Altered leg muscle activity in volleyball players with functional ankle instability during a sideward lateral cutting movement

Objectives

To study the activation patterns of tibialis anterior, peroneus longus and gastrocnemius lateralis muscles during a lateral shuffle maneuver in volleyball players with functional instability of the ankle joint.

Design

Observational case-control study.

Setting

Research laboratory.

Participants

Sixteen players with functional instability and 18 matched controls.

Main outcome measures

RMS values of tibialis anterior, peroneus longus and gastrocnemius lateralis muscles for the 50 ms before initial ground contact, timing of onset of muscle activity and linear envelopes for the period of ground contact were calculated.

Results

Onset values showed similar patterns of activation for both groups. In healthy subjects, gastrocnemius lateralis activated earlier, followed by peroneus longus and tibialis anterior. In the unstable subjects, gastrocnemius lateralis and peroneus longus activated at the same time, followed by tibialis anterior. Unstable subjects also presented lower peroneus longus activity during the 50 ms before initial ground impact, a lower peroneus longus peak magnitude and a higher gastrocnemius lateralis peak magnitude.

Conclusions

Volleyball players with ankle functional instability showed decreased peroneus longus activity before ground impact that may predispose them to repetitive sprains and explain their “giving way” sensation, since peroneus longus is the main ankle evertor and an important stabilizer against sudden and excessive inversion.     

A qualitative approach to combined magnetic resonance imaging and spectroscopy in the diagnosis of prostate cancer

Purpose

To investigate the feasibility and diagnostic value of a whole prostate qualitative approach to combined magnetic resonance imaging and spectroscopy (MRI + MRS) in the detection of prostate cancer in patients with elevated PSA.

Materials and methods

Three hundred and fifty six subjects (mean serum PSA 11.47 ng/ml, range 0.40-133 ng/ml) were examined with fast-T2-weighted images (MRI) and 3D-magnetic resonance spectroscopy (MRS). Both modalities were qualitatively analyzed on a whole prostate basis by a single radiologist using a 4-point diagnostic scale. Prostate cancer was histopathologically proven in 220 patients and non-evidence of cancer was determined after at least 12 months clinical follow-up in 136 subjects.

Results

Receiver operating curve analysis revealed a significantly better diagnostic performance of MRI + MRS (A_z = 0.857) than MRI alone (A_z = 0.801) and MRS alone (A_z = 0.810). The sensitivity, specificity and accuracy of MRI + MRS for detection of prostate cancer were 72.3%, 92.6%, and 80.1%, respectively.

Conclusions

Spectral evaluation with a whole prostate qualitative approach is feasible in routine clinical practice. The combination of MRI and MRS yields superior diagnostic results than either modality alone.     

Criterion-related validity of four clinical tests used to measure hamstring flexibility in professional futsal players

Objective

To examine the criterion related validity of the sit-and-reach test (SR), toe touch test (TT), modified sit-and-reach test (MSR) and back-saver sit-and-reach test (BSSR) for estimating hamstring flexibility measured through the passive straight leg raise test (PSLR) in professional futsal players.

Design

Correlation laboratory study.

Setting

Controlled laboratory environment.

Participants

One hundred and three futsal players (55 males age 26 ± 4 years, 48 females age 23 ± 5 years).

Main outcome measures

Two trials of SR, TT, MSR, BSSR (left and right) and PSLR right and left (hamstring criterion measure) in a randomized order.

Results

Regression analysis was performed to examine the association of SR, TT, MSR and BSSR with PSLR in both males and females separately. In males, only MSR test had moderate association criterion with PSLR (R² = 0.57). In females, SR (R² = 0.86), TT (R² = 0.85), MSR (R² = 0.53) and average BSSR (R² = 0.82) were associated with PSLR.

Conclusions

SR, TT, MSR and BSSR had moderate criterion related validity for estimating hamstring flexibility in female but not male professional futsal players. The authors recommend that researchers, clinicians, and physical therapists adopt one angular test as a measure of hamstring muscle length in futsal players.     

Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

Objective

The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC).

Materials and methods

Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance.Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); the second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12.Analgesic medication use was translated into a morphine-equivalent dose.

Results

The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1.CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed.

Conclusion

RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.     

Comparison of lateral abdominal muscle thickness between weightlifters and matched controls

Objective

To compare lateral abdominal muscle thickness between weightlifters and matched controls.

