Patient perception of magnetic resonance arthrography.

OBJECTIVE: Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients' perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. DESIGN AND PATIENTS: Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including "pain", "needles", "complications", and "discovery of results that would lead to surgery". In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. RESULTS: While many patients expressed fear of "pain" and "needles", after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. CONCLUSION: Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.

MR imaging of anterosuperior calcaneal process fractures.

OBJECTIVE: Fractures of the anterosuperior calcaneal process can be both clinically and radiographically difficult to detect yet, if not recognized and immobilized early, may result in painful nonunion. The purpose of this study was to show that MR imaging is sensitive in the detection of such subtle or radiographically occult fractures, that the pattern of marrow edema corresponds to the two known mechanisms of injury, and that MR imaging can document both healing and nonunion of these fractures. CONCLUSION: MR imaging can reveal subtle or nondisplaced fractures of the anterosuperior calcaneal process. Also, MR imaging can be used to document healing. The pattern of marrow edema limited to the anterosuperior calcaneal process corresponds to the bifurcate ligament avulsion mechanism of injury. Edema in both the anterosuperior calcaneal process and the cuboid is caused by the impaction mechanism of injury.

Treatment of acute esophageal food impaction with glucagon, an effervescent agent, and water.

OBJECTIVE: In 1990, we described a combination therapy that uses glucagon, an effervescent agent, and water to relieve acute esophageal food impaction. The initial trial showed relief of the obstruction in 12 of 16 cases without complication, so we continued the series to determine the safety and effectiveness of this technique. SUBJECTS AND METHODS: Between July 1987 and August 1993, a prospective trial consisting of 43 patients with 48 episodes of acute (less than 24-hr duration) food impaction in the distal two thirds of the esophagus were identified with either a barium or water-soluble contrast agent swallow. Subsequently, we attempted to relieve the obstruction by using 1 mg of IV glucagon, an effervescent agent, and water. A water-soluble esophagogram was obtained immediately in all cases to determine the response to the therapeutic intervention and to look for any complication such as perforation. RESULTS: The combination therapy resulted in the clearance of food obstruction in 33 (69%) of 48 attempts. One complication, a minor mucosal laceration, occurred after two unsuccessful treatments. A lower esophageal ring was the single most common abnormality identified (n = 24). The average width of rings in the successful cases was 15.4 mm and the average in the unsuccessful cases was 13 mm. Other underlying causes of obstruction were esophagitis and stricture. CONCLUSION: Our experience with the use of glucagon, an effervescent agent, and water to relieve acute esophageal food impaction indicates that the technique is highly successful and that serious complications are rare.