Value of MRI of the brain in patients with systemic lupus erythematosus and neurologic disturbance.

Our objective was to review the frequency and pattern of signal abnormalities seen on conventional MRI in patients with suspected neuropsychiatric systemic lupus erythematosus (NP-SLE). We reviewed 116 MRI examinations of the brain performed on 85 patients with SLE, (81 women, four men, aged 21-78 years, mean 40.6 years) presenting with neurological disturbances. MRI was normal or nearly normal in 34%. In 60% high-signal lesions were observed on T2-weighted images, frequently in the frontal and parietal subcortical white matter. Infarct-like lesions involving gray and white matter were demonstrated in 21 of cases. Areas of restricted diffusion were seen in 12 of the 67 patients who underwent diffusion-weighted imaging. Other abnormalities included loss of brain volume, hemorrhage, meningeal enhancement, and bilateral high signal in occipital white-matter. The MRI findings alone did not allow us to distinguish between thromboembolic and inflammatory events in many patients. Some patients with normal MRI improved clinically while on immunosuppressive therapy. More sensitive and/or specific imaging methods, such as spectroscopy and perfusion-weighted imaging, should be investigated in these subgroups of patients with suspected NP-SLE.

An fMRI version of the Farnsworth-Munsell 100-Hue test reveals multiple color-selective areas in human ventral occipitotemporal cortex.

Studies of patients with cerebral achromatopsia have suggested that ventral occipitotemporal cortex is important for color perception. We created a functional magnetic resonance imaging (fMRI) version of a clinical test commonly used to assess achromatopsia, the Farnsworth-Munsell 100-Hue test. The test required normal subjects to use color information in the visual stimulus to perform a color sequencing task. A modification of the test requiring ordering by luminance was used as a control task. Subjects were also imaged as they passively viewed colored stimuli. A limited number of areas responded more to chromatic than achromatic stimulation, including primary visual cortex. Most color-selective activity was concentrated in ventral occipitotemporal cortex. Several areas in ventral cortex were identified. The most posterior, located in posterior fusiform gyrus, corresponded to the area activated by passive viewing of colored stimuli. More anterior and medial color-selective areas were located in the collateral sulcus and fusiform gyrus. These more anterior areas were not identified in previous imaging studies which used passive viewing of colored stimuli, and were most active in our study when visual color information was behaviorally relevant, suggesting that attention influences activity in color-selective areas. The fMRI version of the Farnsworth-Munsell test may be useful in the study of achromatopsia.

Arthroscopic rotator cuff repair using a transhumeral approach to fixation.

A new technique for arthroscopic rotator cuff repair using arthroscopically placed transhumeral sutures is presented. After an adequate acromioplasty is performed, a modified anterior cruciate ligament tibial drill guide is used to drill two or more transhumeral holes from the metaphyseal-diaphyseal junction of the humerus to the greater tuberosity. Sutures are then passed into these holes and through the rotator cuff using cannulated needles. The sutures are tied manually and the repair is inspected. The postoperative protocol is presented. The new technique may be superior to the current methods for arthroscopic rotator cuff repair in that (1) the strength of fixation does not rely on the quality of the bone in the greater tuberosity of the humeral head (which can be quite poor) as suture anchor techniques do, (2) the sutures are easily passed through the rotator cuff without relying on complicated suture passing techniques, (3) the knots are tied without the aide of an arthroscopic knot-tying device, and (4) in cadaveric studies, the failure strength of this new repair was equal to the strength of a traditional open repair. Prospective studies are ongoing to assess the efficacy of this new technique.

Guidelines for privileges in arthroscopic surgery.

This report sets forth flexible guidelines to be used by hospitals or surgery centers to define privileges in arthroscopic surgery. The Arthroscopy Association of North America recognizes that the completion of a residency program, fellowship training, or hands-on workshop does not, per se, guarantee competence in arthroscopic surgery. The demonstration of an applicant's technical and motor skills by direct observation is a vital component of the credentialing process. Threshold criteria of state licensure, completion of surgical residency training, documentation of prior experience, and existing orthopaedic surgical privileges are defined. Levels of complexity of arthroscopic procedures are divided as basic and advanced.

Arthroscopic management of tibial plateau fractures.

Twenty-one tibial plateau fractures with 1 to 5 years follow-up are reviewed for the purpose of demonstrating the positive impact arthroscopy can have on patients sustaining this injury. Controversy between open and nonopen management has existed for decades. Arthroscopy bridges that controversy, allowing the advantages of accurate reduction and rigid fixation without extensive operative exposure. In addition, arthroscopy allows thorough lavage, removal of loose fragments, and accurate diagnosis of associated intraarticular pathology. Since extensive exposure is avoided, rapid recovery with reduced pain and early full range of motion is achieved in patients managed arthroscopically. Biomechanics of rigid percutaneous internal and external fixation are presented to demonstrate that no principles are compromised in arthroscopic management. Associated meniscal and ligamentous injuries in this series are treated either arthroscopically or through secondary accessory incisions. Fractures are classified as to the applicability of arthroscopic management.