Design

A case control study design.

Setting

University laboratory.

Subjects

16 female Thai national weightlifters and 16 matched controls participated in this study.

Main outcome measures

Ultrasound imaging with a 12-MHz linear array was used to measure the resting thickness of transversus abdominis (TrA), internal oblique (IO) and total thickness (Total) of lateral abdominal muscle (LAM) on the right side of abdominal wall. The absolute muscle thickness and the relative contribution of each muscle to the total thickness were determined.

Results

Weightlifters had significantly thicker absolute TrA and IO muscles than matched controls (p < 0.01). Further, the relative thickness of the IO was significantly greater in weightlifters than matched controls (p < 0.05).

Conclusions

The findings of this study suggest that routine Olympic style weight training among female weightlifters appears to result in preferential hypertrophy or adaptation of the IO muscle.     

Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome

Purpose

To compare clinical and computed tomography (CT) measures in extension, 20° and 30° of flexion of symptomatic knees of patient with idiopathic patellofemoral pain syndrome with the contra lateral asymptomatic knee.

Materials and methods

Knees of 52 consecutive patients with idiopathic patellofemoral pain were studied with CT. In 28 patients this condition was unilateral and asymptomatic knee was used as control; 76 knees were symptomatic.

Results

In patients with idiopathic patellofemoral pain we found a greater Q angle and internal condylar facet width in symptomatic knees with regard to asymptomatic knees.

Conclusion

Greater Q angle and medial condylar facet can lead to overpressure on the medial knee compartment during maneuvers that increase contact between patella and medial condylar facet, such as knee flexion and squatting, contributing to development of idiopathic patellofemoral pain.     

Detection of intracranial aneurysms using three-dimensional multidetector-row CT angiography: Is bone subtraction necessary?

Purpose

The aim of this study was to evaluate the usefulness of three-dimensional CT angiography (3D CTA) with bone subtraction in a comparison with 3D CTA without bone subtraction for the detection of intracranial aneurysms.

Materials and methods

Among 337 consecutive patients who had intracranial aneurysms detected on 3D CTA, 170 patients who underwent digital subtraction angiography (DSA) were included in the study. CTA was performed with a 16-slice multidetector-row CT (MDCT) scanner. We created the 3D reconstruction images with and without bone subtraction by using the volume rendering technique. Three neuroradiologists in a blinded fashion interpreted both 3D CTA images with and without bone subtraction. The diagnostic accuracy of both techniques was evaluated using the alternative free-response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive value were also evaluated.

Results

A total of 200 aneurysms (size: 2-23 mm) were detected in 170 patients. The area under the receiver operating characteristic curve (Az) for 3D CTA with bone subtraction (mean, Az = 0.933) was significantly higher than that for 3D CTA without bone subtraction (mean, Az = 0.879) for all observers (P < 0.05). The sensitivity of 3D CTA with bone subtraction for three observers was 90.0, 92.0 and 92.5%, respectively, while the sensitivity of 3D CTA without bone subtraction was 83.5, 83.5 and 87.5%, respectively. No significant difference in positive predictive value was observed between the two modalities.

Conclusions

3D CTA with bone subtraction showed significantly higher diagnostic accuracy for the detection of intracranial aneurysms as compared to 3D CTA without bone subtraction.     

Evaluation of short-term response of high intensity focused ultrasound ablation for primary hepatic carcinoma: Utility of contrast-enhanced MRI and diffusion-weighted imaging

Objective

To explore the significance of contrast-enhanced MRI (CE-MRI) and diffusion-weighted imaging (DWI) in evaluating the short-term response of high intensity focused ultrasound (HIFU) ablation for primary hepatic carcinoma (PHC).

Methods

Thirty-nine lesions in the livers of 27 patients were performed HIFU ablation. Conventional MRI sequences, CE-MRI and DWI were performed 1 week before HIFU and 1 week, 3 months after the therapy, respectively. The short-term responses of HIFU for all lesions were evaluated with MRI.

