All-in-one magnetic resonance arthrography of the shoulder in a vertically open magnetic resonance unit.

BACKGROUND: Magnetic resonance (MR) arthrography frequently involves joint injection under imaging guidance followed by MR imaging in static positions. PURPOSE: To evaluate if MR arthrography of the shoulder joint can be performed in a comprehensive fashion combining the MR-guided injection procedure, static MR imaging, and dynamic motion MR imaging in a single test. MATERIAL AND METHODS: Twenty-three shoulder joints were injected with Gd-DTPA2- under MR guidance. Static MR imaging was performed and included a three-point Dixon method to achieve water-selective images. Dynamic motion MR imaging with and without applying pressure to the upper arm was used to evaluate glenohumeral joint instability. In 10 cases, surgical correlation was available. RESULTS: The all-in-one MR arthrography technique was successful in all patients, and took an average time of 65 min. All but one glenohumeral injection procedure were performed with a single needle pass, and no complications were observed. Out of eight labrum tears seen with static MR imaging, seven were confirmed at surgery. In 10 cases, dynamic motion MR imaging correlated well with the surgeon's intraoperative evaluation for presence and direction of instability. CONCLUSION: MR arthrography of the shoulder joint using a vertically open magnet can be performed as a single comprehensive test, including the injection and the static and dynamic motion MR imaging. Good diagnostic accuracy for intraarticular lesions and glenohumeral instability was found in a small sample.

Efficacy of ketoconazole v nystatin in prevention of fungal infections in neutropenic patients.

A prospective randomized study was undertaken in neutropenic patients to evaluate the efficacy of prophylactic ketoconazole v nystatin in reducing yeast infections. Eighteen patients received 500,000 units of nystatin suspension four times daily, and 18 patients received 200 mg of ketoconazole daily. The nystatin group experienced nine local yeast infections (four thrush, three esophagitis, and two vaginitis); three patients receiving ketoconazole had thrush. No cases of disseminated candidiasis occurred in either group. Ketoconazole was better tolerated than nystatin and neither drug caused toxic effects. In addition to being nontoxic and better tolerated, ketoconazole appeared to be slightly more effective than nystatin in reducing locally severe yeast infections.

Detection of cryptococcal antigen. Comparison of two latex agglutination tests.

The detection of cryptococcal antigen by means of the agglutination of antibody-coated latex particles is an important aid in the diagnosis of cryptococcosis. A commercially available latex agglutination test (IBL kit) was compared with the latex agglutination test from the Center for Disease Control in regard to sensitivity, specificity, and height of antigen titer. Over a 13-month period, 335 specimens were tested with both kits. There was one false-positive reaction with both kits (0.4%) and one false-negative reaction only with the CDC kit, among 18 patients who had meningitis or disseminated infection due to Cryptococcus neoformans. Sera from patients who had localized pulmonary cryptococcosis showed negative results with both kits. The antigen titers measured by the two kits were the same or within two dilutions in 22 of 26 specimens of cerebrospinal fluid or serum from patients who had proved cryptococcosis. Overall, the IBL kit compared favorably with the CDC kit for the detection of cryptococcal antigen in cerebrospinal fluid or serum.

Dermatitis due to Sporobolomyces infection.

A 30-year-old woman had a pruritic skin lesion from which a yeastlike organism, Sporobolomyces holsaticus, was isolated. Members of this group of yeasts are found in the soil throughout the world and have been implicated only twice before in human infection. We report a third case of infection due to a Sporobolomyces organism.

Magnetic resonance imaging of knee cartilage repair.

Cartilage injury resulting in osteoarthritis is a frequent cause of disability in young people. Osteoarthritis, based on either cartilage injury or degeneration, is a leading cause of disability in the United States. Over the last several decades, much progress has been made in understanding cartilage injury and repair. Magnetic resonance (MR) imaging, with its unique ability to noninvasively image and characterize soft tissue, has shown promise in assessment of cartilage integrity. In addition to standard MR imaging methods, MR imaging contrast mechanisms under development may reveal detailed information regarding the physiology and morphology of cartilage. MR imaging will play a crucial role in assessing the success or failure of therapies for cartilage injury and degeneration.

Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.

Medial tibial pain in runners has traditionally been diagnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive marrow involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 symptomatic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a magnetic resonance imaging scan. In 14 of the 18 symptomatic legs, magnetic resonance imaging findings correlated with an established technetium bone scan grading system and more precisely defined the anatomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone involvement with clinical symptoms, allowing for more accurate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic resonance imaging include lack of exposure to ionizing radiation and significantly less imaging time than three-phase bone scintigraphy.

Magnetic resonance imaging manifestations of synovial lesions of the ankle and foot.

Inflammatory, infectious, neoplastic, degenerative, or idiopathic disorders may all be manifested as synovial disease. MR imaging allows noninvasive evaluation of synovial disease and is a highly sensitive modality for detection of synovial pathology. Intravenous or intra-articular contrast administration will sometimes further increase signal differences between inflamed synovium, joint effusion, and surrounding structures.

Synovial lesions of the hand and wrist.

Synovial tissue in the hand and wrist is frequently involved by inflammatory, degenerative, infectious, traumatic, metabolic, or neoplastic lesions. Although normal synovium is not shown on MR images, the morphology and signal characteristics of abnormal synovium is generally well demonstrated. Special MR techniques for accurate quantification of pannus are under investigation.

Rotator cuff impingement. Pathogenesis, MR imaging characteristics, and early dynamic MR results.

