bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication in the Era of Telemedicine
Authors: McGarvey Kevin
Published: June 2019

Telemedicine is starting to impact how people communicate in emergency medicine at the edges of the specialty. It will likely expand in its scope and reach in emergency medicine in the future in ways that will impact traditional workflows and with that how providers regularly communicate with patients, staff members, and other physicians. Currently, telemedicine impacts emergency medicine in particular specialized care scenarios. There are 2 types of telemedicine growing rapidly. Direct-to-consumer telemedicine mainly serves low-acuity issues, like simple pharyngitis and upper respiratory infections. Provider-to-provider telemedicine is used for high-risk cases where a provider needs additional expertise, like giving TPA (Tissue Plasminogen Activator) to acute stroke patients. Communication can become more immediate, direct, and clear in both of these formats, relative to the traditional alternatives. As the use of telemedicine evolves, communication that was at times fragmented, delayed, or inaccessible will become more fluid, allowing for easier care. This trend will mean providers will potentially spend more time in front of a screen than ever before. Clinical decision making and data collection in emergency medicine will become more rapid and complex in many ways as digital health innovations start to take root in the health care system.
Communication in Medical Resuscitation and the Post-Code Debrief
Authors: Perman Sarah M.
Published: June 2019

During high-stakes situations, such as resuscitations, effective communication among providers is of utmost importance to ensuring the best potential patient outcomes. Families can be present in resuscitations, adding an additional complexity and another point of communication focus. After resuscitations, a debriefing session is important to provide an opportunity for reflection and for future improvements. This chapter will focus on principles for improved communication during resuscitations.
Feedback and Communication With Learners in an Emergency Department
Authors: Kaplan Bonnie
Published: June 2019

Feedback and communication are essential components of learner clinical education, important for learner growth and development. The emergency department presents a unique environment for communication that can impact how learners receive feedback. The fast, chaotic environment means common tools often need to be modified to give learners the ability to close the gap between the learner’s actual practice and aspired practice. Formal and informal feedback needs to be employed in an effective and timely fashion while taking into account the varied level of learners, from medical student to resident and fellow. Effective and timely communication and feedback can transform the learning environment from chaos to learned deliberate practice and empower the learner to become the clinician he or she aspires to be.
Glossopharyngeal Neuralgia
Authors: Sagher Oren
Published: June 2019

Glossopharyngeal neuralgia is an uncommon, but devastating pain condition. It shares many features with trigeminal neuralgia, but predominantly affects the posterior tongue and pharynx. Since glossopharyngeal neuralgia pain is frequently triggered by swallowing or movement of the tongue, patients frequently present with weight loss and dehydration. This chapter describes the classic features of this condition, including its association with syncope. The medical management of glossopharyngeal neuralgia is outlined as a primary treatment modality. Surgical considerations are also described, including microvascular decompression or sectioning of the glossopharyngeal nerve. Surgical pearls for both of these procedures are outlined, as well as strategies for complication avoidance and management.
Trigeminal Neuropathic Pain
Authors: Behbahani Mandana A. , Chaudhry Nauman S. , Slavin Konstantin V.
Published: June 2019

Trigeminal neuropathic pain (TNP) involves pain isolated to the distribution of one or more branches of the trigeminal nerve following unintentional injury to that nerve. It is important to distinguish this facial pain syndrome from trigeminal neuralgia, as the treatment is quite different. The diagnosis is typically clinical, although local anesthetic blocks may aid in the diagnosis. Psychological testing is often performed preoperatively. Like other neuropathic pain syndromes, TNP may be treated with peripheral nerve stimulation. This chapter discusses a typical presentation of TNP, as well as the evaluation and management process, including placement of subcutaneous electrodes and connection to an internal pulse generator.
Occipital Neuralgia
Authors: Weiner Richard L.
Published: June 2019

Patients with occipital neuralgia typically complain of intractable, posterior headaches. Prior attempts to treat this condition have traditionally consisted of various strategies to decompress or cut the greater occipital nerve. Some have even advocated the ablation of ganglia or cervical roots that give rise to the occipital nerve. However, such treatments are highly invasive, irreversible, and fraught with failure and complications. Modern strategies employing subcutaneous stimulation of the occipital nerve using linear stimulation arrays are quite effective and lower in invasiveness and risk. This chapter discusses the clinical hallmarks of occipital neuralgia and the technique by which these subcutaneous electrodes are implanted and utilized.
Spinal Cord Injury Transitional Zone Pain
Authors: Sagher Oren
Published: June 2019

The treatment of spinal cord injury pain is one of the most challenging clinical problems in pain neurosurgery. It represents a type of deafferentation pain that resists most treatment modalities. And while ablative neurosurgical procedures have largely been abandoned in the treatment of deafferentation pain, it still plays an important role in transitional zone pain. This chapter outlines the essential clinical features of transitional zone pain following spinal cord injury and describes the use of dorsal root entry zone lesioning (DREZ) in its management. The decision-making process involved in offering this procedure is nuanced, and this chapter provides key considerations important in counseling patients prior to surgery.
Pelvic/Visceral Cancer Pain
Authors: Viswanathan Ashwin
Published: June 2019

