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1.
Khaled Meknas Jüri Kartus Jan Inge Letto Magne Flaten Oddmund Johansen 《Knee surgery, sports traumatology, arthroscopy》2009,17(8):996-1002
Diffuse retro-trochanteric pain occasionally radiating to the lower extremity could be caused by the piriformis or internal
obturator muscle syndromes. Thirteen patients, with retro-trochanteric pain were included in the study. All patients suffered
from a diffuse, but intense and often radiating hip pain. The median duration of the symptoms was 8 (1–20) years. The patients
were treated by a specific supervised stretching programme with special emphasis on the internal obturator muscle. The duration
of the stretching programme was 4 weeks. At inclusion, the median pain on the visual analogue scale (VAS) was 6.0 (3–7). The
VAS for pain decreased to 4.0 (0–7) (p = 0.01) at 12 weeks. Five years after treatment, the VAS for pain was still significantly lower than at inclusion, 4.0 (0–7)
(p = 0.018). A significant reduction in the number of positive Freiberg’s tests and in the number of patients limping was also
observed, both at 3 months and at 5 years after treatment. It appears that a supervised stretching programme renders significant
short and long term decrease in symptom for patients with retro-trochanteric pain. 相似文献
2.
Kentaro Takanami Mioko Saito Yasuharu Matsumoto Koichiro Sugimura Kei Takase 《Annals of nuclear medicine》2020,34(4):233-243
The purpose of this study was to determine the clinical implication of the myocardial FDG uptake patterns by comparing with the results of stress myocardial perfusion imaging (MPI) as the reference standard. By reviewing the medical records, 86 pairs of stress MPI and FDG PET/CT of 84 patients who underwent stress MPI and oncologic FDG PET/CT in 1 month were included in this study. The patterns of the myocardial FDG uptake were classified into five patterns such as ‘low’, ‘diffuse’, ‘basal ring’, ‘focal high’, and ‘focal defect on diffuse high’. MPI was evaluated using a 5-point scoring model ranging from 0 (normal uptake) to 4 (uptake absent) based on the 17-segment model. The summed stress score of 4 or higher was defined as ‘abnormal MPI’. Factors predictive of abnormal MPI were analyzed using a log-rank multivariate test and p < 0.05 was set as significant. Abnormal MPI was observed in only 16 of 36 (44%) patients with ‘low’ pattern, 10 of 23 (43%) patients with ‘diffuse high’ pattern, and 1 of 9 (11%) patients with ‘basal ring’ pattern, but in 8 of 9 (89%) patients with ‘focal high’ pattern, and 8 of 9 (89%) patients with ‘focal defect on diffuse high’ pattern. The log-rank multivariate test revealed that ‘focal high’ and ‘focal defect on diffuse high’ pattern were correlated with an abnormal MPI. These results indicate that further cardiac work-up might be helpful in the patients with ‘focal high’ pattern or ‘focal defect on diffuse high’ pattern of myocardial FDG at oncologic PET. A prospective study should be needed to further support this conclusion. 相似文献
3.
M. H. Baums E. Kahl W. Schultz H. -M. Klinger 《Knee surgery, sports traumatology, arthroscopy》2006,14(5):482-486
Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with
limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. We reviewed 26 (16 male and 10
female) athletes with a mean age of 27 years treated arthroscopically for symptoms due to soft-tissue (group I, n = 12) and bony obstruction (group II, n = 14). They suffered from anterior pain, reduction of dorsiflexion and recurrent swelling with severe impairment in their
sports activities. There was no clinical improvement for at least 6 months despite of conservative treatment with a mean duration
of symptoms about 20 months. There were no further operations. Evaluation included the Karlsson ankle rating score, the activity
score of Tegner, and a visual analogue scale (VAS) reflecting patients’ pain. Conventional radiographs and Magnetic resonance
imaging (MRI) were done preoperatively. All patients were available for follow up after 31 months (range, 25–48 months) with
a significant improvement (p < 0.05) of the Karlsson score from 66 to a mean of 92 at the follow-up examination. The mean Tegner score was eight points
compared to three points preoperatively. Regarding the subjective assessment observed by the decrease of pain and the ability
of the athelete to return to competition sport, there were 25 very satisfied and one unsatisfied athlete. No significant difference
in the outcome of group I and II (p > 0.05) could be estimated. The results demonstrate ’ excellent ’ to ’ good ’ results for arthroscopic treatment of sports-related
anterior ankle pain in a group of athletes who were involved in competition sport. The promising clinical results confirm
an effective way of treating soft-tissue and bony impingement. In addition, we recommend prior to surgery, an adequate course
of non-operative treatment, including modifications in the exercise program and athletic activity. 相似文献
4.
