‘Cranking up’, ‘whacking up’ and ‘bumping up’: X-ray exposures in contemporary radiographic practice

This article explores the use of X-ray exposures following the introduction of direct digital radiography (DDR). Radiographers are central to delivering optimum levels of ionising radiation whilst maintaining sound image quality for radiological interpretation. Yet do radiographers utilise X-ray exposures appropriately? An ethnographic methodology provides insight of two general radiographic environments in the United Kingdom (UK) using participant observation and semi-structure interviews. A central theme uncovered as part of a Doctorate of Philosophy (PhD) study was the lack of autonomy concerning X-ray exposures within the general imaging environment. The findings highlight ‘how radiographers behave’. For example, some radiographers do not alter ‘pre-set’ X-ray exposures, arguably failing to produce images of optimum diagnostic quality. Secondly, radiographers acknowledge ‘whacking up’, ‘cranking up’ and ‘bumping up’ X-ray exposures ensuring image production. In conclusion this article provides an original insight into the attitudes and behaviours of radiographers regarding X-ray exposures in contemporary practices using DDR. Dose and image optimisation are central tenets of radiographic practice that may be hindered in contemporary practices.     

Wrestling With ‘Making Weight’

Certifying growing young athletes to wrestle at below-normal weights may stunt their growth, lower their grades, and impede their social development. They probably won't wrestle well, either.     

Examining a ‘Red Eye’

Primary care physicians often see disorders of the eye that are broadly termed a ‘red eye.’ Fortunately, most causes of a red eye are non-vision-threatening, and once the vision-threatening causes have been ruled out, the condition can usually be successfully treated in the primary care setting. A thorough medical and ocular history and ophthalmic examination will help physicians accurately diagnose such conditions as blepharitis, dacryocystitis, and conjunctivitis. Establishing the etiology will then direct effective treatment.     

On ‘the biology of war’

The Biology of War is an ardent anti‐war treatise as well as a scientific work, written in Germany in 1915 by the then famous Berlin cardiologist Georg F. Nicolai. In the book, which he wrote in prison, Nicolai opposes the social Darwinist apology for war of the time, and discusses the biological basis of bellicosity wherein he stresses the central role of a ‘tribal instinct*. This view is here considered in relation to modern sociobiology. Fighting, almost alone, against the authorities and a public opinion which—folly of the day—glorified war as a ‘struggle for existence’, Nicolai stands as an example for medical peace activities of today—the folly of our time being the threat of nuclear omnicide.     

How to Recognize ‘Athlete's Heart’

Chronic endurance exercise inbrief duces various cardiac adapta- JHHHM tions, including an enlarged left ventricular cavity and an appropriate increase in wall thickness (eccentric hypertrophy), greater ability to increase stroke volume during exercise, and bradycardia at rest. Strength athletes have thicker left ventricular walls with no increase in cavity size (concentric hypertrophy). In the past, chest x-rays and ECG have suggested some of these changes, however, echocardiograms have clearly established the syndrome of the athlete's heart. In addition, these adaptations seldom exceed the range of normal variation seen in the general population. Understanding these alterations helps distinguish healthy adaptations to exercise from signs of disease.     

‘Hot’ and ‘cold’ lesions detected by gallium-67 scintigraphy in a pyogenic liver abscess

Most pyogenic liver abscesses appear to be not in a ⁶⁷Ga-citrate study; rarely, a warm or cold area may also be seen. We present a patient with a pyogenic liver abscess that had both cold and hot areas in the ⁶⁷Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.     

PREFACE TO THE MONOGRAPH‘NAUTICAL MEDICINE’

Worldwidethereareonlyafewcomprehensivebooksonnauticalmedicineandadjacentfields.Thepublicationofthismonographsignifies,hownauticalmedicinehasestablisheditselfinacountryaslargeasChina.Theinau-gurationoftheChineseNauticalMedicalAssociationanditssuccessfulactivitiesduringrecentyearsalreadydemonstratehowimportantnauticalmedicinehascometobeconsideredinChina.Inordertoputintopracticere-searchanddevelopmentinthisfielditisindispensabletopresenttheresultsachievedinanadequateformtointer-estedmedicaldoct…     

Baseball-Funded ‘Andro’ Study Shows Testosterone Increase

Abstract

Objective: Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. Methods: Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ? 10 participants, with trial data that were published within the last 5 years. Results: Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. Conclusion: A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.     

‘Athlete,Heal Thyself,’ Says Physician

Letters to the Editor gives readers a chance to comment on articles we publish and on other issues important to sports medicine practitioners. Illustrative figures are welcome. Send letters to Editor, the physician and sportsmedicine, 4530 W 77th St, Minneapolis, MN 55435; e-mail to psmletters@mcgraw-hill.com.     

ESR-aided evaluation of lyoluminescence processes in ‘Tris’

ESR spectral analysis of γ-ray irradiated lyoluminescence (LL) phosphor powder, Tris (hydroxymethyl) aminomethane—referred to as ‘Tris’ showed the presence of two free radical species. It was observed that at higher exposure levels radical II with a singlet spectrum shows a higher growth compared to radical I with a three component spectrum. Radical I had been identified as RĊHOH. The ESR-LL correlation studies indicate that the RĊHOH radical formed in a low dose range is responsible for LL emission and the radical II either inhibits or does not have any role in the LL process. The LL yield of Tris measured under deoxygenated conditions showed a 40% reduction in the yield in luminol solution and 87% in distilled water. The range of linearity of the γ-ray response extends further from 200 to 2000 Gy when the LL is measured under oxygen equilibrated condition.Based on the results observed, two models for the mechanism of LL in Tris have been proposed. The first LL model of Tris envisages the production of a dinegative luminol molecule and a restored Tris molecule when the LL enhancer luminol is used as the solvent. This is based on the hydrogen abstraction reaction of the RĊHOH radical. The luminol dianion reacts with O₂ to produce the excited singlet state of the aminophthalate ion which gives the LL emission. The second model proposes that the oxidation of RĊHOH radicals will yield organic peroxy radicals which in turn produces hydroperoxy (HO₂) radical and a superoxide anion. The HO₂ disproportionates, or reacts with the superoxide anion to give a singlet oxygen. The LL process in distilled water is probably due to the liberation of these singlet oxygen molecular pairs which are chemiluminescnt. H₂O₂ which is also produced on the disproportionation of HO₂, or one of the interconversion products OH, can also oxidize the luminol molecule to give the emission. The LL saturation, and subsequent reduction at the increasing free radical concentration, are also discussed.     

‘Rib betrays heart’—A case report

Penetrating or stab injuries of the chest are not uncommon and could be accidental, suicidal or homicidal. However, the present case discusses the importance of a careful examination of an unusual presentation in a motor vehicle accident. The case presented with haemopericardium and haemothorax due to penetrating rib injury to the heart, subsequent to blunt force trauma on the posterior chest wall. This case is highlighted, so that it becomes a necessary tool for the forensic experts to have an unprejudiced approach at autopsy and come to a reasonable conclusion.     

The phenomenon of ‘tired moly-99Mo’

The phenomenon of tired moly-⁹⁹Mo results in poor yields of ^99mTcO ₄ ^- obtained from ⁹⁹MoO ₄ ^2- . The solvated electron has been conceived to explain this phenomenon, especially when it occurs in highly alkaline media as obtained in the solvent extraction type of separation system.