Computed tomography and magnetic resonance imaging evaluation of patellofemoral instability

Malalignment and tracking abnormalities of the patellofemoral joint are common causes of anterior knee pain,which are often difficult to evaluate clinically. Conventional radiography, as well as the cross-sectional imaging modalities of computed tomography (CT) and magnetic resonance imaging (MRI) are useful tools for both detecting and quantifying these abnormalities. Acute transient dislocation of the patella, on the other hand, is a relatively uncommon injury accounting for only 2% to 3% of all acute injuries of the knee, and can also be a difficult diagnosis to establish on the basis of history and physical findings alone. MRI is a sensitive, noninvasive method for detecting prior acute transient dislocation of the patella. This article begins by describing the role of CT and MRI as it pertains to the detection of abnormal patellofemoral tracking. Both static and dynamic techniques are described along with the standard criteria used to establish and quantify patellofemoral malalignment abnormalities. Next, the constellation of MRI findings most commonly encountered after acute transient dislocation of the patella are described. These findings include a typical bone bruise pattern involving the anterolateral aspect of the lateral femoral condyle and inferomedial patella, hemarthrosis, and injury to the medial soft-tissue restraints (especially the medial patellofemoral ligament). After transient dislocation of the patella, patients with significant osteochondral injury or disruption of the medial soft-tissue restraints may benefit from surgical repair. The role of MRI in preoperative planning is discussed as it relates to the detection of osteochondral injuries as well as injury to the medial soft-tissue restraints.     

Health Hazards of Selected Rocket Propellants

The study was primarily concerned with the risk of lung cancer in certain occupations. One occupation, asbestos workers, was found to have a definite increased risk of lung cancer, and the risk increased with length of time in the occupation. No other occupation was found to have increased lung cancer hazard. Other causes of mortality were not found related to these occupations except for two groups that had excess mortality from both cancers of the mouth, pharynx, and larynx and from cirrhosis of the liver. These diseases are associated with alcohol consumption, and this is the most likely explanation. The problems involved in the case control and prospective study sequence are discussed. Also the possible masking effect of such a powerful etiologic factor as cigarette smoking is discussed.     

Frey's Syndrome

ABSTRACT: Frey's syndrome is a form of gustatory hyperhidrosis that develops following surgery, trauma, or disease of the parotid gland area. Several theories have been proposed to explain the resulting symptomatology. Treatment often is difficult or ineffective. An unusual case is presented involving a patient with delayed onset of symptoms who responded well to topical application of 20% aluminum chloride in an-hydrous ethyl alcohol.     

The caudal septum angle of deflection: an objective analysis for caudal septum deviation

ObjectivesThe purposes of the study were to describe an objective technique for the evaluation of caudal septum deviation (CSD) and to evaluate the effectiveness of an open septorhinoplasty technique for treatment of CSD.

Study design

A retrospective review of septorhinoplasty cases involving CSD was performed. For all patients, preoperative basal view photographs were analyzed. All patients underwent an external septorhinoplasty approach for treatment of their CSD. After a minimum of 4 months, postoperative basal view photographs were analyzed.

Results

Seventeen patients had significant CSD and airway obstruction. The mean change in their caudal septum angle of deflection was 22° (P < .05). All patients had subjective improvement in their nasal airway obstruction. There were no complications.

Conclusion

We describe a method to objectively analyze CSDs in septorhinoplasty candidates. An external approach using nasal base reconstruction techniques results in an improvement of CSD and subsequent nasal airway patency.     

Infectious Complications in Irradiated Breasts Following Conservative Breast Therapy

Abstract: Delayed infectious complications are reported to occur following radiation therapy in women who have undergone conservative breast therapy. Herein, we have reviewed the clinical history of women undergoing conservative therapy in our institution. Of 46 patients treated over a span of 2 years, 13% developed a delayed infectious complication in their irradiated breast ranging from cellulitis to abscess. Onset occurred weeks to months following the completion of radiotherapy. Women experiencing these infections typically had undergone excision of a large volume of breast tissue and had received a radiation boost as part of the radiotherapy technique. Treatment entailed aggressive antibiotic therapy plus drainage of any abscess. All cases resolved; one patient experienced multiple episodes. Resulting cosmetic appearance was often less than ideal. Awareness of this potential problem is important when discussing treatment options with women newly diagnosed with breast cancer, especially those with larger lesions.     

Hypertrophic subaortic stenosis: Clinical and hemodynamic effects of long-term propranolol therapy

Thirteen patients with hypertrophic subaortic stenosis underwent right and transatrial septal left heart catheterization. Outflow obstruction was measured in the resting state and during a variety of stimulating maneuvers before and after the intravenous administration of 150 μg/kg of propranolol. The patients were then treated with orally administered propranolol and followed up for an average period of 17 months. Nine patients were available for a second catheterization, during which detailed hemodynamic measurements were repeated. Most patients had an initially favorable response to propranolol. However, 3 with an initially good response had a return of symptoms during the period of study. The initial clinical response appeared to correlate with the reduction of outflow obstruction seen after intravenous administration of propranolol. The long-term clinical course correlated with the hemodynamic findings at the second catheterization. The severity or lability of the outflow obstruction during the initial catheterization did not appear to have predictive value for the patient's response to long-term therapy. Propranolol had a favorable effect on the symptomatic state of the patients, but did not appear to change the course of the underlying disease.     

Transsexuals in the military: Flight into hypermasculinity

A sample of 11 male gender-dysphoric patients meeting DSM-III criteria for transsexualism was seen over a 3-year period by a military psychiatrist. Eight patients had extensive military experience, including combat duty in some cases. At the time of evaluation three were on active duty, one was a Department of Defense employee, and four were veterans. Evidence is presented for a hypermasculine phase of development that coincides with the age of enlistment in nearly all cases. The psychodynamic underpinnings of the choice to enlist in transsexual males are discussed. Outcome of military service was premature discharge in over 60%. The military's management of genderdysphoric servicemen is described. Current military policies, in association with the proposed hypermasculine phase of transsexual development, may actually result in a higher prevalence of transsexualism in the military than in the civilian population.The views expressed herein are those of the author and do not necessarily reflect those of the Department of Defense or the United States Air Force.