The management of medically refractory cancer pain is a complex, multi-disciplinary effort. When optimal medical management has failed, neuroablative and neuromodulatory efforts can be used. While neuromodulation is an attractive option due its minimally invasive nature, neuroablation offers the advantage of high efficacy and the lack of maintenance or upkeep requirements. Punctate midline myelotomy is an ablative procedure targeting the ascending visceral pain pathway in the dorsal columns. The procedure can be performed through an open approach creating a mechanical lesion, or percutaneously via either a mechanical lesion or radiofrequency ablation. Careful attention to the spinal cord midline during lesion creation and attention to surgical technique, including an excellent fascial closure, can minimize potential complications.
Postherpetic Neuralgia of the Trigeminal Nerve (Trigeminal Tractotomy-Nucleotomy)
Authors: Teton Zoe , Raslan Ahmed M.
Published: June 2019

Trigeminal tractotomy-nucleotomy (TR-NC) is an effective operation in conditions where peripheral ablation would not be effective or when pain is due to involvement of multiple cranial nerves. Lesioning of the entire nucleus caudalis at the dorsal root entry zone (DREZ) represents a more extensive version of TR-NC. Here the focus is on the less invasive, percutaneous TR-NC or “mini-caudalis DREZ”. The target of TR-NC is the lateral descending trigeminal tract and nucleus caudalis of the spinal trigeminal nucleus. In select patient populations, careful lesion creation can be highly effective in providing immediate and long-lasting pain relief, with minimal adverse effects, lower cost and shorter hospital stays.
Trigeminal Neuropathic Pain
Authors: Field Nicholas C. , Pilitsis Julie G.
Published: June 2019

Motor cortex stimulation is a surgical treatment for medically refractory trigeminal neuropathic pain, a syndrome often caused by nerve injury due to trauma, dental work, or previous surgery for trigeminal neuralgia. Preoperative planning includes pain assessment scales, psychological clearance, and functional magnetic resonance imaging (fMRI) to map the motor cortex. The patient undergoes a craniotomy with trial placement of an epidural electrode array, assisted by neuronavigation, phase reversal monitoring, and somatosensory evoked potential recordings. Less commonly, the electrodes are placed in the subdural space. Postoperative seizure is the most common complication, additionally there are risks for infection and hemorrhage. Programming of the device is performed and the patient undergoes permanent implantation of the system if they achieve a greater than 50% reduction in their pain. Further research is necessary to determine which patients will have the best response to therapy.
Traumatic Injuries of the Thoracolumbar Spine
Authors: Chiang Andrew L. , Lomasney Laurie M.
Published: June 2019

Chapter 3 focuses on acute traumatic injury to the thoracolumbar spine. Imaging strategies will be discussed because imaging plays a critical role in the characterization of fracture patterns, thus providing clues to mechanism of injury and probability of associated neurologic and nonneurologic injury. Delays in diagnosing these fractures can lead to a significantly increased incidence of neurologic deficits as well as chronic pain or instability. Radiographs represent the initial imaging test of choice in the setting of trauma and are generally the primary imaging modality, although cross-sectional imaging, CT, and MRI are also used. In addition, an overview of strategies for conservative and surgical management will be reviewed. Because there is considerable overlap between adult and pediatric injury patterns, adult pathology will be emphasized.
Rib Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 6 on rib trauma reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and treatment of rib fractures. Blunt chest trauma is a common cause of rib injury. This injury can vary in severity and cause respiratory compromise. Ribs usually fracture at the point of impact or posteriorly, where their anatomy renders them structurally weakest. Most rib fractures are stable and are treated conservatively. Flail chest occurs when 3 or more contiguous ribs are fractured in 2 or more places, separating a segment that is free-floating and moves independently, and which may be associated with life-threatening situations.
Sternoclavicular Joint Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 9 discusses sternoclavicular joint trauma. The sternoclavicular joint is a synovial joint with a capsule and adjacent ligaments providing overall stability. Direct or indirect force to the shoulder from mechanisms, such as a motor vehicle collision, sporting injuries, or fall from a height, can cause sternoclavicular joint injury. The 2 main mechanisms for posterior sternoclavicular joint dislocations are discussed. Tearing of the ligaments can result in sternoclavicular joint dislocations, which are more commonly anterior and caused by a blow to the shoulder. Complications related to sternoclavicular joint injury are largely related to the mechanism of injury. CT examination is the gold standard for assessment of dislocation and any potential injury to surrounding structures.
Humerus Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 13 discusses humerus trauma. Humerus fractures are common. Based on anatomic location, they are frequently divided into proximal humerus, humeral shaft, and distal humerus fractures. In the proximal humerus, the surgical neck is most commonly injured, whereas supracondylar fractures are most common among the distal humerus fractures. Fractures of the humeral diaphysis may be associated with radial nerve injury, and supracondylar fractures are sometimes associated with brachial artery injuries. Fractures of the medial epicondyle of the humerus can also be associated with ulnar nerve injury. Multidetector computed tomography (MDCT) is particularly useful for assessment of proximal humerus fractures and for preoperative planning.
Elbow Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the second most commonly dislocated large joint of the body. Radiographs are the mainstay in the evaluation of acute injuries and treatment follow-up. CT examination is helpful in preoperative assessment of complex fractures/injuries. All elbow dislocations are initially close reduced and splinted. Further conservative versus operative treatment depends on complexity of injury.
Hand Trauma
Authors: O’Keeffe Michael , Khursid Kiran , Munk Peter L. , Taljanovic Mihra S.
Published: June 2019

