Muscular control of the patella

Patellofemoral patients are among the most common yet most challenging individuals presenting for orthopedic care. The key word in the previous sentence is individual. A single protocol of care is not sufficient for these special "individuals." Many concepts have been evaluated through review of the peer-reviewed literature with the following highlights: (1) the concept of VMO isolation through specific exercise should no longer be part of our lexicon; (2) patellofemoral patients improve when they are able to enhance quadriceps functional patterns by way of pain-free exercise; (3) patellofemoral patients do not fit into a single "box" but rather require an evaluation-based classification and specific interventional pattern. Many of the special techniques used by clinicians in treating these patients have not been well defined through research and also are lacking in evidence of clinical efficacy. We also must recognize, however, that good clinical observations can be the first step in defining what questions should be asked and how they can be answered. It is vital that we answer the questions without allowing "bad science" through dogma and anecdote to prevail. Likewise, we need to be diligent in determining our successes and failures through well designed and implemented clinical and research studies.     

腰椎椎弓峡部裂的CT诊断价值

目的 :探讨CT对腰椎弓峡部裂的诊断价值。方法 :回顾性分析 48例腰椎弓峡部裂的CT表现。根据腰椎定位像 ,采用与椎间盘前后缘中点连线平行角度 ,扫描范围包括病变椎体的椎弓平面至下一椎体上缘 ,层厚、层距 5 .0mm ,必要时 2 .0mm ,骨窗和脊髓窗双窗位观察。结果 :48例均显示脊椎椎弓峡部层面关节突间部低密度裂隙 ,断面呈锯齿状 ,即“裂隙征”。裂隙周缘骨硬化和 /或出现碎骨片 ,呈现“假肥大小关节”。脊椎滑脱则呈现“假性椎间盘突出征”及”阶梯征”。结论 :椎弓峡部CT薄层扫描对于峡部裂的清晰显示率较X线平片高 ,具有重要的临床意义     

A new approach to computer-aided comparison of skull and photograph

A computer-based method developed for the purpose of checking the results of identification performed with the traditional method of video-superprojection (developed by Helmer and Grüner) is demonstrated; it does not require any special programs in addition to those necessary for digitising the video pictures. The method is suitable for filtering out false-positive cases. A great advantage is that the phase of computer evaluation can be separated from the job performed in the video studio, both in time and space. The process can be reconstructed, which means it can be checked. The results can be easily documented and interpreted for lay people.     

X-ray computed tomography in the surveillance of the course of acute pancreatitis. Values of a new classification of inflammatory lesions]

378 tomodensitometric investigations were performed in cases of acute pancreatitis. The evolution of inflammatory lesions were analyzed with special attention to tissue aggressive inflammation in order to recognize early signs of gravity on CAT scans. Pancreatic lesions less than 15 mm in diameter called "hypodense islets-1" are compatible with oedematous lesions while lesions greater than 15 mm in diameter ("hypodense islets-2") are characteristic of developing necrosis. Tissue aggressive inflammatory lesions were classified in five grades retrospectively and showed that the incidence of abcesses was greater in grade II (76.5%) than in grade I lesions (11.75%).     

骨原发性淋巴瘤影像分析

目的 分析原发性骨淋巴瘤(PLB)及"浮冰征"的影像表现和病理基础.方法 回顾性分析经病理证实且临床资料齐全的41例PLB患者的临床与影像特征.41例全部行X线检查,20例行CT检查,12例行MR检查(3例同时行增强扫描).结果 41例PLB中位于扁骨12例,脊柱8例,长骨17例,其他不规则骨4例.发病最多的部位是股骨(10例,24.4%),其次为髂骨(8例,19.5%).长骨病变位于骨干干骺处者11例.41例中无骨膜反应者37例(90.2%).CT显示骨质破坏轻微而出现软组织肿块者12例,伴有明显软组织肿块者9例,出现"浮冰征"者4例.12例MR检查结果中,10例显示软组织肿块,MRI显示病变范围全部大于CT所显示病变范围,其中1例MRI显示大范围骨质异常,但平片及CT显示骨质破坏不明显.结论 (1)骨质破坏轻而软组织肿块明显,或MRI显示骨质异常范围明显超过平片及CT所见,或MRI显示骨质异常而平片及CT显示骨质破坏较轻或未见明显骨质破坏者提示PLB.(2)"浮冰征"是PLB较为特殊的一种征象,其出现对淋巴瘤的诊断具有一定提示意义.

