Showing papers by "Thomas Jefferson University Hospital published in 2000"

Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy

Abstract: In 1997, the National Cancer Institute (NCI) led an effort to revise and expand the Common Toxicity Criteria (CTC) with the goal of integrating systemic agent, radiation, and surgical criteria into a comprehensive and standardized system. Representatives from the Radiation Therapy Oncology Group (RTOG) participated in this process in an effort to improve acute radiation related criteria and to achieve better clarity and consistency among modalities. CTC v. 2.0 replaces the previous NCI CTC and the RTOG Acute Radiation Morbidity Scoring Criteria and includes more than 260 individual adverse events with more than 100 of these applicable to acute radiation effects. One of the advantages of the revised criteria for radiation oncology is the opportunity to grade acute radiation effects not adequately captured under the previous RTOG system. A pilot study conducted by the RTOG indicated the new criteria are indeed more comprehensive and were preferred by research associates. CTC v. 2.0 represents an improvement in the evaluation and grading of acute toxicity for all modalities.

Imaging Evaluation of Ovarian Masses

Abstract: Adnexal masses present a special diagnostic challenge, in part because benign adnexal masses greatly outnumber malignant ones. Determination of a degree of suspicion for malignancy is critical and is based largely on imaging appearance. Endovaginal ultrasonography (US) is the most practical modality for assessment of ovarian tumors because it is readily available and has a high negative predictive value. Morphologic analysis of adnexal masses is accurate for identifying masses as either low risk or high risk. The most important morphologic features are non-fatty solid (vascularized) tissue, thick septations, and papillary projections. Color Doppler US helps identify solid, vascularized components in a mass. Spectral Doppler waveform characteristics (eg, resistive index, pulsatility index) correlate well with malignancy but generally add little information to morphologic considerations. Computed tomography can help assess the extent of disease in patients before and after primary cytoreductive surgery. Magnetic resonance (MR) imaging is better reserved for problem solving when US findings are nondiagnostic or equivocal because, although it is more accurate for diagnosis, it is also more expensive. The signal intensity characteristics of ovarian masses make possible a systematic approach to diagnosis. Mature cystic teratomas, cysts, endometriomas, leiomyomas, fibromas, and other lesions can be accurately diagnosed on the basis of T1-weighted, T2-weighted, and fat-saturated T1-weighted MR imaging findings.

Chronic daily headache

Abstract: Primary chronic daily headache can be subclassified into disorders of short duration ( or =4 h/attack). Primary chronic daily headache disorders of long duration include chronic tension-type headache, chronic daily migraine (previously called transformed migraine), new daily persistent headache, and hemicrania continua. Four to 5% of the general population have primary chronic daily headache. Most chronic daily headache patients overuse analgesics or ergots. This article will consider recent insights into specific disorders, then psychiatric comorbidity, epidemiology, pathophysiology, and treatment.

MR Imaging of Disorders of the Achilles Tendon

Abstract: he Achilles tendon is among the most frequently injured tendons of the body with a variety of types of traumatic and overuse conditions affecting it. These conditions are common, often come to clinical attention, and are frequently imaged. The pathophysiology of Achilles disorders is complex, and the nomenclature is irregularly applied; this leads to miscommunication between clinicians and radiologists and inconsistencies in the literature. Therefore, we review the anatomy, MR imaging findings, and pathologic findings in an attempt to develop a systematic nomenclature. Gross Anatomy The Achilles tendon originates in the mid leg and is formed by the junction of the two heads of the gastrocnemius muscles and the soleus muscle [1, 2]. The bulk of the Achilles is formed from the gastrocnemius muscle. The larger medial head originates almost entirely from just proximal to the medial femoral condyle, and the smaller lateral head arises from both the posterior and lateral surfaces of the lateral femoral condyle. At the junction of the proximal and mid calf, the two heads of the gastrocnemius muscles and their tendons approximate midline. The gastrocnemius tendon origin is gradual, occurring over approximately 3‐4 cm. The fibers of the medial head originate slightly lower than those of the lateral head. The Achilles tendon is not formed until the soleus muscle inserts onto the gastrocnemius tendon, approximately 3‐4 cm more distally [2]. The plantaris muscle originates from the lateral meniscus and the lateral femoral epicondyle in close association with the lateral head of the gastrocnemius muscle. The plantaris tendon then crosses obliquely between the soleus and gastrocnemius muscles and continues just medial to the Achilles. Various plantaris insertions are seen, but most fibers insert on the medial aspect of the superior calcaneal tuberosity or 1 cm anterior and medial to the Achilles on the calcaneus, a distinct insertion point separate from that of the Achilles. The Achilles‐plantaris complex is termed the “triceps‐surae complex” [3].