Results

28 of the 39 lesions (28/39, 71.8%) showed complete necrosis with no enhancement 1 week and 3 months after HIFU. The apparent diffusion coefficient (ADC) values 1 week and 3 months after HIFU were significantly higher than those 1 week before treatment (p < 0.05). The tumor recurrence was detected in 7 of the 39 lesions (7/39, 17.9%) which had no significant enhancement 1 week after HIFU. On the 3 months follow-up, focal nodules were found on the inner aspects of the treated areas. The ADC values had no significant difference between 1 week before and after treatment (p > 0.05), however, they were significantly higher 3 months after HIFU (p < 0.05). The tumor residuals were detected in 4 of the 39 lesions (4/39, 10.3%) showing enhancement 1 week after treatment and increased size 3 months after HIFU. The ADC values had no significant difference among 1 week before HIFU, 1 week and 3 months after treatment (p > 0.05).

Conclusion

CE-MRI and DWI can be employed to evaluate the short-term response of HIFU ablation for PHC and to guide the patient management.     

Quantitative assessment of perirectal tumor infiltration with dynamic contrast-enhanced multi-detector row CT in rectal cancer

Objective

To evaluate the efficacy of discriminant function analysis of perirectal tumor infiltration with dynamic contrast-enhanced 64-detector row CT in rectal cancer.

Materials and methods

Forty-nine patients with rectal cancer underwent dynamic contrast-enhanced CT. A total of 96 axial CT slices containing the tumors were evaluated. The 96 images were separated into two groups with or without perirectal tumor infiltration based on pathological findings. The discriminant function was set-up using CT density differences between the mass and the adjacent perirectal tissue within 5 mm from the mass at 20 and 40 s as independent variables. The results of the discriminant function analysis were compared to those of CT morphology and pathology.

Results

CT morphological diagnosis was accurate on 71.9% (69/96) of the slices with 82.5% sensitivity and 64.3% specificity. Discriminant function analysis correctly identified 88.5% (85/96) of the slices with 85.0% sensitivity and 91.1% specificity. Overstaging occurred significantly more (P < 0.05) on morphological analysis (20.8%, 20/96) than discriminant function analysis (5.2%, 5/96) of the CT slices.

Conclusions

Discriminant function analysis of dynamic contrast-enhanced CT improves the diagnostic accuracy and specificity of perirectal tumor infiltration in rectal cancer.     

The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain

Objectives

To determine the effect of a combination of a minimalist shoe and increased cadence on measures of patellofemoral joint loading during running in individuals with patellofemoral pain.

Percutaneous treatment of non-contained lumbar disc herniation by injection of oxygen-ozone combined with collagenase

Purpose

To evaluate the therapeutic results of oxygen-ozone combined collagenase injection for the treatment of lumbar disc herniation compared to the surgery. And to explore the role of this minimally invasive treatment as an alternative to disc surgery.

Materials and methods

Two groups of patients (n = 108) were treated with different ways respectively. Minimally invasive group of patients was treated with the injection of oxygen-ozone combined with collagenase into the lumbar disc or the epidural space; the other group was treated with traditional surgery. After the treatment, the patients were followed-up and the therapeutic effect was assessed at 2 weeks, 3 and 12 months by the modified Macnab criteria.

Results

The success rate was 86.11% and 88.89% in minimally invasive group at 3 and 12 months respectively, while 92.59% and 95.37% in surgical group. There was no statistically significant difference between two groups at 3 and 12 months (P = 0.123, P = 0.08). However, the surgical group produced a statistically significant greater improvement for back pain and disability in the first few weeks (P = 0.0001). The success rate was 51.86% and 85.18% at 2 weeks in minimally invasive group and surgical group respectively. No serious complication occurred in this group.

Conclusions

The combination of the oxygen-ozone with collagenase shows significant reductions in pain and improvements in function at 3 and 12 months, it can be considered as an option for the treatment of non-contained lumbar disc herniation instead of surgery.     

MR imaging changes in the trochanteric area of asymptomatic individuals: a potential for misdiagnosis of pain in the trochanteric region

Objective

To investigate the MR imaging appearance of the trochanteric region in a group of patients referred for non-musculoskeletal conditions.

Materials and methods

Forty-five patients (n = 90 hips) referred for non-musculoskeletal conditions were imaged with a coronal T1 weighted fat saturated sequence after intravenous administration of contrast medium. Findings were interpreted by consensus of two experienced radiologists.