Geert Heirwegh Eveline Bruyeer Marleen Renard Anne Uyttebroeck Philippe Demaerel 《European radiology》2010,20(7):1799-1801
We report on a patient with a history of Ewing sarcoma who underwent surgery and subsequent adjuvant chemotherapy and radiotherapy.
He developed low-back pain 6 months after the end of the radiotherapy and during consolidation chemotherapy. Magnetic resonance
imaging showed evidence of myositis corresponding to the ‘radiation-recall phenomenon’, an inflammatory reaction of irradiated
tissue. 相似文献
5.
Choong Wook Lee Joon Beom Seo Jae-Woo Song Mi-Young Kim Ha Young Lee Yang Shin Park Eun Jin Chae Yu Mi Jang Namkug Kim Bernard Krauss 《European radiology》2011,21(1):54-62
Purpose
To evaluate the sensitivity of computer-aided detection(CAD) and dual-energy software(‘Lung PBV’, ‘Lung Vessels’) for detecting peripheral pulmonary embolism(PE). 相似文献6.
Masala S Mastrangeli R Petrella MC Massari F Ursone A Simonetti G 《European radiology》2009,19(1):165-171
Several authors claim that vertebroplasty (PVT) is a successful technique, but long-term effectiveness is still debated. Our
goal was to evaluate the effectiveness of PVT in patients with symptomatic vertebral fractures that had not responded to conservative
treatment. In our centre, 624 patients with 1,253 compression fractures were treated by PVT. Imaging studies, clinical visits
and short- and long-term follow-up were assessed by visual analogue scale (VAS) testing of pain. Statistical analysis was
performed to evaluate pain response after PVT (paired two-tailed t-test) and to assess any differences in pain due to different lesions (ANOVA test). We found a statistically significant improvement
in the patients’ quality of life, particularly in pain (P < 0.001). The average VAS value pre-PVT was 8.0 ± 2.5, which significantly dropped to 1.5 ± 0.4 by 12 months. There were
no significant differences in pain response between the groups of patients with different underlying disease. There was a
low complication rate in our study. PVT should be considered the treatment of choice in vertebral fractures with refractory
pain. With strict evaluation of the clinical indications and subspecialised operators, long-term effectiveness is probable. 相似文献
7.
Khaled Meknas Jüri Kartus Jan Inge Letto Anders Christensen Oddmund Johansen 《Knee surgery, sports traumatology, arthroscopy》2009,17(10):1249-1256
Twelve patients with clinical signs of retro-trochanteric pain syndrome were randomized to either operative treatment or a
control group. Six patients were operated on with sectioning of the tendon to the internal obturator near its insertion to
the trochanter major. There was no significant pain decrease in either group at 6 months. However, at 8 years, the decrease
in pain was significant in the surgical group (P < 0.03) but not in the control group. Three patients in the surgical group who needed pain medication with opioids preoperatively
managed without such drugs at 8 years. Two patients in the surgical group were working half time at the 8 year follow-up.
Before the start of the study the patients had been out of work for 3 and 10 years, respectively. At inclusion 4/12 patients
had minor degenerative changes at the L3–L5 level as seen on computerized tomography or magnetic resonance imaging. At 8 years,
the corresponding change was found in 7/9 patients (P = 0.025). In conclusion, at 8 years after surgical release of the internal obturator muscle, the patients had a significant
decrease in pain compared with the finding at inclusion. The corresponding was not found in the control group. 相似文献
8.
