Elaine S. Gould

Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial

Summary A multisite, randomized, controlled trial showed that nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain. ABSTRACT A multisite, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners provided a 10‐session intervention, pain coping skills training (PCST), in patients’ doctors’ offices (N = 129 patients); the control group received usual care (N = 127 patients). Primary outcomes assessed at baseline, posttreatment, 6‐month follow‐up, and 12‐month follow‐up were: pain intensity, physical functioning, psychological distress, self‐efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary ITT and secondary per‐protocol analyses were conducted. Attrition was within the expected range: 11% at posttreatment and 29% at 12‐month follow‐up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared with the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self‐efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self‐efficacy, were maintained through the 12‐month follow‐up; effects for self‐efficacy degraded over time. Per‐protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more vs less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of nurse practitioner delivery of PCST for chronic osteoarthritis pain.

Necrotizing fasciitis and its mimics: what radiologists need to know.

OBJECTIVE The purpose of this article is to review the imaging features of necrotizing fasciitis and its potential mimics. Key imaging features are emphasized to enable accurate and efficient interpretation of variables that are essential in appropriate management. CONCLUSION Necrotizing fasciitis is a medical emergency with potential lethal outcome. Dissecting gas along fascial planes in the absence of penetrating trauma (including iatrogenic) is essentially pathognomonic. However, the lack of soft-tissue emphysema does not exclude the diagnosis. Mimics of necrotizing fasciitis include nonnecrotizing fasciitis (eosinophilic, paraneoplastic, inflammatory (lupus myofasciitis, Churg-Strauss, nodular, or proliferative), myositis, neoplasm, myonecrosis, inflammatory myopathy, and compartment syndrome. Necrotizing fasciitis is a clinical diagnosis, and imaging can reveal nonspecific or negative findings (particularly during the early course of disease). One should be familiar with salient clinical and imaging findings of necrotizing fasciitis to facilitate a more rapid and accurate diagnosis and be aware that its diagnosis necessitates immediate discussion with the referring physician.

Presacral myelolipoma: a case report and review of imaging findings

Extra-adrenal myelolipoma is a relatively rare entity, with fewer than 50 cases reported in literature. We present a case of a 79 year-old female who presented for evaluation of hip fracture following trauma, where a lobulated presacral mass with mixed fat/soft tissue attenuation was incidentally seen on initial bone algorithm pelvic CT. Subsequent MRI showed signal characteristics of a lesion with mixed fat and soft tissue composition. The lesion demonstrated stability on follow-up imaging. An elective surgical resection was performed which yielded a grossly fatty mass. The diagnosis of presacral myelolipoma was confirmed on microscopic examination. Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of presacral myelolipoma.

Ureteral rupture from aberrant Foley catheter placement: A case report

We present the case of a 59 year old female with history of severe neurologic dysfunction from advanced multiple sclerosis who presented with lethargy and oliguria several hours after urethral Foley catheterization. A contrast-enhanced CT scan of the abdomen/pelvis showed an aberrantly placed Foley catheter with its balloon inflated in the proximal left ureter, a rare complication of Foley catheterization with only 5 other cases reported. Incomplete ureteral rupture was demonstrated and confirmed by a followup CT scan in the urographic phase. One of our institutions Interventional Radiologists then placed a nephroureteral stent across the injured ureter to facilitate healing. The patient expired 9 days after the procedure from unrelated sepsis from a chronic stage IV decubitus ulcer, so long term monitoring could not be performed. Following description of our case, we conduct a literature review of presentations, imaging characteristics, and treatment of ureteral Foley catheter placement.

Utility of positron emission tomography-magnetic resonance imaging in musculoskeletal imaging

Differentiation between neoplastic and nonneoplastic conditions magnetic resonance imaging (MRI) has established itself as one of the key clinical tools in evaluation of musculoskeletal pathology. However, MRI still has several key limitations which require supplemental information from additional modalities to complete evaluation of various disorders. This has led to the development hybrid positron emission tomography (PET)-MRI which is rapidly evolving to address key clinical questions by using the morphological strengths of MRI and functional information of PET imaging. In this article, we aim to review physical principles and techniques of PET-MRI and discuss clinical utility of functional information obtained from PET imaging and structural information obtained from MRI imaging for the evaluation of musculoskeletal pathology. More specifically, this review highlights the role of PET-MRI in musculoskeletal oncology including initial diagnosis and staging, treatment planning and post-treatment follow-up. Also we will review utility of PET-MRI in evaluating musculoskeletal infections (especially in the immunocompromised and diabetics) and inflammatory condition. Additionally, common pitfalls of PET-MRI will be addressed.

Fibrolipomatous Hamartoma of the Median Nerve.

We present the case of a 33-year-old woman who presented with a slowly enlarging mass over the volar aspect of the wrist that had been present since infancy which for the previous year had been causing progressive pain. The lesion was proven to be a fibrolipomatous hamartoma, a rare benign tumor that most commonly affects the median nerve. We discuss the characteristic radiologic appearance of this entity that is often pathognomonic and allows a confident diagnosis without the need for biopsy.

Osteochondroma of the hip with adjacent bursal chondromatosis

It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, “cartilage shedding” from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.

Granulomatous salmonella osteomyelitis associated with anti-tumor necrosis factor therapy in a non-sickle cell patient: a case report

Salmonella osteomyelitis is seen most commonly in patients with sickle cell disease and in those with compromised immune systems. We report on the clinical, histological and imaging findings of salmonella osteomyelitis with intraosseous abscess formation occurring in a non-sickle cell patient receiving anti-tumor necrosis factor (TNF) alpha therapy.

Ethical Issues in Radiology Journalism, Peer Review, and Research

OBJECTIVE Although some research and publication practices are clearly unethical, including fraud and plagiarism, other areas of research and publication, such as informed consent and conflicts of interest, fall into grayer areas. CONCLUSION The purposes of this article are, therefore, to review a variety of relevant ethical issues in radiology-related journalism, peer review, and research; to review the radiology literature to date that has addressed these issues; and to present position statements and potential solutions to these problems.

Soft tissue aneurysmal bone cyst: a rare case in a middle aged patient

Soft tissue aneurysmal bone cyst is a rare entity, with about 20 cases reported in literature, only 3 of which are in patients over 40 years of age. We present a case of a 41 year old Latin American female who presented for evaluation of atraumatic chest pain with radiation to the left shoulder. Her initial workup was negative, including radiographic imaging of the chest and left shoulder. 4 months later, she presented to her orthopedic surgeon with a palpable mass and mild left shoulder pain. Radiographs acquired at that time demonstrated a 7.0 × 5.5 × 6.7 cm mass with rim calcification in the region of the upper triceps muscle. Subsequent CT imaging showed central areas of hypodensity and thin septations, a few of which were calcified. MR evaluation showed hemorrhagic cystic spaces with multiple fluid-fluid levels and enhancing septations. Surgical biopsy was performed and pathology was preliminarily interpreted as cystic myositis ossificans, however on final review the diagnosis of soft tissue aneurysmal bone cyst was made. The lesion was then surgically excised and no evidence of recurrence was seen on a 3 year post-op radiograph. Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of soft tissue aneurysmal bone cyst.