predict ever users' doping intentions. Achievement goals and sportspersonship orientations influence doping intentions indirectly, through the effects of attitudes and self‐efficacy beliefs. Sportspersonship (moral) orientations were relevant to doping intentions among athletes with no prior experiences with doping, while achievement goals and situational temptation were relevant to both lifetime never and ever dopers.     

Intra-arterial digital angiography using a trans-humeral approach in the assessment of ambulatory patients

The authors report their experience with intraarterial digital subtraction angiography (DSA) performed on outpatients via brachial artery catheterization. A total of 120 outpatients were studied for cerebral and lower limbs vascular diseases. Transbrachial catheterization was performed with 5F or, preferably, with 4F angiographic catheters. Success rate was high and the transbrachial approach was always easy. In the course of cerebral examination (18/120 cases) the catheter was always easily positioned in the ascending thoracic aorta, through right transbrachial approach. In the course of abdominal aorta and lower extremities examination (102/120 cases), the ideal catheter positioning--in the descending aorta--was performed in 95/102 cases, by left transbrachial approach, while in 7/102 patients the catheter was placed in the ascending aorta. The complication rate was low: 7/120 ecchymosis, 4/120 small hematomas spontaneously resorbed, and 2/120 transient spasms of brachial artery. The authors suggest trasbrachial intraarterial DSA as an alternative to intravenous DSA in outpatients.     

Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach

A retrospective review of 11 patients seen at the University of British Columbia Sports Medicine Clinic with osteochondral lesions of the talus was undertaken. From our data, a number of points became apparent. There was a predominance of posteromedial talar dome lesions. A flexion-inversion ankle injury could be documented in the majority of cases. There was frequently a long delay in diagnosing these ankle sprain mimics. Historical details which should raise one's index of suspicion include: (1) history of flexion-inversion injury; (2) exercise-related ankle pain; (3) sensations of "clicking and catching"; and (4) persistent swelling. Surgery produced consistently good early results in these active patients without osteotomizing the medial malleolus. Experimental analysis and clinical experience suggest that the optimal radiographic technique for identifying the posteromedial osteochondral lesion consists of an anteroposterior view of the ankle in maximum plantar flexion with the kilovoltage set at 70.     

A systems approach to forensic science applied in the military domain

Forensic science is undertaken in support of law enforcement investigations, criminal justice prosecutions, intelligence, and military objectives. There are different forensic operating models to meet these various objectives and no unified approach to forensic science has been described. There are common challenges in the military domain, which impacts the delivery of forensic science, including: different terminology between organizations, complex operating environments, operating siloes, inward-looking military structures, quality management, and resource constraints. One solution to these challenges is to apply modern organizational theory to military-focused forensic science. Organizational theory is the study of organizations in a structural sense, including objectives, people, structure and management. The modern organizational theory systems approach describes how organizations should be viewed as systems within larger systems. In the work presented in this paper, a systems approach has been applied, for the first time, to military forensic exploitation to address the common issues faced by military organizations. The advantages of applying a systems approach to military forensic exploitation are that it is applicable across forensic science organizations, it is flexible and scalable to meet the changing external environment, and it articulates the redundancies in the system to help address system failures.     

Balance and mobility assessment for ruling-out the peripheral neuropathy of the lower limbs in older adults

