Role of Musculoskeletal Radiology in Modern Sports Medicine.

Musculoskeletal radiology's role in the recent and continued evolution of sports medicine is an exciting and expanding one. In this article we explore a variety of the ways that musculoskeletal radiology contributes to current practices in modern sports medicine, discussing advances across a variety of imaging modalities in the care of both elite athletes and so-called weekend warriors. We describe the technical and ethical factors pertaining to image-guided therapeutic intervention in athletes and speculate on the potential for future developments in the role of imaging in deciding when an athlete may return to participation. We also explore the recent shift to the delivery of imaging facilities at sporting events and in stadiums.

Neuroimaging of central diabetes insipidus-when, how and findings.

Central or neurogenic diabetes insipidus (CDI) is due to deficient synthesis or secretion of antidiuretic hormone (ADH), also known as arginine vasopressin peptide (AVP). It is clinically characterised by polydipsia and polyuria (urine output > 30 mL/kg/day) of dilute urine (< 250 mOsm/L). It is the result of a defect in one of more sites involving the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei of the hypothalamus, median eminence of the hypothalamus, infundibulum or the posterior pituitary gland. A focused MRI pituitary gland or sella protocol is essential. There are several neuroimaging correlates and causes of CDI, illustrated in this review. The most common causes are benign or malignant neoplasms of the hypothalamic-pituitary axis (25%), surgery (20%), head trauma (16%) or familial causes (10%). No cause is identified in up to 30% of cases. Knowledge of the anatomy and physiology of the hypothalamo-neurohypophyseal axis is crucial when evaluating a patient with CDI. Establishing the aetiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. The aim of the pictorial review is to illustrate the wide variety of causes of CDI on neuroimaging, highlight the optimal MRI protocol and to revise the detailed neuroanatomy and neurophysiology required to interpret these studies.

The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?

OBJECTIVES: The Z0011 trial questioned the role of axillary ultrasound (AxUS) in preoperative staging of breast cancer in patients with ≤2 positive sentinel lymph nodes (SLN). The purpose of this study was to correlate the number of abnormal nodes on AxUS with final nodal burden and determine the utility of AxUS with sampling (AxUS + S) in preoperative staging. METHODS: Six hundred and seventy-nine patients underwent pre-operative AxUS. Suspicious nodes were sampled. Negative axillae proceeded to SLN biopsy. The number of abnormal nodes identified on ultrasound and final histology as well as sensitivity and specificity for AxUS + S were calculated. Subgroup analysis was performed on Z0011 eligible patients. RESULTS: Two hundred and ninety-six patients had positive axillary nodes on final histology with 169 detected by AxUS + S (sensitivity 86.2%, specificity 100%, PPV 100 %, NPV 71.9%). Patients with nodal metastases identified by AxUS had a mean burden of 7.3 nodes on histology (1 node on AxUS = 5.2 nodes on histology, 2 nodes on AxUS = 7.5 nodes, >2 nodes = 10.1 nodes). Patients diagnosed on SLNB had a mean burden of 2.2 nodes. CONCLUSION: A single nodal metastasis detected on AxUS + S correlated with a mean of 5.2 nodes on final histology highlighting that AxUS remains essential in guiding appropriate management of the axilla in breast cancer. KEY POINTS: • Axillary ultrasound +/- sampling is an essential technique in preoperative axillary staging. • Axillary ultrasound findings correlate with final histological axillary node disease burden. • Axillary ultrasound can help triage patients who require axillary lymph node dissection. • The role of axillary ultrasound in breast cancer staging continues to evolve.

The lack of augmentation by aspirin of inhibition of platelet reactivity by ticlopidine.