Results

In 54 of 90 hips (60%) no signal changes were seen at the level of the greater trochanter. A linear area of contrast enhancement with a craniocaudal dimension of less than 3 cm, and thickness less than 0.3 cm was seen in 32 of 90 hips (35.6%).A fusiform area of contrast enhancement with a craniocaudal dimension of more than 3 cm, and thickness more than 0.3 cm was seen in 4 hips (4.4%).

Conclusion

An area of signal abnormality may be seen on contrast enhanced studies in asymptomatic persons, located in between the gluteus medius tendon and iliotibial band, and this should not be considered as a cause of pain in the trochanteric region.     

Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase

Purpose

To clarify if the portal venous phase is helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis.

Materials and methods

MDCT and MRI of groove pancreatic carcinomas (n = 7) and groove pancreatitis (n = 15) were retrospectively reviewed by two radiologists independently. The signal intensity on T2-weighted images was subjectively assessed. The presence or absence of common bile duct (CBD) and main pancreatic duct (MPD) strictures, calcifications, and cystic lesions was evaluated. Additionally, the appearance of groove pancreatic carcinoma and that of groove pancreatitis in the portal venous phase on dynamic MDCT and MRI were compared.

Results

There were no significant differences in the signal intensity on T2-weighted images and in the presence or absence of CBD and MPD strictures, calcifications, and cystic lesions between groove pancreatic carcinomas and groove pancreatitis. However, patchy focal enhancement in the portal venous phase was more commonly observed in groove pancreatitis than groove pancreatic carcinoma (Reviewers 1 and 2: 14/15 [93.3%] vs. 1/7 [14.3%], P < 0.0001). In addition, peripheral enhancement was only seen in groove pancreatic carcinomas (Reviewer 1: 4/7 [57.1%] vs. 0/15 [0%], P < 0.005, and Reviewer 2: 3/7 [42.9%] vs. 0/15 [0%], P < 0.05).

Conclusion

The portal venous phase may be helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis.     

Jugular versus subclavian totally implantable access ports: Catheter position, complications and intrainterventional pain perception

Purpose

To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications.

Materials and methods

From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18-85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test.

Results

No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p < 0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n = 4) of the subclavian group versus 2% (n = 1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n = 3) and 1% (n = 1) in the subclavian group, while none of those complications occurred in the jugular group.

Conclusion

Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.     

Évolution chez l'homme de l'Insulin-Like Growth Factor-I dans le liquide interstitiel musculaire suite à un exercice en résistance

Introduction

The impact of resistance exercise on the growth of the vastus lateralis was assessed through interstitial microdialysis measurement of free Insulin-like Growth Factor-I at +3 h30, +4 h50 and +6 h after exercise in 4 healthy subjects.

Results

We observed 3 h30 after exercise an interstitial increase in 3 over 4 subjects, and thereafter a progressive decrease. In the mean time, free or total plasma concentrations did not change.

Conclusion

Resistance exercise seemed to induce an early increase of muscle interstitial free Insulin-like Growth Factor-I in order to initiate muscle growth by an autocrine – paracrine way.     

Pain and complications of directional vacuum-assisted stereotactic biopsy: comparison of the Mammotome and Vacora techniques

Objective

The aim of our study is to compare the Mammotome and Vacora methods of stereotactic directional vacuum-assisted biopsy in terms of pain and complications.

Materials and methods

From June 2001 to May 2005, 1114 consecutive patients underwent directional stereotactic vacuum-assisted breast biopsy (DVAB) for nonpalpable mammographically detected breast lesions (BI-RADS 3, 4 or 5). Respectively 967 and 147 patients underwent the Mammotome and Vacora procedures. Pain was evaluated with a visual analog scale. Immediate and late complications were recorded.

Results

The mean ± S.D. (range) pain scores in the Mammotome and Vacora groups were 1.7 ± 1.8 (0-9) and 2.9 ± 2.3 (0-10), respectively (p < 0.001). Patient age and operator experience were the main determinants of pain. Immediate complications were significantly more frequent in the Mammotome group (p = 0.003), and so were late hematomas (p = 0.04). Moderate and severe complications occurred exclusively in the Mammotome group.

Conclusion

The Mammotome technique is associated with a higher risk of immediate and late complications, while the Vacora technique is associated with more frequent severe pain. Patient age was the major factor influencing pain. Further prospective studies are needed to clarify factors incriminated in pain or complications after DVAB procedures.     