The peripheral neuropathy of the lower limbs (PNLL) is an important cause of balance and mobility impairment in older adults. The nerve conduction study (NCS) is the gold standard for PNLL diagnosis. Aim of this work is to establish the sensitivity (Sn) and the specificity (Sp) of the balance and mobility examination for the PNLL in older adults.This study consecutively recruited 72 participants (>65 years) who accessed to the clinical neurophysiology outpatient clinic for suspected PNLL. Participants were given the NCS and four clinical tests. Mobility was evaluated by the Timed Up and Go (TUG) test, the Performance Oriented Mobility Assessment (POMA) and the de Morton Mobility Index (DEMMI). In addition the Clinical Evaluation of Static Upright Stance (CELSIUS) scale was developed for a selective evaluation of static balance.Based on the NCS, 36% of participants had PNLL. The CELSIUS scale (cutoff: 19.5/24), the TUG test (cutoff: 9.6 s) and the DEMMI scale (cutoff: 17.5/19) have high Sn (0.92 ÷ 0.96), but low Sp (0.28 ÷ 0.43) for the PNLL in the older adult. POMA scale (cutoff: 14.5/16) has low Sn (0.73), but acceptable Sp (0.85). In addition, CELSIUS, DEMMI and TUG negative likelihood ratios are 0.13, 0.17 and 0.12, respectively.Balance and mobility examination have high sensitivity for PNLL. CELSIUS score > 19/24, DEMMI score > 17/19 or TUG time ≤ 9.6 s substantially reduce PNLL likelihood. These clinical measures are thus recommended for ruling-out PNLL in the older adult.     

Reliability and validity of a return to sports testing battery for the shoulder

ObjectiveTo determine the validity, intra- and inter-rater, and absolute reliability of a return to sport testing battery for the shoulder in a healthy cohort.DesignCross-sectional design. All participants completed a battery of strength (isokinetic, isometric, and repetition to failure) and functional assessments on two occasions. Concurrent validity to isokinetic testing was assessed, and intra-rater, inter-rater, and absolute reliability were established for all assessments.SettingControlled clinical environment.ParticipantsThirty healthy adults active in recreational sports participated, mean age 24.0 ± 1.6 years;Main outcome measuresCorrelations (Pearson’s r), reliability (Intraclass Correlation Coefficient), Standard error of the measurement, Minimal detectable change.ResultsCorrelations to isokinetic assessments at 60° & 180°/second were moderate to strong for isometric (r: 0.68–0.80) and functional testing (r: 0.55–0.83) and weak for repetition to failure testing (r: 0.37–0.74). All isokinetic (ICC: 0.88–0.94), isometric (ICC: 0.83–0.94), and functional assessments (ICC: 0.80–0.92) had good to excellent intra-rater reliability, while repetition to failure testing had poor to moderate reliability (ICC: 0.48–0.57). The inter-rater reliability of the isometric assessments was moderate to excellent (ICC: 0.71–0.92) across movements. Expressed as a percentage of the mean, the standard error of the measurement ranged from 7% to 25% and the minimal detectable change ranged from 20% to 69% across all assessment methods.ConclusionThe isokinetic, isometric, and functional assessments used in this return to sports testing battery demonstrates acceptable validity and reliability. Further refinement to the methods used to assess muscular endurance is needed to improve reliability. This study offers clinicians information that can be utilized in clinical decision-making as it relates the testing battery’s psychometric properties.     

经膜髓帆入路四脑室病变切除术的临床研究

目的探讨经膜髓帆入路切除第四脑室病变的手术方法及优点。方法17例第四脑室及周围占位病变,男7例,女10例,年龄5～49岁,平均26．6岁。其中髓母细胞瘤5例,室管膜瘤5例,表皮样囊肿2例,脑囊虫病2例,脉络丛乳头状瘤3例。手术采用小脑延髓裂膜髓帆入路,显微镜下分离两侧小脑延髓裂,游离小脑扁桃体,根据病变大小切开脉络膜和下髓帆,显露四脑室,将病变切除,严密缝合硬膜,骨瓣复位。结果17例病变均全切除,术后早期恢复良好,无重残及死亡。11例术后随访3～21个月,无重残及死亡,其中8例行CT或MRI检查,无复发。结论经小脑延髓裂膜髓帆入路切除四脑室肿瘤不需切开小脑蚓部,且可扩大四脑室的显露,减少术后并发症的发生。     

