Knee - lateral capsular anatomy

The lateral capsule of the knee is a bit complex with anterior and posterior structures. Anteriorly we have the ilio-tibial tract, but posteriorly there are a bunch of structures including the lateral collateral ligament, biceps femoris tendon, the arcuate ligament, etc. that contribute to the capsule.

There is an excellent review article by Recondo J et al in a special issue of Radiographics published some years ago, in 2000, that deals with this anatomy in detail.

Morel-Lavallee lesions

Until two weeks ago, I hadn't even heard of this term. Morel-Lavallee lesions are collections that occur due to the skin and subcutaneous fatty tissue abruptly separating from the underlying fascia, most commonly in the trochanteric region and upper thigh. These have a typical appearance and location.

If we are aware of this entity, it should not be difficult making the diagnosis when a typical case comes across.

Doctors not liable for criminal prosecution except in grossly negligent cases

The newspapers and wires have been agog this morning with the news of a Supreme Court ruling that disallows criminal prosecution of doctors except in the "most negligent" scenarios. However, damages may still have to be paid by the doctors, as part of civil cases.

In a way this is a good thing, because it prevents patients from using the police and the criminal judiciary from harassing us. More and more we have seen that because the civil and consumer courts take their own time in meting out justice, patients turn for immediate relief to neighborhood goons, politicians and the police who if nothing else come to the clinics and hospitals and try and arrest the doctor.

Jimi's MRI

For those who get it, here is today's "Case in Point" cartoon by Rob Esmay showing Jimi Hendrix in an MRI scanner.

Wait times growing for mammograms - maybe there is an opportunity here?

Due to low reimbursement and high malpractice liabilities, more mammography centres are closing than opening at the rate of 2:1. This is leading to increased wait times for screening mammograms in the US?

As it is there are significant wait times for screening mammograms in the UK as well.

Do we sense an opportunity here?

The first Siemens Sensation 64 installation in the US

As with all things in the US, the Sensation 64 from Siemens was installed with fanfare at the Mayo Clinic, Rochester.

The new scanner promises a lot and it is possible that this may completely change the way we look at coronary artery imaging.

Pre-operative breast MRI after USG-guided biopsy

This is one more article by Cheung YC et al in the Annals of Surgical Oncology, on the increasing role of breast MRI in the pre-operative evaluation of breast cancers. In 5 of 36 index cases, breast MRI made a difference to the management of the patient.

MRI for fetal-pelvic index

A recent article in the American Journal of Obstetrics & Gynecology reports the use of MRI in determining the fetal-pelvic index in patients with prior Cesarians, at risk for CPD. The authors found the technique useful as it helped them stratify the patients into favorable, unfavorable and intermediate zones, which impacted management.

There have been many papers earlier on MRI pelvimetry, but this technique has never really caught on with obstetricians. As recent as 2002, in the AJR, there was an article that concluded that unless there are improvements in the assessment of the shape and size of the pelvic outlet, routine use of MRI pelvimetry cannot be recommended.

This is one more indication for MRI that could be pursued.

RA-related lung disease: CT - Radiology 2004: 232: 81

This article by Tanaka N et al is a retrospective study of lung changes in patients with RA. The analysis shows that that in RA, four CT patterns are common: usual interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis and organizing pneumonia. Patients with bronchiolitis had both follicular bronchiolitis and constrictive bronchiolitis.

NEJM -- Use of Lasers for Vision Correction of Nearsightedness and Farsightedness

The July 29, 2004 issue of NEJM has a "Clinical Practice" article on lasers for myopia. The article, meant for non-ophthalmologists, succintly describes PRK, LASIK and LASEK, their indications, contra-indications and complications.

For many of us radiologists who wear spectacles, this article may be of interest.

All NEJM articles have full-text access from India.

NEJM - Mind Reading

For those interested in reflecting on doctor-patient relationships, the NEJM of July 29, 2004 has an interesting single-person account of an interaction that the author had with one particular patient. The issues involved, the author's thought processes and the eventual outcome make for engrossing reading (kind of like a short story).

About medical journals....bmj.com 2004 Smith 329 (7460): 242

Richard Smith the ex-editor of BMJ (he stepped down yesterday) talks about his journey as the editor-in-chief of the BMJ as well as the state-of-affairs in medical journals today. For those interested in such matters, it makes for an extremely interesting read.