Rotator cuff tear: clinical experience with sonographic detection

Between June 1986 and April 1988, 86 sonographic examinations of the shoulder were performed on patients suspected of having rotator cuff tears. Major sonographic diagnostic criteria included (a) a well-defined discontinuity usually visible as a hypoechoic focus within the cuff, (b) nonvisualization of the cuff and (c) an echogenic focus within the cuff. Seventy-five patients underwent both sonography and arthrography. Compared with arthrography alone, ultrasound examinations enabled detection of 92% of rotator cuff tears (24 of 26 tears), with a specificity of 84% and a negative predictive value of 95%. Correlation was obtained in 30 of these patients who underwent surgery for rotator cuff tear or other soft-tissue abnormality. In this group, the sensitivity of sonography for detection of a tear was 93%, with a specificity of 73%, while for arthrography sensitivity was 87% and specificity was 100%. These data indicate that sonography is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury.     

Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.     

Hypoxia-inducible factor-1alpha and the glycolytic phenotype in tumors

Metastatic tumors generally exhibit aerobic glycolysis (the Warburg effect). The advent of [18F]fluorodeoxyglucose positron emission tomography imaging, coupled with recent findings linking hypoxia-inducible factor (HIF-1alpha) overexpression to aggressive cancers, has rekindled an interest in this aspect of tumor metabolism. These studies explore the role of HIF-1alpha in human breast cancer lines and its relationship to glycolytic regulation. Here we demonstrate that, under normal oxygen conditions, nonmetastatic cells consume less glucose and express low HIF-1alpha, whereas metastatic cells constitutively express high glycolysis and HIF-1alpha, suggesting that dysregulation of HIF-1alpha may induce the Warburg effect. This hypothesis was tested by renormalizing HIF-1alpha levels in renal carcinoma cells, leading to inhibition of aerobic glycolysis.     

Physical function is impaired but quality of life preserved in patients with fibrous dysplasia of bone

Fibrous dysplasia of bone (FD) is a congenital, non-heritable skeletal disorder that is associated with multiple skeletal complications, including repeated fractures, limb length discrepancy, and bone pain. The disease-specific impact of FD on quality of life outcomes is unknown. We sought to understand the impact of the scope and extent of the skeletal disease on quality of life in adults and children with FD. The health-related quality of life was quantified in a population of adults (n = 56) and children (n = 22) with FD using validated health assessment questionnaires, the Medical Outcomes Study 36 Item Short-Form Health Survey, volume 2 (SF36) (adults) and the Child Health Questionnaire Parent Form 50 (CHQ-PF50) (children). Clinical demographic data and skeletal disease burden scores (SDBS, amount of skeleton involved with FD) were measured, and correlations with health-related quality of life were sought. The SF36 and CHQ-PF50 revealed lower Physical Function Summary scores in FD patients compared to the U.S. population norms (adult 41 vs. 50, Z score < -5.0, pediatric 39 vs. 50, Z score < -5.0). However, the SF36 and CHQ-PF50 Mental/Psychological summary scores were not different from those of U.S. population norms (adult 50 vs. 50, Z score = 0, pediatric 48 vs. 50 Z score = -0.9). The score on the Physical Function Domain of both tools was strongly negatively associated with the SDBS (adult Spearman rho = -0.43, P = 0.009, pediatric Spearman rho = -0.72, P = 0.005). The groups of adult and pediatric patients with SDBS > 30 had decreased Physical Function Domain scores when compared to those with scores < 30 (adult 35 vs. 45, P = 0.002, pediatric 57 vs. 78, P = 0.04, respectively). One of the largest effects was seen in the parents of children with FD, who had significantly lower Parental Emotional scores than those of the parents of healthy norms (54 vs. 88, Z score < -5.0), suggesting a high degree of emotional morbidity in the parents of children with FD. Despite measurable functional limitations in adults and children, and significant parental emotional impairment, patients with FD achieve a high level of social and emotional function. These data are important for prognosis and parental reassurance.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.