Efficient radiological assessment of the internal snapping hip syndrome

The aim of this study was to evaluate the diagnostic value/significance of various imaging techniques for demonstrating the underlying causative pathology of clinically suspected internal snapping hip syndrome. We intended to define the most efficient diagnostic imaging algorithm that leads to a specific definite therapy for this rare hip disorder. The imaging studies of 54 patients (43 women, 11 men, average age 58 years) with the clinical suspicion of internal snapping hip syndrome were compared for their diagnostic value/significance for finding the underlying pathology. Radiological workup included plain radiographs of the pelvis and hip joints (n=54), ultrasound (US) of the hip joints (n=29), computed tomography (CT) of the pelvis and proximal femur (n=17), and magnetic resonance imaging (MRI) of the pelvis/hip joint (n=21). In order to establish an efficient diagnostic algorithm we compared the diagnostic value of each imaging technique alone and in combination with the other methods. The underlying causative pathology could be established in 37% of patients (n=20) by the use of conventional radiographs alone and in 46% of the patients (n=25) by US alone, and in combination in 83% of the patients (n=45). By adding CT to the radiological workup, we established final diagnosis in 88% (in combination with X-ray; n=15/17) and 94% (together with X-ray and US; n=16/17) of the patients. Whenever MR imaging was used a causative pathology was found in all patients (100%; n=21). The most efficient radiological algorithm in the assessment of patients with internal snapping hip syndrome is the combination of plain radiography and US. MR imaging can be retained for unresolved and difficult cases.     

In vivo imaging of gene expression:

With the ability to readily engineer genes, create knock-in and knock-out models of human disease, and replace and insert genes in clinical trials of gene therapy, it has become clear that imaging will play a critical role in these fields. Imaging is particularly helpful in recording temporal and spatial resolution of gene expression in vivo, determining vector distribution, and, ultimately, understanding endogenous gene expression during disease development. While endeavors are under way to image targets ranging from DNA to entire phenotypes in vivo, this short review focuses on in vivo imaging of gene expression with magnetic resonance and optical techniques.     

Outpatient transition of an infant with permanent neonatal diabetes due to a KCNJ11 activating mutation from subcutaneous insulin to oral glyburide

Abstract:  Neonatal diabetes mellitus is rare, may either be transient or permanent, and may be caused by mutations in any of the several different genes. Until recently, most forms of permanent neonatal diabetes required lifelong subcutaneous insulin for management; however, permanent neonatal diabetes due to activating mutations in the KCNJ11 gene, which encodes the Kir6.2 protein subunit of the ATP-sensitive K⁺ (K_ATP) channel, may be amenable to oral sulfonylurea therapy. We describe a case of an 18-month-old infant with permanent neonatal diabetes due to an activating KCNJ11 mutation successfully transitioned from subcutaneous insulin therapy to oral sulfonylurea therapy in the outpatient setting.     

Viral hepatitis in Germany: poor vaccination coverage and little knowledge about transmission in target groups

Background  

In Germany, vaccination against hepatitis B is recommended for infants, children and adolescents since 1995 and for specific target groups since 1982. Little is known about knowledge about viral hepatitis and attitudes toward hepatitis B vaccination-factors likely to influence vaccine uptake.     

Prognostic significance of the time of developing motor deficits before radiation therapy in metastatic spinal cord compression: one-year results of a prospective trial

Purpose: To investigate prospectively the prognostic value of the time of developing motor deficits before radiation therapy (RT) for post-treatment functional outcome in metastatic spinal cord compression.

Methods and Materials: From November 1998 until October 1999, 57 patients were included. Two subgroups were formed according to the time of developing motor deficits before RT: 1–14 days (n = 29) and > 14 days (n = 28). Therapeutic effect on motor function was evaluated by an 8-point scale directly, 6, 12, and 24 weeks after RT. Patients with rapid deterioration of motor function within 48 h before RT (n = 14) were evaluated separately.

Results: Directly after RT, 26/28 patients (93%) of the group developing motor deficits > 14 days showed improvement of motor function, in comparison to 3/29 patients (10%) of the group 1–14 days (p < 0.001). Deterioration rates were 0% (> 14 days) and 45% (1–14 days). In patients with rapid deterioration of motor function within 48 h before RT, prognosis was poor (improvement 0%, no change 43%, deterioration 57%). Results were comparable 6, 12, and 24 weeks after RT.

Conclusion: A slower development of motor deficits before RT predicts a better post-treatment functional outcome. In patients with rapid deterioration of motor function within 48 h before RT, prognosis was extraordinarily poor. These results support the findings of our preceding retrospective analysis.     

Reliability and validity of the pain observation scale for young children and the visual analogue scale in children with burns

The aim of this study was to assess if the pain observation scale for young children (POCIS) and the visual analogue scale (VAS) are reliable and valid instruments to measure procedural and background pain in burned children aged 0-4 years. Burn care nurses (n=73) rated pain from 24 fragments of videotaped children during wound care procedures and during periods of rest using the POCIS and the VAS. Intraclass correlations were used to assess inter-rater and intra-rater reliability for the POCIS and the VAS. Internal consistency for POCIS was assessed by Cronbach's alpha. The POCIS has shown poor to moderate inter-rater reliability, moderate to good intra-rater reliability and an acceptable internal consistency. The VAS turned out to have poor inter-rater reliability and poor to moderate intra-rater reliability. Due to poor results of inter-rater reliability in both scales, construct validation is left undone until more acceptable results are obtained. Factors explaining the results are the large number of raters, the manner they were trained and a lack of variation between pain classes in video fragments. Although not all results were satisfying, an easy to use scale as POCIS has promising qualities and deserves further reliability research.     

Infektionsepidemiologische Ausbildungs- und Trainingsprogramme

The German Field Epidemiology Training Programme (FETP) and the European Programme for Intervention Epidemiology Training (EPIET) were founded to develop a network of epidemiologists for the surveillance and control of communicable diseases. During their 2-year training, FETP or EPIET fellows are based at the Robert Koch-Institut or other European host institutes and have to conduct outbreak investigations, carry out surveillance and research projects and publish the results. Since 1995, all 22 FETP and 94 EPIET fellows have conducted and published numerous outbreak investigations, surveillance and research projects, for example on pathogens inducing salmonellosis, influenza, SARS or avian influenza. Currently, 70% of FETP and EPIET alumni are working in key positions in communicable disease control on a regional, national or international level. The German FETP and the European EPIET programme offer high quality practical training in applied epidemiology. The expert knowledge of the alumni of both training programmes will be incorporated into the new European Centre for Disease Control (ECDC) and determine the future direction of infectious disease epidemiology in Germany and Europe.