核心脏病学在心力衰竭中的临床应用

核心脏病学的显像技术是一种常用的无创的诊断心力衰竭的重要手段,在评估心力衰竭程度和指导心力衰竭治疗方面发挥了重要作用。定量门控SPECT心肌灌注显像借助其定量分析软件,可以定量评价心脏容积、左心室射血分数、每搏输出量、心脏舒张功能。静息和（或）负荷心肌灌注显像不仅能鉴别非缺血性心力衰竭和缺血性心力衰竭,而且能判别心肌是否存在活性。核心脏病显像技术能轻易地鉴别出舒张性心力衰竭（也称为射血分数正常的心力衰竭）,它通过高峰充盈率和高峰充盈率时间可以准确地评估舒张性心力衰竭的程度。借助三维成像等新技术定量门控SPECT能有效评估左室运动情况,评估室壁厚度对其是一个很好的补充。心肌灌注显像还常用于判别患者是否适合植入心脏除颤器及是否适合进行心脏再同步化治疗。123I-间碘苄胍神经递质显像能为心力衰竭患者提供预后信息。心肌代谢活动与其功能密切相关,能量代谢底物是评价药物治疗是否有助于提高心力衰竭患者心功能的一个指标,123I-15-(p-碘苯基)3-R,S-甲基十五烷酸是一种临床研究中常用的心肌代谢显像示踪剂。借助新示踪剂的应用,包括神经递质显像和心肌代谢显像在内的核心脏病学显像技术常用来完善心力衰竭的诊断。核心脏病学显像技术在诊断心力衰竭及指导临床治疗方面做出了巨大贡献。     

Quantitation of myocardial iodine-123 MIBG uptake in SPET studies: a new approach using the left ventricular cavity and a blood sample as a reference

In patients with chronic heart failure increased sympathetic activity is related to unfavourable prognosis. Since myocardial iodine-123 metaiodobenzylguanidine ([¹²³I]MIBG) uptake is related to myocardial noradrenaline content, i.e. cardiac sympathetic activity, measurement of myocardial [¹²³I]MIBG uptake may be of clinical use in determining prognosis or the effect of pharmacological intervention in these patients. The aim of the present study was to evaluate a new method to quantitate myocardial [¹²³I]MIBG uptake with respect to reproducibility and accuracy. Eighteen [¹²³I]MIBG planar and single-photon emission tomography (SPET) studies of patients with chronic heart failure were evaluated. Myocardial uptake was calculated from the myocardial (MYO) to left ventricular cavity (C) count density ratio and the¹²³I activity in a blood sample. This was performed employing planar LAO images, a single-slice SPET method using the midventricular myocardial short-axis slice, and finally a multi-slice SPET method analysing semi-automatically drawn volumes of interest (VOIs). The accuracy of the multi-slice SPET method was verified using a cardiac phantom. The planar method was found to be reproducible [intra- and interobserver coefficients of variation (IACV and IRCV) were 0.025 and 0.012 respectively] but the mean MYO/C count density ratio was only 1.31±0.16 as a consequence of overprojection. For the single-slice SPET method IACV was 0.2 and IRCV was 0.13, representing poor reproducibility. For the multi-slice SPET method IACV was 0.051, IRCV was 0.047 and the mean MYO/C count density ratio was 5.4±2.42. Accuracy was 81% at a true MYO/C count density ratio of 6 in the phantom. It is concluded that the multi-slice SPET method using the left ventricular cavity VOI and a blood sample as a reference is a reproducible and accurate method for assessing myocardial [¹²³I]MIBG uptake.     

A proposed modification of the Wada test for presurgical assessment in temporal lobe epilepsy

We report experience with a modification of the Wada test used before temporal lobe resection in patients with drug-resistant epilepsy. Our procedure consists of injection of amytal via a microcatheter into the anterior choroidal artery or the P2 segment of the posterior cerebral artery and simultaneous presentation of verbal and figural memory test material before, during and after the injection. Pros and cons of the modification and inherent shortcomings of the amytal test are discussed on the basis of the results in ten patients.     