Survival Advantage From Higher-Dose Radiation Therapy for Clinically Localized Prostate Cancer Treated on the Radiation Therapy Oncology Group Trials

Abstract: PURPOSE: We evaluated the effect of external-beam radiation therapy on disease-specific survival (death from causes related to prostate cancer) and overall survival in men with clinically localized prostate cancer. METHODS: From 1975 to 1992, 1,465 men with clinically localized prostate cancer received radiation therapy on four Radiation Therapy Oncology Group phase III randomized trials and were pooled for this analysis. No one received androgen-deprivation therapy with his initial treatment. All original histology had central pathologic review for grading using the Gleason classification system. Total delivered radiation dose ranged from 60 to 78 Gy (median, 68.4 Gy). The median follow-up time was 8 years. RESULTS: A Cox regression model revealed that Gleason score was an independent predictor of disease-specific survival and overall survival. The 10-year disease-specific survival rates by Gleason score were as follows: score of 2 through 5, 85%; score of 6, 79%; score of 7, 62%; and score of 8 through ...

Multicenter evaluation of the AMPLICOR and automated COBAS AMPLICOR CT/NG tests for detection of Chlamydia trachomatis.

Abstract: The fully automated COBAS AMPLICOR CT/NG and semiautomated AMPLICOR CT/NG tests were evaluated in a multicenter trial for the ability to detect Chlamydia trachomatis infections. Test performance compared to that of culture was evaluated for 2,236 matched endocervical swab and urine specimens obtained from women and for 1,940 matched urethral swab and urine specimens obtained from men. Culture-negative, PCR-positive specimens that tested positive in a direct fluorescent-antibody test or in a confirmatory PCR test for an alternative target sequence were resolved as true positives. The overall prevalences of chlamydia were 2.4% in women and 7.2% in men. The COBAS AMPLICOR and AMPLICOR formats yielded concordant results for 98.1% of the specimens. With the infected patient as the reference standard, the resolved sensitivities of COBAS AMPLICOR were 89.7% for endocervical swab specimens, 89.2% for female urine specimens, 88.6% for male urethral swab specimens, and 90.3% for male urine specimens. When results were analyzed as if only a single test had been performed on a single specimen type, the resolved sensitivity was always higher. The resolved specificities of PCR were 99.4% for endocervical swab specimens, 99.0% for female urine specimens, 98.7% for male urethral swab specimens, and 98.4% for male urine specimens. The internal control revealed that 2.4% of the specimens were inhibitory when initially tested. Nevertheless, valid results were obtained for 98.6% of the specimens because 59.1% of the inhibitory specimens were not inhibitory when a second aliquot was tested. The COBAS AMPLICOR and AMPLICOR CT/NG tests for C. trachomatis exhibited equally high sensitivity and specificity with both urogenital swab and urine specimens and thus are well suited for screening for C. trachomatis infection.

A practical guide to caring for caregivers.

