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  • 1
    Digitale Medien
    Digitale Medien
    Economic Considerations for the Diagnosis and Therapy of Meniscal Lesions: Can Magnetic Resonance Imaging Help Reduce the Expense? (1997)
    Springer
    World journal of surgery 21 (1997), S. 363-368 
    Details
    ISSN: 1432-2323
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. With magnetic resonance imaging (MRI) the surgeon has such an effective diagnostic tool in the diagnosis of a meniscal lesion that the times of diagnostic arthroscopy should be in the past. A total of 823 patients with clinically diagnosed meniscal lesions were divided into two groups: group A, 143 patients underwent MRI and 75 of those arthroscopy; group B, 680 patients, 201 (30%) of whom were operated after being only clinically examined. MRI was done on a Siemens Medical System Magnetom 1.5 Tesla with a 256 × 256 matrix. Spinal echo and gradient echo images were performed with slices of 2 to 4 mm thickness. All meniscal tears were graded according to Reicher and Crues, respectively. Grades III and IV were judged to be positive for a meniscal lesion. Arthroscopy was carried out under general anesthesia and the usual technique. The MRI revealed the following results: Medial meniscus: accuracy 95%, positive predictive value (PPV) 92%, negative predictive value (NPV) 95%, sensitivity 98%, and specificity 82%; lateral meniscus: accuracy 97%, PPV 92%, NPV 98%, sensitivity 94%, and specificity 98%. The overall values for MRI of the medial and lateral menisci combined were: accuracy 96%, PPV 93%, NPV 98%, sensitivity 96%, and specificity 90%. The clinical examination often failed to diagnose a meniscal lesion: accuracy 64%, PPV 59%, NPV 89%, sensitivity 96%, and specificity 33% for the medial meniscus. For the lateral meniscus the accuracy was 91%, PPV 61%, NPV 98%, sensitivity 89%, and specificity 91%. The overall values for the clinical investigation of the medial and lateral menisci combined were: accuracy 78%, PPV 60%, NPV 94%, sensitivity 93%, and specificity 62%. Investigation of all 201 patients operated from group B with MRI would have cost $160,800. The cost of 30% fewer arthroscopies would have been $562,800—in total $723,600. The operation of all 201 patients cost $804,000. Hence about $80,000 could have been saved by scanning all 201 patients and therefore reduce the rate of diagnostic arthroscopies.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/PL00012254
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  • 2
    Digitale Medien
    Digitale Medien
    Renal transplant hemodynamics in children: Prospective analysis of colour coded versus pulsed Doppler sonography (1992)
    Springer
    Pediatric radiology 22 (1992), S. 163-168 
    Details
    ISSN: 1432-1998
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In 30 children with renal allografts the diagnostic validity of pulsed Doppler (PD) versus colour coded Doppler (CD) sonography was assessed prospectively. 46 PD examinations were performed calculating the resistive index (RI) in the segmental arteries in comparison to 46 CD scans, where renal blood flow throughout the grey-scale image was displayed. In addition, point-spectral analysis with calculation of the RI was also performed on the CD scans. The time for examination ranged from five to ten minutes for the PD and from three to five minutes for the CD study. Concordant findings for the PD and CD technique were generally obtained (normal blood flow pattern on PD — excellent visualization of renal blood flow on CD, reduced or reversed diastolic flow on PD — poor visualization of renal blood flow on CD). There was close correlation of the RI values obtained by the PD and CD scans. CD sonography facilitated point-spectral analysis in shortening the time for examination. The ability to visualize focal hemodynamic alterations provided a higher diagnostic accuracy in comparison to PD sonography.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02012486
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  • 3
    Digitale Medien
    Digitale Medien
    Color-coded Doppler evaluation of cholecystic varices in portal hypertension (1990)
    Springer
    Pediatric radiology 21 (1990), S. 71-72 
    Details
    ISSN: 1432-1998
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract A 11-year-old white girl presented with a diagnosis of thrombosis of the portal vein after newborn septicemia. Duplex sonography revealed significant narrowing of the portal vein and its right and left branches. A Doppler signal could only be obtained in certain short segments of the portal vein and indicated hepatopetal flow. Color-coded Doppler sonography showed extensive varicose veins in the gallbladder with a bigger draining vessel running to the porta hepatis. Documentation of varices like those in the gallbladder wall confirms the diagnosis of portal hypertension and may increase the sensitivity of Doppler sonography. Color mapping has the potential to detect unexpected flow and to analyze blood flow to better advantage.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02010822
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  • 4
    Digitale Medien
    Digitale Medien
    Sonographic detection of internal jugular vein thrombosis after central venous catheterization in the newborn period (1994)
    Springer
    Pediatric radiology 24 (1994), S. 577-580 
    Details
    ISSN: 1432-1998
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We sonographically investigated the internal jugular veins of 40 children who had undergone catheterization of the vein (group A: silastic catheter,n-24; group B: polyurethane catheter,n=16) in the neonatal period. The average age at catheter implantation was 43±73 days, the average birthweight 2414±1145 g, and the average gestational age 34.8±5.0 weeks. We performed follow-up longitudinal and transverse high resolution sonographic scans including routine examination of the contralateral jugular vein at a mean age of 3.7±1.5 years. In group A thrombotic alterations were detected in 8 aut of 24 patients. In three of these patients we found mild clinical symptoms. In group B thrombotic alterations were detected in 1 aut of 16 patients without clinical symptoms. Mean birthweight (1815 versus 3313 g) and mean gestational age (32.3 versus 38 weeks) were significantly lower and indwelling time of the catheters (18 versus 11 days) was significantly longer in group A. Our results indicate that jugular vein thrombosis is a frequent long-term complication in neonates after jugular vein catheterization. High resolution ultrasonography is an adequate method for detecting jugular vein thrombosis and should therefore routinely be performed for long-term follow-up.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02012737
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  • 5
    Digitale Medien
    Digitale Medien
    Impact of Spinal Degenerative Changes on the Evaluation of Bone Mineral Density with Dual Energy X-Ray Absorptiometry (DXA) (1997)
    Springer
    Calcified tissue international 60 (1997), S. 430 -433 
    Details
    ISSN: 1432-0827
    Schlagwort(e): Key words: Dual-energy X-ray Absorptiometry — Degenerative factors — Postmenopausal women — Bone mineral density — Osteoporosis.
