Concerns for medical radiation programs in Australian universities

The Australian higher education system is in a state of great change. The Federal education minister, Dr Brendan Nelson, has indicated that he intends to continue introducing far-reaching reforms that will impact significantly on how universities conduct teaching and research. The future allocation of government funding for university programs, including those in medical radiation, will have a significant effect on how those programs are delivered and could even determine whether programs remain viable. There will be a financial imperative for academic departments to strengthen research activity and to obtain funding from non-government sources, such as full-fee paying students, in order to generate enough income to cover program delivery. Medical radiation education in Australia is also facing many other challenges. Some of these are longstanding, such as the high cost of medical radiation program delivery, poor levels of research activity and difficulty in recruiting and retaining academic staff. Other problems have arisen recently, such as increased competition for students and a critical shortage of available training placements in clinical practice. The aim of this paper is to raise and explore these issues from a university perspective.     

Gore-Tex prosthetic ligament in anterior cruciate deficient knees

Reconstruction for symptomatic anterior cruciate deficient knees has yielded varying success rates. Prosthetic cruciate replacement has recently become a potentially attractive alternative. The results of the Gore-Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported. Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2 degrees of extension and 10 degrees of flexion, and at 12 months was 0 degrees of extension and 4 degrees of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated improvement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improvement in the injured-normal knee difference score throughout the follow-up period. Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving. Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cystic meningiomas. Report of seven cases

Seven patients with cystic meningioma are reported. The computerized tomography appearance of these meningiomas may mimic that of a glial or metastatic tumor with cystic or necrotic changes, and lead to an incorrect presumptive diagnosis. Radiological evaluation and recognition are important for the surgical removal of these potentially curable neoplasms.     

Peripheral blood CD3 and CD4 T-lymphocyte reduction correlates with severity of liver cirrhosis

Summary Immunological disturbances with impairment of immune function and a higher incidence of lymphoproliferative disorders and other malignancies have been described in liver cirrhosis patients. To investigate the pathogenetic mechanism(s) involved in such associated we looked for a possible imbalance in peripheral blood T-lymphocyte subpopulations in patients with liver cirrhosis of differing severity. Immunophenotyping and counts of peripheral blood T-lymphocyte subpopulations were carried out using monoclonal antibodies conjugated with different fluorochromes in 31 consecutive cirrhotic patients and 23 matched healthy volunteers. Univariate and multivariate analyses of lymphocyte phenotype counts were performed and odds ratios were computed. Statistically significant associations, according to both univariate and multivariate analyses, were found between case/control status and mean CD3 and CD4 T-lymphocyte counts (P<0.0001). A strong correlation was found between the Pugh’s index and CD3 and CD4 lymphocyte counts, with a clear reduction of these phenotypes with increasing liver cirrhosis. Median CD3 and CD4 values were 2,283 and 1,329/μl respectively among controls and 896, 801, and 492/μl and 515, 514, and 307/μl, respectively in categories A, B, and C of Pugh’s classification. Very high odds ratios were found using the median values of CD3 and CD4 as a threshold. There was a statistically significant decrease for each of the T-cell phenotypes studied (CD2, CD3, CD4, CD8, CD16, CD19, CD20, CD56, CD57) between patients and controls (P<0.0001). The progressive and severity-related decrease in mean peripheral blood CD3 and CD4 counts in liver cirrhosis suggests a progressive impairment of protective immune function and may be a factor facilitating malignancy in cirrhotic patients.     

Radiology of the foot in chronic alcoholism

The authors have reviewed the radiographic patterns of the foot in 28 patients affected by neuropathic joint disease complicating alcoholism, out of a series of 82 chronic alcoholic patients. Sixteen of them were also affected by diabetes mellitus. On the basis of X-ray findings, lesions were divided into three groups, reflecting the evolution of the disease: 1) early changes, especially affecting the soft tissues and joints; 2) definite lesions, consisting of fractures, osteolysis, bone destruction and amputation, periarticular debris; 3) "healing" signs, simulating degenerative joint disease, which cause severe and weakening deformities. Tabes dorsalis and diabetic osteoarthropathy must be differentiated from alcohol-induced syndrome. Even though a correct differential diagnosis is often difficult to reach, it must be kept in mind that focal/diffuse osteopenia is the most characteristic manifestation of alcoholic osteopathy, whereas different radiographic findings simulate chronic degenerative arthropathies.     

Rehabilitation of the knee after anterior cruciate ligament reconstruction

From the Kerlan-Jobe Orthopaedic Clinic, 501 E. Hardy Street, Suite 200, Inglewood, CA 90301. New information regarding the isometric placement of the anterior cruciate ligament (ACL) substitute, revascularization process, and biomechanical stresses have all contributed to and been incorporated in the rehabilitation program after ACL reconstruction. Treatment protocols specifically designed for the patient following ACL reconstruction are imperative to return the individual to his or her preinjury status. Care is taken to limit the amount of stress placed on the ligament substitute especially at end of range extension. A program incorporating techniques for developing range of motion and strength while still preserving stability at the knee joint is still of the utmost importance. This program is a revision of a previously reported regimen from this facility (Brewster, Moynes, Jobe, J Orthop Sports Phys Ther 5:121-126, 1983) and is based upon clinical experience and research information. J Orthop Sports Phys Ther 1989;11(1):8-18.