The aim of this study was to evaluate the accuracy of previously reported neuroimaging signs in establishing or excluding the diagnosis of idiopathic intracranial hypertension (IIH). In a retrospective study, 30 patients with confirmed IIH and 56 controls were evaluated with brain magnetic resonance imaging. All examinations were evaluated in a blinded fashion by three neuroradiologists for the presence or absence of the ‘traditional’ signs of IIH: empty sella turcica, deformation of the pituitary, slit-like ventricles, ‘tight’ subarachnoid spaces, flattening of the posterior globe, protrusion of the optic nerve, enhancement of the optic nerve head, distension of the optic nerve sheath and vertical tortuosity of the optic nerve. Optic nerve protrusion and enhancement, slit-like ventricles and tight cerebrospinal fluid spaces were not significantly associated with IIH (P>0.05). Posterior globe flattening, optic nerve sheath distension, optic nerve tortuosity, pituitary deformity and empty sella turcica were significantly associated with IIH (P<0.05). However, most of these are not helpful in a clinical setting, with the exception of posterior globe flattening. This is the only sign that, if present, strongly suggests the diagnosis of IIH (specificity 100%, 95% CI 93.6% to 100%; sensitivity 43.5%, 95% CI 27.3% to 60.8%; positive likelihood ratio 49.7). The majority of the reported signs for IIH on cross-sectional imaging are not helpful in establishing or excluding the diagnosis of IIH, and are of no value in the clinical setting. Flattening of the posterior aspect of the globe is the only sign that, if present, is suggestive of the diagnosis of IIH. 相似文献
9.
Stattaus J Maderwald S Baba HA Gerken G Barkhausen J Forsting M Ladd ME 《European radiology》2008,18(12):2865-2873
The purpose of this study was to evaluate the diagnostic efficacy of magnetic resonance (MR)-guided biopsy of focal liver
lesions within a short, wide-bore 1.5-T MR system and to determine the duration and accuracy of needle placement using MR
fluoroscopy guidance in 25 patients. Accuracy of needle placement was evaluated in two orthogonal planes, and the out-of-plane
angle of needle deflection was measured. Needle positioning was characterised subjectively as centred, peripheral, or exterior
relative to the lesion. Exterior positioning was corrected by a step-by-step procedure. Surgical resection (n = 6), previous histologies (n = 8), or clinical/radiological follow-up (n = 11) served as the ‘gold standard’. The guidance needle could be placed successfully using MR fluoroscopy in 20 of 25 patients
(80%). Needle placement was rated as ‘centred’ in 11 and as ‘peripheral’ in nine patients. Median needle deflection was 2.6
degrees, with a median deviation of 3.4 mm. In five patients, the direct approach failed or was rated as ‘exterior’; therefore,
repositioning after needle stabilisation with a stainless-steel stylet was necessary. The diagnostic yield of all biopsies
was: sensitivity 95.5%, specificity 100.0% and accuracy 96.0%. In conclusion, MR-guided biopsies in a short, wide-bore MR
system yielded highly reliable biopsy results, and in most cases the direct approach with MR fluoroscopy guidance proved to
be fast and accurate. 相似文献
10.
Introduction The UK Neurointerventional Group (UKNG) has developed a unified database for the purposes of recording, analysis and clinical
audit of neuroangiography and neurointerventional procedures. It has been in use since January 2002.
Methods The database utilizes an Access platform (Microsoft) comprising separate but linked programs for data collection and analysis.
The program that analyses aneurysm therapy has been designed to mirror the criteria used in the International Subarachnoid
Aneurysm Trial (ISAT).
Results Data entered into the main database immediately update the analysis program producing clinical outcome scores in the form
of a report. Our local database (Wessex) now contains records on more than 1,750 patients including nearly 350 aneurysm coilings
and a total of approximately 500 neurointerventional, vascular procedures. Every time a new piece of information is added
to the main database the reporting database is automatically updated which allows ‘real-time’ audit and analysis of one’s
clinical practice. The clinical outcome scores for aneurysm treatment are presented in such a way that we can directly compare
our results with the ‘Clinical Standard’ set by ISAT.
Conclusion This database provides a unique opportunity to monitor and review practice at national level. The UKNG wishes to share this
database with the wider neurointerventional community and a copy of the software can be obtained free of charge from the authors. 相似文献
11.
Harmon KG 《Current sports medicine reports》2007,6(6):354-361
The evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, multiple pathologies often
coexist, different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with
groin pain have had symptoms significantly limit their activity, have tried prolonged rest and various treatment regimens,
and received differing opinions as to the cause of their pain. Often times the diagnosis given depends on the physician’s
specialty. This article focuses on the groin structures and looks at three specific entities—“sports hernia,” public bone
edema, and entrapment neuropathies—as potential causes of chronic groin pain. Potential diagnostic and treatment strategies
are also discussed. 相似文献
12.
