Faculty Bibliography

Musculoskeletal manifestations are seen in approximately 3% of tuberculosis (MTb) cases, more commonly in the spine. Extra-axial bone and joint MTb is infrequently encountered in the West. In the last decade, public health strategies for control of MTb have been so successful in industrialized countries that many clinicians are unfamiliar with the range of extrapulmonary manifestations of MTb and therefore hold a low index of suspicion for MTb in the diagnosis of bone and joint infection. MTb, however, persists as a serious and significant cause of musculoskeletal pathology in many parts of the world and for specific patient cohorts in industrialized countries. Knowledge of the patient groups at risk and awareness of the varied osteoarticular manifestations of MTb are essential for timely diagnosis and intervention and potential cure

Anthracyclines and platinums have activity in GYN, lung, breast and upper GI tumors, lymphomas and sarcomas. C and PLD (Doxil, Caelyx) have non-overlapping toxicity profiles: C produces myelosuppression, nausea and peripheral neuropathy while PLD causes schedule-dependent mucocutaneous toxicity. This study aimed to define the RPTD of the two agents in combination. Design: Patients (pt) received C and PLD on D1 of a 21 day schedule. 5 dose levels (DL) were studied (C AUC / PLD mg/m2): DL1: 4/20; DL2: 4/25; DL3: 4/30; DL4: 5/30; DL5: 6/30. DLT were febrile neutropenia, G4 heme or G3 non-heme toxicity other than hypersensitivity (HSR). Pt with heme toxicity could omit C in later cycles and continue PLD until disease progression. Pt with mucocutaneous toxicity extended the PLD dosing interval to 28 days. Results: 20 pt were treated: 7M/13F. Age: med 58.5, range 36-85. Tumors: ovarian (EOC)(7), MMT (2), endometrial (1), cervix (2), H&N (3), NPC (2), leiomyosarc (1), breast (1), islet cell (1). Prior chemo: 13. Pt received a median of 4 cycles of C/PLD (range 1-8) and 8 pt received maintenance PLD after cessation of C. No DLT occurred at any DL. At DL5 (n=6 eval), C1 toxicities were G1-2 ANC/Hb (4), G2 vaginal mucositis (1), G2 HSR (1), G1-2 nausea/vom (2), G2 fatigue (1), G2 hand-foot syndrome (1), G1 diarrhea (1). No cardiac events were observed. RECIST responses were observed in 4 pts (MMT 2, NPC 1, EOC 1). In pt with EOC, Ca125 responses were seen in 4/4 evaluable pt. Conclusions: C and PLD can be safely administered together at full dose, and maintenance PLD is feasible. This combination warrants phase III evaluation in ovarian cancer and may be a useful regimen in other solid tumors. Supported by M01 RR00096 and the Lynne Cohen Foundation for Ovarian Cancer Research

MR imaging has surpassed all other imaging modalities to become the 'gold standard' for imaging evaluation of ACL injury. The accuracy and sensitivity of MR imaging for evaluation of ACL tears is excellent when correlated with clinical tests and arthroscopic findings, and is improved in equivocal cases with assessment of secondary signs for ACL tear. The MR imaging assessment of partial and chronic ACL tears is less accurate but is clinically useful. MR imaging provides information about associated injuries prior to surgery. Radiologic diagnostic methods for the assessment of ACL tears on MR images are well established; recent techniques such as dedicated cartilage imaging offer new information of use to clinicians about the sequelae of ACL injuries

Intraosseous hemangiomas are uncommon, constituting less than 1% of all osseous tumors. The most frequent sites are the calvaria and the vertebral column. Involvement of the facial bones is rare, and occurs most commonly in the maxilla, mandible, and nasal bones. Only 20 cases of zygomatic involvement have been reported in the English-language literature. We report a case of an intraosseous hemangioma of the zygoma documented by CT and MR studies

The diagnosis of tuberculosis of the musculoskeletal system is difficult for many reasons. As Walker states, to diagnose tuberculosis one must consider the possibility. The uncommonness of osteoarticular MTb results in clinician inexperience, which leads to overlooking the diagnosis. Subtle early manifestations may elude detection. Negative skin tests and normal chest films do not exclude the consideration of tuberculosis. The most conclusive means of reaching the diagnosis (biopsy and culture) necessitate invasive procedures that are not always definitive, and may require repeated attempts. Management and surgical decisions, however, rely on prompt diagnosis; diagnostic delay has prognostic implications and results in significant morbidity. Musculoskeletal tuberculosis produces no pathognomonic imaging signs, and in advanced stages mimics other disease processes. Despite these difficulties, the diagnostician's goal is to catch the disease as early as possible, because antibiotic treatment can lead to resolution and obviate more radical management. The radiologist must be aware of the groups at greatest risk, and typical and atypical presentations at imaging. The eventual eradication of MTb is conceivable, although not presently within our grasp. Maintaining reasonable suspicion and developing cognizance of the patterns of presentation allow the radiologist to diagnose efficiently the patient who presents with osteoarticular tuberculosis

The anatomy of the biceps brachii muscle-tendon complex is reviewed. Particular attention is given to the tendon of the long head. Pathologic conditions affecting the biceps are discussed with respect to clinical features and current ideas regarding pathogenesis, which are correlated with the appearance at MR imaging

OBJECTIVE: The purpose of this study was to describe the CT features of infradiaphragmatic air that may develop in patients after mechanically assisted ventilation, its location, its pathway of transdiaphragmatic dissection, and its extension into the abdomen. MATERIALS AND METHODS: We retrospectively evaluated six consecutive adult patients with pneumomediastinum associated with positive end-expiratory pressure therapy who developed intraabdominal air and were imaged with CT in our institution-between 1993 and 1995. Abdominal CT examinations were reviewed and correlated with the clinical findings, follow-up examinations, and exploratory laparotomies in four patients. RESULTS: In four patients, air present in the anterior mediastinum (endothoracic fascia) was seen to extend into the anterior abdominal wall within the extraperitoneal space. In a fifth patient, the air was located extraperitoneally and intraperitoneally. In the remaining patient, air was present exclusively in the peritoneal cavity. In only two patients did we detect small amounts of air in the posterior retroperitoneum. In five patients, we also detected subcutaneous emphysema and/or air dissection into the muscle planes of the anterolateral abdominal wall. CONCLUSION: In patients on mechanically assisted ventilation, anterior mediastinal air can dissect through the diaphragm into the anterior abdominal extraperitoneal space. This anterior pathway of infradiaphragmatic extension of air can be erroneously diagnosed as intraperitoneal air, which may lead to unnecessary exploratory laparotomies. Also, anterior mediastinal air can enter the peritoneal cavity, particularly in patients with a history of median sternotomy