Association of posterior tibial tendon abnormalities with abnormal signal intensity in the sinus tarsi on MR imaging

Objective. To evaluate the association of abnormal signal intensity within the sinus tarsi with abnormalities of the posterior tibial tendon (PTT) on MR imaging. Design and patients. Sinus tarsi abnormalities were identified on 30 ankle MR examinations in 29 patients. The PTT and anterior talofibular ligament were retrospectively analyzed for abnormalities in these same patients. Results and conclusions. Tears of the anterior talofibular ligament were found in 13 of 30 (43%) ankles. PTT abnormalities (complete tear, partial tear or dislocation) were seen in 14 of 30 (47%) studies, and were distributed relatively equally between those patients with and without lateral ligament tears. Our results provide evidence of an association between abnormalities of the PTT and the sinus tarsi. The finding of abnormal signal intensity within the sinus tarsi on MR imaging should alert the radiologist to potential abnormalities of the PTT. Received: 17 March 2000 Accepted: 17 May 2000     

Work experience in adolescents with spinal cord injuries

The purpose of this study is to compare the work experiences of adolescents with spinal cord injuries (SCI) to peers without disabilities. Twenty-eight adolescents with SCI and 25 age-matched individuals without disabilities (controls) took part in the study.A structured telephone questionnaire was used to assess their experience of household chores, volunteer jobs, and paid work. The mean age at interview was 16.2 years for those with SCI and 16.0 years for control participants. There was no significant difference between the individuals with SCI and the control participants in chores or volunteer work experiences, but the individuals with SCI were significantly less likely to have paid work experience than control participants (chi2 = 13.670, p<0.001). Of the older adolescents, aged >15 to 19 years, five of 15 individuals with SCI and 16 of 16 control participants had paid work (Fisher exact test p<0.001). Of individuals with SCI, those with milder injuries and those injured at a younger age were more likely to have work experience.     

Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. Multicenter phase III clinical trials. Efficacy of early imaging

The efficacy of contrast-enhanced magnetic resonance imaging (MRI) for detecting and characterizing, or excluding, hepatic masses was assessed in 404 patients, following the intravenous administration of mangafodipir trisodium (MnDPDP) injection, a hepatic MRI contrast agent. An initial contrast-enhanced computed tomography (CT) examination was followed by unenhanced MRI, injection of MnDPDP (5 micromol/kg IV), and enhanced MRI at 15 minutes post injection. Agreement of the radiologic diagnoses with the patients' final diagnoses was higher for enhanced MRI and for the combined unenhanced and enhanced MRI evaluations than for unenhanced MRI alone or enhanced CT using the clinical diagnosis as the gold standard. Mangafodipir-enhanced MRI uniquely provided additional diagnostic information in 48% of the patients, and patient management was consequently altered in 6% of the patients. MnDPDP-enhanced MRI was comparable or superior to unenhanced MRI and enhanced CT for the detection, classification, and diagnosis of focal liver lesions in patients with known or suspected focal liver disease.     

Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety)

The short-term safety of mangafodipir trisodium (MnDPDP) injection was studied in 546 adults with known or suspected focal liver lesions. An initial contrast-enhanced computed tomography examination was followed by unenhanced magnetic resonance imaging (MRI), injection of MnDPDP (5 micromol/kg), and enhanced MRI. Adverse events were reported for 23% of the patients; most were mild to moderate in intensity, did not require treatment, and were not drug related. The most commonly reported adverse events were nausea (7%) and headache (4%). The incidence of serious adverse events was low (nine events in six patients) and not drug related. Injection-associated discomfort was reported for 69% of the patients, and the most commonly reported discomforts included heat (49%) and flushing (33%). Changes in laboratory values and vital signs were generally transient, were not clinically significant, and did not require treatment. There were no clinically significant short-term risks from exposure to MnDPDP.     

Why IFR (instrument flight rules)?

