Centrally-administered AMPA antagonists increase locomotion in parkinsonian rats.

It was shown in the present study that three antagonists of the alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) glutamate receptor, including 2,3-dihydroxy-6-nitro-7-sulfamoylbenzo(f)quinoxaline (NBQX), 1-(4-aminophenyl)-4-methyl-7,8-methylenedioxy-5H-2,3-benzodiazepine (GYKI 52466) and 6-(1H-imidazole-1-yl)-7-nitro-2,3-(1H, 4H)-quinoxalinedione (YM90K), caused marked reversal of akinesia when administered into the entopeduncular nucleus of rats rendered parkinsonian by bilateral substantia nigra pars compacta lesion. These data suggest that centrally active AMPA antagonists may have therapeutic utility in the treatment of idiopathic Parkinson's disease.

Rotator cuff strain: a post-traumatic mimicker of tendonitis on MRI.

OBJECTIVE: To determine whether there is a subset of young patients (< 35 years) with acute, post-traumatic insults to the rotator cuff which mimic the early stages of impingement. DESIGN AND PATIENTS: One hundred and ninety-seven consecutive shoulder MR images were retrospectively reviewed, and the results of 83 clinically correlated. Two observers independently evaluated the location of intra-tendon signal and adjacent bone marrow abnormalities on T1- and T2-weighted images. These findings were correlated with age, history of trauma, and surgical or clinical follow-ups. RESULTS: Patients younger than 35 years had signal intensity that was more localized in atypical locations (posterior aspect of the supraspinatus tendon), more commonly associated with marrow abnormalities (presumed bone bruise), and more often associated with trauma. Younger patients also were less likely to require surgery, especially if they showed bone bruises. This differentiated them from older patients (> 45 years), who demonstrated more widespread signal within the tendon, rare bone bruises, and more frequent surgery. CONCLUSIONS: Localized tendon signal in atypical locations of the supraspinatus tendon, particularly when associated with bone bruise and young age, suggests the possibility of a post-traumatic strain.

Effect of foot and ankle MR imaging on clinical decision making.

PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging of the ankle and hindfoot on clinical decision making. MATERIALS AND METHODS: Eighty-one consecutive patients were prospectively examined with MR imaging of the foot and ankle. The referring clinician (one of two orthopedic surgeons or one of two podiatrists) assigned a clinical diagnosis (with a corresponding confidence score of 1-5) and a tentative treatment plan before and after the MR imaging examination and reading. A two-tailed, paired Student t test was used to determine the effects of MR imaging on the diagnosis and treatment. RESULTS: Of the 81 patients examined, 38 (47%) had a post-MR imaging diagnosis that differed from the pre-MR imaging diagnosis (P < .001). Treatment plans were subsequently changed in 28 patients (34%) (P < .001). MR imaging had a statistically significant effect regardless of the assigned, pre-MR imaging clinical confidence rating. MR imaging was also noted to play a key role in surgical planning regardless of the effect on diagnosis. CONCLUSION: MR imaging of the foot and ankle has an effect on clinical decision making. Regardless of the clinician's confidence in diagnosis, MR imaging consistently plays a central role in further defining the diagnosis and treatment.

Relative attractiveness of diagnostic radiology: assessment with data from the National Residency Matching Program and comparison with the strength of the job market.

PURPOSE: To quantify medical students' preferences for various specialties and to compare shifts in specialty preference with overall employment market prospects. MATERIALS AND METHODS: By using National Residency Matching Program data, a previously validated help-wanted index (HWI), and American Medical Association (AMA) salary data, the authors quantified medical students' preferences for various specialties and examined the association of shifts in specialty preference with overall trends as seen in the strength of the diagnostic radiology match and its relationship with the job market. The authors established a proxy for the relative attractiveness (RA) of diagnostic radiology (relative to all specialties) in the match, which was calculated by subtracting the percentage fill rate for all specialties from that for radiology. The RA values were plotted for 1990-2000 and compared with trends in the HWI, American College of Radiology data, and AMA salary data. RESULTS: The RA of diagnostic radiology varied greatly during the past 10 years, with a low in 1996 and a return to its high in recent years. There is a relationship between the RA and economic vitality of diagnostic radiology, with the RA lagging behind the HWI and AMA salary data by 2 years. CONCLUSION: Medical students appear to have an in-depth understanding of the economic forces at play in the health care job market and incorporate this information into their choice of a specialty.

Patient perception of magnetic resonance arthrography.

OBJECTIVE: Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients' perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. DESIGN AND PATIENTS: Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including "pain", "needles", "complications", and "discovery of results that would lead to surgery". In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. RESULTS: While many patients expressed fear of "pain" and "needles", after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. CONCLUSION: Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.