Shoulder impingement can be diagnosed based on clinical findings, but clinical staging of its severity, which may range from reversible edema and hemorrhage to a complete rotator cuff tear, is often not possible. MR imaging allows direct examination of the thickness, signal characteristics, and continuity of the rotator cuff. Furthermore, MR imaging can be used not only to determine the status of the cuff, but also to detect pathology involving surrounding structures and to identify anatomic variations that may contribute to the impingement. Rapid MR imaging during active unguided shoulder motion will likely further increase our understanding of the biomechanics of the shoulder at different stages of impingement, and may shed further light on the pathogenesis of this disorder.

MR imaging of stress reactions, muscle injuries, and other overuse injuries in runners.

Running-related injuries are increasingly common, and most often due to overuse. This article briefly discusses the biomechanics of running, and a general review of stress lesions of bone; site-specific reviews of bony stress lesions and other running-related soft tissue injuries; and associated MR imaging findings.

Shoulder MRI after impingement test injection.

OBJECTIVE: To determine how long injected fluid from an impingement test remains in the bursa or adjacent soft tissues after an injection. DESIGN AND PATIENTS: Six patients prospectively underwent MRI of the shoulder immediately before and after an impingement test injection, and at 3 days, 2 weeks and 4 weeks later. MR images were evaluated and graded for fluid distribution within the bursa and adjacent soft tissues. The rotator cuff was evaluated for signal abnormalities related to the injection. RESULTS AND CONCLUSION: Three days after the injection, the soft tissue fluid had returned to pre-injection levels or less in five of the six patients. No patients showed rotator cuff signal abnormalities related to the impingement test injection. We recommend a delay of 3 days before a shoulder MR examination after an injection has been performed, to avoid misinterpretations.

Polyostotic fibrous dysplasia with severe pathologic compression fracture of L2.

A case of a progressive pathologic compression fracture of L2 due to polyostotic fibrous dysplasia is presented. Such unusually severe involvement, requiring decompression and surgical fusion, in the absence of significant recent or remote trauma, has not previously been reported.

MR imaging of ulnar impaction.

The ulnar impaction syndrome of the wrist is a well-recognized clinical entity, usually showing distinct radiographic features including a positive ulnar variance and degenerative subchondral changes of the distal ulna, proximal lunate, and proximal triquetrum. Confirmation of the clinical and plain film findings with advanced imaging is often necessary to exclude other entities with a similar clinical presentation. Although arthrography and bone scintigraphy are helpful in this work-up, magnetic resonance imaging (MRI) appears to be both a sensitive and a specific means of evaluation. The imaging studies in four patients with clinically and surgically diagnosed ulnar impaction are described, with emphasis on MRI findings. MRI appears to be the modality of choice in the evaluation of patients with suspected ulnolunate impingement.

MR imaging of cyclops lesions.

OBJECTIVE: Localized anterior fibrosis (cyclops lesion) is a known cause of extension loss of the knee after anterior cruciate ligament (ACL) reconstruction. We describe MR imaging as a noninvasive diagnostic tool to examine cyclops lesions. SUBJECTS AND METHODS: Thirty-three MR studies of 31 patients with residual persistent extension loss after ACL reconstruction using patellar tendon autograft were reviewed and compared with results of second arthroscopy. We used MR imaging to describe the ACL graft signal intensity and course, tibial and femoral tunnel placement. quantitative measurements of notch size and shape, and the presence or absence of cyclops lesions. When a cyclops lesion was revealed on MR imaging, the signal-intensity characteristics, location, and size were documented. Preoperative MR imaging findings were then correlated with findings at arthroscopy. RESULTS: The sensitivity, specificity, and accuracy of revealing a cyclops lesion on MR imaging were 85.0%, 84.6%, and 84.8%, respectively. We found no statistically significant differences in the size of intercondylar notches for patients with and patients without cyclops lesions. CONCLUSION: MR imaging was sensitive, specific, and accurate in revealing cyclops lesions in a subgroup of patients with extension loss after ACL reconstruction.

Antimicrobial resistance of Haemophilus species in patients with chronic bronchitis.

Haemophilus influenzae strains resistant to ampicillin have become an important cause of disease in pediatric patients. Because many adults with chronic bronchitis carry Haemophilus organisms in their tracheobronchial tree and because antimicrobial agents are used commonly in these patients, we assessed the prevalence of resistance to ampicillin and other antimicrobial agents in this population. We studied 150 Haemophilus isolates (73 H. influenzae, 69 H. parainfluenzae, 6 H. parahemolyticus, and 2 H. hemolyticus) obtained from 138 patients with chronic bronchitis from January 1978 through March 1979. Ampicillin resistance due to production of beta-lactamase was found in 7 of the 150 isolates (4.7 %)-2 H. influenzae, 4 H. parainfluenzae and 1 H. parahemolyticus. Resistance to tetracycline was found in 9 strains (6 %), but all strains were susceptible to chloramphenicol.

[Stress fractures in athletes]. / Ermüdungsfrakturen bei Athleten.

Stress fractures are one of the most common overuse injuries seen in athletes, accounting for up to 20% of all injuries presented to sports medicine clinics. Runners are particularly prone to these injuries, however, it is difficult to predict injury as there is usually a critical interplay between the athlete's biomechanical predisposition, training methods, and other factors such as diet, and muscle strength and flexibility. This article will discuss the key clinical findings for the majority of stress fractures encountered in a sports medicine practice. A classification scheme will also be described that will allow the clinician to make appropriate treatment decisions based on the degree of risk for each injury.