Compartment syndromes. Early diagnosis and a bedside operation

Delays in diagnosis and treatment of compartment syndromes of the lower extremities result in significant morbidity and mortality. Knowledge of the anatomy of the lower leg compartments provides clues to earlier diagnosis as to the specific compartments involved in these syndromes. A simple physical examination is described that focuses on this. Furthermore, a simple "bedside" operation is described that provides excellent decompression of all of these compartments without fibulectomy.     

Dietary magnesium, not calcium, regulates renal thiazide receptor

This study reports for the first time a relationship between dietary Mg and the renal thiazide-sensitive Na-Cl cotransporter (TZR, measured by saturation binding with 3H-metolazone). Ion-selective electrodes measured plasma ionized magnesium (PMg++), calcium (PCa++), and potassium (PK+). Restricting dietary Mg for 1 wk decreased PMg++ 18%, TZR 25%, and renal excretion of magnesium (UMg) and calcium (UCa) more than 50% without changing PCa++, PK+, or plasma aldosterone. A low Mg diet for 1 d significantly decreased PMg++, TZR, UMg and UCa. Return of dietary Mg after 5 d of Mg restriction restored PMg++ and TZR toward normal. In the control, Mg-deficient, and Mg-repleting animals, TZR correlated with PMg++ (r = 0.86) and with UMg (r = 0.87) but not UCa (r = 0.09). Increasing oral intake of Mg for 1 wk increased PMg++ 14%, TZR 32%, UMg 74%, and UCa more than fourfold without changing PCa++ or PK+. In contrast, increasing dietary Ca content from 0.02% to 1.91% did not change TZR, but increased UCa fivefold without changing PCa++. Hormonal mediators (if any) involved in the relationship between dietary Mg and TZR remain to be elucidated, as does the relationship between TZR and tubular reabsorption of Mg.     

Effect of tendon orientation on MR imaging signal intensity: a manifestation of the "magic angle" phenomenon

To determine whether orientation in the static field may be responsible for the frequent occurrence of increased signal intensity within normal tendons at magnetic resonance (MR) imaging, seven healthy volunteers were imaged by means of a 1.5-T unit and standard clinical pulse sequences. The wrist, ankle, and shoulder regions were evaluated with local coils. Imaging was performed with tendon orientations ranging from 0 degree to 90 degrees in relation to the constant magnetic induction field (B0). Markedly increased intratendinous signal intensity was observed at the "magic angle" of 55 degrees, intermediate signal intensity was observed at 45 degrees and 65 degrees, and no signal intensity was observed at 0 degree and 90 degrees. Signal intensity was evident only when a short echo time was used. The authors believe that tendon orientation greatly affects tendon signal intensity in vivo. Increased signal intensity due to the magic angle effect may be misdiagnosed as tendinous degeneration, tendinitis, or frank tear.     

A clinical diagnostic model for the assessment of asbestosis: a new algorithmic approach

Asbestosis, one of the pneumoconioses that is defined by a set of clinical, radiographic, and pathologic findings, occurs as a result of exposure to asbestos fibers. Several approaches have attempted to describe the presence, progression, or extent of asbestosis. However, these approaches have attempted to describe the presence, progression, or extent of asbestosis. However, these approaches have limitations or lack correlations with other diagnostic modalities. We propose a comprehensive clinical diagnostic model that uses the sensitivities and specificities of the various clinical, radiographic, and pathologic findings to generate a set of "likelihood numbers." These likelihood numbers, contribute to the calculation of a value that can indicate the probability of asbestosis. The clinical diagnostic model is heuristic in that a specific feature supportive of the diagnosis of asbestosis may be tested as to its sensitivity and specificity, and new features may be added to the model. The model also indicates how probabilistic a given set of findings is in the diagnosis of asbestosis and suggests what additional data may make the diagnosis more or less statistically probable. Regarding the radiologic considerations of asbestosis, the strength of the clinical diagnostic model is that it is capable of supporting a diagnosis of asbestosis in the presence of a normal chest radiograph and, conversely, may reject the diagnosis of asbestosis despite the radiographic finding of pulmonary fibrosis.     

Reality and a mock coalface

Getting back to work after injury or illness often presents problems of readjustment and lack of confidence especially in jobs which involve environmental stress and hard physical work such as mining and the steel industry. Rehabilitation is the key to a successful return to employment. Author reports on a visit to the Miners Rehabilitation Centre at Talygarn in Glamorgan.     

Ups and downs at unit level

The status of the unit administrator is quite often fourth or fifth in line because under the present structure administrators cannot take important decisions without consultation with other colleagues in different disciplines says the Royal Commission. Author looks at the work of one unit administrator at Tooting Bec Hospital.     

The kindly kidnappers

If to the average child in the street going into hospital is like being kidnapped, as a doctor recently put it, then to the child who lives in Birmingham 'operation baby snatch' may not be such a bad thing. For the children's hospital there strives to be more like a home from home.