A decreased threshold for platelet activation apparently contributes to the risk of cardiovascular events, such as acute myocardial infarction. To evaluate the impact of specific agents, we characterized platelet reactivity in 9 healthy subjects before and after 5 days of ingestion of 4 commonly prescribed regimens, 81 mg of aspirin daily, 325 mg of aspirin daily, ticlopidine 250 mg twice daily, and ticlopidine plus 325 mg of aspirin daily. Platelet reactivity was assessed with (1) aggregometry induced by 4 microM adenosine diphosphate (ADP) and collagen (0.19 mg/ml) and performed in platelet-rich plasma; and (2) flow cytometric determination of ADP-induced (0.2, 0.8, and 1.5 microM) P-selectin expression in whole blood. Because anticoagulants alter platelet reactivity, results were obtained with 3 anticoagulants, citrate, enoxaparin, or corn trypsin inhibitor (CTI, a specific inhibitor of factor XIIa without effect on other coagulation factors). Ingestion of aspirin did not alter platelet activation as assessed with flow cytometry. Inhibition of the second phase of aggregation was seen with ADP-induced aggregation in platelet-rich plasma anticoagulated with citrate but not enoxaparin or CTI. Ingestion of ticlopidine led to inhibition of ADP-induced aggregation and P-selectin expression. Inhibition of platelet reactivity after the combination of aspirin and ticlopidine did not differ from ticlopidine alone. Marked interindividual variability in platelet reactivity was seen after ingestion of ticlopidine. The results indicate that assessment of effects of specific pharmacologic regimens with accurate and readily available assays of platelet reactivity may facilitate effective prophylaxis and treatment of high-risk subjects with antiplatelet regimens designed to optimally diminish platelet reactivity.

Viral antibodies in coyotes from California.

Prevalence of antibodies against canine parvovirus (CPV), canine distemper virus (CDV), and canine adenovirus type 1 (CAV) were determined among 152 coyotes (Canis latrans) at the Naval Petroleum Reserves (NPRC; California, USA) from 1985 to 1990. Overall prevalence of antibodies to CPV, CDV, and CAV was 66%, 37%, and 68%, respectively. Prevalence of CPV and CDV varied significantly among years. Antibody prevalence did not differ between sexes for any disease, but did vary significantly among age classes and was lowest for pups (< 1-yr-old). Among pups, antibody prevalence increased with age for all three diseases. Coyotes are a potential source of viral exposure for endangered San Joaquin kit foxes (Vulpes macrotis mutica), but variation in coyote abundance did not appear to influence antibody prevalence among kit foxes.

Serum chemistry values of the endangered San Joaquin kit fox (Vulpes macrotis mutica).

Serum chemistry values were obtained from 64 adult San Joaquin kit foxes (Vulpes macrotis mutica) in western Kern County, California (USA). The goal of the study was to establish normal chemistry values for this endangered species. No significant differences were found for mean values of alanine aminotransferase (217.1 IU/l), alkaline phosphatase (44.2 IU/l), cholesterol (145.6 mg/dl), total protein (5.8 g/dl), creatinine (0.63 mg/dl), calcium (8.2 mg/dl), albumin (3.0 g/dl), glucose (129.2 mg/dl), amylase (196.8 IU/l), sodium (153.7 mEq/l) and phosphorus (5.42 mg/dl) between sexes or seasons. Significant differences were noted for aspartate aminotransferase, blood urea nitrogen and potassium between seasons. Possible disturbances in normal hepatic and renal functions were noted.

Killing of Cryptococcus neoformans by human peripheral blood mononuclear cells stimulated in culture.

Since cell-mediated immunity (CMI) is critical for host defenses against the encapsulated fungus Cryptococcus neoformans, the production of human antifungal effector cells as a consequence of the CMI response was investigated. Peripheral blood mononuclear cells (PBMC) were stimulated in culture with killed C. neoformans. Stimulated (but not unstimulated) PBMC killed a subsequent inoculum of live encapsulated organisms, with maximal killing seen after 3-7 days. Killing required the presence of both adherent and nonadherent stimulated PBMC and was enhanced by anticapsular antibody. In contrast, unstimulated PBMC and the adherent fraction of stimulated PBMC killed an isogenic acapsular strain of C. neoformans. These data suggest that the CMI response controls cryptococcosis by eliciting two populations of fungicidal cells acting synergistically. Moreover, capsule, by thwarting the ability of unstimulated PBMC to kill C. neoformans, seems to obligate the host to mount an immune response to generate fungicidal cells.

