The value of injectable viscoelastic supplements for joints.

Intra-articular viscoelastic supplements are commonly administered by musculoskeletal radiologists for the treatment of symptomatic osteoarthritis (OA). This article provides an overview of the putative mechanism of action of the agents, a brief review of the evidence base underlying the practice, a commentary on some of the major society guidelines regarding the treatment, and a description of the adverse events that are associated with intra-articular hyaluronic acid administration.

Sports-Related Groin Pain Secondary to Symphysis Pubis Disorders: Correlation Between MRI Findings and Outcome After Fluoroscopy-Guided Injection of Steroid and Local Anesthetic.

OBJECTIVE: The objective of our study was to correlate patterns of injury on preprocedural MRI with outcome after targeted fluoroscopy-guided steroid and local anesthetic injection of the symphysis pubis and its muscular attachments in a group of athletes with chronic groin pain. MATERIALS AND METHODS: Forty-five patients with chronic sports-related groin pain underwent MRI of the pelvis and a targeted fluoroscopy-guided symphyseal corticosteroid and local anesthetic injection. Preprocedural MRI was reviewed. The presence or absence of a "superior cleft" sign (i.e., rectus abdominis-adductor longus attachment microtearing), "secondary cleft" sign (i.e., short adductor [gracilis, adductor brevis, and pectineus muscles] attachment microtearing), osteitis pubis, and extrasymphyseal pelvic abnormalities was recorded. Patients were followed up a mean time of 23 months after the procedure, and outcome was recorded. Correlation was made between preprocedural MRI findings and outcome. RESULTS: Forty-two percent of the patients had an isolated superior cleft sign, 7% had an isolated secondary cleft sign, and 11% had isolated osteitis pubis. Thirty-one percent of patients had a more complex injury, and 9% had a normal symphysis pubis. Overall, 89% of the patients experienced an improvement in symptoms. The response was sustained after a minimum of 6 months in 58% of the patients. The presence of the superior cleft sign was more frequently associated with a complete recovery. CONCLUSION: Fluoroscopy-guided corticosteroid symphyseal injection is a safe and effective treatment of sports-related groin pain. It is more frequently associated with a complete recovery in patients who display an isolated superior cleft sign on MRI. MRI not only is useful in characterizing groin injuries but also may be helpful in predicting response to therapeutic injection.

Injectable Viscoelastic Supplements: A Review for Radiologists.

OBJECTIVE: Hyaluronic acid (HA) is increasingly used by musculoskeletal radiologists in the treatment of osteoarthritis (OA). Although the evidence base for its efficacy is controversial, it remains in common use. With initial evidence suggesting its efficacy in the knee, it is now offered for treating OA of the hip, ankle, and elsewhere. CONCLUSION: HA is available in a wide variety of preparations, which may vary in concentration and chemical composition. Clinicians offering intraarticular HA injection should be familiar with the common preparations available and the principal differences between them, its mechanism of action, and the profile of adverse effects associated with its use.

Attitudes of the medical profession to whole body and organ donation.

Cadaveric dissection remains an important part of undergraduate medical education in anatomy. In a concerted effort to rise the number of doctors in practice in Ireland the amount of medical school placements has been increased steadily since 1995. This poses a problem as the number of cadavers has remained unchanged despite an overall increase in the population Ireland over the last twenty years. The medical profession plays a central part in raising public awareness of living and post-mortem organ donation. Previous studies have examined the attitudes of medical students to whole body donation, however to our knowledge this is the first study that evaluates the attitudes of medical professionals. We assess the opinions of junior and senior doctors at the time of their dissection experience and in their current practice. We show that their attitudes have changed as their clinical experience grows.

Pain relief after varicocele embolization: The patient's perspective.

INTRODUCTION: Long-term efficacy of treatment with varicocele embolization is poorly documented from the patient's perspective. This study assessed patients' perceived changes in pain scores pre- and post-testicular vein embolization. In addition, the effect of testicular vein embolization on quality of life (QoL) parameters was assessed. METHODS: All patients treated with embolization for varicocele-related orchalgia were analysed (2009-2015). A standardized pain impact questionnaire was used to assess pain scores pre- and post-procedure. The primary outcome was to assess patients' pain relief post-varicocele embolization. The secondary outcome was patients' perceived efficacy of the embolization procedure in terms of improvement in QoL parameters. RESULTS: Sixty patients underwent varicocele embolization due to persistent orchalgia; of which 44 responded to the questionnaire. The mean pre-procedural pain score was 5.4/10 (range of 1.5-9). Post-procedure questionnaire was performed at a median of 58 months (range 28-106 months). At 1, 6 and 12 months post-procedure, the mean pain score was 1.57, 0.55 and 0.3, respectively. 50% (n = 22) reported complete pain relief 1-month post-embolization while 89% (n = 39) of patients reported complete resolution of pain at 1 year. Among the measured QoL parameters; varicocele embolization resulted in significant improvement in return to work, housework, socializing, exercise, sexual relations, and sleeping post-embolization (P < 0.01). CONCLUSION: Varicocele embolization results in a durable reduction in pain scores compared to their pre-operative values. Information from this study will allow clinicians to convey the potential improvements in pain parameters to patients undergoing embolization of symptomatic varicoceles.

The role of liver resection in patients with metastatic breast cancer: a systematic review examining the survival impact.