Chapter 17 discusses hand trauma. Metacarpal and phalangeal fractures are common, as are dislocations of the interphalangeal and metacarpophalangeal joints. These injuries may be related to sports or work trauma or result from a fall. Osseous injuries are frequently associated with ligamentous or tendon injury. Most hand injuries are stable and can be treated with closed reduction and immobilization. Significantly displaced fractures and those with substantial intraarticular extension often require operative repair including Kirschner-wire stabilization or open reduction and internal fixation. Generally, the treatment option that achieves the desired reduction and degree of fixation, allows early motion, and minimizes soft-tissue injury should be preferred.
Pelvic Bone Trauma
Authors: Mar Winnie A. , Chadaz Tyson S.
Published: June 2019

Chapter 18 discusses pelvic trauma and reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and treatment of pelvic and acetabular fractures. Most pelvic fractures are stable and include pubic rami fractures, avulsion fractures, and the Duverney fracture. Pelvic fractures may be associated with significant hemorrhage or bladder or urethral injury. The Young and Burgess classification of pelvic fractures is discussed including lateral compression, anterior compression, and vertical shear injuries. The Letournel and Judet classification of acetabular fractures into elemental and associated fractures is also delineated. It is important to recognize pelvic avulsion fractures as they may simulate tumor or osteomyelitis during the healing phase.
Foot Trauma
Authors: Mar Winnie A. , Chadaz Tyson S.
Published: June 2019

Chapter 24 reviews the mechanism of injury, imaging strategy, imaging characteristics, and treatment of foot trauma including the calcaneus, talus, navicular, Lisfranc joint, metatarsals, and phalanges. Classification of fractures and associated injuries are also discussed. Radiographs should be performed first in the evaluation of foot trauma. Standard views of the foot are anterior-posterior (AP), lateral and oblique. CT with multiplanar reformats is commonly used for preoperative assessment of calcaneal fractures and can show tendon entrapment. CT examination is also frequently performed for talar head, neck and body fractures for presurgical planning to assess the degree of displacement, joint reduction, comminution and intraarticular involvement.
Stress Fracture
Authors: Porrino Jack , Wyatt Alvin R.
Published: June 2019

Stress fractures are divided into fatigue and insufficiency fractures. Fatigue fractures are the result of repetitive overuse of normal bone. The injury is commonly sports-related and affects a variety of bones throughout the axial and appendicular skeleton. The diagnosis is predicated on the clinical presentation and imaging confirmation. Insufficiency fractures occur as a result of normal stress to weakened (osteopenic or osteoporotic) bones. MRI provides the highest sensitivity and specificity in detection of stress fractures. Treatment is often conservative, however, stress fractures involving the displacement of weight-bearing bones or occurring along the tension side of the femoral neck may necessitate surgical intervention.
Physeal Injury
Authors: Porrino Jack , Wyatt Alvin R.
Published: June 2019

Chapter 26 discusses physeal injury. The epiphysis and physis are vulnerable to injury in skeletally immature individuals, as the ligamentous and capsular support of the joint is much stronger than the cartilage. Fractures involving the physis are classified according to the Salter-Harris classification scheme. The diagnosis is typically made by radiography, with cross-sectional imaging reserved for clinically ambiguous cases and assessment of severity or injury sequela. Although Salter-Harris type I and II injuries typically are managed with closed reduction and immobilization, Salter-Harris type III through V injuries often require surgery to reduce the risk of physeal arrest or management of bony bridging.
Psoriatic Arthritis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 33 discusses psoriatic arthritis, which is a seronegative spondyloarthropathy (SpA) affecting the peripheral and axial skeleton that may precede skin manifestations. Psoriatic arthritis is a challenging diagnosis because it often initially presents without psoriasis, lacks specific serologic markers, and resembles osteoarthritis and other inflammatory arthropathies. It is associated with joint erosions, destruction, and ankylosis often involving the distal interphalangeal (DIP) joints. Radiography is the primary imaging modality for initial diagnosis and monitoring disease progression and treatment efficacy. Skin and nail involvement and characteristic imaging findings are key criteria for diagnosis. MRI and US of symptomatic joints and/or MRI of the sacroiliac (SI) joints may be useful in clinically challenging cases.
Calcium Hydroxyapatite Deposition Disease
Authors: Vossen Josephina A.
Published: June 2019