Growth inhibition of Cryptococcus neoformans by cultured human monocytes: role of the capsule, opsonins, the culture surface, and cytokines.

Despite a presumed critical role of macrophages in the host response to cryptococcal infections, previous studies have failed to show growth inhibition of encapsulated Cryptococcus neoformans by human peripheral blood cultured monocyte-derived macrophages (MO-M phi). Here, we examined whether MO-M phi could be induced to inhibit growth of an encapsulated strain and an isogenic acapsular mutant strain of C. neoformans. MO-M phi were cultured in microwells, and inhibition was measured by comparing CFU at 0 and 24 h after fungal challenge. MO-M phi cultured on plastic surfaces failed to inhibit growth of the encapsulated strain, even in the presence of pooled human serum and/or anticapsular antibody. Moreover, the presence of anticapsular antibody significantly enhanced fungal growth. However, if MO-M phi were cultured on surfaces coated with fibronectin or poly-L-lysine (but not laminin or collagen) and yeast cells were opsonized with pooled human serum, then complete growth inhibition occurred. Preincubation with various concentrations of tumor necrosis factor, granulocyte macrophage colony-stimulating factor, 1,25-dihydroxycholecalciferol, or supernatants from C. neoformans-stimulated lymphocytes failed to activate macrophages for enhanced antifungal activity. The addition of gamma interferon resulted in a significant loss of growth inhibition. For the acapsular strain, complete growth inhibition was observed regardless of the choice of culture surface, opsonins, or cytokines. Fungicidal activity, as measured by a significant decrement in CFU compared with the initial inoculum, was not observed under any conditions tested. These data demonstrate that macrophages are capable of inhibiting cryptococcal growth but that this capacity is markedly influenced by the culture surface, opsonins, cytokines, and the fungal capsule.

Human neutrophil degranulation stimulated by Aspergillus fumigatus.

Previous studies have established that human neutrophils (PMN) are unable to kill resting conidia (RC) of Aspergillus fumigatus but can kill conidia that have been preincubated in culture medium until swollen but not yet germinated. Compared with swollen conidia (SC), RC stimulate a relatively weak PMN respiratory burst. In the present study, we further examined the mechanisms of resistance of RC to neutrophil killing by comparing neutrophil degranulation and phagocytosis following stimulation by RC and SC opsonized in pooled human serum. RC, compared with SC, stimulated significantly less release of both the primary granule marker beta-glucuronidase and the secondary granule marker lactoferrin. PMN also phagocytosed significantly greater numbers of SC, although the differences in phagocytosis were not great enough to account for the differences in degranulation. Suboptimal stimulation of degranulation and phagocytosis may thus contribute to the inability of neutrophils to kill RC. Moreover, reagent lactoferrin bound avidly to both RC and SC, raising the possibility that PMN-released lactoferrin may contribute to antifungal activity at the conidial surface by competing for iron or catalyzing the formation of oxygen radicals.

Results of a cleanup and treatment test at the Nevada test site: evaluation of vacuum removal of Pu-contaminated soil.

We have conducted experiments to evaluate the effectiveness of removing contaminated soils from the Nevada Test Site with a large truck-mounted vacuum cleaner. Our results show that this method is effective, relatively easy, and safe for equipment operators. With four passes of the truck-mounted vacuum, 92% of the 241Am (and the accompanying 239 + 240Pu) was removed and resuspension rates were reduced by more than 99%. The ecological impact was, however, serious in terms of soil erosion and destruction of small animal habitats. Compared to standard earth-moving techniques, vacuuming permits a significant reduction in the volume of soil collected to achieve the desired level of decontamination, and the volume reduction could result in cost savings for packaging, shipment, and burial. This cost savings would only be realized for projects involving decontamination of the top 5 cm of soil.

Activation of C3 and binding to Aspergillus fumigatus conidia and hyphae.

