Caudal slope of the tibia and its relationship to noncontact injuries to the ACL.

To determine the role that an increased caudal slope of the tibia might have on the incidence of anterior cruciate ligament (ACL) injury, tibial slope was measured in 49 patients (50 knees), with noncontact ACL injury mechanisms (group 1) and an age-matched group of 39 patients (50 knees) with a diagnosis of patellofemoral pain syndrome (group 2). No significant difference was noted in mean posterior slope between the two groups (group 1: 9.7+/-1.8 degrees and group II: 9.9+/-2.1 degrees) or after controlling for bilateral patients in two separate trials. These results indicate that increased caudal tibial slope does not appear to be a risk factor in the creation of noncontact injuries to the ACL.

Owner satisfaction with partial mandibulectomy or maxillectomy for treatment of oral tumors in 27 dogs.

Twenty-seven dogs with oral tumors were treated with either rostral mandibulectomy, partial mandibulectomy, or partial maxillectomy. Owner satisfaction with the respective surgical procedure was assessed by telephone survey; 85% of owners were satisfied with the decision to treat their dogs. The percentage of satisfied owners was directly proportional to the increase in pet life span. Although difficulty in eating was noted for 12 (44%) of 27 dogs, pain was perceived to be reduced by the surgery for most animals. All owners found the cosmetic appearances of their dogs acceptable after facial hair regrew. The quality of the pets' lives was perceived by the owners to be most improved after rostral mandibulectomy and least improved after partial maxillectomy.

The impact of 2D versus 3D quantitation of tumor bulk determination on current methods of assessing response to treatment.

PURPOSE: Measurements from sequential axial "2D" data in cancer patients are commonly used to assess treatment response or disease progression. This study compares the volume of tumor bulk calculated with 3D reconstructions with that calculated by conventional methods to determine if it might change patient classification. METHOD: All medical, gynecologic, and pediatric oncology patients under treatment who were evaluated with serial CT scans between January 1, 1992, and July 31, 1994, for whom the digital data were available were included in this study. For each tumor site, the maximum diameter and its perpendicular were measured and multiplied together to yield an area. The sum of areas of the measured lesions was used as an approximation of overall 2D tumor volume. In addition, the 2D area of each site was multiplied by its height, yielding a 2D volume. Last, the digital data were loaded into a 3D computer system and total 3D tumor volumes determined. All medical and gynecologic oncology patients were treated based upon the 2D area of tumor. The pediatric oncology patients were treated based upon the 2D volume of tumor measured as per standard practice. The members of each treating oncologic service assessed their patients as to how the other two methods would have changed their classification of the patients' response category. RESULTS: Four hundred thirty-three CT scans were performed in 139 patients, which included 204 baseline and 294 follow-up CT examinations. Seventy patients had new tumor foci and would have been classified as failure by all three methods of tumor bulk measurement. The 3D volume versus the 2D area method of tumor bulk assessment would have changed response categories in 52 of the 294 follow-up CT examinations (p < 0.0001). Thirty-five patients were recategorized from either "no response" to "failure" (21 patients) or "no response" to "response" (14 patients) categories. If only those follow-up studies without new metastatic foci are considered, the 3D volume versus the 2D area methods of tumor assessment would have changed the treatment response category in 23.2%. The use of the 2D volume method of calculating tumor volume of bulk tended to overestimate the overall tumor size by an average of 244 cm3 (p = 0.001). CONCLUSION: The 3D method of tumor volume measurement differs significantly from conventional 2D methods of tumor volume determination. Large prospective studies analyzing the usefulness of 3D tumor volume measurements and assessing possible changes in patient response categories would be required for full utilization of this more accurate method of following disease bulk.

The quality of 3D reconstructions from 1.0 and 1.5 pitch helical and conventional CT.

PURPOSE: CT data are commonly used to create 3D images. For this purpose, thin and overlapped slices are desirable. Helical (spiral) CT offers the ability to adjust the slice reconstruction interval from 0 to 100%. However, its use in 1.0 and 1.5 pitch helical CT and 3D imaging, especially with respect to surface detail, is relatively untested. METHODS: Ten objects selected for their varying size, shape, and density were scanned (fourth generation Picker PQ2000) by contiguous 2,4 and 8 mm conventional and helical sequences. The latter were obtained with a pitch of both 1.0 and 1.5 and were reconstructed into a 3D image with 0-75% overlapping of the reconstructed slices. Each of the 24 different sequences per scanned object was reconstructed into identical sets (projections) of 3D images displayed on color film. The 24 3D image sets for each object were submitted to six blinded radiologists who separately ranked them from best to worst. RESULTS: 3D reconstructions obtained from CT scans with a thinner slice thickness, half-field (15 cm FOV), and helical technique were rated as statistically superior. The 1.0 and 1.5 helical sequences obtained with a 4 or 8 mm slice thickness scored statistically better than 3D reconstructions from equivalent conventional scans. Overlapping of the reconstructed helical slices by 25-75% generally improved the quality of the 3D reconstruction. CONCLUSION: Helical CT with either a 1.0 or a 1.5 pitch offers the ability to obtain higher quality 3D reconstructions than from comparable conventional CT scans.