Antonio Pascarella Riccardo Ciatti Fabio Pascarella Carmine Latte Mariano Giuseppe Di Salvatore Luciano Liguori Germano Iannella 《Knee surgery, sports traumatology, arthroscopy》2010,18(4):509-513
This study describes a modified AMIC technique consisting of perforations according to Pridie, rather than microfractures,
and the covering of the focus of the lesion with a biological collagen patch enriched with bone marrow blood drawn through
the knee itself. This technique allows advantages of both the Pridie technique and the in situ proliferation of mesenchymal
cells beneath a biological collagen membrane, ‘augmented’, with bone marrow blood. The collagen membrane forms the roof of
a ‘biological chamber’, and serves to protect and contains the stem cells as they differentiate into chondrocytes, which will
form a healthy regenerative cartilage. 相似文献
13.
Synovial sarcoma (SS) arises in soft tissues but may invade adjacent bone. We describe a case of SS presenting as aggressive
lysis of the proximal ulna, the imaging of which suggested a primary bone lesion. Needle biopsy showed a ‘small round blue
cell tumour’, and a primitive neuroectodermal tumour (PNET)/Ewing sarcoma was suggested on the basis of the imaging appearances.
The definitive diagnosis of synovial sarcoma was made following molecular genetic studies, which demonstrated a fusion product
incorporating the genes SYT and SSX1. The importance of correct diagnosis to guide appropriate management, and, therefore,
the necessity for molecular genetic studies, is discussed. 相似文献
14.
Andreas Schlotmann John H. Clorius Sandra N. Clorius 《European journal of nuclear medicine and molecular imaging》2009,36(10):1665-1673
Purpose
The recognition of those hydronephrotic kidneys which require therapy to preserve renal function remains difficult. We retrospectively compared the ‘tissue tracer transit’ (TTT) of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) with ‘response to furosemide stimulation’ (RFS) and with ‘single kidney function < 40%’ (SKF < 40%) to predict functional course and thereby need for surgery. 相似文献15.
Gunther P Schenk JP Wunsch R Holland-Cunz S Kessler U Troger J Waag KL 《European radiology》2006,16(11):2527-2532
Acute testicular torsion in children is an emergency and has to be diagnosed urgently. D oppler sonography is increasingly
used in imaging the acute scrotum. Nevertheless, in uncertain cases, surgical exploration is required. In this study, we attempted
to define the role of Doppler sonography in the diagnostic workup of the acutely painful scrotum. All patients admitted between
1999 and 2005 with acute scrotal pain were included. After clinical assessment, patients were imaged by Doppler sonography
with a ‘‘high-end’’ instrument. In cases of absent arterial perfusion of the testis in Doppler sonography, surgical exploration
was carried out. Patients with unaffected perfusion were followed clinically by ultrasound for up to 2 years. Sixty-one infants
and children aged 1 day to 17 years (median: 7.9 years) were included. In 14 cases, sonography demonstrated absent central
perfusion, with abnormal parenchymal echogenicity in six. Absence of venous blood flow together with reduction of central
arterial perfusion was found in one infant. In these 15 patients, surgical exploration confirmed testicular torsion. Among
the other 46 patients, we found four cases with increased testicular perfusion and 27 with increased perfusion of the epididymis.
In one infant, a testicular tumour was found sonographically, and orchiectomy confirmed diagnosis of a teratoma. Follow-up
examinations of the conservatively treated patients showed good clinical outcome with physiologic central perfusion as well
as normal echogenic pattern of both testes. No case of testicular torsion was missed. By means of Doppler sonography, an unequivocal
statement regarding testicular perfusion was possible in all cases. The initial Doppler diagnosis was confirmed by operative
evaluation and follow-up ultrasound. Testicular torsion can therefore be excluded by correctly performed ultrasound with modern
equipment.
Patrick Gunther and Jens-Peter Schenk contributed equally to this work 相似文献
16.
Kelly A. Meiklejohn James F. Wallman Mark Dowton 《International journal of legal medicine》2011,125(1):27-32
The utility of the forensically important Sarcophagidae (Diptera) for time since death estimates has been severely limited,
as morphological identification is difficult and thermobiological histories are inadequately documented. A molecular identification
method involving the sequencing of a 658-bp ‘barcode’ fragment of the mitochondrial cytochrome oxidase subunit I (COI) gene
from 85 specimens, representing 16 Australian species from varying populations, was evaluated. Nucleotide sequence divergences
were calculated using the Kimura-two-parameter distance model and a neighbour-joining phylogenetic tree generated. All species
were resolved as reciprocally monophyletic, except Sarcophaga dux. Intraspecific and interspecific variation ranged from 0.000% to 1.499% (SE = 0.044%) and 6.658% to 8.983% (SE = 0.653%),
respectively. The COI ‘barcode’ sequence was found to be suitable for the molecular identification of the studied Australian
Sarcophagidae: 96.5% of the examined specimens were assigned to the correct species. Given that the sarcophagid fauna is poorly
described, it is feasible that the few incorrectly assigned specimens represent cryptic species. The results of this research
will be instrumental for implementation of the Australian Sarcophagidae in forensic entomology. 相似文献
17.