Abstract: Patients who provide care to family members or friends with dementia are likely to be in a family physician's practice. The caregiver role can be stressful, and identifying these patients can give the family physician opportunities to help patients cope with the challenges of the caregiver role. Family physicians have a systematic approach for assessing the degree of caregiver burden in these patients. Because caregivers are at increased risk for depression and anxiety, screening should be done to exclude the presence of either disorder. The caregiver's skill in managing behavioral problems in the family member with dementia should be assessed. If there are problems, family physicians should provide practical counseling about common caregiving stresses and about resources that benefit caregivers. Helping the caregiver learn strategies for coping with difficulties may help reduce some of the stress the caregiver is experiencing.

Multicenter Evaluation of AMPLICOR and Automated COBAS AMPLICOR CT/NG Tests for Neisseria gonorrhoeae

Abstract: The fully automated COBAS AMPLICOR CT/NG and semiautomated AMPLICOR CT/NG tests were evaluated in a multicenter trial for their ability to detect Neisseria gonorrhoeae infections. Test performance compared to that of culturing was evaluated for 2,192 matched endocervical swab and urine specimens obtained from women and for 1,981 matched urethral swab and urine specimens obtained from men. Culture-negative, PCR-positive specimens that tested positive in a confirmatory PCR test for an alternative target sequence within the N. gonorrhoeae 16S rRNA gene were considered to be true positives. The overall prevalences of gonorrhea were 6.6% in women and 20.1% in men. The COBAS AMPLICOR and AMPLICOR formats yielded concordant results for 98.8% of the specimens and exhibited virtually identical sensitivities and specificities. The results that follow are for the COBAS AMPLICOR format. With the infected patient as the reference standard, the resolved sensitivities of PCR were 92.4% for endocervical swab specimens and 64.8% for female urine specimens. There were no significant differences in these rates between women with and without symptoms. Among symptomatic men, COBAS AMPLICOR sensitivities were 94.1% for urine and 98.1% for urethral swabs; for asymptomatic men, the results were 42.3 and 73.1%, respectively. In comparison, the sensitivities of culturing were 84.8% for endocervical specimens, 92.7% for symptomatic male urethral specimens, and only 46.2% for urethral specimens obtained from asymptomatic men. When PCR results were analyzed as if only a single test had been performed on a single specimen type, the resolved sensitivity was always higher. The resolved specificities of PCR were 99.5% for endocervical swab specimens, 99.8% for female urine specimens, 98.9% for male urethral swab specimens, and 99.9% for male urine specimens. The internal control revealed that 2.1% of specimens were inhibitory when initially tested. Nevertheless, valid results were obtained for 99.2% of specimens because 60.0% of the inhibitory specimens were not inhibitory when a second aliquot was tested. The COBAS AMPLICOR CT/NG test for N. gonorrhoeae exhibited high sensitivity and specificity with urethral swab and urine specimens from men and endocervical swab specimens from women and thus is well suited for diagnosing and screening for N. gonorrhoeae infection.

Biliary Dilatation: Differentiation of Benign from Malignant Causes—Value of Adding Conventional MR Imaging to MR Cholangiopancreatography

Abstract: PURPOSE: To determine the value of conventional T1- and T2-weighted images and gadolinium-enhanced dynamic magnetic resonance (MR) images as a supplement to MR cholangiopancreatographic (MRCP) images in differentiation of benign from malignant causes of biliary dilatation. MATERIALS AND METHODS: MR studies in 62 patients with biliary dilatation with proved causes included conventional T1- and less heavily T2-weighted images, as well as gadolinium-enhanced dynamic images and heavily T2-weighted MRCP images. Two radiologists reviewed MRCP images alone, MRCP images with nonenhanced T1- and T2-weighted MR images, and MRCP images with nonenhanced and gadolinium-enhanced dynamic images. RESULTS: For differentiation of benign from malignant causes of biliary dilatation, the area under the receiver operating characteristic curve (Az) was significantly (P < .05) larger for MRCP images interpreted with T1- and T2-weighted images (0.9547 for reader 1, 0.8404 for reader 2) than for MRCP images alone (0.8144 for reade...