Chapter 37 discusses calcific hydroxyapatite deposition disease (HADD). Hydroxyapatite (HA) crystal deposition disease is a systemic disease of unknown etiology that is caused by periarticular and/or intraarticular deposition of HA crystals. The shoulder is the most commonly involved joint with calcification in the supraspinatus tendon, but not all patients with HADD are symptomatic. Radiography is the main diagnostic tool for HADD, which may show calcifications of varying size and shape in the periarticular tendons, bursae, and joint capsule with joint destruction. Ultrasound can be useful in evaluation and image-guided treatment of calcific tendinitis.
Scleroderma
Authors: Vossen Josephina A.
Published: June 2019

Chapter 41 discusses scleroderma, which is a rare autoimmune condition that can affect any organ system. The pathogenesis of scleroderma is complex and remains incompletely understood. Scleroderma affects women more than men and frequently becomes apparent in the fourth to sixth decades of life. Skin involvement is the most common manifestation and often associated with musculoskeletal involvement, especially in the hands. Imaging findings overlap with other connective tissue diseases and erosive arthritides. Radiographs of symptomatic body parts, most commonly the hands, are the standard initial imaging assessment of the musculoskeletal system. Soft tissue calcifications and sclerodactyly are characteristic with less common articular changes resembling the erosive arthritides.
Osteoarthritis of the Upper and Lower Extremity Joints
Authors: Hayashi Daichi , Guermazi Ali , Roemer Frank W.
Published: June 2019

Chapter 44 discusses osteoarthritis (OA) of the upper and lower extremity joints. Imaging plays an increasingly important role in understanding the disease process of OA of the upper and lower extremities. Radiography is the gold standard in OA imaging and is used for establishing the diagnosis and grading disease severity. Radiography can visualize features of OA, such as osteophytes and joint-space narrowing. MRI can image all relevant osseous and soft tissues within the joints and enables visualization of cartilage morphology and composition.
Diffuse Idiopathic Skeletal Hyperostosis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 48 discusses diffuse idiopathic skeletal hyperostosis (DISH), which is a rarely symptomatic, benign condition of extensive ossification of ligament and tendon attachments to bone. It is primarily overlap of the imaging features of DISH and the seronegative spondyloarthropathies (SpA) that makes it a clinically significant entity. Imaging is frequently limited to radiographs of the spine acquired for unrelated reasons. MRI and CT are secondary imaging techniques most helpful in distinguishing DISH from the SpA and evaluating spine fractures. Treatment is rare, but surgical removal of anterior cervical spine ossifications may be required in cases of dysphagia.
Spinal Fixation Hardware
Authors: Hoover Kevin B. , Hunter Tim B.
Published: June 2019

Chapter 49 discusses spinal fixation hardware. The spine is the primary structural support of the human body. Traumatic, neoplastic, infectious, or degenerative disruption of the 3 columns of the spine causing pain and instability are the primary indications for spine surgery. Implanted hardware is used to provide short-term stability while osseous fusion of bone graft develops. Radiographs are routinely used for pre- and postoperative evaluation. Spinal fusion is used to restore and maintain disc space height, to decompress the spinal canal and neural foramina, to maintain normal lordosis, and to increase the stability of involved segments. Cross-sectional imaging is important for identified hardware and soft tissue complications.
Sarcoidosis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 50 discusses sarcoidosis, which is a systemic disease that often involves the musculoskeletal system. The radiographic changes seen in sarcoid of the phalanges are characteristic, however, involvement of bone and other tissues may be occult or nonspecific. Tissue sampling is often required for diagnosis, especially when sarcoid resembles metastatic disease. The organ systems most commonly involved in sarcoid are the lungs, lymph nodes, skin and eyes. Radiographs are the standard first study used to evaluate symptomatic hand or foot involvement. Uncommon, palpable soft tissue lesions are best evaluated by MRI. Systemic corticosteroids are the primary treatment of active sarcoidosis.
Malignant Vascular Bone Tumors
Authors: Stacy G. Scott
Published: June 2019

The organization of vascular bone tumors can be thought of as a spectrum of disease including both benign and malignant entities. Chapter 61 focuses on the malignant tumors, which have elicited much controversy and debate. These include 2 vascular tumors of bone recognized by the World Health Organization: epithelioid hemangioendothelioma and angiosarcoma. Although there are no characteristic imaging features that would obviate the need for biopsy of these entities, they may present with multifocal bone lesions, which can suggest the diagnosis of a vascular tumor. This chapter will describe the clinical, pathophysiological, and imaging features of these malignant vascular bone tumors, with a brief mention of treatment strategies.
Miscellaneous Tumors and Tumorlike Conditions
Authors: Meyer John , Anwar Nabeel
Published: June 2019

Chapter 62 discusses miscellaneous tumors and tumorlike conditions. A number of commonly encountered primary benign and malignant skeletal lesions, including cystlike and lipomatous lesions, do not fall within the histological categories noted in other chapters. As with all subspecialties in radiology, taking the clinical context, such as patient’s age and symptoms, into account when interpreting a study is invaluable. The differential diagnosis for many musculoskeletal lesions can be narrowed down to a short list simply by considering the age of the patient and location of the lesion, both within the body and within an individual bone. Just as much attention should be directed to learning these clinical features as the imaging characteristics for each lesion.
Radiation Changes
Authors: Thomas Stephen , McCann Stephanie
Published: June 2019

