The normal temporomandibular joint: MR and arthrographic correlation

Magnetic resonance (MR) images of 28 normal temporomandibular joints were obtained and correlated with respective arthrograms. There was a spectrum in the configuration and thickness of normal articular menisci. The anterior band varied from thin with a flat inferior margin to thick with a bulbous, convex inferior margin. The anatomic configuration of the meniscus as seen with MR correlated directly with normal variations of the anterior recess seen with arthrography. Concavity of the superior aspect of the anterior recess as seen on arthrography was caused by a thick, bulbous anterior band of the meniscus, whereas a flat anterior recess resulted from a thin anterior band without a convex inferior margin. This study emphasizes that the appearance of a concave anterior recess on static arthrograms is not necessarily due to a displaced meniscus.     

Brucellar and tuberculous spondylitis: comparative imaging features

Radiographs, scintigrams, computed tomographic scans, and magnetic resonance (MR) images of 17 patients with brucellar spondylitis and 15 with tuberculous spondylitis were analyzed to identify distinguishing features. Characteristic findings of brucellar spondylitis included predilection for the lower lumbar spine (68% of lesions), bone destruction limited to the end plates, disk collapse (16 of 19 disks), and granulation tissue or localized soft-tissue edema (17 of 19 sites). MR imaging showed diffuse increased signal in vertebrae and disks on long repetition time (TR)/echo time (TE) images in four patients and focal increased signal with normal disks in one. Epidural extension was best seen on short TR/TE images in four. Tuberculous spondylitis was characterized by predilection for the midthoracic spine (73%), vertebral destruction with gibbus deformity (60%), disk collapse, and paraspinal abscesses (14 of 15). On MR images signal intensity of affected vertebrae was similar to but more severe than findings in patients with brucellar spondylitis. Scintigraphy was the least helpful in differentiating the two infections. Lesions of tuberculous spondylitis affecting the lower lumbar spine were difficult to differentiate from those of brucellar spondylitis.     

Flow artifacts in double-contrast esophagography

Artifacts related to barium flow during double-contrast esophagography may obscure mucosal surface details. Double-contrast esophagograms with flow artifacts of 35 patients were evaluated to determine the effect on radiographic interpretation and to assess the method of examination. Initial radiographs obtained during swallowing of barium were compared with those obtained after a slight delay while patients repeatedly dry swallowed. When severe surface flow artifacts were present, the extent of mucosal disease was underestimated in all cases. Mild surface flow artifacts interfered with the demonstration of the reticular pattern of Barrett esophagus, and luminal flow artifacts caused misinterpretation. The demonstration of strictures was unaffected by flow artifacts. This study suggests that the dry swallowing maneuver and some delay improve depiction of esophageal surface details on double-contrast radiographs and obviate interpretive error from barium flow artifacts.     

Digital subtraction arthrography

The technology of digital subtraction image processing was applied as a substitute for conventional arthrographic subtraction techniques in the evaluation of 29 joints in 27 patients. There were 15 total hip replacements, one total knee replacement, eight wrists, three shoulders, and two ankles. Information regarding prosthetic component loosening and ligamentous disruption of carpal bone articulations could be determined with a high degree of accuracy when compared with information gained using conventional radiographic methods. Our results indicate that this method may be a suitable substitute for other arthrographic techniques.     

Reed-Sternberg cells in Hodgkin's cell lines HDLM, L-428, and KM-H2 are not actively replicating: lack of bromodeoxyuridine uptake by multinuclear cells in culture

We compared the proliferation of mononuclear and multinuclear cells in four Hodgkin's cell lines, HDLM-1, HDLM-1d, L-428, and KM-H2, by examining their capacity to incorporate bromodeoxyuridine (BrdUrd) into nuclei. Approximately 5% of all cells in HDLM-1 cultures had two or more nuclei, a characteristic of Reed-Sternberg (RS) cells. Unlike mononuclear Hodgkin's (H) cells, these RS cells exhibited no uptake, or only minimal uptake of BrdUrd, suggesting that they did not replicate actively. Cytogenetic study showed that 25% of the HDLM-1 cells contained a tetraploid (4X) set of chromosomes with a characteristic two-peak distribution. Following treatment of HDLM-1 cells with phorbol ester, the percentages of 4X cells and RS cells increased to 50% and 12%, respectively. This increase in RS cells was not likely to be due to cell fusion as shown by the absence of hybridization of BrdUrd- positive and -negative nuclei. Phorbol ester has a short-term effect of blocking the exit of cells from G1 into S phase, but no effect on the transition from S phase to G2/M phase. The block is more prominent in 2X cells than in 4X cells, which may explain the increase in percentage of 4X cells in phorbol ester-treated cultures. In addition, phorbol ester induced the differentiation of H-RS cells, which was accompanied by loss of the marker HeFi-1 from the cell surface. Approximately one third of the RS cells did not express HeFi-1, or expressed only minimal amounts. The findings led us to the following conclusions: (1) The 4X cells probably are formed from 2X H cells as a result of disturbed cytokinesis, but not a cell fusion. (2) A considerable number of 4X cells were H cells, because the number of 4X cells consistently exceeded that of RS cells. (3) Since mitotic figures are extremely rare in RS cells and these cells did not show active BrdUrd uptake, the increased number of RS cells must also be a consequence of disturbed cytokinesis of H cells or a result of nuclear transformation (twisting, convolution, or separation of the nucleus) in H cells. (4) Most RS cells lose their proliferating capacity and some RS cells may undergo further differentiation. Uptake of BrdUrd and phorbol ester induction were also studied on the other three H-RS cell lines, HDLM-1d, L-428, and KM-H2, with results similar to those for HDLM-1.     