INTRODUCTION: Air medical services can use aircraft equipped to fly under visual flight rules (VFR) or instrument flight rules (IFR). IFR allows the pilot to fly safely into lower weather minimums, potentially increasing the number of EMS flights that can be completed. We examined the advantages and disadvantages of both methods of helicopter flight, the potential service gain with IFR capability, and the financial feasibility of using IFR in an urban air medical program. METHODS: Retrospective data were collected on the number of missed flights for Vanderbilt LifeFlight during a 6-year period. Focusing on 2 recent years, we examined the number of flights missed because of weather. Data were prospectively obtained on missed flights that could have been completed with IFR from April 1997 to March 1998. Financial estimates were calculated to determine the revenue potential of an IFR program. RESULTS: An average of 24% of flights were missed from 1991 to 1997. In 1996-97, primary reasons for missed flights included poor visibility and low clouds, conditions in which IFR capable helicopters could fly. Prospective data from 1997-98 indicated an average of 6.7 missed flights per month potentially could have been completed with IFR. Analysis of expenses and revenue suggest that converting a ship from VFR to IFR, which involves both equipment purchases and pilot training, is economically feasible given the potential revenue gained by the number of flights completed during marginal weather conditions. CONCLUSION: Implementing an IFR program increases the safety margin and allows better EMS service to the community.     

Technical advances in pediatric laparoscopy have had a beneficial impact on splenectomy

PURPOSE: The aim of this study was to demonstrate the effects of recent technical advances on the safety and benefits of pediatric laparoscopic splenectomy. METHODS: A retrospective review was conducted of patients undergoing laparoscopic splenectomy from January 1998 to January 2000. Technical advances utilized during this period included the harmonic scalpel, a specialized flexible hilar retractor, a larger, wire-rimmed specimen bag, and lateral patient positioning. RESULTS: Laparoscopic splenectomy was performed successfully on 18 patients aged 3 to 17 years (median, 9). The indications were hereditary spherocytosis (n = 10), idiopathic thrombocytopenic purpura (n = 5), and other (n = 3). Eight patients had concomitant procedures including cholecystectomy (n = 3), resection of an accessory spleen (n = 3), and other (n = 2). The median operating time, including the concomitant procedures, was 125 minutes (range, 70 to 235). Patients tolerated a regular diet on median postoperative day 1 (range, 1 to 3), and 16 were discharged home on or before postoperative day 2. None of the patients required blood product transfusion or conversion to an open technique. There were no complications, and all patients had returned to usual activity by 2 weeks. CONCLUSION: With recent technological advances, the laparoscopic approach has become easy to perform, safe, and should be considered the procedure of choice for pediatric splenectomy.     

Frontal sinus surgery 2004: update of clinical anatomy and surgical techniques

Endoscopic frontal sinus surgery is still considered difficult, risky to perform, and likely to result in a high failure rate. We have previously reported on our technique of endoscopic frontal sinus surgery, stressing the importance of identification and preservation of natural outflow tract. Our study of frontal sinus anatomy shows that the mean frontal ostium anterior—posterior and transverse dimensions are 7.22 ± 2.78 mm and 8.92 ± 2.95 mm, respectively; therefore, dissection of obstructive structures in frontal recess leads to a wide opening of frontal sinus outflow. A key surgical landmark in our technique is the superior attachment of the uncinate process. This article provides an update of the surgical anatomy of the frontal recess region and our surgical technique, as well as a discussion of our approach to frontal sinus revision surgery.     

Linear Nevus Sebaceus Syndrome with bilateral complex limbal choristomas and extraocular muscle involvement

A case of a child with bilateral fleshy limbal masses with a coloboma of the right upper lid is discussed. Systemic examination revealed two patches of alopecia on the right frontoparietal and right occipital areas of the scalp. Punch biopsy and histopathological examination led to the diagnosis of Linear Nevus Sebaceus Syndrome (LNSS) with bilateral complex limbal choristomas. The authors have stated that they do not have a significant financial interest or other relatioship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.