Abstract：

Objective To analyze the imaging features of primary lymphoma of the bone,and discuss the special feature of the "floating ice sign". Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement).Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur(10, 24.4%), followed by the ilium(8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). "Floating ice sign" was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT,could strongly imply the diagnosis of primary lymphoma of the bone. "Floating ice sign" was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.     

Abstracts DEGRO 2017

Aim

This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.

Methods

Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.

Results

Several large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.

Conclusion

Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.

     

Preoperative assessment of vascular invasion in exocrine pancreatic cancer by multidetector CT

Purpose

To evaluate multidetector CT (MDCT) signs of vascular invasion in pancreatic carcinoma.

Patients and methods

Retrospective review of preoperative dynamic MDCT of 42 patients with pathologically proven pancreatic carcinoma.

Results

Surgically confirmed invaded vessels were 19 arteries and 33 veins. Multiple signs of vascular invasion were assessed.

Conclusion

Significant advances have been made in the ability of MDCT to visualize pancreatic cancer and to stage disease when close attention is paid to technique with special attention to multiple signs of vascular invasion.     

肾结核的CT诊断

目的:探讨肾结核的CT诊断价值。方法:回顾性分析了20例经病理或临床确诊的肾结核CT资料。结果:19例病灶CT表现为多发“花瓣”状囊腔15例、单发囊腔2例、囊实性肿块1例、自截肾1例,其中病灶内伴钙化者有9例;余1例肾内CT阴性。15例肾盂壁增厚,10例输尿管壁环形增厚,一般肾盂不扩张或轻度扩张。2例膀胱壁增厚伴挛缩1例。结论:肾结核具有较特征性的CT表现,CT是目前最有效的影像学诊断方法之一。     

Whole-brain voxel-based morphometry of white matter in mild cognitive impairment

Purpose

The purpose of this study was to analyze whole-brain white matter changes in mild cognitive impairment (MCI).

Materials and methods

We studied 14 patients with MCI and 14 age- and sex-matched healthy control subjects using voxel-based morphometry (VBM) on T1-weighted 3D datasets. The data were collected on a 3T MR system and analyzed by SPM2 to generate white matter volume maps.

Results

Voxel-based morphometry revealed diffusively reduced white matter in MCI prominently including the bilateral temporal gyrus, the right anterior cingulate, the bilateral superior and medial frontal gyrus and right parietal angular gyrus. White matter reduction was more prominent in anterior regions than that in posterior regions.

Conclusion

Whole-brain white matter reduction in MCI patients detected with VBM has special distribution which is in line with the white matter pathology of MCI.     

Trends in head and neck radiology

Trends in clinical research of head and neck radiology are well described within four articles published in the European Radiology in the last 2?years. One constant top issue is to gain more, better or new morphological information by so-called "conventional" methods (CT, MRI) with thin-sliced imaging including special reconstructions. The addition of functional or metabolic methods (e.g. diffusion-weighted MRI, dynamic contrast-enhanced MRI, positron emission tomography) to anatomical imaging is a further general trend in oncological radiology over the last few years and has been invaluable in head and neck radiology.     

Welfare effects of substituting traditional police ballistic weapons with non-lethal alternatives

Background

The introduction of non-lethal weapons for police and special trained forces is justified with reduced impacts on health and safety in for all those involved in missions. Current medical research therefore focuses on health-related effects on a case by case perspective. A purely economic view, however, identifies cost/benefit-related facts only regarding cost of ownership comprising materials, service, replacement and training. While each approach is reasonable and adequate from both points of view, we aim at enhancing this discussion by an overall medico-economic dimension.

Objective

This article aims to shed light on the overall welfare effects of substituting traditional ballistic firearms with non-lethal weapons using the example of conducted electrical weapons (CEW), such as the Taser.

Material and methods

In order to answer this question the total costs of traditional ballistic firearms are compared to the total cost of CEW. Consequently, probability of use serves as an antecedent in the model, whereas the cost of application results as a logical consequence. Based on these considerations, the threshold level of application can be determined. The model was tested with a dataset consisting of Taser applications in England and Wales from 2009 and 2010.

