Risk assessment for anterior cruciate ligament injury.

INTRODUCTION: Anterior cruciate ligament tears are one of the most frequent soft tissue injuries of the knee. A torn anterior cruciate ligament leaves the knee joint unstable and at risk for further damage to other soft tissues manifested as pain, dislocation, and osteoarthritis. A better understanding of the anatomical details of knee joints suffering anterior cruciate ligament tears is needed to understand and develop prediction models for anterior cruciate ligament injury and/or tear. MATERIALS AND METHODS: Magnetic resonance images of 32 patients with anterior cruciate ligament tears and 40 patients with non-tears were evaluated from a physician group practice. Digital measurements of femoral condyle length, femoral notch width, anterior cruciate ligament width in the frontal and sagittal plane, and the anterior cruciate ligament length in the sagittal plane were taken in both groups to identify trends. Monte Carlo simulations were performed (n = 2000) to evaluate the relationship between notch width index and sagittal width and to establish functional relationships among the anatomical parameters for potential injury risk. Sensitivity analysis performed shows the risk of anterior cruciate ligament injury a function of force and notch width index. RESULTS: Females have a significantly shorter anterior cruciate ligament when compared to that of males. The notch width index was also significantly different between torn and non-torn individuals. The NWI was not significantly different between genders (p value = 0.40). CONCLUSIONS: Anterior cruciate ligament injury has been shown to be caused by the forces which act on the ligament. These forces can result from hyperextension of the tibia or the internal rotation of tibia. The anatomical parameters of the knee joint (i.e., notch width index, anterior cruciate ligament width and length) have no role in the cause of an injury.

An unusual case of metastasis to the left side of the heart: a case report.

INTRODUCTION: Cardiac metastases are found in six to 20% of autopsies of patients with malignant neoplasm. The most common neoplasms that metastasize to the heart are malignant melanoma, lymphoma, and leukemia, but the relative numbers are greater with breast and lung cancers, reflecting the most common incidence of these cancers. CASE PRESENTATION: A 60-year-old Hispanic man presented to our hospital after being transferred from an outside hospital for workup and evaluation of an adrenal mass of the abdomen and pelvis, found on computed tomography. His chief complaint upon admission was altered mental status. Physical examination was unremarkable. He was alert and oriented and had a dry and non-erythematous oropharynx, and bilateral diffuse wheezing on lung examination. Computed tomography of the chest showed multiple hypodense lesions in the left ventricular myocardium, suggestive of metastases. There were also tiny sub-centimeter nodular densities in the right upper and lower lobes. Adrenal glands contained hypodense lesions, which showed characteristic adenocarcinomatous malignant cells. CONCLUSION: Cancers which have metastasized to the heart are found in six to 20% of patients with malignant neoplasms. The right side of the heart is more commonly involved in metastasis. This study is unusual in that a tumor of an unknown primary origin had metastasized to the left side of the heart.

Iodixanol: risk of subsequent contrast nephropathy in cancer patients with underlying renal insufficiency undergoing diagnostic computed tomography examinations.

OBJECTIVE: To assess the risk of contrast-induced nephropathy in cancer patients with underlying renal insufficiency receiving the iso-osmolar intravenous contrast agent iodixanol for diagnostic computed tomography (CT) examinations. METHODS: Institutional review board approval was obtained with waiver of informed consent. Our study was a retrospective evaluation comparing the incidence of contrast-induced nephropathy in consecutive patients with underlying renal insufficiency undergoing diagnostic CT examinations receiving iodixanol from November 2003 to June 2005 with a comparison group of patients with normal baseline renal function over the same period. Renal insufficiency was considered a serum creatinine level more than 1.2 mg/dL in females and more than 1.5 mg/dL in males. Contrast nephropathy was considered an absolute elevation of 0.5 mg/dL or 25% elevation in serum creatinine level. RESULTS: In the group of patients receiving iodixanol with underlying renal insufficiency (189 patients), 9.0% developed contrast nephropathy (P = 0.015) with 4.8% of patients developing irreversible renal damage (P = 0.03). This compared with 4.9% of patients receiving iodixanol (185 patients) and 3.1% of patients receiving iohexol (194 patients) with normal baseline renal function developing contrast nephropathy (P = 0.38) with 3.2% of the iodixanol patients and 1.0% of the iohexol patients developing irreversible renal damage (P = 0.13). CONCLUSIONS: The risk of contrast-induced nephropathy is significantly higher in patients with underlying renal insufficiency receiving iodixanol than that for patients with normal baseline renal function, but this should not serve as an absolute contraindication for these patients to receive intravenous iodinated contrast for diagnostic CT examinations particularly in patients with life-threatening clinical questions in which contrasted CT may provide valuable information.