Ultrasound treatment of nonunion of the hook of the hamate in sports activities

Two cases of nonunion of the hook of the hamate were treated with low-intensity pulsed ultrasound. The patients were baseball players and had been injured as a result of hitting repeatedly. Nonunion was detected on computed tomography (CT) and was exposed to ultrasound for 20 min a day for 4 months. In both cases pain at the hypothenar eminence disappeared, and bone union was confirmed on CT at the end of the ultrasound treatment.     

Dental age assessment (DAA): a study of a Caucasian population at the 13 year threshold

The purpose of this study was to develop a Reference Data Set for Dental Age Assessment at the 13 year old threshold in Caucasian children.

Patients, Materials and Methods

The Reference Data Set comprised 5187 re-used Dental Panoramic Tomographs (DPTs) between the ages of 11-15 years, from both the Eastman Dental Hospital and King’s College Dental Hospital archives. Tooth Development Stages were recorded for the left maxillary and mandibular teeth and all four permanent third molars (Demirjian et al., 1973, Demirjian 1978). A separate Study Sample of DPTs, comprising 50 males and 50 females aged between 10 and 16 years was collected to test the accuracy of the method. Summary Data was generated for the individual Tooth Development Stages which consisted of the number (n-tds), mean (x), standard deviation (sd) and the standard error (se). By using the mathematical techniques of meta-analysis, this data was used to estimate the age of each subject in the Study Sample. The estimated Dental Age derived was compared to the gold standard of Chronological Age.

Results

The mean difference between the Chronological Age and Dental Age was determined to be −0.1 years (−1.2 months) for males and 0.05 years (−0.6 months) for females.

Conclusion

Dental Age was reliably estimated at the 13 year threshold.     

Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy

Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1–17.8 years (9.8±4.3 years; mean±SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential epileptogenic zone but does not provide additional benefit beyond SPET in presurgical assessment of children with intractable epilepsy. The impact of different pathologies on the efficacy of SPM warrants further study.     

Magnetic resonance imaging in the assessment of urologic disease: an all-in-one approach

The aim of this study was to evaluate an “all-in-one” MR procedure to examine the kidneys, the renal vascular supply and renal perfusion, and the urinary tract. In 64 patients (58 with urologic disease and 6 healthy volunteers), MR was performed including: (a) T1- and T2-weighted imaging; (b) 3D contrast-enhanced MR angiography (MRA), including the renal arteries, renal veins, as well as renal perfusion; and (c) 3D contrast-enhanced MR urography (MRU) in the coronal and sagittal plane. For the latter, low- and high-resolution images were compared. Prior to gadolinium injection, 0.1 mg/kg body weight of furosemide was administered intravenously. The results were compared with correlative imaging modalities (ultrasonography, intravenous urography, CT), ureterorenoscopy and/or surgical–pathologic findings. Visualization of the renal parenchyma, the vascular supply, and the collecting system was adequate in all cases, both in nondilated and in dilated systems and irrespective of the renal function. One infiltrating urothelial cancer was missed; there was one false-positive urothelial malignancy. Different MR techniques can be combined to establish an all-in-one imaging modality in the assessment of diseases which affect the kidneys and urinary tracts. Continuous refinement of the applied MR techniques and further improvements in spatial resolution is needed to expand the actual imaging possibilities and to create new tracts and challenges in the MR evaluation of urologic disease. Received: 27 September 1999; Revised: 20 January 2000; Accepted: 22 May 2000     

Sonographic assessment of a suspected biloma:A case report and review of the literature

A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.     

Validity of the assessment method of skeletal maturation by cervical vertebrae: a systematic review and meta-analysis

Objectives:

To perform a systematic review with meta-analysis to answer the question: is the cervical vertebrae maturation index (CVMI) effective to replace hand–wrist radiograph (gold standard) in determining the pubertal growth spurt in patients undergoing bone growth?

