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While most discoid menisci occur sporadi- diagnosis kamagra polo 100mg for sale erectile dysfunction pumps buy, including the type of meniscus generic kamagra polo 100mg overnight delivery erectile dysfunction caused by spinal cord injury, can be estab- cally, there are isolated reports of a familial occurrence lished by arthroscopy. Although other congenital malformations are no administered in the same anesthetic session, we dispense more common in children with discoid menisci than in with the MRI scan for a clinically suspected discoid menis- the normal population, osteochondrosis dissecans does cus and, if there is a need for treatment, proceed directly to occur more frequently in association with a discoid me- arthroscopy. A recent study diagnosis include meniscal cysts, congenital subluxation of showed an even stronger association betweed a discoid the knee, congenital cruciate ligament aplasia, the snap- meniscus and osteochondritis dissecans of the lateral ping of tendons and dislocation of the patella. Treatment Pathogenesis While discoid menisci cause no, or just a few, symptoms, It was initially assumed that the disc shape developed as there is no need for surgical treatment. If frequent, un- a result of incomplete breakdown of the central section of pleasant snapping occurs, however, arthroscopy and pos- the meniscus. However, embryological studies have shown sible treatment are indicated. Many authors continue to that the lateral meniscus does not show a discoid appear- recommend a complete lateral meniscectomy, and good ance at any phase of fetal development. For this reason (particularly for the com- the joint space has formed, the central mesenchymal mass plete and incomplete types), only the central section of has disappeared and mesenchymal tissue is only present the meniscus should be removed. This procedure should, at the edges, where the cartilage subsequently differenti- if possible, be performed by arthroscopy and is technically ates to form the menisci. In discoid meniscus, therefore, more difficult than a resection for a flap or bucket-handle fibrocartilage must develop from mesenchymal tissue at a tear. The treatment of the hypermobile Wrisberg type, site where this does not normally occur. In these cases the normal anchorage of the lateral posterior horn, although we do not have extensive lateral menisci on the tibial condyle is lacking, and the experience with this procedure and we are unaware of meniscus is only secured to the lateral meniscofemoral corresponding reports in the literature. Such menisci are hypermobile and become hypertrophied as a result of mechanical loading. MRI studies with adults have shown Multiple epiphyseal dysplasia that meniscal tears occur significantly more frequently in This condition is described in detail in chapters 4. The (rare) more serious form (Fairbank type) mal, horseshoe-shaped menisci. In some patients, however, only the Clinical features, diagnosis two femoral condyles are affected. The clinical picture re- Symptoms are only very rarely present in infancy and sembles that of osteochondrosis dissecans, except the foci do not usually appear until the age of 5–6 years, when a are larger and present on both sides. On ex- be located in unusual sites, for example on the anterior amination, the snapping phenomenon can be elicited on aspect of the lateral femoral condyles (⊡ Fig. This finding is observed particularly in the hyper- Dysplasia epiphysealis hemimelica mobile Wrisberg-type, which is normally symptomatic, This disorder is described in detail in chapter 4. Radiography regularly shows a slight laginous formations in the epiphyses and carpal or tarsal widening of the lateral knee joint space. The common- A discoid meniscus is readily visualized by an MRI est sites are the tarsal bones and the distal femoral and scan. However, in addition to the cost aspect, this in- proximal tibial epiphyses (⊡ Fig. The changes lead vestigation involves the drawback of often having to be to joint incongruity and deformity, with genu valgum or performed under anesthesia in small children. Aichroth PM, Patel DV, Marx CL (1991) Congenital discoid lateral meniscus in children. Bensahel H, Dal Monte A, Hjelmstedt A, Bjerkreim I, Wientroub S, 3 Matasovic T, Porat S, Bialik V (1989) Congenital dislocation of the knee. Blauth W, Hippe P (1991) The surgical treatment of partial tibial deficiency and ankle diastasis. Boyd HB (1982) Pathology and natural history of congenital pseudarthrosis of the tibia. Caskey P, Lester E (2002) Association of fibular hemimelia and clubfoot. Choi N, Kim N, Kim H (2001) Medial and lateral discoid meniscus in the same knee.