Intraspinal primitive neuroectodermal tumor: Imaging findings in six cases

Purpose

To retrospectively review CT and MRI findings in a series of six intraspinal primitive neuroectoderal tumors and to find out their radiological features.

Methods

CT and MRI of six patients with surgically and pathologically proved intraspinal primitive neuroectoderal tumor were retrospectively reviewed. The tumor location, morphological features, signal intensity, calcification, contrast enhancement characteristics, involvement of paraspinal soft tissues and adjacent bony structures were assessed.

Results

Of six patients, four had extradural lesions and two had intradural, extramedullary lesions. Most lesions were well defined and manifested heterogeneous iso- or hypo-intense signal on T1-weighted imaging and hyper-intense signal on T2-weighted imaging and moderate attenuation on CT, and were heterogeneously enhanced after contrast enhancement. The lesion extending through the intervertebral foramen with a large paraspinal soft tissue mass formed was found in four patients and vertebral bone involvement was seen in four patients.

Conclusions

Although imaging findings are not specific of intraspinal primitive neuroectoderal tumor, this diagnosis could be suggested when MR imaging depicts an intradural, extramedullary or extradural large well-circumscribed mass which extends out from intervertebral foramen and invades paraspinal soft tissues or vertebral bones in a young patient.     

Radiocontrast media-associated exanthema: identification of cross-reactivity and tolerability by allergologic testing

Background

All iodinated radiocontrast media (RCM) may cause hypersensitivity reactions, either immediate-type within 5-10 min of RCM injection or delayed-type, which become apparent more than 1 h after RCM exposure. Delayed-type hypersensitivity to RCM may pose a problem for future radiologic investigations because due to possible immunological cross-reactivity all iodinated RCM are usually avoided.

Objective

The aim of this study was not only to identify the causal RCM for the exanthema but also to demonstrate that patients may receive alternative iodinated RCM despite a history of RCM-induced allergic exanthema.

Methods

We evaluated 32 patients with a history of exanthema after RCM application using standardized patch, prick and intradermal skin testing. In case of positive skin tests intravenous challenges with skin-test-negative RCM were performed to identify non-ionic monomer RCM which are tolerated.

Results

In 6 out of 32 patients skin tests strongly suggested a delayed-type non-IgE-mediated allergic hypersensitivity to the RCM iomeprol (3 x), iopromide (2×), and iopamidol. In 4 patients alternative non-ionic monomer RCM (2× iosarcol, iopromide, and iomeprol) were identified by controlled challenge tests.

Conclusions

The evaluation of patients with RCM-associated exanthema should always include appropriate skin tests ensuring that patients with a delayed-type allergic RCM-induced exanthema are not missed. Moreover, allergologic testing may identify alternative RCM of the group of non-ionic monomers, which are tolerated in future radiologic investigations.     

Vulnerable plaque: Detection of agreement between multi-detector-row CT angiography and US-ECD

Objectives

The purpose of this work was to evaluate the agreement between ultra-sound echo-color Doppler (US-ECD) and multi-detector-row CT angiography (MDCTA) in the characterization of vulnerable plaque.

Methods

From January 2004 to January 2007 658 patients who underwent both MDCTA and US-ECD for the study of carotid arteries, were retrospectively evaluated (453 males, 205 females). For all subjects the following parameters were analysed: plaque morphology (regular versus irregular), type of the plaque (fatty, mixed and calcified) and presence of ulcerations. Statistical analysis was performed to calculate concordance between the two techniques employed.

Results

In the definition of the type of plaque, the observed agreements were 77.2% and the kappa value was 0.657 (95% confidence interval: 0.615-0.699). The weighted kappa resulted 0.644. In the definition of ulceration plaque, the observed agreements were 88.4% but the kappa value was only 0.325 (95% confidence interval: 0.201-0.449). Agreement observed in the evaluation of plaque morphology was 78.3% with a kappa value of 0.513 (95% confidence interval: 0.452-0.574).

Conclusion

We observed a good agreement between US-ECD and MDCTA in the assessment of plaque type whereas a poor agreement resulted in the evaluation of plaque ulceration. The use of US-ECD and MDCTA provides different results in the evaluation of plaque. Our results suggest that information deriving from US-ECD should be always critically compared with other diagnostic techniques.