Results

As a result, the overall welfare effects of substituting traditional ballistic firearms with non-lethal weapons for police and special armed forces can be estimated and therefore contribute to the decision-making process from a medico-economic welfare perspective.

     

三种不同桡动脉穿刺置管方法的成功率比较

目的通过比较三种不同穿刺方法的置管成功率,探讨当前临床上最优的动脉穿刺置管方法。方法对需进行有创动脉压监测的450例患者随机分为3组,每组150例。A组为对照组:采用通用Vasocan Braunule套管针;B组和C组均为试验组:B组采用ARROW桡动脉专用套管针;C组采用改良Vasocan Braunule套管针进行桡动脉穿刺置管,所有动脉穿刺操作均由本院同一住院医师实施,最后对各组穿刺成功率进行比较。结果B、C两组成功率与A组比较差异明显(P<0.01);B组C组之间无显著差异(P>0.05)。结论改良Vaso-can Braunule套管针行桡动脉穿刺置管成功率较高,且费用低廉。     

Scintigraphy in the clinical evaluation of disorders of mineral and skeletal metabolism in renal failure

In patients with renal bone disease skeletal and extra-skeletal abnormalities can be visualised using conventional bone scintigraphy. Some of these abnormalities are associated with characteristic scintigraphic appearances, which are reviewed in detail, and the possible mechanisms involved are discussed. Specific imaging with iodine 123 serum amyloid P component and iodine 131 ₂-microglobulin is also discussed in the diagnosis of ₂-microglobulin amyloidosis specific to patients on dialysis. In the light of available evidence, it appears that bone scintigraphy plays, so far, a limited role in the clinical evaluation of skeletal and extra-skeletal abnormalities in chronic renal failure. The potential role of bone scintigraphy in identifying patients with aluminium-related bone disease needs to be investigated further, and in this respect special attention must be given to the problem of high soft-tissue activity associated with impaired renal function. Timing haemodialysis sessions before scintigraphic imaging deserves wider recognition as it reduces high soft-tissue activity, thereby allowing bone uptake to be assessed more accurately. Specific imaging of amyloidosis resulting from ₂-microglobulin deposition is a promising technique, but the relative value of the two proposed radiopharmaceuticals needs further clarification.Offprint requests to: E.K.J. Pauwels     

Roentgen treatment of calcified deposits. A special technique.

Radiation treatment of benign ailments has seriously been questioned in recent years. A decision for or against can only be based on a "cost-benefit" analysis. In the treatment of calcified deposits in the shoulder or hip region, the authors have used radiation qualities assuring optimal absorption in the deposits and having demonstrable beneficial effects. In order to minimize the "cost", the irradiation parameters have been considered with special care.     

Heat-exercise hyperpyrexia

A fatal case of "heat stroke" occurring on exercise in temperate conditions is described. Possible mechanisms for increased susceptibility are discussed and attention is drawn to a possible overlap with the malignant hyperpyrexia (MH) syndrome. The second day of strenuous exercise may be a time of special risk. More frequent consideration of dantrolene treatment in heat injury is suggested and the term "heat-exercise hyperpyrexia" is proposed to replace "heat stroke" and "exertional hyperpyrexia".     

Madelung综合征的CT与MRI表现

目的 探讨Madelung综合征的CT与MRI表现特征.方法 搜集5例Madelung综合征患者,5例中Ⅰ型3例,Ⅱ型2例.5例患者均行CT检查,1例行CT增强扫描,2例行MR平扫.分析其临床特点及影像表现.结果 3例Ⅰ型Madelung综合征表现为躯干上部浅层皮下脂肪及颈深层脂肪增多,肿物弥漫分布于颈部、上胸及肩部,呈现"马颈圈"、"牛颈"样特征性表现;2例Ⅱ型表现为四肢近端、前胸壁皮下脂肪明显增厚,呈"大力水手"的特殊外观;5例患者均有腹直肌前方、腹股沟皮下脂肪增厚及阴囊内脂肪堆积.CT显示病变部位浅层皮下脂肪增多,CT值为-30～-70 HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示增厚的脂肪组织,呈典型的短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔.结论 结合长期大量酗酒史,CT与MR检查对Madelung综合征可明确诊断,并明确病变范围及周围组织分界,对手术治疗方案提供有价值的信息.