Cluster headache with aura.

Abstract: Article abstract Cluster headache with aura is rare. The authors retrospectively reviewed 101 cluster headache patient charts at the Jefferson Headache Center. Six patients had an associated aura, five visual and one olfactory, lasting 5 to 120 minutes. Only one had migraine (without aura). Auras always occurred with or were followed by a severe cluster headache. Two patients were related.

Strictureplasty for Crohn's disease: meta-analysis.

Abstract: PURPOSE: The objective of this study was to analyze patient outcome after strictureplasty for management of intestinal stricture caused by Crohn's disease based on differences in surgical procedures. METHODS: A MEDLINE search was performed using a medical subject heading analysis for strictureplasty in Crohn's disease. Meta-analysis of multiple variables for outcome was performed using random-effects models. RESULTS: Five hundred six patients underwent 1,825 strictureplasties for Crohn's disease with minimal morbidity and zero mortality. Ninety percent of strictures were less than 10 cm in length. Approximately 85 percent of these procedures used the Heineke-Mikulicz technique and 13 percent used Finney strictureplasty. Forty-four percent of procedures included concurrent bowel resection. Recurrence rate of Crohn's disease after strictureplasty was increased in patients with longer study duration after surgery (P=0.04), who showed symptoms of active disease (P=0.02), who experienced preoperative weight loss (P=0.02), or who received the Heineke-Mikulicz procedure (P=0.008). The proportion of patients requiring additional surgery was increased with longer study duration (P=0.006), with properative weight loss (P=0.001), or with the Heineke-Mikulicz procedure (P=0.005). The proportion of patients requiring additional surgery was decreased when a Finney strictureplasty was used (P=0.008) as compared with those treated by the Heineke-Mikulicz procedure. CONCLUSION: Although the Heineke-Mikulicz technique is most often used for Crohn's strictureplasty, outcome analysis revealed the Finney strictureplasty may reduce the reoperation rate.

Recurrent trigeminal neuralgia attributable to veins after microvascular decompression.

Abstract: Objective To demonstrate the cause of and optimal treatment for recurrent trigeminal neuralgia (TN) in cases where veins were observed to be the offending vessels during the initial microvascular decompression (MVD) procedure. Methods An electronic search of patient records from 1988 to 1998 revealed that 393 patients were treated with MVD for TN caused by veins. The pain recurred in 122 patients (31.0%). Thirty-two (26.2%) of these patients underwent reoperations. Clinical presentations, recurrence intervals, surgical findings, and clinical outcomes were analyzed. Results Analysis of 32 consecutive cases of recurrent TN initially attributable to veins revealed a female predominance (female/male = 26:5), with one female patient exhibiting bilateral TN caused by venous compression. Patient ages ranged from 15 to 80 years, with a prevalence in the seventh decade. The V2 distribution of the face was involved more frequently than other divisions. For 24 patients (75%), recurrence occurred within 1 year after the initial operation. At the time of the second MVD procedure, development of new veins around the nerve root was observed in 28 cases (87.5%). After successful subsequent MVD procedures, the pain was improved in 81.3% of the cases. Conclusion The recurrence rate for TN attributable to veins is high. If pain recurs, it is likely to recur within 1 year after the initial operation. The most common cause of recurrence is the development and regrowth of new veins. Even fine new veins may cause pain recurrence; these veins may be located beneath the felt near the root entry zone or distally, near Meckel's cave. Because of the variable locations of vein recurrence, every effort must be made to identify recollateralized veins. Given the high rate of pain relief after a second operation, MVD remains the optimal treatment for the recurrence of TN attributable to vein regrowth.

