Continuing education mri spectrum of medial collateral ligament injuries and pitfalls in diagnosis

The medial collateral ligament (MCL) is made up of different components and spans the medial aspect of the knee. With injuries the superficial or deep and posterior components may be involved. A variety of conditions including MCL bursitis, medial osteoarthritis, medial cellulitis, medial bursitis, medial meniscal cyst, meniscocapsular separation, and retinacular tear may present with high signal surrounding the MCL fibers and simulate an MCL tear

Subperiosteal ganglion cyst of the tibia : a communication with the knee demonstrated by delayed arthrography

We report a patient with a subperiosteal ganglion cyst of the tibia which was imaged by radiography, arthrography, CT and MRI. The images mere correlated with the arthroscopic surgical and histological findings. Spiculated formation of periosteal new bone on plain radiographs led to the initial suspicion of a malignant tumour. Demonstration of the cystic nature of the tumour using cross-sectional imaging was important for the precise diagnosis. Communication between the ganglion cyst and the knee was shown by a delayed arthrographic technique, and the presence of this communication was confirmed at arthroscopy and surgically

Evidence of increased axillary blood flow velocity without increased handgrip strength and endurance in persons with a fibromuscular axillary arch

Background: The purpose of this in vivo study was to compare axillary artery blood flow velocity, and maximal handgrip strength and endurance performance in young subjects with and without an axillary arch (AA). Materials and methods: One hundred and fifty-six young adults were screened for the presence of an AA on their dominant arm side. After physical examination subjects were checked using diagnostic echography for the presence of an AA. Sixteen subjects with an AA and 15 without an AA had their axillary artery peak systolic velocity quantified in 3 different arm positions using Doppler ultrasound. Maximal handgrip strength and endurance performance was quantified in the same positions using a functional rehabilitation system. Results: Mean peak systolic velocity was significantly higher in the AA group compared to controls in abduction/external rotation of the arm during muscle relaxation (p = 0.003) and contraction (p = 0.01). No significant differences between groups were found for maximal handgrip strength and endurance performance. Conclusions: This study provides evidence for a transient axillary artery compression by the AA in a throwing position. This is not reinforced by additional contraction of the shoulder muscles along with the AA. Axillary artery compression does not influence maximal handgrip strength and endurance performance in symptom-free young adults

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey

Background: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. Methods: We enquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. Results: The same three information sources – professional meetings & conferences, peerreviewed journals and medical colleagues – were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. Conclusion: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs

Powdered Cross-Linked Gelatin Methacryloyl as an Injectable Hydrogel for Adipose Tissue Engineering

The tissue engineering field is currently advancing towards minimally invasive procedures to reconstruct soft tissue defects. In this regard, injectable hydrogels are viewed as excellent scaffold candidates to support and promote the growth of encapsulated cells. Cross-linked gelatin methacryloyl (GelMA) gels have received substantial attention due to their extracellular matrix-mimicking properties. In particular, GelMA microgels were recently identified as interesting scaffold materials since the pores in between the microgel particles allow good cell movement and nutrient diffusion. The current work reports on a novel microgel preparation procedure in which a bulk GelMA hydrogel is ground into powder particles. These particles can be easily transformed into a microgel by swelling them in a suitable solvent. The rheological properties of the microgel are independent of the particle size and remain stable at body temperature, with only a minor reversible reduction in elastic modulus correlated to the unfolding of physical cross-links at elevated temperatures. Salts reduce the elastic modulus of the microgel network due to a deswelling of the particles, in addition to triple helix denaturation. The microgels are suited for clinical use, as proven by their excellent cytocompatibility. The latter is confirmed by the superior proliferation of encapsulated adipose tissue-derived stem cells in the microgel compared to the bulk hydrogel. Moreover, microgels made from the smallest particles are easily injected through a 20G needle, allowing a minimally invasive delivery. Hence, the current work reveals that powdered cross-linked GelMA is an excellent candidate to serve as an injectable hydrogel for adipose tissue engineering

Agenesis of the pubic symphysis detected with SPECT-CT

The pelvis is composed of 3 paired bones (ischiac, pubic and iliac bones) and the sacrum. Any part of the pelvis can be congeni tally absent, but the sacrum is the most commonly affected. The absence can be partial or complete; unilateral or bilateral and can occur in an isolated fashion or be part of a malformation syndrome

Pigmented villonodular synovitis of the midfoot

A 60-year-old man presented with a longstanding slowly growing swelling at the dorsal aspect of the left midfoot. The lesion was imaged with CT, ultrasound, and MR. On CT bony erosions were evident. On MR the lesions appeared bifocal and one component was hypointense on T2 weighted images suggesting hemosiderin deposits. The other component was hyperintense on T2 which is more unusual for PVNS. Imaging findings, however, suggested PVNS which was pathologically confirmed. A unique finding in this case is the late age of presentation of the disorder. Also the bifocal nature of the lesion is relatively uncommon

Traumatic avulsion of the trochanter minor in a 15-year-old boy: an uncommon injury.

A 15-year-old boy was seen at the emergency department with severe groin pain following an acute soccer injury. The pain irradiated towards the knee region. He was unable to move his right leg, and unable to stand on it. Physical examination revealed an extremely tender groin. Hip function was difficult to assess due to the severe pain. Hip and pelvis radiographs demonstrated a 1.3 cm large bone fragment detached and displaced superiorly relative to the trochanter minor (Fig. A). MR images revealed the retracted bone fragment (arrow) with the iliopsoas tendon (arrowheads) attached to it (Fig. B, C ). The tendon, bone fragment and trochanter minor were surrounded by a hyperintense fluid collection. Ultrasound also revealed the bone fragment with the attached tendon, although the relationship to the deeper trochanter minor was difficult to appreciate on ultrasound ). Recovery was uneventful. The patient was seen back after 9 weeks and clinical symptoms had complete subsided with entirely normal hip testing

Unilateral sight loss in a 4-year-old girl

For 6 weeks the parents of a 4-year-old girl had noticed a difference between the two eyes of their child. Ophtalmological examination revealed leukocoria. This finding raised clinical suspicion of retinoblastoma. MRI was performed. On T2 weighted images a hypointense mass relative to the vitreous humor was evident. There were several hypointensities compatible with calcifications. An area of retinal detachment was also seen. On T1 weighted images a mildly hyperintense mass relative to vitreous humor was seen. It showed marked contrast enhancement. On diffusion weighted images there was restricted diffusion suggestive for a tumoral lesion. The imaging findings were compatible with a retinoblastoma without transscleral or optic nerve extension. The tumor was complicated by retinal detachment reducing visual potential. The patient was treated with enucleation of the affected eye