Pelvic fractures-A guide to classification and management.

Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

Extensive perineal soft tissue disruption with 'open-book' pelvic fracture.

We present a case in which direct visualisation of the nature and extent of a perineal soft tissue injury following pelvic trauma was achieved through the use of multi-modality and multi-planar imaging. The case emphasises the importance of a flexible approach to imaging as a problem-solving technique after severe pelvic trauma.

Therapeutic impact of percutaneous spinal biopsy in spinal infection.

OBJECTIVE: To investigate the therapeutic impact of percutaneous spinal biopsy in patients with suspected spinal infection. DESIGN AND PATIENTS: A review of the case notes and imaging features of 36 patients who underwent percutaneous spinal biopsy was performed. From this group 20 patients with a prebiopsy diagnosis of spinal osteomyelitis were identified. Management before biopsy was noted including the use of antimicrobial therapy. The results of the histology and microbiology were noted along with the subsequent diagnosis and management. RESULTS: Eight of the 20 patients (40%) had received antibiotics before the biopsy. An organism was isolated in 8/20 cases (40%). Of the eight patients on antibiotics, two grew an organism (25%), including one case of candida in a patient receiving flucloxacillin. Out of 12 patients not on antibiotics there were six cases where an organism was isolated (50%). The result of the biopsy led to a change in management in seven of the 20 patients (35%). CONCLUSIONS: Many clinicians are treating spinal osteomyelitis empirically with antibiotics before biopsy, but this reduces the chance of isolating an organism and determining antibiotic sensitivity. Despite this biopsy led to a change in management in 35% of cases.

Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings.

OBJECTIVE: To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features. DESIGN AND PATIENTS: MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. RESULTS: Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist ( P=0.009). All other features showed no significant correlation ( P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present ( n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium ( P=0.048 and P=0.023) but not non-gadolinium sequences ( P>0.05). CONCLUSION: The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain.

A survey of self-restraint, self-injury, and other maladaptive behaviors in an institutionalized retarded population.

Psychologists of a state school for mentally retarded persons were surveyed to assess the prevalence of self-restraint, self-injurious behavior (SIB), and other maladaptive behaviors for clients in their facility. Results indicated that almost all clients reliably identified as engaging in self-restraint also engaged in self-injurious behavior while other maladaptive behaviors for self-restraining clients occurred much less frequently. The occurrence of SIB in the school's population was substantially lower than in the self-restraining population. Results are discussed in terms of future research investigating a functional relationship between self-restraint and SIB. Clinical implications for the use of self-restraint as an intervention for SIB also are discussed.

Micellar high-performance liquid chromatographic determination of folylpolyglutamate hydrolase activity.

A rapid and sensitive method for the quantitative determination of folylpolyglutamate hydrolase activity in crude tissue extracts was developed. The procedure is based on high-performance liquid chromatographic separation of folate analogue mono- and polyglutamates on a reversed-phase column using sodium dodecyl sulfate in water as the mobile phase. Interfering substances in tissue extracts were removed by gel filtration on centrifugally-eluted mini-columns of Sephadex G-25 prior to incubation of polyglutamate substrate with tissue extract hydrolase. Reactions were terminated by denaturation of the enzyme in sodium dodecyl sulfate, which subsequently served as the micellar solvent system for chromatographic separation of substrate from reaction products.