Timothy R.B. Johnson

Magnetic resonance imaging of the shoulder. Current techniques and spectrum of disease.

Magnetic resonance imaging is an excellent modality for imaging pathological processes of the shoulder joint. It allows high-resolution imaging of all anatomic structures, including the glenoid, the humeral head, the articular cartilage, the acromion, the muscles and tendons of the rotator cuff, the labrum, the biceps tendon, and the glenohumeral ligaments, in multiple orthogonal planes. Numerous technical options and several pulse sequences can be utilized for the performance of magnetic resonance imaging of the shoulder. The aim of this review is to update orthopaedic surgeons on the technical aspects of performing magnetic resonance imaging of the shoulder. In addition, this report will define the normal anatomy of the shoulder as demonstrated by magnetic resonance imaging and review the spectrum of disease detectable with this technique. After reviewing this article, the reader should (1) have a basic understanding of the physics, pulse sequences, and terminology of magnetic resonance imaging; (2) be able to systematically evaluate the findings of a complete magnetic resonance imaging examination of the shoulder and know the features of normal shoulder anatomy; (3) be able to identify various tissue types on T1-weighted, fat-suppressed T2-weighted, and proton-density images; and (4) be able to diagnose certain pathological processes of the shoulder on the basis of magnetic resonance imaging findings. ### Process of Image Production First, the subject is positioned in the scanner. For magnetic resonance imaging of the shoulder, the patient is supine and the arm is held at the side, as opposed to across the chest, in order to minimize transmission of respiratory motion to the shoulder. The arm is placed in slight external rotation to optimally orient the supraspinatus tendon in order to prevent confusing overlap with the infraspinatus tendon on coronal oblique images1. The external rotation also allows maximum visualization of the supraspinatus insertion2. The magnetic field of …

The association between occupational factors and preterm birth: A United States nurses' study☆

OBJECTIVE Our purpose was to evaluate factors associated with preterm birth among a national sample of U.S. nurses. STUDY DESIGN We conducted a case-control study of 210 nurses whose infants were delivered prematurely (< 37 weeks) (cases) and 1260 nurses whose infants were delivered at term (> or = 37 weeks) (controls). An occupational fatigue score was constructed from four sources and varied from 0 to 4. The relation between occupational activity (including hours working and fatigue score) and preterm birth was analyzed with the use of Pearson chi 2 tests, estimates of odds ratios with 95% confidence intervals, and multivariate logistic regression; we controlled for confounding factors. RESULTS Factors significantly associated with preterm birth included hours worked per week (p < 0.002), per shift (p < 0.001), and while standing (p < 0.001); noise (p = 0.005); physical exertion (p = 0.01); and occupational fatigue score (p < 0.002). The adjusted odds ratios were 1.6 (p = 0.006) for hours worked per week (< or = 36 vs > 36) and 1.4 (p = 0.02) for fatigue score < 3 vs > or = 3. CONCLUSIONS Preterm birth among working women may be related to hours worked per day or week and to adverse working conditions.

Fetal neurobehavioral development: Associations with socioeconomic class and fetal sex

This longitudinal study investigated neurobehavioral development in the human fetus from 24 to 36 weeks gestation. Subject (N=103) were stratified by socioeconomic class. Fetal data were collected for 50 min at three intervals, and included measures of heart rate, movement, and biobehavioral patterns. Repeated measures analysis of variance by fetal sex and maternal socioeconomic status was used to detect maturation effects and group differences. With advancing gestation, fetuses exhibited reduced heart rate, increased heart rate variability and coupling between movement and heart rate, increased movement vigor, and more biobehavioral concordance. Male fetuses displayed higher heart rate variability throughout gestation and somewhat earlier emergence of biobehavioral organization than females. Fetuses of women of lower socioeconomic status had reduced heart rate variability, moved less often and with less vigor, showed less coupling between movement and heart rate, and had fewer episodes of synchronous quiescence/activity. Results are discussed in terms of development of the central nervous system.

A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term

OBJECTIVE The purpose of this study was to determine if prostaglandin E2 in a controlled-release vaginal pessary can produce cervical ripening at term. STUDY DESIGN This was a double-blind, randomized, placebo-controlled study conducted at a university center and involving 81 patients with 42 receiving active agent. Categoric data were analyzed by Pearsons chi 2 or logistic regression. Continuous variables were analyzed by analysis of variance and the F test. RESULTS Prostaglandin E2 was significantly better than placebo at cervical ripening and at decreasing the time to rupture of membranes, the time to onset of labor, the need to give oxytocin, and the time to vaginal delivery. Multiparous women benefitted more than primiparous ones. The cesarean section rate decreased only for multiparous women. Uterine hyperstimulation occurred only with prostaglandin E2 and after the onset of labor. CONCLUSIONS Prostaglandin E2, when administered in a controlled-release vaginal pessary, is affective in producing cervical ripening at term. This agent should be used on inpatients who are under continuous monitoring and it should be removed at the onset of labor.

Migration and women’s health

Women have been migrating at similar rates to men for the past 40 years, and comprised about half of all migrants in 2005. Women and children are most affected by displacement as a result of wars and human trafficking. In some cases, the health of female migrants is improved via integration into better health systems in the host country. More often, however, the health of female migrants is affected negatively. Women are doubly disadvantaged because they are discriminated against as women and as migrants. Female migrants are also highly vulnerable to acts of sexual abuse, rape, and violence. This is especially true for women in refugee camps, whose reproductive health needs are often overlooked. To improve the health of female migrants it is important to develop and implement policies that recognize and insist on the respect of the rights of migrants.