Endometrial Polyps: MR Imaging Features and Distinction from Endometrial Carcinoma

Abstract: PURPOSE: To determine the magnetic resonance (MR) imaging characteristics of endometrial polyps and the accuracy of MR imaging in distinguishing endometrial polyps from endometrial carcinomas in a case-control study. MATERIALS AND METHODS: Cross-referencing pathology records with MR studies from two institutions disclosed 35 patients with surgically proved endometrial polyp or carcinoma after controlling for tumor size. All MR examinations were performed at 1.5 T with T2-weighted fast spin-echo sequences in multiple planes. Three independent readers blinded to histologic diagnoses and clinical data scored each image for the presence of several defined findings. RESULTS: A central fibrous core (low signal intensity on T2-weighted images) and intratumoral cysts (high signal intensity on T2-weighted images) were seen more frequently in endometrial polyps than in carcinomas; myometrial invasion and necrosis showed high predictive value for carcinomas. The readers' responses showed a mean sensitivity of 79%, s...

MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals.

Abstract: Objective: To differentiate MR imaging characteristics of symptomatic as compared with asymptomatic Achilles tendons.

MR imaging of disorders of the posterior tibialis tendon.

Abstract: 627 lthough posterior tibial tenosynovitis was first described in 1930 [1], it was not until the 1980s that posterior tendon dysfunction became recognized as a clinical entity [2, 3]. It is best to think of posterior tibialis tendon abnormalities as a continuum of disorders that causes dysfunction because the predominant manifestations of pathoanatomy are functional rather than symptomatic [4]. Because most of these disorders are not clinically painful, patients seek medical attention relatively late [5]. Therefore, on imaging, we usually see the later stages of the disorder [6]. More recently, many patients, particularly those with inflammatory processes such as rheumatoid arthritis, are presenting earlier, and the imaging spectrum of the disease is becoming better understood [7, 8].

Prediction of preterm birth by second trimester cervical sonography in twin pregnancies.

Abstract: Objectives To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation. Methods Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation. Results Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length ≤ 25 mm and ≤ 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0–10.3 and R.R. 3.6, C.I. 1.6–7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02–0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix ≤ 30 mm and any funneling were strongly predictive of PTD. Conclusions Both cervical length ≤ 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Physiology of the menstrual cycle

Abstract: The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. All these events and interventions alter the levels and cycling of sex hormones and may cause a change in the prevalence or intensity of headache. The menstrual cycle is the result of a carefully orchestrated sequence of interactions among the hypothalamus, pituitary, ovary, and endometrium, with the sex hormones acting as modulators and effectors at each level. Oestrogen and progestins have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. The primary trigger of menstrual migraine appears to be the withdrawal of oestrogen rather than the maintenance of sustained high or low oestrogen levels. However, changes in the sustained oestrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches that occur with premenstrual syndrome appear to be centrally generated, involving the inherent rhythm of CNS neurons, including perhaps the serotonergic pain-modulating systems.

Preoperative evaluation of living renal donors: comparison of CT angiography and MR angiography.

Abstract: PURPOSE: To compare computed tomographic (CT) angiography and magnetic resonance (MR) angiography for preoperative evaluation of living renal donors. MATERIALS AND METHODS: Thirty-five living renal donors underwent preoperative contrast material–enhanced CT angiography and gadolinium-enhanced MR angiography. Each study was interpreted by two independent radiologists blinded to all other studies and to interpretations provided by other reviewers. Eighteen kidneys had surgical correlation. RESULTS: CT demonstrated 33 supernumerary arteries in 19 patients, bilateral solitary arteries in 16 patients, and 18 proximal arterial branches in 16 patients. MR demonstrated 26 supernumerary arteries in 15 patients, bilateral solitary renal arteries in 20 patients, and 21 proximal arterial branches in 16 patients. Interobserver agreements for MR (κ = 0.74) and CT (κ = 0.73) were similar to the agreement between MR and CT (κ = 0.74). Among the kidneys chosen for nephrectomy, one small accessory artery and one proximal a...