Chapter 64 discusses radiation changes. Radiation has long been used to treat soft tissue and bone neoplasms. In many instances, radiation can cause changes in the bones and soft tissues that are recognizable on imaging studies and should not be mistaken for aggressive processes. The effects of radiation may vary based on whether the patient is skeletally mature at the time of exposure. Some patients with prior radiation exposure are at risk for developing benign and malignant neoplasms. This chapter discusses the effects of radiation on the skeletal system, noting different effects based on skeletal maturity, as well as mentioning some of the radiation-induced neoplasms.
Malignant Soft Tissue Masses
Authors: Blount Kevin J.
Published: June 2019

Chapter 66 discusses malignant soft tissue masses. Soft tissue malignancies are less common than those of benign origin but should be in the differential diagnosis for any soft tissue mass. Malignant soft tissue tumors have a wide range of clinical and imaging appearances, which can present a diagnostic challenge. If the imaging features of the soft tissue mass are not entirely characteristic for a benign diagnosis, biopsy should be performed. After initial radiographs, MRI is considered the best imaging modality to characterize malignant soft tissue lesions. Prompt diagnosis is critical because a diagnostic delay is associated with a worse clinical outcome.
Synovial Chondromatosis
Authors: Mar Winnie A.
Published: June 2019

Chapter 67 discusses synovial chondromatosis, which is a neoplastic process that can lead to a monoarticular erosive arthropathy. It is divided into primary and secondary forms, and this chapter focuses on primary synovial chondromatosis. It can occur in joints, bursae and tendon sheaths, and can be calcified or noncalcified. The knee and hip are the most commonly involved joints. Pathologically, there is subsynovial hypertrophy with cartilaginous nodules. These cartilaginous bodies can detach and may calcify and ossify. The pathophysiology, epidemiology and treatment are discussed, and the imaging features of this disease on radiographs, CT, and MRI are described.
Osteoporosis
Authors: Haar Peter J.
Published: June 2019

Chapter 71 discusses osteoporosis, which is a systemic skeletal disease characterized by generalized loss of bone mass. Osteoporosis is the most common metabolic bone disorder. Symptoms in osteoporosis arise from complications, particularly fractures. Early diagnosis is important because osteoporotic fractures can markedly decrease quality of life and reduce life expectancy. Radiography alone is inadequate for detecting early bone loss. MRI has a higher sensitivity for detecting nondisplaced fractures in osteopenic bone than does radiography. Dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosis and fracture risk prediction. Detection of fragility and insufficiency fractures is highly important in patient care, often initiating lifestyle modification and pharmacologic therapy.
Rickets and Osteomalacia
Authors: Haar Peter J.
Published: June 2019

Chapter 72 discusses rickets and osteomalacia. Abnormal mineralization of bone is termed osteomalacia in adults and rickets in children and it may be caused by a variety of conditions in which there is a lack of available calcium or phosphorus for mineralization of osteoid. Radiographic findings of osteomalacia include osteopenia, bowing deformities, and pseudofractures, whereas findings of rickets include additional radiographic abnormalities of the growth plates. Diagnosis of osteomalacia and rickets often involve blood analysis, imaging findings, and identification of the specific underlying cause. Radiography is the most useful imaging modality in the diagnosis and evaluation of these conditions. Treatment of osteomalacia and rickets depends on the underlying cause.
Paget Disease
Authors: Haar Peter J.
Published: June 2019

Chapter 73 discusses Paget disease, which is a progressive bone disease of excessive bone turnover and abnormal, disordered bone remodeling. Paget disease generally affects older patients. Paget disease has an initial active phase with a focal zone of osteolysis and an inactive phase with bone enlargement, trabecular coarsening, and cortical thickening. The diagnosis of Paget disease is usually made with radiographs, though cross-sectional imaging can be useful for early diagnosis in the skull and spine. Rare complications of Paget disease include neural impingement and sarcomatous degeneration. Treatment is provided with medical therapy and surgical treatment of pathologic fracture or prophylactic fixation.
Plasma Cell Dyscrasias
Authors: Hoover Kevin B.
Published: June 2019

Chapter 76 discusses plasma cell dyscrasias, which are currently incurable diseases resulting from the proliferation of plasma cells and the secretion of immunoglobulins with associated anemia and end-organ damage. These diseases are more common in men than women and more common in African Americans than whites. Multiple myeloma is the most common of the plasma cell dyscrasias. Blood and urine testing, bone marrow biopsy, and radiography are the primary tests used for diagnosis. Radiographs are the standard tools in disease staging and monitoring with advanced imaging used primarily for evaluating symptomatic patients with negative radiographs and patients in clinical trials.
Histiocytoses
Authors: Hoover Kevin B.
Published: June 2019

