Radiology
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A total of 109 patients were studied after receiving radiation therapy that included a dose to the spinal cord. In addition to irradiation of the primary site, 59 patients received radiation to the lower neck. ⋯ The authors stress that prolonged fractionation of treatment, fixation of the head during treatment, precise dosimetry, and close surveillance of the patient are important factors in avoiding radiation myelitis. The authors also stress the importance of controlling divergence of multiple beams by employing appropriate shields.
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Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior tibiofibular ligament fails to tear during an injury. Since they are generally the result of external rotation and abduction, they are almost always seen in association with other fractures and ligamentous injuries at the ankle joint. While their presence usually does not change the therapeutic approach, occasionally a large fragment may require a separate fixation screw. Fractures of the posterior tibial tubercle should not be confused with fractures of the posterior articular margin (posterior malleolus), which have a worse prognosis.
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Case Reports
Renal and hepatic microaneurysms: report of a new entity simulating polyarteritis nodosa.
A case of 22-year-old woman with autopsy-proved poorly differentiated carcinoma diffusely involving the visceral organs is presented. Angiographic findings typical of polyarteritis nodosa were demonstrated. The necrotizing vasculidities which form microaneurysms are reviewed, and a new cause is added to this differential diagnosis.
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Fluoroscopically controlled intra-articular facet joint block is a reliable method of diagnosing low back pain and sciatica caused by lumbar facet arthropathy. Of 20 patients studied, 13 had complete and immediate relief of pain, confirming the diagnosis, Six patients have been free of pain for more than six months following a single facet joint block with injection of a local anesthetic and corticosteroid suspension. Preliminary findings suggest that computed tomography has an important role in diagnosing symptomatic facet arthropathy.
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Lumbar facet arthropathy is an important cause of low back pain and sciatica. Intra-articular facet block can confirm symptomatic facet joint disease. Good understanding of the anatomy of the joint and fluoroscopic control are essential for intra-articular placement of anesthetics and steroids.