Laparoscopy in the "normal" infertile patient: a question revisited.

Abstract: Study Objective To determine the prevalence of reproductive pathology in a group of infertile women thought to be at low risk for altered pelvic anatomy. Design Retrospective chart review and follow-up (Canadian Task Force classification II-2). Setting Academic-affiliated, private reproductive endocrinology practice. Patients One hundred infertile women. Intervention Diagnostic and/or therapeutic laparoscopy. Measurements and Main Results Of 100 patients with a negative reproductive work-up up to the point of laparoscopy, 68 had pathology of reproductive significance: intrinsic tubal disease 24, peritubal adhesive disease 34, and endometriosis 43, some in combination. Laparoscopy was especially helpful in establishing treatment protocols for older women, who were referred for assisted reproductive techniques earlier than otherwise might have been the case. Women conceived after hormone therapy and after operative intervention. Although the hysterosalpingogram was read as normal in all women, tubal disease was diagnosed laparoscopically, independent of endometriosis, in 27 patients, with 2 having complete obstruction. Endometriosis stage I–II was found in 22 patients, stage III in 13, and stage IV in 6. Conclusion Even in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high. Although some pregnancies were achieved after operative intervention, frequently laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women. Frequently the degree of pathology was such that a full operating suite was necessary to provide adequate instrumentation and anesthesia for operative intervention, which would not have been the case with office laparoscopy.

Efficacy of anterior odontoid screw fixation in elderly patients with Type II odontoid fractures.

Abstract: Object. Type II odontoid fractures are the most common trauma-related dens fracture. Although Type III odontoid fractures have a high union rate when external immobilization is applied, Type II fractures are associated with high rates of nonunion, particularly in elderly patients and those with posteriorly displaced fractures or fractures displaced by more than 6 mm. Because elderly patients may not also tolerate external immobilization in a halo vest, alternative techniques should be explored to identify a method for managing these higher-risk patients. In this study the authors examine the efficacy of anterior odontoid screw fixation in a high-risk group of 10 elderly patients ( � 65 years of age) treated for Type II odontoid fractures. Methods. A retrospective review of all patients with Type II odontoid fractures treated at two institutions between September 1997 and March 2000 was performed. Demographic data, neurological examination, fracture type and degree of displacement, treatment method, and outcome data were examined at discharge. Ten patients older than 65 years who had sustained a trauma-related odontoid fracture and had undergone an anterior odontoid screw placement procedure were retrospectively reviewed. Fracture displacement (mean 6.6 mm) was observed in all but one patient, and in seven there were posteriorly displaced fractures. Seven were successfully treated with anterior screw fixation and external orthosis alone; in one patient in whom poor intraoperative screw purchase had been observed, the fracture healed after undergoing halo vest therapy. Only one patient was shown to develop a nonunion requiring a subsequent posterior fusion procedure. Conclusions. Odontoid screw fixation can be safely performed in elderly patients, and frequent bone union is demonstrated. However, osteopenia may preclude adequate screw fixation in some patients.

Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging.

Abstract: The purpose of this study was to determine whether the finding of an enlarged hilar periportal space is a sign for early cirrhosis at magnetic resonance (MR) imaging. Forty-one pathologically proved cirrhotic patients in the early stage of disease who did not show conventional imaging findings of cirrhosis (early cirrhosis group) and 47 patients without history of chronic liver diseases (control group) were included in this study. MR images were qualitatively and quantitatively evaluated for the presence of enlargement of the periportal space. Enlargement of the periportal space was seen in 98% of patients in the early cirrhosis group, while this finding was seen in 11% of patients in the control group (P < 0.0001). The mean value of the hilar periportal fat thickness was significantly greater (P < 0.0001) in the early cirrhosis group (15.5 ± 6.2 mm) than in the control group (5.3 ± 3.1 mm). The sensitivity, specificity, accuracy, and positive predictive value of this finding for the MR diagnosis of cirrhosis with a cutoff value of 10 mm were 93%, 92%, 92%, and 91%, respectively. Enlargement of the hilar periportal space is a helpful sign at MR imaging in the discrimination between normal and early cirrhotic livers. J. Magn. Reson. Imaging 2000;11:136–140. © 2000 Wiley-Liss, Inc.