Chapter 77 discusses histiocytoses, which are uncommon myeloid cell disorders. Langerhans cell histiocytosis (LCH) is the most common, with Erdheim-Chester disease (ECD) being less common. In LCH and ECD, the bones are most commonly involved. The imaging characteristics of the histiocytoses are nonspecific, and biopsy is often required for diagnosis. Radiography is standard for the initial assessment of suspected bone lesions. MRI is used to confirm a solid neoplasm, narrow the differential diagnosis, evaluate for risk of pathologic fracture, and guide biopsy. CT is usually performed in areas with lymphadenopathy. Treatment of skeletal disease is most commonly surgical and limited to symptomatic patients or those at risk for pathologic fracture.
Mucopolysaccharidoses
Authors: Hoover Kevin B.
Published: June 2019

Chapter 84 discusses mucopolysaccharidoses, which are genetic, lysosomal storage diseases resulting in the accumulation of glycosaminoglycans (GAG) in the soft tissues. Musculoskeletal complications of mucopolysaccharidosis (MPS) are common beginning in childhood. These result from abnormal ossification and periarticular GAG accumulation. Radiographs of the axial and appendicular skeleton (skeletal survey) are used for the baseline assessment of MPS disease. Progression of skeletal abnormalities is monitored with annual cervical spine MRI. Stem cell transplantation is the treatment of choice in MPS I, and enzyme replacement therapy (ERT) is the treatment of choice in MPS I Hurler-Scheie and Scheie, MPS II, and MPS VI.
Soft Tissue Infections
Authors: Shikhare Sumer N. , Peh Wilfred C. G.
Published: June 2019

Chapter 88 outlines the key radiologic features of soft tissue infections and the diagnostic value of the different imaging modalities such as conventional radiography, US, CT, and MRI. Soft tissue infections present in various forms that involve varying depths from skin to deeper tissues. Early diagnosis may be challenging because of nonspecific clinical presentations, resulting in delay in management. The advent of cross-sectional imaging has improved diagnostic capabilities dramatically, with US, CT, and particularly MRI being the pillars of evaluation. Prompt and appropriate imaging workup of the various MSK soft tissue infections aids early diagnosis and in demonstrating the extent of the disease process, as treatment delay significantly reduces the cure rate and increases the risk of complications.
Atypical Mycobacterial Infections
Authors: Arkun Remide
Published: June 2019

Chapter 90 reviews atypical mycobacterial infections of the musculoskeletal system, which are uncommon. At least 15 species of atypical mycobacteria have been mentioned in the literature as the cause of musculoskeletal infection. There is no evidence of human-to-human transmission, and therefore these infections do not pose a public health risk. The patients may present with nonhealing wounds, cellulitis, superficial and deep fasciitis, tenosynovitis, myositis, soft tissue abscesses, osteomyelitis, septic arthritis, and infectious spondylitis. Imaging findings are nonspecific and the differential diagnosis includes tuberculosis and various fungal and bacterial infections. The diagnosis is made by tissue sampling and culturing. With negative cultures, identification of different Mycobacterium species can be made by using polymerase chain reaction. Drug-resistant infections warrant surgical debridement.
Leprosy
Authors: Arkun Remide
Published: June 2019

Chapter 97 reviews leprosy (Hansen disease), which is a chronic granulomatous infection caused by the obligate intracellular bacillus, Mycobacterium leprae. The disease is still endemic in various regions of the world with 70% of cases in India, Myanmar, and Nepal. Skin and peripheral nerves are primarily affected. Nerve involvement results in loss of sensory and motor function, which may lead to frequent trauma and amputation. Nerve abscesses may occur in various forms of leprosy because of caseation of nerve fasciculi. The ulnar nerve is most commonly involved. Ulcers, osteomyelitis, periostitis, and other neuropathic changes in the bones of the hands and feet are the result of prolonged anesthetic changes seen in leprosy patients. Radiography is the initial imaging technique for bone lesions. US and MRI are used in the evaluation of nerve involvement.
Knee Arthrography
Authors: DelGiudice Matthew
Published: June 2019

Chapter 102 describes indications, technique, and imaging findings of knee arthrography. Knee arthrography is selectively performed in clinical practice for MRA, typically in younger patients. Indications include evaluation for meniscal re-tear after prior repair, osteochondral injuries, and therapeutic injections (most commonly steroid). Extension of intraarticular contrast into the meniscal substance indicates a tear or re-tear. Abnormal course of the cruciate ligament fibers indicates a tear. Contrast undermines unstable osteochondral lesions and extends into the hyaline cartilage defects. Complications are rare but include infection and bleeding.
Internal Derangement of the Hip
Authors: Omar Imran M.
Published: June 2019

Chapter 107 discusses the hip and its component tissues, including the bones, labrum, synovial tissues, muscles, and tendons, and covers the MRI appearances of many of the most common pathologies that occur in and around the hip joint. The hip is a ball-and-socket joint consisting of the femoral head and the cup-shaped acetabulum. Because of its shape, the hip allows multi-axial movements, including flexion/extension, abduction/adduction, and internal/external rotation. A number of supporting structures, including the acetabular labrum and joint capsule, surrounding muscles and tendons, and bursae, help stabilize the hip and allow for a smooth range of motion. Injuries to any of these structures can result in hip pain and loss of function. MRI has become the test of choice to assess hip internal derangement because of its superior assessment of soft tissues and bone marrow and its contrast resolution, which improves conspicuity of pathologic conditions.
Internal Derangement of the Knee
Authors: Garg Ankur
Published: June 2019

