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Aim: To investigate the short-term outcome and associated injuries of bone bruising in the acutely injured knee., Method and Materials: Thirty patients (age range 17-39 years, mean 28 years) with bone bruising identified on magnetic resonance imaging (MRI) after an acute knee injury were rescanned 12-14 weeks post-injury. The volume of bone bruising was measured on coronal STIR (short TI inversion recovery) images and correlation made with the presence and type of ligamentous and osteochondral injuries., Results: All bone bruises were present on repeat MRI. Twenty of the 30 patients (67%) had associated anterior cruciate ligament (ACL) injuries, seven of the 30 (23%) had collateral ligament injuries and three of the 30 (10%) had no associated ligamentous injuries. Greater than 50% reduction in bone bruise volume was demonstrated at repeat scanning in 24 of the 30 patients (80%) and less than 50% in five of the 30 patients (17%). One patient showed an increase in volume of bone bruising at follow-up. There was no correlation between initial size or size reduction of bone bruising and the presence/absence or type of associated injuries. In 21 patients the bone bruises resolved from the periphery, whilst eight patients showed bone bruises that resolved towards the joint margin, all of whom had associated osteochondral injuries. Of the 30 patients, 17 showed bone bruising that extended to the joint margin, 10 of whom had associated osteochondral injuries on MRI. On clinical review some degree of knee pain was still present in all but one of the patients reviewed. The single patient who reported complete resolution of symptoms was one of the three patients with isolated bone bruising., Conclusion: Bone bruises persist for at least 12-14 weeks, which is longer than previously quoted. Two discrete patterns of bone bruise resolution have been demonstrated. The size and persistence of bone bruising is not related to the presence or absence or type of associated ligamentous injuries.

Hepatic nuclear factor 4 (HNF4) is a transcription factor whose expression is crucial for mouse embryonic development, for liver-specific gene expression and for the prevention of one form of maturity-onset diabetes of the young. Its domain structure has been defined previously and is similar to other members of the nuclear receptor superfamily. A repressor domain has now been localised to a region of 14 amino acids (residues 428-441) near the C-terminus of HNF4 and is sufficient by itself to repress the activity of the activation function 2 (AF2) domain. Multiple mutations within this repressor domain enhance activity. Interestingly, this repressor domain shares homology with a repressor domain in the progesterone receptor. In a detailed mutagenesis study of the AF2 core, we demonstrate that L 366, which is conserved in the AF2 core between HNF4 and a number of orphan nuclear receptors, is essential for the full activity of the AF2 domain. Furthermore, a double mutation of E 363 and L 366 suggests that these residues might act in a cooperative manner.

Differences in perceived self-concept and sexual response before and after spinal cord injury were examined. Twenty-four women between the ages of 20 and 40 completed a questionnaire and participated in a brief taped interview. Most of the women viewed themselves as very or somewhat attractive and had been involved in a sexual relationship since injury. The majority viewed sexual relationships as very enjoyable, although many commented that changes in bowel and bladder function had inhibited sexual expression. The need for more effective sexual counseling was highlighted. A trend was noted for an interrelationship between sexuality and self-concept in adapting to acquired disability.

Family Focus is a training program implemented by the Division of Physical Therapy at Stanford University in cooperation with the Mental Research Institute of Palo Alto, California. Through this program, inpatients at the Stanford University Hospital and their families have the opportunity to live in a modular home on the hospital grounds prior to discharge and receive training in the activities they will need to carry out at home. Psychologists consult with the physical therapists on ways to help the family cope with stressful situations. The advantages of including the entire family in health care planning and treatment are described and suggestions are made for applying the principles in any physical therapy setting.