The Relationship of Clinical and Academic Productivity in a University Hospital Radiology Department

Abstract: OBJECTIVE. The purpose of this study was to evaluate the relationship between clinical and academic productivity over a 2-year period in a university hospital radiology department.MATERIALS AND METHODS. Clinical productivity, as determined by the number of total professional relative value units generated, was compared with academic productivity, which was determined by the number of published peer-reviewed articles, published non-peer-reviewed articles, published abstracts, and presentations delivered by each full-time clinical faculty member. The relationships of age, academic rank, administrative position, and division within the department were also assessed for their effect on relative value units and academic productivity.RESULTS. We found a significant inverse relationship between relative value units and the number of published peer-reviewed articles, published abstracts, and presentations. Age, academic rank, and administrative responsibilities had no effect on the number of relative value units....

Teaching a multidisciplinary approach to cancer treatment during surgical clerkship via an interactive board game.

Abstract: Background: Although educators agree that the approach to cancer management must be multidisciplinary, medical students usually observe cancer patients through the eyes of a single specialist at any given time. Methods: In order to teach third-year medical students that cancer management is multidisciplinary, we developed the Oncology Game, an interactive, computer-assisted board game built on the principles of self-directed learning and student-student interaction. Eight "patients" with different histologic types of cancer are distributed randomly to 4 students, who play in teams of 2. The object is for the team to obtain the best treatment for its patients by advancing them via a roll of dice through surgical, medical, and radiation oncology clinics in the order most logical for the patient's particular cancer type. To test improvement in cognitive skills as a function of play, 16 students participated in a tournament taking parallel pretest and posttests before and after each round of play. Results: Students demonstrated a statistically significant change in the total number of questions answered correctly each time they played the Oncology Game (F = 4.16, P = 0.018; Pretest Round 1: 8.88 ± 0.58; Posttest Round 1: 9.63 ± 0.42; Pretest Round 2: 10.75 ± 0.62; Posttest Round 2: 11.5 ± 0.85). Post hoc pairwise comparison revealed a significant improvement in student performance after playing two rounds of the Oncology Game. Based on the postgame survey, students felt they improved their understanding of oncologic principles (4.56 ± 0.13), knowledge of malignancies (4.50 ± 0.13), and appreciation for the multidisciplinary nature of cancer management (4.56 ± 0.13). Conclusions: Improved test scores and postgame survey results demonstrate that third-year medical student students can learn about basic oncology principles and gain an appreciation for oncology as a multidisciplinary field of medicine through an interactive, computer-assisted board game.

Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience.

Abstract: PURPOSE: To determine if radiographic, computed tomographic (CT), and magnetic resonance (MR) imaging findings can help differentiate spinal neuropathic arthropathy from disk space infection. MATERIALS AND METHODS: Imaging studies in 33 patients were evaluated, including 14 patients with spinal neuropathic arthropathy (12 radiographic, seven CT, and six MR studies) and 19 with disk space infection (13 radiographic, nine CT, and 12 MR studies). Potential imaging discriminators, including endplate sclerosis or erosions, osteophytes, spondylolisthesis, facet involvement (narrowing or erosions), vacuum disk, paraspinal soft-tissue mass, joint disorganization, and osseous joint debris, were recorded, as were MR imaging signal intensity and gadolinium-enhancement characteristics. RESULTS: The most helpful findings for diagnosis of spinal neuropathic arthropathy were vacuum disk on radiographs and CT images, debris on radiographs and CT and MR images, disorganization on radiographs and CT and MR images, facet in...