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They are all members of the American Board of Medical Specialties (abms kamagra polo 100mg lowest price impotence in diabetics. Allergy and Immunology American Board of Allergy and Immunology 510 Walnut St order 100 mg kamagra polo with amex erectile dysfunction in young men. Through her communications firm, Sugar-Webb & Associates, she frequently works with health care organizations and physicians. She is the former director of pub- lic affairs at Mount Sinai Hospital on Chicago’s west side. Prior to that appointment, she was a research and policy writer for the American Medical Association, where she worked on the Health Policy Agenda for the American People, the AMA’s blueprint for the delivery of health care in the twenty-first century. Sugar-Webb holds a baccalaureate degree in literature from Simmons College in Boston and a master’s degree in education from Boston University. Her broad experience as a teacher includes directing a program for high school dropouts from the inner city and implementing a training program for teachers of the disabled at City Colleges of Chicago. Baert With 88 Figures in 141 Separate Illustrations, 11 in Color and 3 Tables 1 23 IV Contents David Wilson, FRCP, FRCR Department of Radiology Nuffield Orthopaedic Centre NHS Trust Windmill Road, Headington Oxford OX3 7LD UK Medical Radiology · Diagnostic Imaging and Radiation Oncology Series Editors: A. Sartor Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology Library of Congress Control Number: 2003060242 ISBN 3-540-66828-4 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi- cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature. Davis, Heidelberg Production Editor: Kurt Teichmann, Mauer Cover-Design and Typesetting: Verlagsservice Teichmann, Mauer Printed on acid-free paper – 21/3150xq – 5 4 3 2 1 0 Contents V Dedication To all your children and to the young people in our family: Emma, Phil, Iain, Neil, Rachael, Siân, Natalie and Jack. Contents VII Foreword During recent years the important role of ultrasound in the diagnosis and management of musculoskeletal diseases has become well established. The specific strengths of this modal- ity become quite evident in the examination of children because of the absence of ionising radiation and the close interaction between examiner and patient. This volume highlights the role of ultrasound as a primary or adjuvant diagnostic modal- ity in a range of musculoskeletal disorders and describes its contribution for problem solving and for better patient management. Wilson, is a world-renowned expert in the field with a great dedication and interest in paediatric ultrasound. The authors of individual chapters were invited to partici- pate because of their long-standing experience and major contributions to the radiological literature on the topic. I would like to thank the editor and the authors and congratulate them most sincerely for their superb efforts that have resulted in this outstanding volume. This book will be of great value not only for general and paediatric radiologists but also for paediatricians and paediatric orthopaedic surgeons. It will provide all of these specialists with state-of-the-art information on a narrow but fascinating medical field. I am confident that it will meet the same success with readers as previous volumes in this series. Baert Contents IX Preface When I started examining patients with ultrasound for musculoskeletal disorders we were still using static “B” scanners. Whilst my contemporaries were enthusiastically specialising in the use of nuclear medicine and ultra- sound, I chose to take an interest and eventually a full-time specialisation in a system rather than a machine. The principal strength of this choice is that I use all imaging methods and hopefully have insight into their advantages and weaknesses in each potential application. It does mean that I have little knowledge of what goes on in the abdomen, chest or brain and that, for better or worse, I will have to work with orthopaedic surgeons and rheumatologists for the remainder of my career. Reading textbooks on imaging I am struck by the sometimes tortuous reasoning that others employ to explain why their preferred technique is useful to make a diagnosis in all illnesses. They are at times blinkered to the strengths of a rival method and often overlook the potential for correlation of the signs on more than one technique. My view is that mus- culoskeletal radiologists should be skilled in the interpretation of plain films, ultrasound, nuclear medicine, CT and MRI. To miss out one of these is to be like a gardener with a fork and rake but no spade. There is no place for rivalry as all are needed to carry out an accurate, safe and effective practice.

If you want to cite a paper that has been submitted but not yet accepted for publication 100mg kamagra polo amex erectile dysfunction pills walgreens, you should include a copy of the manuscript of that paper together with your paper when you send it to a journal buy kamagra polo 100 mg without prescription xyzal impotence. If the citation of an informal data source, such as verbal or written information, is acceptable to a journal, and often it is not, then it is cited as follows: R. Such references appear only in the text and are not included in the reference list. Increasingly, information found on the web may be acceptable for inclusion in some journals and, if so, should follow the standard citation style shown below. All electronic references must give the same information as for a printed source but, because web content and addresses frequently change, web citations must include the retrieval date. An example of a correct web citation is as follows: American Psychological Association. Peer review A naturalist’s life would be a happy one if he had only to observe and never to write. Charles Darwin (1809–1892) Peer review is the cornerstone of good science but, that said, it is a peculiar process. The peer-review process is inherently fraught with difficulty because you are essentially asking for criticism, although you would, no doubt, prefer praise. To receive praise is a truly wonderful, feel-good experience, but only the criticism can help to improve your paper. Although you need peer review, criticism is hard to take no matter how it is packaged, so take a deep breath, put your feelings aside, and remember that, if your coauthors misinterpret what you have written or find your paper difficult to read, then others will too. The quality of peer review can vary widely from positive comments, ticks, and slight alterations of wording through to abject, unwarranted criticism and suggestions that your paper requires a complete rethink. Fortunately, the best peer review resides in the middle ground and provides positive suggestions for change and improvement. In planning who to select to peer review your work, it is a great advantage if you have a mentor who is able to provide insight and creativity, and who can help you to negotiate your way through the review process. Whatever type of feedback you receive, it will almost certainly be both the most confronting and the most valuable contribution to the development of your paper. Once your paper is underway, it is time to ask for peer review from either your coauthors or coworkers. This will help to ensure that the methods have been described in detail, that the results are reported accurately, and that the findings are 106 Finishing your paper stated clearly and are not overinterpreted. This is vital for upgrading the standard of your paper, both in terms of the science and the presentation. Peer review will help you to develop your ideas, improve the scientific integrity of your results, and produce an eminently more readable paper. The good news is that, with good writing practice, peer review should not be too painful or too depressing. If you start with a plan in mind, design the paper with a purpose, and write in short, clear sentences, you will create a product that the reviewers will find easy to read and therefore can respond to more easily in an intellectual way. This is important because intellectual contributions are far more valuable to the advancement of papers than comments on grammar and organisation. When papers are badly constructed and poorly written, reviewers tend to concentrate on trying to fix the immediate problems of presentation rather than thinking about the content and the big picture. This, in turn, prompts an endlessly frustrating review-edit-amend roundabout without any major focus on content. Naturally, it is better if a paper stays on a sensible and planned track from day one rather than being continually pushed and pulled into everyone’s different ideas of what shape it should take. Constructing a paper with well- articulated aims from square one tends to focus on content and to ensure that major structural changes are not requested at the end, just when you thought you were finished. If you can achieve this, the whole review process is shorter and more purposeful, and everyone enjoys the rewards of seeing the paper progress quickly towards a publishable document. By asking for peer review, you are in effect asking colleagues to assist you with the scholarship of your work. You should never pass a draft out for review before it is truly ready, that is before it has reached the highest standard to which you can take it. The thoughtlessness of repeatedly handing out ill-prepared documents tends to wear reviewers down.