Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament-Torn Knees.

BACKGROUND: Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. PURPOSE: To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. RESULTS: Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations (P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. CONCLUSION: The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).

Ovarian teratoma presenting as small bowel obstruction in an elderly lady-A case report.

Teratomas of the ovary are of the mature or immature type. The mature variety is called dermoid cysts, which is the most frequent benign germ cell tumour of the ovary in the reproductive age group. They are usually asymptomatic until they reach a significant dimension.(1) Pressure effect, torsion and rupture of an ovarian cyst may present as an acute abdomen. A case is presented where an elderly lady presented with small bowel obstruction due to a very large, non-adherent to the intestine, dermoid cyst.

Magnetic resonance arthrography of the shoulder: accuracy of gadolinium versus saline for rotator cuff and labral pathology.

OBJECTIVE: The purpose of this study was to evaluate the necessity of intra-articular gadolinium versus saline alone in magnetic resonance arthrography (MRA) of the shoulder. MATERIALS AND METHODS: Our database was reviewed for 100 consecutive shoulder MRA examinations performed between January 2007 and December 2007. Patient information was blinded and images were retrospectively reviewed by at least two radiologists with dedicated musculoskeletal training. T2-weighted (T2W) images were initially analyzed in isolation to simulate MRA with saline alone. After a delay, the full study was analyzed including T1-weighted (T1W) and T2W images. If there was a significant discordance between the two analyses with regard to rotator cuff or labral pathology, the study was again reviewed by all evaluators in consensus to determine if the T1W images offered additional diagnostic information and increased diagnostic confidence. RESULTS: Of the 100 MRA examinations, there were 15 discordant cases. Two cases were discordant with regard to rotator cuff pathology and 13 were discordant on the basis of labral pathology. When the discordant cases were reviewed in consensus, the T2W images appeared to display rotator cuff and labral pathology as definitively as the T1W images. Interobserver and intraobserver variability was favored to have played a role in causing the discordances. CONCLUSIONS: MRA of the shoulder performed with joint distention provided by saline alone appears to offer equivalent diagnostic information to MRA performed with gadolinium enhancement. This protocol modification improves efficiency by eliminating several image series and provides a small cost savings by eliminating gadolinium.

Non-epithelial malignancies and metastatic tumours of the breast.

INTRODUCTION: Non-epithelial breast malignancies include primary lymphomas, sarcomas, haematological malignancies, melanomas as well as secondary metastases to the breast. They account for less than 1% of all breast tumours. The demographics and clinical features are similar to epithelial breast cancers but the prognosis and management options are often very different. Most reported series are small with limited follow-up. The main aim of this study was to review our experience for these malignancies and to compare this with the published literature. METHODS: A 14-year retrospective review of all breast resection specimens was completed in the Antrim Area Hospital Cancer Unit. Clinical records of patients diagnosed with non-epithelial breast malignancies were then reviewed for data regarding patient demographics, clinical presentation, pre-operative investigations, operative findings and outcome. Pathology reports were examined carefully for tumour type, location and for evidence of lymphovascular spread. This data was compared with the available literature. RESULTS: Nineteen (F = 16) patients were found to have non-epithelial breast malignancies between April 1994 and August 2007. Mean age was 61.6 years (range 25-86). 17 patients (89.5%) presented with a palpable lump, mastalgia or skin change, while 2 (10.5%) patients' tumours were detected through screening. The histological types of non-epithelial malignancies were as follows: lymphoma (n = 8; M = 1 and F = 7, mean age: 68.5 range 52-86), sarcoma (n = 5; M = 1 and F = 4, mean age 56.4 range 29-69), malignant melanoma (n = 3; M = 1 and F = 2, mean age 54.3 range 25-70), multiple myeloma (n = 1; F, 71), metastatic renal cell carcinoma (n = 1; F, 63) and metastatic carcinoid tumour (n = 1; F, 52). The mean follow-up was 1541 days (32-4589 days). Nine patients were alive at the end of follow-up. Only 1 of 11 deaths was not directly related to the malignancy. The average time from surgery to death was 798.5 days (range 32-3248 days). CONCLUSION: Non-epithelial breast malignancies are rare cancers with significant mortality rates. Correct diagnosis and avoidance of inappropriate therapies requires a comprehensive triple assessment and a multidisciplinary management approach.

Substituted hexahydrobenzodipyrans as 5-HT2A/2C receptor probes.

A pair of substituted hexahydrobenzodipyrans was designed as molecular probes for determining the steric restrictions of the agonist binding site of serotonin 5-HT2A and 5-HT2C receptors. The rationale for the design of these receptor ligands, their chemical synthesis, rat behavioral pharmacology in the two-lever drug discrimination assay using LSD-trained rats, affinity for cloned rat 5-HT2A and 5-HT2C receptors and agonist functional activities are reported.