Chapter 108 focuses on knee MRI, first discussing some general technical considerations of musculoskeletal MRI, and then discussing individual components, including the menisci, cruciate and collateral ligaments and articular cartilage, which often contribute to knee pathology. After initial radiographic assessment, MRI is the most helpful imaging modality to detect internal derangement of the knee, and the knee is the most commonly ordered extremity MRI examination. MRI is an extremely powerful tool for determining the source of the patient’s symptoms and directing future treatment, and it is the most sensitive imaging study to evaluate the menisci, ligaments, tendons, and muscles in the setting of knee pain or instability. Additionally, MRI is also an excellent tool to evaluate the bones and articular cartilage.
Imaging of Articular Cartilage
Authors: Hoover Kevin B.
Published: June 2019

Chapter 111 discusses imaging of articular cartilage. The importance of cartilage in normal joint function necessitates the use of high-resolution sequences for cartilage assessment. Cartilage loss is inferred on radiographs and CT images by the presence of joint space loss, altered alignment, and subchondral bone changes. MRI allows the direct assessment of articular cartilage structure and injury in contrast to the indirect visualization obtained with radiography and CT. Direct visualization in situ has helped to advance the treatment of injured cartilage, which is increasingly common in clinical practice. The imaging of cartilage composition may aid in the development of treatments that prevent or stabilize cartilage injury.
Common Congenital Syndromes
Authors: Gilbertson-Dahdal Dorothy L.
Published: June 2019

Chapter 114 focuses on several of the more commonly seen types of skeletal dysplasia, such as achondroplasia, Hurler syndrome, osteogenesis imperfecta, and thanatophoric dwarfism. Skeletal dysplasia results from genetic mutations that cause abnormalities in bone or cartilage. There are more than 450 skeletal dysplasias and most are rare. Many dysplasias are detected on prenatal US, and family history, physical examination, and molecular and genetic testing are also used in diagnosis. A skeletal survey is recommended including skull AP and lateral; thoracolumbar spine AP and lateral; and AP views of the chest, pelvis, upper limbs, and lower limbs. Treatment options and management vary.
Ultrasound of the Shoulder
Authors: Yablon Corrie M.
Published: June 2019

Chapter 120 discusses US of the shoulder, which is most commonly performed to evaluate the tendons of the rotator cuff. In this examination, the long head of the biceps tendon, subacromial-subdeltoid bursa, and acromioclavicular joint are also examined. US demonstrates equal diagnostic accuracy to MRI in the assessment of partial- and full-thickness rotator cuff tears. Dynamic US of the shoulder is useful to evaluate subacromial and subcoracoid impingement as well as long head of the biceps tendon subluxation or dislocation. US is excellent in evaluating the postoperative rotator cuff, as the metallic susceptibility artifact encountered in MRI is not a problem in US.
Ultrasound of the Hip and Thigh
Authors: Morag Yoav
Published: June 2019

Chapter 123 discusses US of the hip and thigh. US scanning of the hip and thigh is frequently used in evaluation of hip joint effusions and synovitis; common tendon pathology about the hip and pelvis, including the gluteal, hamstring, iliopsoas, and adductor tendons; muscle injuries; and in evaluation of hip bursae such as the iliopsoas and trochanteric bursae. Dynamic US evaluation may identify the etiology of a “snapping hip,” which has a number of potential etiologies. US examination may be comprehensive or focal. A patient-guided examination in the area of focal symptoms may help in identification of subtle pathology.
Ultrasound of the Calf, Ankle, and Foot
Authors: Morag Yoav
Published: June 2019

Chapter 125 discusses US examination of the calf, ankle, and foot, which is frequently performed to evaluate for muscle, tendon, and ligamentous injuries; joint effusions and synovitis; bursitis; plantar fasciitis; and Morton neuroma. US measurements of Achilles tendon ruptures in different ankle positions may help in guiding treatment selection. Dynamic US evaluation is the imaging study of choice to evaluate for peroneal tendon dislocation and intrasheath subluxation. The posterior tibial tendon (PTT) is the most commonly injured tendon at the medial aspect of the ankle which can be readily evaluated with US. US scanning may be comprehensive or focused to the region of interest.
Ultrasound-Guided Musculoskeletal Procedures
Authors: Lopez-Ben Robert
Published: June 2019

Chapter 128 discusses US-guided musculoskeletal (MSK) procedures. US is an effective imaging modality to guide MSK interventions, such as joint and soft tissue injections and aspirations. Preferred anatomical approaches for needle access for arthrocentesis, injection of contrast for MR arthrography, or injection of local corticosteroid for antiinflammatory effects to different joints are reviewed. A comprehensive US scanning of the targeted area should be performed prior to the intervention. Linear high-frequency transducers provide better detail in superficial locations, but curvilinear array transducers may be needed when targeting deeper structures. Aspiration of abscesses, hematomas, and ganglion cysts, and soft tissue biopsies are readily performed with US guidance. US guidance is effective for lavage and aspiration of calcific tendinosis and for guiding more novel interventions such as platelet-rich plasma injections for degenerative overuse injuries to the tendons and muscles.
Introduction
Authors: Hoskin Peter
Published: June 2019

