Recognizing upper-extremity stress lesions.

Athletes in sports such as baseball, gymnastics, weight lifting, javelin, and racket sports are susceptible to stress lesions in the bones of the upper extremities. Injuries range from periostitis to bone spurs to stress fractures. Injuries in adolescents typically involve the growth plates, while midshaft injuries at the area of muscle insertion are more common in adults. It's especially important to detect these injuries in adolescents because untreated stress lesions at growth plates can have serious consequences. Plain films demonstrate obvious fractures and physeal injuries, but triple-phase bone scans are often needed to define the extent of stress lesions.

Differentiating Stress Fracture From Periostitis.

In brief Even in the age of high-technology MRI and CT, the triple-phase bone scan (TPBS) remains an exceptionally useful and accurate tool in evaluating athletic injuries. This is perhaps best seen in active people with overuse injuries of the tibia, femur, or humerus when plain films are negative but bone pain persists. Differentiating periostitis from stress fracture requires analyzing distinctive TPBS appearances and patterns.

The role of nuclear medicine bone scans in evaluating pain in athletic injuries.

The utilization of nuclear medicine bone scanning examinations early in the diagnostic process allows physicians to render prompt and correct treatment in urgent or difficult athletic cases. Bone scanning should be performed for athletic injuries whenever (1) x-rays are normal but bone or joint pain persists; (2) x-rays are positive but it cannot be determined if the findings are acute or chronic; (3) soft-tissue injuries present and x-rays are not useful; and (4) bone pain or joint impairment present without a history of trauma.

Bullet embolus: heart to right femoral artery.

Our case report of survival from a cardiac gunshot wound with subsequent embolization to the right femoral artery has included plain films and arteriographic confirmation, a review of the mechanics of intracardiac bullet embolization, its incidence, survival rates, and management, and review of the literature.

Testicular radionuclide angiography and static imaging: anatomy, scintigraphic interpretation, and clinical indications.

Radionuclide testicular angiography and static imaging is an easy, rapidly performed study. Its usefulness in separating acute testicular torsion from acute epididymitis has been confirmed. Increased angiographic perfusion with definition of the testicular and deferential arteries in the spermatic cord and the pudendal artery posteriorly is equated with inflammation. Intense increased vascularity on the blood pool image is seen in abscess and acute inflammation, while cases of tumor and trauma have mild increases. Acute or missed testicular torsion, uncomplicated hydroceles, and spermatoceles show absent vascularity. On the static images, decreased activity is characteristic of the stage and location of the avascular structure, Technical factors are stressed.

Management of foot conditions of the diabetic patient.

Twenty-five years' experience in the management of the diabetic foot is reviewed. Diagnostic aids and surgical principles which proved worthwhile in preventing major amputations are stressed.