van Vliet EP Hermans JJ De Wever W Eijkemans MJ Steyerberg EW Faasse C van Helmond EP de Leeuw AM Sikkenk AC de Vries AR de Vries EH Kuipers EJ Siersema PD 《European radiology》2008,18(11):2475-2484
We aimed to separate the influence of radiologist experience from that of CT quality in the evaluation of CT examinations
of patients with esophageal or gastric cardia cancer. Two radiologists from referral centers (‘expert radiologists’) and six
radiologists from regional non-referral centers (‘non-expert radiologists’) performed 240 evaluations of 72 CT examinations
of patients diagnosed with esophageal or gastric cardia cancer between 1994 and 2003. We used conditional logistic regression
analysis to calculate odds ratios (OR) for the likelihood of a correct diagnosis. Expert radiologists made a correct diagnosis
of the presence or absence of distant metastases according to the gold standard almost three times more frequently (OR 2.9;
95% CI 1.4–6.3) than non-expert radiologists. For the subgroup of CT examinations showing distant metastases, a statistically
significant correlation (OR 3.5; 95% CI 1.4–9.1) was found between CT quality as judged by the radiologists and a correct
diagnosis. Both radiologist experience and quality of the CT examination play a role in the detection of distant metastases
in esophageal or gastric cardia cancer patients. Therefore, we suggest that staging procedures for esophageal and gastric
cardia cancer should preferably be performed in centers with technically advanced equipment and experienced radiologists. 相似文献
18.
Discrete synchronous multifocal osteoid osteoma of the humerus 总被引:1,自引:0,他引:1
A 24-year-old patient is described who had a 4-year history of pain in the right upper arm, with distinct night pain, that
responded to salicylates. From the findings on conventional radiography, bone scintigraphy and MRI a multifocal osteoid osteoma
was suspected, with one focus in the cancellous region of the greater tuberosity and a second cortical focus at the proximal
humeral diaphysis. The resection ’’en bloc’’ of both tumors and histological examination confirmed the diagnosis. The patient
was painfree after the curative resection of the two osteoid osteomas. Osteoid osteoma is a frequently found benign bone tumor,
accounting for approximately 11% of cases. In rare cases a multicentric occurrence has been described. A possible occurrence
of more than one osteoid osteoma in a single bone, not verified histologically, has been reported only three times in the
literature. In patients with scintigraphic and radiographic findings of two foci, discrete synchronous multifocal osteoid
osteomas should be suspected. 相似文献
19.
A 65-year-old male patient with an 8-year history of poliostotic Paget’s disease complained of shoulder pain that started
6 months prior to admission. An extensive lytic area was identified in the right proximal humerus along with Paget’s disease.
There was cortical destruction and a soft tissue mass. Following an incisional biopsy, a diagnosis of grade 2 chondrosarcoma
associated with Paget’s disease was made. The histologic identification of chondrosarcoma associated with Paget’s disease
is rare. However, the presence of a calcified matrix in a destructive lesion associated with Paget’s disease should alert
the radiologist and the pathologist to the possibility of a chondromatous differentiation taking place in the sarcoma associated
with Paget’s disease. The histologic evaluation of the lesion will form the basis for the diagnosis. 相似文献
20.
Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification
of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has
been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging
alone. The purpose of this study was to evaluate patients’ perception of the fear and discomfort, and to assess their overall
acceptance of the intra-articular gadolinium injection.
Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography
of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most
commonly associated with the procedure including ”pain”, ”needles”, ”complications”, and ”discovery of results that would
lead to surgery”. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked
to rate their perception of pain.
Results. While many patients expressed fear of ”pain” and ”needles”, after having undergone the injection their overall pain rating
score was low. Only 6% actually found gadolinium arthrography more painful than expected.
Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the
intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order
MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.
Received: 15 November 1999 Revision requested: 30 December 1999 Revision received: 4 February 2000 Accepted: 8 February 2000 相似文献