Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty

Objective To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. Design Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients’ forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. Patients Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. Results and Conclusions At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined. Name of Institution where research was performed: Wilford Hall Medical Center, San Antonio, Texas, USA.     

“红丝带关爱中心”在艾滋病患者护理服务中的作用

目的探讨"红丝带关爱中心"在艾滋病患者护理服务中的作用。方法为患者建立健康电子档案,实施网络和电话健康咨询、心理咨询、行为干预、健康教育及法律援助等服务。结果提高了患者的满意度(P0.01),减少了艾滋病的传播(P0.01)。结论 "红丝带关爱中心"在艾滋病护理服务中深化了优质护理服务,减少了艾滋病的传播。     

Temperature, heart rate, and blood pressure changes associated with clinical MR imaging at 1.5 T

Temperature, heart rate, and blood pressure responses to high-field-strength magnetic resonance (MR) imaging were studied in 50 patients who underwent procedures at exposures to radiofrequency radiation above the present recommended whole-body average specific absorption rate (SAR) of 0.4 W/kg. Body temperature significantly increased an average of 0.2 degrees C. The highest body temperature recorded after MR imaging was 37.5 degrees C. There was no significant correlation between the change (before and after imaging) in body temperature and whole-body average SARs. Changes in skin temperatures were variable, depending on anatomic site. The largest change was 3.5 degrees C, and the highest skin temperature recorded after imaging was 35.1 degrees C. There was a modest correlation between the change in skin temperatures and whole-body average SARs. Average heart rate and average mean blood pressure measured immediately before imaging were not significantly different afterward. High-field-strength MR imaging at the whole-body average SARs of 0.42-1.2 W/kg studied was not associated with any temperature- or hemodynamic-related deleterious effects.     

A qualitative investigation into why patients change their GPs

BACKGROUND: In the past patients have rarely changed doctor. The UK Government has made such change easier and it appears to be becoming more common. Changing doctor without changing address may be indicative of dissatisfaction with the GP service. Previous research in this area has been largely quantitative. OBJECTIVE: To identify why patients change their GP although they have not moved house. METHOD: Qualitative investigation of patients' experiences. In depth interviews of 24 patients were conducted to determine why they had left their previous doctor. Letters describing the process of change were received from a further 17 patients. Analysis was performed using standard qualitative techniques. RESULTS: The decision to change was in most cases multi- factorial. Interviews yielded more detailed and richer accounts than letters. For interviewees, rudeness or the attitude of the doctor was the commonest reason. Overall, 19 different reasons, in four categories, were identified. The largest single category was accessibility, closely followed by attitudinal problems. Clinical issues and personal characteristics of the doctor were less common. The majority of those responding by letter gave only one reason, usually distance. CONCLUSION: Patients change doctor after careful consideration and commonly for interpersonal reasons. There is usually one critical factor in the decision to change. Factors may be modifiable or non-modifiable. Critical event audit may enable GPs to analyse the reasons why patients leave their lists.      

Meniscal tears: pathologic correlation with MR imaging

Menisci from 12 autopsies and above-knee amputations were imaged with magnetic resonance (MR) at 1.5 T and then sectioned for gross and histologic examination. A histologic staging system was developed and showed a one-to-one correlation with corresponding grades of MR signal intensities. Histologic stages 1 and 2 represented a continuum of degeneration culminating in stage 3 fibrocartilaginous tears, seen most frequently in posterior-horn segments of the medial meniscus. Correlation of histologic stages with MR signal intensity allows for an improved diagnostic reading of MR images.     

Temporomandibular joint: MR assessment of rotational and sideways disk displacements

The accuracy of coronal and sagittal magnetic resonance (MR) imaging was examined in the assessment of rotational and sideways displacements of the temporomandibular joint (TMJ) disk. Rotational disk displacement implies a combination of anterior and medial or lateral displacements, whereas sideways displacement implies pure medial or lateral displacement without an anterior component. Multiple 3-mm-thick coronal and sagittal MR images were obtained of 18 fresh TMJ autopsy specimens and compared with the observations in corresponding coronal cryosections. MR imaging correctly delineated the mediolateral position of the disk in 15 joints (83%) and incorrectly delineated it in three joints (17%). Osseous anatomy was correctly assessed in 17 joints (94%). On cryosections, six joints (33%) showed medial disk displacement and two joints (11%) showed lateral displacement. In five of these eight joints the medial or lateral displacement occurred in conjunction with an anterior displacement, that is, rotational displacement. Clinical MR imaging in 37 patients (61 joints with coronal images) showed medial or lateral disk displacement in 16 joints (26%). This study suggests that rotational and sideways displacements of the TMJ disk are an important aspect of internal derangement. The multiplanar capabilities of MR are suitable for an assessment of these abnormalities.