Methods:

A search in three databases was performed, in which studies were selected that compared one of the two main assessment methods for cervical vertebrae (Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995; 107: 58–66, or Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002; 72: 316–23) to a carpal assessment method. The main methodological data from each of the texts were collected and tabulated after. Later, the meta-analysis of the correlation coefficients obtained was performed.

Results:

19 articles were selected from an initial 206 articles collected. Regardless of the method used, the results of the meta-analysis showed that every article selected presented a positive correlation between skeletal maturation assessment performed by cervical vertebrae and carpal methods, with discrepancy of values between genders indicating higher correlation for the female gender (0.925; 0.878) than for the male (0.879; 0.842). When the assessment was performed without gender separation, correlation was significant (0.592; 0.688) but lower in the cases when genders were separated.

Conclusions:

With the results of this meta-analysis, it is safe to affirm that both CVMIs used in the present study are reliable to replace the hand–wrist radiograph in predicting the pubertal growth spurt, considering that the highest values were found in female samples, especially in the method by Hassel and Farman.     

The validity of the sphygmomanometer for shoulder strength assessment in amateur rugby union players

ObjectivesTo determine the concurrent validity of a sphygmomanometer for assessing shoulder strength in the I, Y and T positions during the athletic shoulder test (ASH test). Force platforms were used as the gold standard measurement tool for this purpose.DesignShoulder strength was assessed using force platforms and a sphygmomanometer, both placed on the floor and the participant positioned prone. One rater assessed strength, taking three measurements in each of the I, Y and T positions, using the sphygmomanometer and force platforms. Concurrent validity was calculated using the force platforms as the gold standard device.SettingData was collected within the treatment room of an amateur rugby club.ParticipantsTwenty male amateur rugby players (25.15 years old ± 3.27 years) were recruited for this study.Main outcome measuresPeak force across the shoulder girdle was assessed using the force platforms and sphygmomanometer which provided values in Newtons (N) and millimetres of mercury (mmHg) respectively.ResultsResults showed high concurrent validity (Pearsons r = 0.76–0.81) between the sphygmomanometer and the force platform. Coefficient of determination (r² = 0.59–0.67) showed the sphygmomanometer to have a valid predictive model in the I, Y and T positions.ConclusionsThe sphygmomanometer is suitable for monitoring force transfer across the shoulder during the ASH test, and is able to quantify peak force in mmHg. The sphygmomanometer enables coaches and clinicians to accurately quantify force production across the shoulder girdle in order to screen and monitor players at a low cost.     

Quality assessment of out sourced after-hours computed tomography teleradiology reports in a Central London University Hospital

The study was designed to assess the quality of out sourced after-hours computed tomography teleradiology service reports. We evaluated 1028 patients over a time period of five month in 2009/2010 (437 female, 591 male, mean age: 51 years, range: 0-97 years) who were referred either by the A&E or other in house departments from 7 pm to 8 am for different reasons. Reporting was done by a teleradiology service provider located in the UK and Australia. Reports were assessed during the routinely performed morning meeting by a panel of in house radiologists. Assessment was done by a five point agreement scale (5="No disagreement", 1="…unequivocal potential for serious morbidity or threat to life"). In 811 (79%) patients no disagreement was found, 164 (16%) were rated as category 4, 40 (4%) as category 3 ("…likelihood of harm is low"). In 13 (1.3%) patients a decision of category 2 was made ("…strong likelihood of moderate morbidity but not threat to life"). No category 1 decision was made. As this was just a discrepancy decision, a follow up of the category 2 patients was done over a period of a maximum of 6 months. In 8 (0.8%) patients the in house reports were correct, in 2 (0.2%) patients the teleradiology service provider was right and in 3 (0.3%) patients the final diagnoses remained unclear. In conclusion there was a small rate (0.8%) of proven serious misinterpretations by the teleradiology service provider, but these were less than in comparable studies with preliminary in house staff reports (1.6-24.6%).