Imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow.

Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.     

Mechanismen der arteriellen Restenose und Therapieansätze zur Prävention

Both vascular surgery and endovascular interventions traumatise the arterial wall, especially the endothelium. The vessel responds with neointimal hyperplasia and/or constrictive remodelling, and this is still the limiting factor in curative interventions. Stent placement prevents constrictive remodelling but is the main trigger for in-stent restenosis. Hyperproliferation of neointimal tissue is the main response to arterial thrombosis, local inflammation or medio-intimal injury such as occurs, for example, after balloon dilatation in the region of arterial anastomoses or of a thrombectomy (Fogarty-manoeuvre). At present, research on prevention of restenosis is focused on inhibiting neointimal hyperproliferation by using drug-eluting stents, and especially sirolimus- or paclitaxel-eluting stents. In addition, further experimental research work is in progress, with the aim of esablishing new treatment regimens and solving the problem of neointimal formation, thrombosis and constrictive remodelling. These include both local and systemic pharmacological therapy, brachy- and laser therapy, and many genetic treatment options, some of which are currently the subjects of experimental studies and early-stage clinical trials. Gene therapy seems like a promising way of preventing restenosis, but has not yet been tested in clinical trials. In the near future, selective, simultaneous, and perhaps even polyphasic regulation for gene silencing of two or more genes involved in the development of restenosis could improve the long-term patency rate.