Aneurysmal bone cyst developing after anterior cruciate ligament tear and repair.
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Biomedical subjects
Publications and source records attributed to D Magid.
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Lymphoma can involve any part of the musculoskeletal system. Primary musculoskeletal lymphoma is rare but can occur in bone (reticulum cell sarcoma) or in the skin and subcutaneous tissues (mycosis fungoides). Secondary involvement in the musculoskeletal system is more common and can have a variety of radiologic findings. The definitive diagnosis of musculoskeletal lymphoma, however, is difficult to make by using imaging criteria alone. Any part of the musculoskeletal system can be involved and, therefore, a wide variety of primary and secondary neoplasms or inflammatory processes may have similar radiologic findings. The main differential diagnostic considerations, depending on the age of the patient and the clinical presentation, include osteosarcoma, Ewing's tumor, metastatic disease (from breast, lung, thyroid, or renal primary lesions), as well as chronic osteomyelitis or myositis. Primary and secondary bone lymphoma can be indistinguishable radiologically and histologically, but modern imaging techniques allow more accurate differentiation of primary from secondary bone involvement. This pictorial essay illustrates the CT findings of primary and secondary lymphoma involving bone, muscle, and skin and subcutaneous tissues.
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Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease.
The widespread diffusion of affordable computers into the scientific and educational community has provided the opportunity to design medical and scientific teaching programs illustrated either by hand or by utilizing commercially available software and manipulating existing computer generated images. The medical illustrator can provide the ideal aesthetic link between text format information and the visual representation of such knowledge in a concise presentation format. The availability of interactive multimedia programs has given the medical illustrator an environment to create and enhance Hypermedia designed specifically for the purpose of medical education. This paper will focus on the incorporation of illustration and screen design into "CT The Game," an experimental medical teaching program currently being developed in the Johns Hopkins Body CT Imaging Laboratory. The program is designed to provide an enjoyable approach to learning Computed Tomography (CT), and is directed toward an audience of medical students, residents, and fellows.
The increasing availability of personal and departmental computers in radiology departments has led to increasing interest in data management. Data base management software must be system compatible, simple, and flexible to insure its acceptance and constant use. Once in place, such a system streamlines the daily documentation of interesting cases for conference, follow-up, research, and quality assurance. The authors have developed such a data base program for tracking computed body tomography cases in their department, which can be run as a portable computer to maximize ease of access and therefore usage.
In what ways and under what conditions does an object appear to differ from its enantiomorph (its mirror reflection)? This 'mirror question' or its popular counterpart, "Why does a mirror reverse left and right but not up and down?" is frequently encountered, but an acceptable answer is not to be found in the literature. The question is approached as an experimental problem in visual psychophysics. A mirror optically reverses the axis perpendicular to its surface. What are the perceptual consequences of this stimulus transformation? This question is examined in four experiments by using stimuli of varying complexity and familiarity. Apparent reversals are demonstrated along right-left, front-back, top-bottom, and oblique axes, depending on the perceived asymmetries of the stimulus object. Perceived asymmetry is shown to depend both on structural asymmetries and on canonical axes and orientations defined by social convention. It is concluded that an object appears to differ from its enantiomorph by an apparent reversal along the axis of least perceived asymmetry. Implications for perceptual frames of reference and for the perception of symmetry are discussed.
Conventional transaxial computed tomography (CT) is superior to plain radiography in depicting the sacrum. Because of the shape and orientation of the sacrum, CT provides oblique views of the structures of interest. With easily reproducible landmarks and standard transaxial CT data, orthogonal image sets can be produced that provide a true en face orientation matching the obliquity of the sacrum. This allows optimal visualization of the paired foramina and of the sacroiliac joints for better assessment of trauma, tumor, or inflammatory disease.
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CT plays a limited but distinct role in the evaluation of the hand and wrist. It is most useful in assessing bone and joint anatomy and has only a secondary role in soft tissue abnormalities. The clearest value of CT is in assessing trauma and post-traumatic complications, such as malunion, nonunion, or avascular necrosis, where careful attention to position and technique can yield important information not otherwise obtainable.