Knowledge, attitudes, and demographic factors influencing cervical cancer screening behavior of Zimbabwean women.

AIMS The aims of this study were (1) to estimate what proportion of rural females had received cervical screening, (2) to assess knowledge, beliefs, attitudes, and demographics that influence cervical screening, and (3) to predict cervical screening accessibility based on demographic factors, knowledge, beliefs, and attitudes that influence cervical screening. METHODS The study sample consisted of randomly selected, sexually active, rural females between 12 and 84 years of age. Five hundred fourteen females responded to an individually administered questionnaire. RESULTS Of the 514 participants, 91% had never had cervical screening and 81% had no previous knowledge of cervical screening tests; 80% of the group expressed positive beliefs about cervical screening tests after an educational intervention. Females who were financially independent were 6.61% more likely to access cervical screening compared with those who were dependent on their husbands. Females in mining villages were 4.47% more likely to access cervical screening than those in traditional rural reserve villages. Females in resettlement villages were 20% less likely to access cervical screening than those in traditional rural reserve villages. CONCLUSIONS Accessibility of screening services could be improved through planning and implementation of screening programs involving community leaders and culturally appropriate messages. The government should incorporate the human papillomavirus (HPV) vaccine in its immunization program for adolescents, and health education should be intensified to encourage women and their partners to comply with diagnostic and treatment regimens.

Gestational age assessment. I. analysis of individual clinical observations.

Accurate assessment of the estimated date of confinement is a cornerstone of obstetric care. Traditionally this date has been predicted from historical and clinical examinations; however, there have been few studies of the accuracy of such predictions. Multiple estimators of gestational age were examined in 418 patients who were delivered of infants weighting larger than or equal to 3,000 gm, following spontaneous onset of labor. Mean intervals from an event to delivery were calculated for last menstrual period (284.2 days), quickening (156.3 days), first audible fetal heart tones (136.2 days), uterine fundus at the umbilicus (140.8 days), and measurements of the fundal height. The variability in each of these estimators was examined and compared. The last menstrual period, if known with certainty, is the most accurate estimator, followed by the uterus at the umbilicus, first heard fetal heart tones, fundal height, and quickening.

Gestational age-specific birthweights of twins versus singletons

In order to more adequately characterize patterns of intrauterine growth retardation in twins, the mean birthweights of all nonanomalous white or black twins born between 24 and 41 weeks of gestation and surviving until discharge over an 11-year period (547 infants) and all similar singletons (19,072 infants) were compared by completed weeks of gestation. Between 24 and 35 weeks of gestation, the mean birthweights for the 547 twins and the 19,072 singletons were comparable and did not consistently differ statistically. From 36 to 41 weeks gestation, however, the difference became large, consistent, and statistically significant for each week at P less than 0.0001. This difference was present among all subgroups of twins, ie, in all males, females, blacks, and whites; it was still evident when the sample was further stratified by both race and sex (black males, white males, black females, white females). These data suggest a pattern of growth retardation in twins compared to singletons which is large, consistent, and statistically significant beginning at 36 weeks gestation. Clinically, these data also suggest the need for ultrasonic examination early in gestation (24-32 weeks) to document normal growth and to provide baseline data, and show the importance of such monitoring later in gestation, specifically after 36 weeks.

Viral respiratory disease in pregnancy

Purpose of review Recently there has been an increased concern over viral respiratory infections and their potential for a pandemic. This concern makes it important to review the most current guidelines for the management of viral respiratory diseases in pregnancy. Recent findings The topics covered are influenza, avian influenza, and severe acute respiratory syndrome. Summary Pregnant women have an increased susceptibility to viral respiratory diseases. The most common respiratory virus to infect pregnant women is influenza. All women who intend to become pregnant or are pregnant should receive the influenza vaccine. If a pregnant woman develops influenza she should be treated with supportive care. Antiviral medications should be reserved for cases where the benefits outweigh the risks. Avian influenza (H5N1) is a new emerging virus usually contracted from direct contact with diseased birds. There is no commercially available vaccine at this time to prevent infection. Pregnant women should be treated aggressively with supportive care and antiviral medications, as the significant risk of maternal mortality outweighs the potential fetal risks. Pregnant women diagnosed clinically with severe acute respiratory syndrome should be treated empirically, as a serologic diagnosis can take weeks to confirm. The treatment of pregnant women with severe acute respiratory syndrome should be without ribavirin.

Leukocyte esterase activity in human amniotic fluid for the rapid detection of chorioamnionitis

Chorioamnionitis plays an important role in perinatal morbidity and mortality. Fast and accurate diagnosis poses a major problem. A prospective study was performed to assess the value of positive leukocyte esterase test (Chemstrip 9) for the diagnosis of chorioamnionitis during labor. We evaluated 21 patients with chorioamnionitis in labor at term and used 21 matched control subjects. The sensitivity and specificity of leukocyte esterase activity were compared with those of amniotic fluid cultures, Gram stains, maternal pyrexia and leukocytosis, and fetal tachycardia. The sensitivity in diagnosing chorioamnionitis was 91% and the specificity was 95%. The use of this test strip could provide a rapid, inexpensive screening test for chorioamnionitis.