Case report 612: Rhabdomyosarcoma of the right psoas muscle.
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Biomedical subjects
Publications and source records attributed to D Magid.
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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.
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Computed tomography (CT) has revolutionized the evaluation of musculoskeletal pathology. Until recently, however, CT of the postoperative orthopaedic patient has been severely limited by its inability to provide useful information in the vicinity of acetabular and femoral implants. Typically the hardware produces extensive artifacts that can markedly degrade the whole image. Methods are now available to reduce the metal artifact. Following hip arthroplasty, these methods have been used to plan for revision arthroplasty and to evaluate the contralateral side for avascular necrosis.
Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool (copyright and trademark of the Body CT Imaging Laboratory, Department of Radiology, The Johns Hopkins Medical Institutions) that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.
Volumetric image processing is a new approach to generating simulated three-dimensional images from transaxial CT data. The major advantages compared to conventional surface-rendering 3D technique include: preservation of every pixel of CT data for increased accuracy of rendered image; tissue layer translucency allowing appreciation of multiple tissue layers on each image; simulation of real-time rotation in varying axes for optimal appreciation of abnormalities; and a high-speed, high-capacity computer setup which generates high-quality images rapidly, giving the system sufficient flexibility for these complicated functions while remaining user friendly and fast.
A new software program provides the real-time display of high-resolution computed tomographic reformation in the axial, coronal, sagittal, or oblique views. The advantages of this new technique over the standard multiplanar format include (a) larger image display format, (b) reconstruction of entire dataset for each of up to 192 sections, (c) real-time viewing, (d) interactive real-time oblique imaging, and (e) on-screen correlation of multiplanar and three-dimensional images.
Advanced computed tomographic and computer graphic techniques enhance diagnostic accuracy and offer the means by which three-dimensional operative planning can be achieved. These techniques have been used to diagnose hip pathology, rehearse and evaluate surgical plans, assess postoperative results, and design individualized prostheses.
Transaxial computed tomographic (CT) data can be used to generate images rapidly in the coronal and sagittal planes (two-dimensional CT) and create simulated three-dimensional images. The techniques and advantages of an integrated two-dimensional/three-dimensional CT approach to musculoskeletal trauma are illustrated and discussed.
Three-dimensional imaging has evolved rapidly. We believe that volumetric image processing (VIP) represents a major advance within this modality. VIP preserves the fidelity of the original computed tomography (CT) data and allows the viewer to interact with the images in real time. This complements and integrates the information acquired on two-dimensional CT studies, as illustrated in three representative cases.
Fifty-six patients with musculoskeletal disorders involving the shoulder were examined using two-dimensional computed tomography multiplanar reconstruction and volumetric three-dimensional (3D) image processing. Two- and three-dimensional imaging of the shoulder demonstrated advantages over conventional radiography in clarifying areas of complex anatomy. The techniques were found most beneficial for (1) delineating complex fractures; (2) evaluating joint instability; (3) localizing foreign bodies; (4) detecting lytic lesions; (5) assessing soft tissue pathology; and (6) identifying causes for decreased range of motion. Two-dimensional multiplanar reconstruction provided superior views of the scapula and permitted a better understanding of the orientation of the glenoid. Multiplanar reconstruction displayed deep soft tissue anatomy more clearly, including the course of important neurovascular structures. Volumetric 3D imaging added several unique perspectives, providing a more comprehensive representation of the shoulder and its articulating surfaces. The ability to rotate the shoulder about he vertical and horizontal axes in an animated video loop and to edit away confusing, overlying structures provided a "real-time" 3D model of the shoulder for planning treatment.
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