Take-home informed consent for intravenous contrast media: do patients learn more?

RATIONALE AND OBJECTIVES: In 1978, Morrow et al published the results of a simple technique for raising radiation oncology patients' levels of awareness about medical options. They reported that providing written information at least 24 hours in advance was an effective tool for increasing the baseline knowledge in this patient group. However, Morrow's cohort consisted exclusively of cancer patients receiving radiation therapy. The authors of this article are concerned with whether the encouraging results reported by Morrow are reproducible when applied to patients awaiting invasive radiologic procedures. METHODS: One hundred sixty consecutive outpatients awaiting contrast were block randomized into one of eight groups based on age, sex, and previous contrast exposure. For each group, half were given their consent form at least 24 hours prior, and the other half at the time of their procedure. All patients were tested at the time of their procedure to evaluate knowledge retention. RESULTS: Comparison between the two study groups showed no overall statistically significant differences either in knowledge (experimental group 4.7 +/- 1.32 versus 4.38 +/- 1.30 control group) or level of satisfaction. Additionally, individuals experienced with contrast failed to outperform those who had never previously been given contrast. There is no significant difference in the performance between the two sexes regardless of group. CONCLUSIONS: The providing of information 24 to 72 hours in advance of an invasive procedure does not have a beneficial effect over just providing the same information at the time of the study.

Fine-needle aspiration biopsy versus fine-needle capillary (nonaspiration) biopsy: in vivo comparison.

PURPOSE: To evaluate, in vivo, the efficacy of fine-needle capillary (nonaspiration) biopsy (FNCB) versus fine-needle aspiration biopsy (FNAB) when performed at the same site with a coaxial technique. MATERIALS AND METHODS: In 91 patients, biopsy was performed at 140 sites in 93 lesions mostly throughout the chest and abdomen with either FNCB or FNAB, or both (98 sites). A coaxial technique with a 22-gauge needle was used. The quality of the specimen was graded by a blinded pathologist, who also made a pathologic diagnosis. RESULTS: No statistically significant difference was noted in the graded criteria performance plus diagnostic yield between the two techniques. When performed before FNAB, FNCB yielded a better quality specimen of a particular site. However, there was no difference in the graded quality of FNAB whether performed before or after FNCB. Insufficient specimens were obtained at 30 (21.4%) of 140 sites with FNCB versus only 18 (12.8%) with FNAB. CONCLUSION: FNCB is an alternative to FNAB and provides a cellular diagnostic specimen from most lesions. When a coaxial method is used and both techniques are employed, the diagnostic accuracy of these techniques is 84%.

CT percutaneous biopsy guns: comparison of end-cut and side-notch devices in cadaveric specimens.

OBJECTIVE: The purpose of this study was to compare the efficacies of four different types of end-cut biopsy guns with the side-notch Tru-cut biopsy gun. MATERIALS AND METHODS: A total of 25 liver, 15 kidney, 10 pancreas, and 15 breast biopsies were performed in the tissue from five autopsies with each of 12 different biopsy devices/biopsy depths. The tissue obtained was evaluated by an experienced cytopathologist who, not knowing which gun was used to obtain each specimen, used a predetermined grading scheme. RESULTS: When tissue was obtained, the end-cut biopsy guns performed equivalently to the side-notch biopsy gun in all four tissues. However, the end-cut guns had a significant number of "zero" biopsies (biopsy attempts during which no tissue was obtained). The proportion of zero biopsies with the end-cut guns ranged from up to 28% in the liver to 60% and 73% in the breast and kidney, respectively. CONCLUSION: The end-cut biopsy guns are easy to use and potentially can obtain high-quality specimens. However, the rate of zero biopsies during which no tissue is obtained is a serious deficiency. As a result, the use of the end-cut biopsy gun should be encouraged only for use with an introducer, with which multiple biopsy specimens can easily be obtained without additional needle punctures.