Bacterial renal infection: role of CT

The imaging studies done on 62 patients hospitalized for acute renal infections were retrospectively reviewed. Thirty-six (58%) had one or more abscesses, 17 (27%) had focal or diffuse acute bacterial nephritis, five (8%) had pyonephrosis, and four (6%) had pyelonephritis. All had prolonged fever (greater than or equal to 72 hours) and leukocytosis. Among 25 patients examined with both ultrasound (US) and computed tomography (CT), US failed to depict three of five (60%) cases of acute bacterial nephritis and seven of 15 (47%) intrarenal and extrarenal abscesses. One renal abscess was misdiagnosed as a tumor at CT. US is not an adequate screening test for detecting lesions that may require invasive therapy. CT is more sensitive for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of radiologic or surgical intervention.     

Treatment of Casualties in a Forward Hospital of Indian Army : Nine year Experience

Background

To analyze the outcome of the management of casualties in a level II trauma centre of a forward hospital of Armed Forces over a nine year period. Retrospective analysis of all casualties received in a single forward hospital of Indian Army was carried out.

Method

During 9 years (1990-1998), a total of 5737 casualties were received in a single level II zonal hospital of the Army in a forward area. Majority of the injuries were caused by bullets, or by fragments of improvised explosive devices. A policy of aggressive resuscitation and early primary repair of injuries was followed. General surgeons routinely performed craniotomies, thoracotomies, laparotomies, stabilization of fractures by fixators and repair of vascular injuries.

Result

38% of patients had injuries to several body parts (polytrauma), resulting in a total of 8578 injuries. Region-wise distribution of injuries was as follows : 14.2% head and neck injuries, 13.3% chest wounds, 13.5% abdominal injury and 59% extremity wounds. The overall mortality rate was 3.6%. The complication rate was about 7% with infection as the major complication. The results of primary repair of colonic injuries were similar to those of staged repairs. The results after primary closure of war wounds were better than those treated with delayed primary closure in selected cases.

Conclusion

Prompt evacuation, speedy resuscitation and early definitive repair of war injuries results in low mortality and morbidity. A motivated and dedicated team and adequate availability of blood and ancillary services adds to the excellent outcome. The policy of primary repair of colonic and selected soft tissue injuries appears justified in selected cases.Key Words: Casualties, Improvised Explosive Devices, Militancy, Trauma     

Norms of the Rorschach Test for Indian Subjects

Background

The clinical utility of the Rorschach test in Indians is hampered by the absence of reliable normative data. Method : The Rorschach by Dlopfer''s method was administrated to 1256 subjects consisting of 300 normal army personnel, 300 normal civilians, 250 schizophrenics, 300 neurotics and 106 patients with organic disorders.

Results

The Rorschach protocols of normal Indian army personnel and normal civilians showed significant differences from one another and also from the western norms. These differences are culturally determined and are not indicative of low intelligence or psychopathology. Patients with schizophrenia, neurosis, head injury and epilepsy show significant differences from the records of normal subjects. The protocols of army schizophrenics show significant deviations from those of normal army personnel and these changes revert to normal with clinical recovery.

Conclusion

The Rorschach test is not a culture fee test as claimed earlier. In view of the differences from Western norms, Rorschach protocols of Indians should be interpreted using the norms for Indians. In the case of army personnel the norms for army personnel should be used. While the use of the Rorschach to study the personality patterns of normal individuals and as an aid to clinical diagnosis was strongly supported, the findings of the study indicate that the test can also be employed to assess therapeutic response of patients with schizophrenia.Key Words: Rorschach test, norms, schizophrenia, neurosis