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The prevention of the spread of acquired immunodeficiency syndrome (AIDS) depends on an educated public reducing their risk of infection. To test the hypothesis that effective community AIDS education can be based in an emergency department, we designed and evaluated two educational interventions in a high-volume urban ED. A pretest/post-test design was used in which subjects were assigned to receive either an active education program, a passive education program, or no education program. Knowledge gains and self-reported risk-reduction behavior were evaluated by follow-up testing within a five-week period. The active and passive groups had significantly greater knowledge gains than the control group (P less than .001). Significantly greater reported reductions in high-risk behavior were found in both the active and passive groups compared with the control group (P less than .01). This study demonstrates that an ED-based AIDS education program can have a significant impact on improving knowledge and reducing self-reported risk behaviors.
Malignant melanoma is an aggressive neoplasm that can involve virtually every organ system. This article provides a review of the various appearances on computed tomographic (CT) scans of melanoma involving the chest, abdomen, and musculoskeletal system. Specific emphasis is placed on the typical and atypical CT manifestations of disease as well as the similarity of these findings to those for other disease entities. The importance of accurate staging of melanoma is stressed.
Thirteen patients with 15 ankle fractures potentially requiring surgical reduction according to plain film criteria were studied with transaxial CT, from which static and animated interactive two-dimensional (2-D) images and animated volumetric three-dimensional (3-D) images were generated. CT criteria believed to parallel well-accepted plain film criteria for triage of ankle fractures were developed and applied. The tibiofibular, talofibular, and tibiotalar articulations were characterized and, where possible (nine cases), compared with the (presumably normal) contralateral ankle. Talocrural angle measurements were made on interactive coronal measurements and compared with standard plain film measurements. Fracture fragment displacement, rotation, and impaction were noted. Posterior tibial lip disruption was quantified. Information derived from the 2-D/3-D CT study led to cancellation of proposed surgery in three of the distal fibular fractures and in two distal tibial fractures. There was far less variation than anticipated between the talocrural angles of the injured and normal ankles, and both injured and normal ankles deviated significantly from the accepted standard of 84 degrees. Displacement at the level of the fibular fracture was a poor predictor of more distal disruption. Two-dimensional CT was found to provide anatomic detail and information superior to either plain film or 3-D CT; 3-D CT was preferred by the surgeons for final surgical planning and for integration of the 2-D data. CT altered management in five of the 13 patients studied, supporting our belief that 2-D/3-D CT can be of significant value in assessing ankle fractures.
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Multimedia is a form of computer data presentation that uses multiple formats (text, illustration, sound, and animation) to enhance attention to and retention of presented information. Hypermedia is a nonlinear, branched access version of this that allows the user to pursue information more freely and variably than a linear format does. We used the hypermedia format to create an interactive medical teaching program that we believe holds the user's interest and attention better than a straight-text style does.
The care of lung cancer patients involves a specialized team approach. Complications arising from the underlying illness or its treatment are common occurrences that must be anticipated and treated properly. Psychosocial issues commonly arise in patients and their families during the course of the illness. Caregivers skilled in helping a patient and family members come to terms with this frequently fatal disease are integral members of a multidisciplinary team of cancer specialists.
The bony pelvis should be carefully evaluated on computed tomography (CT) scans of the lower abdomen and pelvis performed for staging cervical cancer or for evaluating suspected recurrence. CT provides optimal imaging of the spine and pelvis, frequently providing a clinically relevant supplement to bone scan or plain film information. In a study of eight patients with skeletal metastases from cervical carcinoma and three cases of radiation osteitis, overlap existed in their imaging characteristics. Metastases were always lytic but nearby sclerotic areas from radiation were often present. Radiation osteitis may be lytic, sclerotic, or mixed, and both may avidly accumulate bone-scanning radiotracers. The absence of a soft tissue mass, slow progression, blastic elements, and sharply defined borders on CT suggest radiation necrosis. However, in some lesions within a radiation portal, biopsy or MRI may be required for final diagnosis.