INTRODUCTION: Approximately 10% of breast cancer patients will present with solid organ metastases, while up to 30% will develop metastatic disease during their treatment course. Liver metastases are usually treated with systemic chemotherapy. Although colorectal liver metastases are routinely resected, this is not yet the standard of care for breast cancer-related liver metastases. This review examines the evidence for resection of breast cancer-related liver metastases. METHODS: A systematic review identified 25 articles for inclusion, 12 papers concerning patients with isolated liver metastases, and 13 papers concerning patients with extrahepatic metastases. Data from 1080 patients were included. RESULTS: Two hundred eighty patients underwent hepatic resections for breast cancer-associated metastases with no extrahepatic metastases. Reported 5-year survival ranged from 24.6 to 78%. Median overall survival ranged from 29.5 to 116 months. For patients with oligometastatic disease undergoing resection, 5-year survival ranged from 21 to 57%, with median overall survival ranging from 32 to 58 months. Reported 30-day morbidity ranged from 14 to 42% for isolated and multiple metastases. CONCLUSION: Hepatic resection can be considered in the management of breast cancer patients with isolated liver metastases as well as those with oligometastatic disease.

Uterine Artery Embolization: An Analysis of Online Patient Information Quality and Readability with Historical Comparison.

RATIONALE AND OBJECTIVES: Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing. MATERIALS AND METHODS: A list of applicable, commonly used searchable terms was generated, including "Uterine Artery Embolization," "Fibroid Embolization," "Uterine Fibroid Embolization," and "Uterine Artery Embolisation." Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded. RESULTS: The most common applicable term was "Uterine Artery Embolization" (492,900 results). Mean DISCERN quality of information provided by UAE websites is "fair"; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization-recommended 7-8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites. CONCLUSIONS: Quality of online UAE information remains "fair." Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7-8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information.

Is the Internet a Suitable Patient Resource for Information on Common Radiological Investigations?: Radiology-Related Information on the Internet.

RATIONALE AND OBJECTIVE: This study aimed to assess the quality of Internet information about common radiological investigations. MATERIALS AND METHODS: Four search engines (Google, Bing, Yahoo, and Duckduckgo) were searched using the terms "X-ray," "cat scan," "MRI," "ultrasound," and "pet scan." The first 10 webpage results returned for each search term were recorded, and their quality and readability were analyzed by two independent reviewers (DJB and LCY), with discrepancies resolved by consensus. Analysis of information quality was conducted using validated instruments for the assessment of health-care information (DISCERN score is a multi-domain tool for assessment of health-care information quality by health-care professionals and laypeople (max 80 points)) and readability (Flesch-Kincaid and SMOG or Simple Measure of Gobbledygook scores). The search result pages were further classified into categories as follows: commercial, academic (educational/institutional), and news/magazine. Several organizations offer website accreditation for health-care information, and accreditation is recognized by the presence of a hallmark or logo on the website. The presence of any valid accreditation marks on each website was recorded. Mean scores between groups were compared for significance using the Student t test. RESULTS: A total of 200 webpages returned (108 unique website addresses). The average DISCERN score was <50 points for all modalities and search engines. No significant difference was seen in readability between modalities or between search engines. Websites carrying validated accreditation marks were associated with higher average DISCERN scores: X-ray (39.36 vs 25.35), computed tomography (45.45 vs 31.33), and ultrasound (40.91 vs 27.62) (P < .01). Academic/government institutions produced material with higher DISCERN scores: X-ray (40.06 vs 22.23), magnetic resonance imaging (44.69 vs 29), ultrasound (46 vs 31.91), and positron emission tomography (45.93 vs 38.31) (P < .01). Commercial websites produced material with lower mean DISCERN scores: X-ray (17.25 vs 31.69), magnetic resonance imaging (20.8 vs 40.1), ultrasound (24.11 vs 42.35), and positron emission tomography (24.5 vs 44.45) (P < .01). CONCLUSIONS: Although readability is adequate, the overall quality of radiology-related health-care information on the Internet is poor. High-quality online resources should be identified so that patients may avoid the use of poor-quality information derived from general search engine queries.

A bibliometric analysis of the citation classics of acute appendicitis.

INTRODUCTION: Acute appendicitis is one of the most commonly encountered emergency surgical conditions. An understanding of the most highly cited research works in this field is key to good evidence based clinical practice. AIMS: To perform a bibliometric analysis on the 100 most frequently cited articles in the field of acute appendicitis. METHODS: The database of the Institute for Scientific Information (ISI) Web of Science Expanded citation index was searched to identify the 100 most frequently cited articles in the field of acute appendicitis. The web of science expanded citation index tracks article citations made since 1946. RESULTS: The top 100 most frequently cited articles were selected for analysis in this series. The most frequently cited article was cited 649 times and the least cited three article 93 times. The average number of citations per article was 167.74. The top 100 cited articles originated from 17 countries. Over half of the papers originated from the USA. Fifty-one of the papers concentrated on diagnostics of acute appendicitis. Thirty-six papers looked at the treatment of acute appendicitis with 30 of these dealing with the surgical management of the disease. There were 6 studies at level 1a, 20 studies at level 1b and 43,5,17 and 9 studies at levels 2, 3, 4 and 5 respectively. CONCLUSIONS: Bibliometric analysis of the citation classics in a given field can provide interesting insights into the relationship between the quality of research outputs and clinical practice. The study of acute appendicitis remains an active field of research with a growing body of higher quality evidence underpinning our clinical practice.

Disappearing portal venous gas in acute pancreatitis and small bowel ischemia.

We report an usual case of hepatic portal venous gas (HPVG) in the setting of acute pancreatitis and small bowel ischemia. Interestingly, the HPVG disappeared within 2 hours of the original computed tomography scan, despite the patient having small bowel ischemia. The patient had a complicated clinical course, dying 62 days postadmission. This case highlights that HPVG in setting of acute pancreatitis and small bowel ischemia has a very high morbidity and mortality, requiring early detection and aggressive surgical management.