Anteromedial Subtalar Dislocation

Subtalar dislocation is the simultaneous dislocation of the distal articulations of the talus at both the talocalcaneal and talonavicular joints. It can occur in any direction and can always produce significant deformity. The medial dislocation is most common. Less common presentations are lateral, anterior, and posterior dislocations. These dislocations are associated with osteochondral fractures. Closed reduction and immobilization remain the mainstays of treatment. Proper radiographs and computed tomography scan confirm the postreduction alignment stability of subtalar joints and intraarticular fracture fragments. We report a case of anteromedial subtalar dislocation with no osteochondral fracture fragments in a 25-year-old man.     

The effect of positional realignment on dose delivery to the prostate and organs-at-risk for 3DCRT.

In this study, we evaluate the impact of daily image-guided patient repositioning on dose delivery to prostate and sensitive organs in the treatment of prostate carcinoma with 3-dimensional conformal radiation therapy (3DCRT). Five patients with substantial ultrasound-documented interfractional prostate motion during their 3DCRT treatment course were selected. Starting with the original treatment plan, 2 additional plans were retrospectively generated for each patient. In one set, organ contours were moved for each fraction, thus simulating positioning with misalignment caused by organ motion if ultrasound guidance were not used. In a second set of plans, the isocenter was shifted, as were the organ contours, simulating realignment based on the ultrasound image. In all cases, the number of planned monitor units was set to those of the original plan. For a given patient, isodose distributions, dose-volume histograms (DVHs), equivalent uniform dose (EUD) for prostate, and generalized equivalent uniform dose (gEUDs) for bladder and rectum were calculated for each fraction and then combined for each shift condition. In all reconstructed plans, the results show no substantial changes in dose coverage of the prostate <0.21% change in EUD) compared to the original plan. However, in some cases with no realignment, a larger volume of the bladder or rectum gets higher dose, with the consequent gEUD for each organ significantly greater compared to the original plan.     

In vivo imaging of a stable paramagnetic probe by pulsed-radiofrequency electron paramagnetic resonance spectroscopy

Imaging of free radicals by electron paramagnetic resonance (EPR) spectroscopy using time domain acquisition as in nuclear magnetic resonance (NMR) has not been attempted because of the short spin-spin relaxation times, typically under 1 μs, of most biologically relevant paramagnetic species. Recent advances in radiofrequency (RF) electronics have enabled the generation of pulses of the order of 10–50 ns. Such short pulses provide adequate spectral coverage for EPR studies at 300 MHz resonant frequency. Acquisition of free induction decays (FID) of paramagnetic species possessing inhomogenously broadened narrow lines after pulsed excitation is feasible with an appropriate digitizer/averager. This report describes the use of time-domain RF EPR spectrometry and imaging for in vivo applications. FID responses were collected from a water-soluble, narrow line width spin probe within phantom samples in solution and also when infused intravenously in an anesthetized mouse. Using static magnetic field gradients and back-projection methods of image reconstruction, two-dimensional images of the spin-probe distribution were obtained in phantom samples as well as in a mouse. The resolution in the images was better than 0.7 mm and devoid of motional artifacts in the in vivo study. Results from this study suggest a potential use for pulsed RF EPR imaging (EPRI) for three-dimensional spatial and spectral-spatial imaging applications. In particular, pulsed EPRI may find use in in vivo studies to minimize motional artifacts from cardiac and lung motion that cause significant problems in frequency-domain spectral acquisition, such as in continuous wave (cw) EPR techniques.     

Ovarian giant cell tumor with cystadenocarcinoma.

A 25-year-old woman had a malignant ovarian tumor with two distinct tumor patterns: pseudomucinous cystadenocarcinoma and malignant giant cell tumor of bone. One area of the tumor had a lining of tall columnar epithelium with abundant mucin production; however, another area of the same tumor had a number of large multinucleated giant cells that resembled osteoclasts, intermingled with mononuclear stromal cells. There was no blending of the two tumor patterns. Mitoses were frequent in both areas. A probable histogenesis of the tumor from a malignant teratoma is suggested.     

Synthesis and carcinogenic activity of 5-fluoro-7-(oxygenated methyl)-12-methylvenz[a]anthracenes.

Treatment of 7,12-benz[a]anthraquinone (2) with methylmagnesium iodide or methyllithium yields mixtures of cis- and trans-7,12-dihydro-7,12-dihydroxy-7,12-dimethylbenz[a]anthracenes (3a,b), in which the ratio of cis to trans lies in the 3--4:1 region. Each isomer afforded high yields of 7-chloromethyl-12-methylbenz[a]anthracene (5) on treatment with hydrogen chloride in ethyl acetate. Similarly, 5-fluoro-7,12-benz[a]anthraquinone (8) afforded a mixture of cis- and trans-5-fluoro-7,12-dihydro-7,12-dihydroxy-7,12-dimethylbenz[a]anthracenes (9) which yielded 7-chloromethyl-5-fluoro-12-methylbenz[a]anthracene (10) on treatment with HCl. The chloromethyl compounds, 5 and 10, yielded 7-acetoxymethyl-12-methylbenz[a]anthracene (6) and 7-acetoxymethyl-5-fluoro-12-methylbenz[a]anthracene (11) on treatment with acetate ion. Hydrolysis of 6 and 11 yielded 7-hydroxymethyl-12-methylbenz[a]anthracene (7) and 5-fluoro-7-hydroxymethyl-12-methylbenz[a]anthracene (12), respectively. Since neither 11 nor 12 is appreciably carcinogenic, the carcinogenic metabolism of 7,12-dimethylbenz[a]anthracene (DMBA) probably does not involve attack at the 7-methyl group.