Radiotherapy remains the most important non-surgical treatment in the management of cancer. Chapter 1 discusses the various types of radiotherapy and how, in recent years, rapid advances in the technology available to radiotherapy have been made. There is a challenge to the practising clinician to remain abreast of these and harness them to their best use in the management of patients.
Treatment delivery, intensity-modulated radiotherapy, and image-guided radiotherapy
Authors: Tsang Yat Man
Published: June 2019

Chapter 3 discusses how successful delivery of external beam radiotherapy such as intensity-modulated radiotherapy and image-guided radiotherapy involves a number of complex processes beginning with the decision by the clinical oncologist to use radiotherapy as part of the patient’s cancer management, through the preparation and planning of the patient’s treatment, to the verification of the patient position and radiation dose delivered at the time of treatment.
Upper gastrointestinal tract
Authors: Falk Stephen
Published: June 2019

Chapter 7 discusses the upper gastrointestinal tract, and addresses the technical challenges of these cancersin relation to tumour volumes, anatomical situation, and poor normal tissue tolerance, particularly of the intra-abdominal contents. More contemporaneous treatment techniques such as intensity-modulated radiotherapy and stereotactic ablative radiotherapy have not currently made significant impact in the routine treatment of upper gastrointestinal tumours in the UK.
Rectal cancer
Authors: Glynne-Jones Rob , Harrison Mark
Published: June 2019

Chapter 8 assesses the role of radiation therapy in rectal cancer, with emphasis on preoperative imaging, patient selection for preoperative chemoradiotherapy and short-course preoperative radiotherapy, and postoperative chemoradiation. The various available planning techniques are described. More conformal techniques such as intensity-modulated radiotherapy, volume-modulated arc therapy, and brachytherapy are also covered. In addition, the chapter reviews chemoradiation and radiotherapy as an adjunct to local excision and endoluminal irradiation.
Bladder cancer
Authors: James Nicholas , Fackrell David , Zarkar Anjali
Published: June 2019

Chapter 11 discusses the considerable controversy about the optimal management of localized, muscle invasive bladder cancer. Surgical removal of the bladder is considered the ‘gold standard’ in many countries but there is no randomized trial to underpin this statement, and many patients are unfit for surgery. Reported 5-year survival rates with radiotherapy are similar to surgical series and there are many patients for whom radical surgery is simply not suitable and hence bladder-preserving techniques are appropriate.
Vulva and vagina
Authors: Hoskin Peter
Published: June 2019

Chapter 15 discusses vulval and vaginal cancer, radical treatment of inoperable tumours of the vulva and palliative treatment, patient care, and both radical and palliative treatment of vaginal cancer patients.
Central nervous system tumours
Authors: Burnet Neil G , Harris Fiona , Pinkham Mark B , Burton Kate E , Whitfield Gillian A
Published: June 2019

Chapter 17 discusses central nervous system tumours, including principles, planning volumes, dose distribution, high- and low-grade glioma, ependymoma, medulloblastoma, germ cell tumours , vestibular (acoustic) schwannoma, pituitary tumours (including craniopharyngioma), meningioma, and primary spinal cord tumours.
Sociology and the study of cities
Authors: Orum Anthony M.
Published: June 2019

Cities, as well as urban places, are a fascinating focus of study. Sociology comes into its own when studying not only physical urban spaces, but also processes that happen in urban spaces. Various schools of study of sociology have highlighted various aspects. For several decades the Chicago School of Sociology shaped urban sociology as a whole. For example, urban sociologists, whether at Chicago or elsewhere, see the city as a place consisting of different concentric zones—a zone of manufacturing, for example, as well as a red light district, and particular ethnic settlements. Each of these zones carries with it various issues related to mental health, well-being, and mental illness. Some of the earliest studies in urban mental health originated from Chicago. The concept of public space and its functioning creates a number of issues that need exploration. There appears to be a genuine intellectual division and tension between those who insist that public space permits people to gather and express themselves freely and those who insist that the reality of the world today has eliminated the notion of public space. This chapter explores these issues within the broader context of globalization.
Internal migration and internal boundaries
Authors: Ventriglio Antonio , Bhugra Dinesh
Published: June 2019

The recent spate of global migration for geo-political reasons hides the fact that human migration has occurred over several millennia. Perhaps social media has led to acute awareness of the impact of immigration on social, political, and economic aspects of the new country. Urban areas and conurbations tend to attract refugees and asylum seekers. The contributions that migrants make are often ignored or forgotten. Migrants are mostly psychologically and physically resilient, but acculturation processes may not always go smoothly, creating discrimination by the larger community. Some migrant groups show higher rates of psychiatric disorders, but these have to be seen in the context of discrimination in policies of employment, housing, etc., and physical and psychological acculturation. Political, social, and economic factors are likely to play a role in the genesis of depression in urban migrants. Specific social factors may influence the individual’s functioning soon after arrival, but other factors may emerge after moving into the city.