Positron emission tomography of the thorax. The current clinical status]

The non-invasive diagnostic assessment of thoracic lesions has been greatly enhanced by the use of positron emission tomography with metabolic active radio-compounds such as fluor-18 labeled deoxyglucose. Four clinical fields of use were established: differential diagnostic evaluation of lesions (T-staging); classification of adenopathy (N-staging); therapy response monitoring; diagnostic evaluation of recurrence. The upcoming challenges for clinical use are limited availability and necessary technical and qualitative standardizations.     

Presumed vestibular hemorrhage secondary to warfarin

Hemorrhage secondary to anticoagulant therapy is well documented. We report a patient who presented with acute vertigo and unilateral deafness while on warfarin and was found to have a probable hemorrhage in the labyrinth, identified on MRI.     

Impact of clinical history on fracture detection with radiography

The effect of knowledge of localizing symptoms and signs in the detection of fractures was studied. Forty radiographs of the extremities were examined twice by seven radiologists; the sessions were separated by 4 months. In 26 cases, a subtle fracture was present; 14 cases were normal. In half of the cases at each session, the precise location of pain, tenderness, or swelling was provided. The observer was asked to determine if the case was normal or abnormal (provide the exact location of the fracture) and to indicate the degree of confidence in the diagnosis. Responses were converted to a numeric scale for analysis. Analysis of receiver operator characteristic parameters indicates that clues regarding location of trauma facilitate detection of fractures. The improvement is based largely on an increased true-positive rate without an increased false-positive rate, regardless of the decision criteria of the radiologist (overall willingness to "overread" or "underread"). This has direct clinical applicability and reinforces the plea of radiologists for precise clinical information.     

Early recognition of postoperative hematoma formation

Summary Postoperative hematoma formation must be treated as a potential infection. One fourth of all postoperative hematomas are already contaminated. Ultrasonographical examination is an effective method for early recognition of such postoperative hematomas. Ultrasonic diagnosis on a routine basis is not necessary, but it should be carried out as soon as clinical symptoms appear. Our postoperative late results with only one early and one late infection after 100 postoperative treatments of the hip joint and femoral shaft emphasize the importance of early diagnosis of hematomas.

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Zusammenfassung Die drohende Infektion im postoperativen Verlauf nach Osteosynthesen bereitet diagnostische Probleme, da keine objektiven Kriterien vorhanden sind. Das postoperative Hämatom ist als eine drohende Infektion zu beurteilen. 1/4 aller postoperativen Hämatome sind bereits kontaminiert. Die Ultraschalluntersuchung ist eine wirksame diagnostische Hilfe zur frühzeitigen Erkennung der drohenden Infektion bei postoperativen Hämatomen. Sie muß sicherlich nicht routinemäßig, bei klinischem Verdacht aber frühzeitig durchgeführt werden. Das postoperative Spätergebnis mit lediglich einem Frühund Spätinfekt bei 100 operativen Eingriffen am Hüftgelenk und Oberschenkelschaft belegen die Bedeutung der frühzeitigen Hämatomdiagnostik.