Barton Milestone

MR appearance of uterine dehiscence in the post-cesarean section patient.

PURPOSE CT has been shown to be unreliable for detecting uterine dehiscence in the postoperative period after cesarean section (c-section). The purpose of this investigation is to describe the MR appearance of uterine dehiscence in this setting and identify features that distinguish complete from partial dehiscence. METHOD Over an 82 month period, all charts and MR reports of patients that underwent MRI of the pelvis after c-section were reviewed for uterine dehiscence. Altogether, 55 patients were imaged. Positive cases for dehiscence were retrospectively reviewed by two radiologists. Imaging criteria for complete dehiscence consisted of transmural disruption. Criteria for partial dehiscence consisted of disruption of the endometrial and/or serosal layer, without transmural extension. RESULTS On MRI, five patients demonstrated abnormalities suggestive of incisional dehiscence. Based on these imaging criteria, two of these showed complete dehiscence that was proven at surgery and three showed findings of partial dehiscence. The optimal imaging plane was perpendicular to the incision. CONCLUSION MR features may be utilized to identify total uterine dehiscence and may be more effective than CT.

Constancy of proline hydroxylation in collagen synthesized at different temperatures by poikilotherms

Abstract Previous experiments have suggested that the body temperature of an organism may in part regulate the hydroxyproline content of its collagen. In order to test this hypothesis, the hydroxyproline content of the collagen synthesized at different temperatures by fish cells in culture and by intact amphibian larvae was measured. High levels of prolyl hydroxylation were found at both low and high temperatures, which eliminates the possibility that temperature can directly modulate prolyl hydroxylation in vivo . Synthesis and hydroxylation of collagen appear to be coordinated so that unstable underhydroxylated molecules are not produced under normal circumstances.

Clinical significance of increased density in the proximal femoral marrow detected by visual inspection on abdominopelvic postcontrast CT examination.

PURPOSE The purpose of this study was to ascertain the clinical significance of increased density of the proximal femoral diaphyseal marrow when incidentally detected on postcontrast abdominopelvic CT examinations. METHOD The proximal femoral marrow of 63 patients was classified as normal or abnormal based on visual inspection by three attending radiologists. Abnormal density was defined as attenuation greater than that of adjacent musculature. The attenuation of the marrow was also measured. All patient medical records were reviewed for pertinent laboratory and clinical data. RESULTS Increased marrow density had a low sensitivity for anemia (28%) but a high specificity and positive predictive value (100%) for anemia. Three of these patients had unilaterally increased attenuation associated with local pathology. Visual inspection was adequate for identifying abnormalities in instances of underlying malignancy. CONCLUSION Increased density of the proximal femoral diaphysis is a highly specific finding for a marrow replacement process. Anemia was the most common clinical diagnosis in our series of patients with abnormal marrow density. Although the sensitivity for increased bone marrow attenuation is low, the extremely high specificity and positive predictive value of this finding for marrow reconversion and/or replacement suggest that even if detected incidentally, it should not be disregarded and, in the absence of a preexisting causative diagnosis, warrants further evaluation. The specific pattern of marrow abnormality may be helpful in differentiating localized processes from other processes that may affect hematopoietic function in a more widespread or global distribution. In particular, visual inspection of marrow density was more specific for identifying asymmetric marrow density in localized processes than was a quantitative measure of difference between the two femurs (>20 HU).