Abstract：

Objective To determine the CT and MR findings of Madelung syndrome. MethodsFive cases of Madelung syndrome were collected in our hospital from February 2006 to June 2009, including 3 cases of typeⅠMadelung syndrome and 2 cases of typeⅡ Madelung syndrome. The 5 cases were all examined by CT, meanwhile 1 case by CT enhancement scanning and 2 cases by MR. The clinical characteristics and imaging manifestations were analyzed. Results CT and MR images in 3 patients of typeⅠMadelung syndrome displayed fat accumulation within the subcutaneous tissue of the upper trunk and deep layer tissue of neck. The diffuse masses were located around the neck, upper chest and shoulders, which were called "horse collar"and " buffalo humps". The other 2 cases of type Ⅱ Madelung syndrome displayed fat thickening within the subcutaneous tissue of the proximal extremities, anterior chest wall, showing special appearance of "vigorous sailor". All the 5 patients showed fat deposit within the subcutaneous tissue of the anterior rectus abdominis, inguina and fat accumulation within the scrotum. CT showed proliferated fat at the subcutaneous tissue of the involved regions. The CT value of proliferated fat were between -30 and -70 HU. The proliferated fat tissue all could be displayed on MR T1WI,T2WI and T2WI fat suppression sequence, with typical hypointensity on T1WI and hyperintensity on T2WI, hypointensity on fat-suppression sequence and fibrous septation presenting among fat tissue. Conclusion Combination with the history of long-term alcohol abuse, the Madelung syndrome could be diagnosed by CT and MR, which had great value in the surgical planning for identifying the extent of disease.     

Computed tomography of the bony pelvis: a protocol for multiplanar imaging. Part I: Normal anatomy

The normal gross and computed tomographic anatomy of the bony pelvis is briefly reviewed, with special reference to the bony masses of greatest concern to a surgeon. Normal transverse computed tomography (CT) images are shown. I describe a unique, comprehensive protocol for multiplanar CT reformation of the osseous pelvis. This algorithm provides "direct-view" images that are considerably more reliable than "mental reformatting" from transverse images alone. The procedure is of particular value in assessing fractures and dislocations occurring separately or together.     

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases

Objective

To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast.

Materials and Methods

This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon.

Results

All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases.

Conclusion

Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.     

Unusual MR manifestations of neurocysticercosis

Summary MR and CT features of neurocysticercosis are variable and depend fundametally on the stage in evolution of the infection, location, number and size of the worm. The authors retrospectively evaluated MR images obtained on a 2.0T superconducting unit in 22 neurocysticercosis patients and observed various MR features including some new findings. A variety of MR findings are presented with special reference to six case reports. The features include: (1) a large simple cyst containing both internal septations and a scolex; (2) suprasellar racemose cysts mimicking other cysts, (3) a fourth ventricular cyst readily depicted by aid of CSF flow-void in the sagittal plane; (4) degenerating cysts showing white target appearance; (5) granulomatous lesions having a black target appearance; and (6) a meningitic form showing Gd-DTPA enhancement of basal cisterns and of a subacute infarct.     

Measurement procedure for further radiologic analysis of bone. A review of the quantitative radiology of the skeleton

The reasons for using measurements of bone density for further analysis of changes in metabolic bone diseases are pointed out. Besides the easy methods of visual comparison of X-ray images and "microradioscopy", the methods of quantitative radiology are discussed. The X-ray morphometry method is presented, including the new results of measurement of various bones of the skeleton. Structural analysis of spongy and compact bone tissue from the X-ray image using opto electronic image transformation is demonstrated. The techniques of X-ray photodensitometry and isotope-densitometry are explained. The importance of a reproducible calibration standard and the special value of reference systems containing a known concentration of hydroxyapatite are shown. Special information is given regarding the present status of the development of the new technique of quantitative computer tomography (QCT) or computer tomometry with the aid of a solid reference system. This new reference system is constructed from various concentrations of hydroxyapatite in "solid water" (a polyethylene mixture) and is demonstrated in detail. The results of comparing measurements of the 2nd lumbar vertebral body are shown. Finally, the clinical importance of measurements of the "apatite value" of vertebral trabecular bone tissue and of various trabecular areas of the skeleton is emphasized.