Imaging the infrapatellar tendon in the elite athlete.

Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated.

MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases.

AIM: To describe the magnetic resonance imaging (MRI) features of posterior ankle impingement syndrome (PAIS) in classical ballet dancers. MATERIALS AND METHODS: A retrospective review was undertaken of 25 MRI examinations of the ankle performed on 23 ballet dancers over a 26-month period. Images were examined for the presence of osseous and soft-tissue anatomical variants at the posterior ankle and imaging signs of PAIS. All patients presented with symptoms and signs suggestive of PAIS including posterior ankle pain, swelling and stiffness during plantar flexion. RESULTS: Anatomical variants predisposing to PAIS including as os trigonum and tuberosity arising from the superior calcaneum were clearly depicted. The most common imaging feature of PAIS in our series was high T2 signal posterior to the talocalcaneal joint indicating synovitis (n = 25). Thickening of the posterior capsule (n = 13) and tenosynovitis of flexor hallucis longus (n = 17) were also common. An os trigonum was an infrequent finding (n = 7). Bone marrow oedema, commonly in the posterior talus (n = 10) or in a patchy distribution (n = 10) was often noted. CONCLUSION: MRI is a useful diagnostic tool in PAIS, and in the present series, clearly demonstrates the anatomical variants and range of osseous and soft-tissue abnormalities associated with this condition. Prospective studies are needed to understand the significance and importance of individual MRI findings in producing the symptoms of PAIS.

Medium-term dexa analysis of an uncemented femoral component.

We investigated the bone remodelling around the AML uncemented femoral component using DEXA analysis and plain radiography in 19 patients at a mean of 89 months from operation. All patients had previously been analysed at a mean of 32 months after surgery. We found a decrease in bone mineral density around the AML implant between the two scans in Gruen zones 1,2 and 6 of up to 8%, but an increase in zones 4,5 and 7 of up to 36%. The increase in zones 4 and 5 were statistically significant (P>0.05). The relative difference between the operated and unoperated hips also showed a reduction in the bone density ratio with time, except in zones 4 and 5 where an increase was seen. We confirm the results of previous studies of proximal stress shielding and distal loading around the AML implant and demonstrate that bone remodelling continues in the medium term. (Hip International 2004; 14: 182-8).

Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication.

OBJECTIVE: This study was carried out to examine the neuropsychological status of patients treated for pituitary tumour by transfrontal surgery, transphenoidal surgery or medical treatment only, with or without radiotherapy. DESIGN AND MEASUREMENTS: Three groups of 23 patients who had been treated for pituitary tumour were compared with 23 healthy controls on a range of neuropsychological measures. The surgical patients were also subdivided into two groups and compared. The neuropsychological measures were standardized psychological tests designed to assess aspects of attention, memory and executive function. PATIENTS: The patients were those who had been treated with transfrontal surgery (n = 23), transsphenoidal surgery (n = 23) and medication only (n = 23). The groups did not differ with respect to age, education or premorbid ability level as assessed by the National Adult Reading Test. All participants were free of known sources of cognitive impairment other than pituitary tumour. RESULTS: Comparison of the four groups revealed that nearly half of the transfrontal, one-third of the transsphenoidal and one-quarter of the non-surgical group had three or more neuropsychological tests scores below the 10th percentile compared to less than 5% of the controls. Impairments in memory and executive function were found in both surgical groups. The non-surgical patients appeared to have problems only on tasks requiring high levels of cognitive processing. Differences were found between the two surgical groups with respect to the severity of the cognitive impairment, the transfrontal patients having more severe impairment than the transsphenoidal. No significant negative effects on cognitive functioning were associated with radiotherapy; however, transfrontal surgery patients who had not been treated with radiotherapy were found to be more impaired than other patients. This was thought to be related to radical surgery. CONCLUSIONS: Many patients with treated pituitary tumour suffer significant cognitive impairment. The severity and nature of impairment differs between treatment groups, although the cause of this could not be addressed by this study. Recommendations are made for future research and clinical practice.

The effect of treatment variables on mood and social adjustment in adult patients with pituitary disease.

OBJECTIVE: Studies of mood in hypopituitary adults have yielded inconsistent results. This investigation was carried out to investigate whether treatment characteristics may be responsible for the inconsistent results. DESIGN AND MEASUREMENTS: We compared three groups of patients with a group of matched healthy controls on self-report measures of mood and social adjustment (Beck depression inventory, State-trait anxiety inventory, Social adjustment scale (modified)) and a measure of quality of life (Nottingham health profile, NHP). PATIENTS: The patient groups were those treated with transfrontal surgery (n = 23), transsphenoidal surgery (n = 23) or medication only (n = 23). In addition, a close informant of each subject was asked to complete a social adjustment measure about the subject's level of adjustment. RESULTS: On the self-report mood and social adjustment measures and the emotion sub-scale of the NHP, the transsphenoidal and medication patient groups rated themselves as being more depressed, anxious and having poorer social adjustment than the transfrontal or control groups. The close informants, however, rated all three patient groups as having poorer social adjustment than the controls. Patients treated with surgery and without radiotherapy reported fewer symptoms of depression than those treated with radiotherapy. Realistic self-appraisal of social adjustment in surgical patients was found only in those treated with transsphenoidal surgery without radiotherapy. CONCLUSIONS: Patients treated for pituitary tumour, excepting those treated with transfrontal surgery and to a lesser extent those treated with radiotherapy, suffer from mild mood disturbance and self-perceived decreased social adjustment. All patient groups are seen by others as having decreased social adjustment, raising the possibility that the transfrontal patients and possibly those who have had radiotherapy, lack insight. This may explain some of the discrepancies in the previous literature and needs to be taken into account when using self-report measures with these patients.

Cognitive dysfunction in patients treated for pituitary tumours.

Assessment of neuropsychological status and mood was carried out on 36 patients who had been treated for pituitary tumour and on 36 healthy controls. Impairments in memory and executive function were exhibited by the patients even when other known causes of cognitive dysfunction had been excluded. There was no difference in mood between the two groups, and the deficits in cognitive dysfunction were not related to mood disturbance or to the effects of radiotherapy. The defects were however, related to the presence of surgery, although not to the type of surgery. Reasons for the cognitive dysfunction are unclear but are likely to be multifactorial possibly including the effects of neurosurgery and/or hormone imbalance resulting from pituitary surgery.

Peer review as an aid to improving the completeness of psychiatric case notes.

Clinical auditing and the setting of goals for continuing education are often based on case note reviews. Deficiencies in the comprehensiveness of the recorded case history place some restrictions on the usefulness of such reviews as guides to continuing education programmes. In this study, attempts were made to improve the quality of the data in psychiatric case notes by peer discussion, and by altering the case note recording guidelines. After each educational intervention a further detailed audit of the subsequent case histories was performed. Significant differences emerged in a few subsections of the case notes, but overall there was little change. Possible explanations for these findings are discussed.

The reliability of a micro-computer administration of the MMPI.

A computerized version of the MMPI was developed that incorporated both administration and scoring. This method was compared with the original manual form (N = 87). The results indicated that the test-retest reliability was high regardless of the method of administration and that similar results were obtained on the computer and on the manual forms of the MMPI.