Complement activation by Aspergillus fumigatus may play a crucial role in stimulating binding and killing of this organism by phagocytes. We examined the amount and type of C3 deposited on resting conidia, swollen conidia, and hyphae of A. fumigatus after incubation in pooled human serum. All three life forms of A. fumigatus were potent activators of the complement cascade, with deposition on the organisms of similar amounts of C3 per unit of surface area. The rate of deposition was slowest for resting conidia, although maximal deposition was still achieved within 40 min. The roles of the alternative and classical pathways were assessed by use of serum chelated with magnesium EGTA [magnesium ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid] and with an alternative pathway reconstituted from the six purified alternative-pathway proteins. Complement activation by resting conidia was mediated by the alternative pathway. In contrast, there was a progressive dependence on the classical pathway as the fungal particles matured into swollen conidia and then hyphae. Treatment with hydroxylamine, which disrupts ester linkages, removed 89 to 95% of the C3 bound to all three forms of A. fumigatus. This released C3 contained a mixture of C3b and iC3b, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. These data demonstrate that although all three forms of A. fumigatus are potent activators of the complement system, the transition from resting conidia to swollen conidia to hyphae results in progressive changes in the manner in which the fungal particles interact with the complement system. The lack of participation of the classical pathway in complement activation by resting conidia may have important implications regarding their ability to effectively stimulate phagocytes.

Radionuclide transport from soil to air, native vegetation, kangaroo rats and grazing cattle on the Nevada test site.

Between 1970 and 1986 the Nevada Applied Ecology Group (NAEG), U.S. Department of Energy, conducted environmental radionuclide studies at weapons-testing sites on or adjacent to the Nevada Test Site. In this paper, NAEG studies conducted at two nuclear (fission) sites (NS201, NS219) and two nonnuclear (nonfission) sites (Area 13 [Project 57] and Clean Slate 2) are reviewed, synthesized and compared regarding (1) soil particle-size distribution and physical-chemical characteristics of 239 + 240Pu-bearing radioactive particles, (2) 239 + 240Pu resuspension rates and (3) transuranic and fission-product radionuclide transfers from soil to native vegetation, kangaroo rats and grazing cattle. The data indicate that transuranic radionuclides were transferred more readily on the average from soil to air, the external surfaces of native vegetation and to tissues of kangaroo rats at Area 13 than at NS201 or NS219. The 239 + 240Pu resuspension factor for undisturbed soil at Area 13 was three to four orders-of-magnitude larger than at NS201 and NS219, the geometric mean (GM) vegetation-over-soil 239 + 240Pu concentration ratio was from ten to 100 times larger than at NS201, and the GM GI-over-soil, carcass-over-soil and pelt-over-soil 239 + 240Pu ratios for kangaroo rats were about ten times larger than at NS201. These results are consistent with the finding that Area 13, compared with NS201 or NS219, has a higher percentage of radioactivity associated with smaller soil particles and a larger percentage of resuspendable and respirable soil. However, the resuspension factor increased by a factor of 27 at NS201 when the surface soil was disturbed, and by a factor of 12 at NS219 following a wildfire. The average (GM) concentration of 239 + 240Pu for the GI (and contents) of Area 13 kangaroo rats and for the rumen contents of beef cattle that grazed Area 13 were very similar (400 vs. 440 Bq kg-1 dry wt, respectively) although the variability between individuals was very large. The GM carcass-over-GI 239 + 240Pu concentration ratio for kangaroo rats at Area 13, Clean Slate 2, and NS201 were similar in value (approximately 2 X 10(-2)), as were the GM GI-over-vegetation concentration ratios (approximately 2 X 10(0)) (no statistical differences).(ABSTRACT TRUNCATED AT 400 WORDS)

Serological survey for selected diseases in the endangered San Joaquin kit fox (Vulpes macrotis mutica).

