Harold J. Schneider

A new consideration in athletic injuries. The classical ballet dancer.

The professional ballet dancer presents all of the problems of any vigorous athlete. The problems include osteochondral fractures, fatigue fractures, sprains, chronic ligamentous instability of the knee, meniscal tears, impingement syndrome, degenerative arthritis of multiple joints and low back pain. Attention to minor problems with sound conservative therapy can avoid many major developments and lost hours. Observations included the extraordinary external rotation of at the hip without demonstrable alteration in the hip version angle and hypertrophy of the femur, tibia and particularly the second metatarsal (in female dancers). Careful evaluation of the range of motion of the extremities, serial roentgenographic examination, and systematic review of previous injuries, training programs and rehearsal techniques have been evaluated in a series of cases to provide the basis for advice to directors and teachers of the ballet.

Rhenium-186 hydroxyethylidene diphosphonate for the treatment of painful osseous metastases

Rhenium-186 (tin)hydroxyethylidene diphosphonate (HEDP) is a new radiopharmaceutical that localizes in skeletal metastases in patients with advanced cancer. A single intravenous administration of approximately 34 mCi (1,258 MBq) resulted in significant improvement in pain in 33 of 43 evaluable patients (77%) following the initial injection, and in 7 of 14 evaluable patients (50%) following a second treatment. Patients responding to treatment experienced an average decrease in pain of about 60%, with one in five treatments resulting in a complete resolution of pain. The only adverse clinical reaction was the occurrence after about 10% of the administered doses of a mild, transient increase in pain within a few days following injection. Statistically significant but clinically unimportant decreases in total white blood cell counts and total platelet counts were observed within the first 8 weeks following the injection; no other toxicity was apparent. Rhenium-186(Sn)HEDP is a useful new compound for the palliation of painful skeletal metastases.

Stress Injuries and Developmental Change of Lower Extremities in Ballet Dancers

Radiographs of the hip and lower extremities of 52 professional ballet dancers were evaluated. Among the various abnormalities, some similar to those found in athletes, were specific patterns of stress hypertrophy of the femora, tibiae, fibulae, and the first three metatarsal bones, and multiple stress fractures of the femoral necks and tibiae. This group of findings is sufficient to identify the classical ballet dancer.

High-resolution computed tomography of the wrist in patients with carpal tunnel syndrome

High resolution computed tomography (CT) was used to scan the wrists of 19 patients with idiopathic carpal tunnel syndrome. Thirteen normal volunteers were used as controls. Measurements obtained from the CT images included the cross-sectional area of the carpal tunnel, the relative amount of synovium within the carpal tunnel, the attenuation coefficient of the carpal tunnel, and the thickness of the transverse carpal ligament. No significant difference in any of these measurements was found when comparing the wrists of symptomatic patients with controls. High resolution CT of the wrist does not appear to be of value in the preoperative evaluation of patients with idiopathic carpal tunnel syndrome.

Spigelian Hernias: Anatomy and Roentgenographic Manifestations

The anatomy of an uncommon but important type of lateral ventral hernia is reviewed. The key radiographic findings are air or contrast filled bowel seen laterally outside the confines of the peritoneal cavity, the “beak sign” of hernia, the sharp constriction of the proximal herniated loop, and the intermittent nature of the hernia. The setting in which to consider this diagnosis—acute bowel obstruction, intermittent abdominal pain, and “vanishing masses”—is discussed. The alert radiologist can suggest this diagnosis in cases in which the lesion is not found or appreciated by the clinician.

Roentgen findings in obstructed diaphragmatic hernia.

As one reviews the rather extensive literature concerned with obstructed diaphragmatic hernia, it becomes evident that there has been considerable difficulty in making this diagnosis. Yet our own experience indicates that it can be promptly established roentgenologically if certain basic facts and principles are kept in mind. The importance of early recognition of this condition cannot be overemphasized, since strangulation and other serious sequelae so often supervene that in untreated cases the mortality approaches 90 per cent (19). Obstruction may complicate any type of diaphragmatic hernia (3, 20). It is relatively rare, however, in right-sided traumatic hernia since the liver generally prevents the gut from entering the chest (14). The present discussion will be limited to hiatal and traumatic hernia of the left hemi-diaphragm, the two most common types, but the roentgen signs to be described are applicable as well to hernias through the other orifices. Obstructed diaphragmatic hernia is not rare. Su...

Case report 211

Fig. 1A, B. A is a conventional anteroposterior roentgenogram of the left iliac bone. B is a standard tomogram of the left iliac bone. These studies show a small, welldefined ovoid, lytic lesion, approximately 1 cm in diameter, with a thin sclerotic margin, occupying the medial third of the left iliac bone. The lesion abuts on the outer margin of the sacroiliac joint. The zone of transition around the lesion is narrow. Sclerosis (not present two years previously) involves the lower 1/2 of the adjacent sacroiliac joint and the brim of the iliac bone inferior to the lytic lesion. An incidental finding is a transitional fifth lumbar vertebra

The Roentgen Appearance of the Small Bowel During Long-Term Hemodialysis for Chronic Renal Disease

Abstract Eight of 18 patients on long-term hemodialysis showed roentgen evidence of small bowel mucosal thickening resembling edema or hemorrhage. Limited surgical material offered presumptive evidence of intestinal edema, accounting for the small bowel abnormality. The findings could not be correlated to the patients age, sex, number of dialyses, or type of treatment, nor was a direct relationship to hypoalbuminemia or fluid retention state established.

Case report 470

Fig. 1 A, B. Conventional anterioposterior and lateral radiographs of the left knee and upper leg show a large, expanding, lytic metadiaphyseal lesion in the upper end of the fibula. Some linear and flake-like fragments of bone are noted within and at the margins of the expansile lesion. The transition margins of the head and diaphysis of the fibula are irregular and frayed. Some permeative lytic changes are noted for a very short distance beyond the transition margin in the diaphysis.

How to Prepare an Exhibit in Radiology—Adaptable and Inexpensive

Problems in preparing scientific exhibits including size, adaptability to different viewboxes, transportation and cost can be partially solved by following a step-by-step procedure. Corresponding illustrations are provided.