Blood from endangered San Joaquin kit foxes (Vulpes macrotis mutica) inhabiting the Elk Hills Naval Petroleum Reserve, Kern County, and the Elkhorn Plain, San Luis Obispo County, California, was collected in 1981, 1982 and 1984 and sera were tested for antibodies against 10 selected pathogens. Proportions of kit fox sera containing antibodies against pathogens were: canine parvovirus, 100% in 1981-1982 and 67% in 1984; infectious canine hepatitis virus, 6% in 1981-1982 and 21% in 1984; canine distemper virus, none in 1981-1982 and 14% in 1984; Francisella tularensis, 8% in 1981-1982 and 31% in 1984; Brucella abortus, 8% in 1981-1982 and 3% in 1984; Brucella canis, 14% in 1981-1982 and none in 1984; Toxoplasma gondii, 6% in 1981-1982; Coccidioides immitis, 3% in 1981-1982; and Yersinia pestis and Leptospira interrogans serotypes canicola, grippotyphosa, hardjo, icterohaemorrhagiae, and pomona, none in 1981-1982. Although antibodies against selected pathogens were present, no clinical indications of disease were observed in these fox populations.

Hematologic values of the endangered San Joaquin kit fox, Vulpes macrotis mutica.

Between 1981 and 1982 blood samples were collected from 64 adult San Joaquin kit foxes, Vulpes macrotis mutica, in western Kern County, California. The goal of the study was to establish normal blood values for this endangered species, and to determine whether changes in them could be used to assess the possible effects of petroleum developments on these foxes. None of the values differed significantly between the sexes, or between foxes sampled in developed habitats compared with foxes sampled in undisturbed habitats. Mean values of Hb, MCH, MCHC, and WBC counts differed significantly between summer and winter. Average hematological characteristics were: RBC, 8.4 X 10(6)/microliter; Hb, 14.5 g/dl (summer), 15.6 g/dl (winter); PCV, 46.9%; MCV, 56.3 fl; MCH, 17.8 pg (summer), 18.4 pg (winter); MCHC, 31.2 g/dl (summer), 33.2 g/dl (winter); and WBC, 6,200/microliter (summer), 7,500/microliter (winter). Comparisons of hematological data for kit foxes, coyotes (Canis latrans), and wolves (Canis lupus) confirmed a previously published observation that within mammalian families RBC counts are correlated inversely with body weight, and that MCV is correlated directly with body weight.

Unilateral abdominal mass: an unusual presentation of autosomal dominant polycystic kidney disease in children.

Autosomal dominant polycystic kidney disease is rarely diagnosed in infancy or childhood. The renal involvement is typically bilateral. We describe two children with ADPKD (autosomal dominant polycystic kidney disease) presenting with a unilateral renal mass. The value of a careful genetic history and the role of sonography will be discussed.

Intravenous alimentation and insensible water loss in low-birth-weight infants.

Insensible water loss (IWL) was measured in six premature infants, between 4 and 21 days of age, by continuous weight monitoring on an electronic balance inside an incubator. Multiple measurements of IWL were made during the sequential infusion of 10% dextrose in 0.225% NaCl, 10% dextrose-amino acid solution, or 10% dextrose-amino acid and a commercial intravenous fat emulsion. Each solution was administered for three hours by constant infusion through a scalp vein needle. The order of the infusion was random and a 30- to 60-minute infusion with 5% dextrose water was given between each solution. During the infusion of 10% dextrose in 0.225% NaCl and 10% dextrose + amino acid solution, IWL was 1.0 +/- 0.8 gm/kg/hr and 1.1 +/- 0.8 gm/kg/hr, respectively. In contrast, IWL increased significantly to 1.6 +/- 0.7 gm/kg/hr when additional calories were given using the 10% dextrose-amino acid with the intravenous fat emulsion (P less than .005). There was a positive correlation between calorie intake and IWL. These data suggest that parenteral nutrition solutions with intravenous fat emulsion are rapidly metabolized and the increase in IWL is probably secondary to an increase in thermogenesis.

Radiation effects in free-ranging pocket mice, Perognathus parvus, during the breeding season.

Captive and free-ranging Great Basin pocket mice, Perognathus parvus, were exposed to ionizing radiation during the breeding season, April-June, in 1971. The values for the median lethal dose (LD(50)) at 30 days plus or minus the standard deviation were 880 +/- 14 rads and 780 +/- 27 rads, respectively, and the slopes of the survivorship curves were significantly different. These differences suggested that there was a synergism between radiation-induced and environmental sources of mortality, since the field data were corrected for natural mortality (5 percent) in the controls.