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Medizin , Physik
    Notizen: Abstract. The purpose of this study is to evaluate degenerative factors in a postmenopausal patient group and differentiate the influence on bone mineral density (BMD) measurements by dual-energy X-ray absorptiometry (DXA). The patients and methods included an investigation of 144 postmenopausal women (mean 63.3 years) with PA-DXA of the spine. Degenerative factors (osteophytes, osteochondrosis, scoliosis, and vascular calcification) were evaluated from plain lumbar radiographs, their estimated probability was analyzed as a function of age, and their influence on BMD measured by PA-DXA was determined. The results of the study revealed osteophytes in 45.8%, vascular calcifications in 24.3%, scoliosis in 22.2%, osteochondrosis in 21.5%. The estimated probability for degenerative factors increased from 35 to 80% in the 55- to 70- year age group. Osteophytes and osteochondrosis were associated with up to a 14% increase in BMD values (P 〈 0.001). Vascular calcifications showed a positive trend, whereas scoliosis did not show a discernible influence. We concluded that degenerative factors, except for scoliosis, showed an influence on BMD as measured by DXA. Their prevalence increased rapidly between 55 and 70 years of age. Interpretation of PA-DXA spine data for subjects of or above this age range should be complemented by plain film radiographs.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002239900258
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  • 6
    Digitale Medien
    Digitale Medien
    Clinical and sonographic evaluation of the risk of rupture in the Achilles tendon (1997)
    Springer
    Archives of orthopaedic and trauma surgery 116 (1997), S. 14-18 
    Details
    ISSN: 1434-3916
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Chronic pain in the region of the Achilles tendon is a common problem and often a sign of progressive degeneration of the tendon which may lead to its rupture. We studied the clinical course and sonograms in 36 patients with achillodynia to find a prognostic parameter enabling us to estimate the risk of rupture. The patients were evaluated clinically for swelling and tenderness and by high-resolution real-time sonography. The sonograms were graded according to the tendon thickness as normal (〈 6 mm), minimal (6–8 mm), moderate (8–10 mm) to high-grade (〉 10 mm) in the sagittal diameter of the transverse section, and alterations of echotexture were described as diffuse, circumscribed, or inhomogenous. At the time of the primary investigation, we found thickening and alterations of the echotexture in 33 of 72 tendons. In 48 tendons we found pain and local or diffuse swelling in the Achilles tendon region (sensitivity 0.58, specificity 0.79). After a follow-up of 48 ± 8 months, 7 tendons had ruptured spontaneously. Analysis of the sonograms of the patients taken prior to the rupture showed a high-grade thickening in 4 cases, moderate thickening in 2 cases, and a diameter between 6 and 8 mm in one patient. In no case did we find a rupture of a tendon primarily classified as normal. Patients without sonographic changes exhibited a significantly better clinical outcome following conservative treatment. Sonography was found to be a valuable tool for determination of the tendon's thickness and echotexture. In 28% of our patients with thickening, circumscribed lesions of the echotexture, and chronic pain, a spontaneous rupture occurred.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00434093
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  • 7
    Digitale Medien
    Digitale Medien
    Clinical and sonographic evaluation of the risk of rupture in the Achilles tendon (1996)
    Springer
    Archives of orthopaedic and trauma surgery 116 (1996), S. 14-18 
    Details
    ISSN: 1434-3916
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Chronic pain in the region of the Achilles tendon is a common problem and often a sign of progressive degeneration of the tendon which may lead to its rupture. We studied the clinical course and sonograms in 36 patients with achillodynia to find a prognostic parameter enabling us to estimate the risk of rupture. The patients were evaluated clinically for swelling and tenderness and by high-resolution real-time sonography. The sonograms were graded according to the tendon thickness as normal (〈 6 mm), minimal (6–8 mm), moderate (8–10 mm) to high-grade (〉 10 mm) in the sagittal diameter of the transverse section, and alterations of echotexture were described as diffuse, circumscribed, or inhomogenous. At the time of the primary investigation, we found thickening and alterations of the echotexture in 33 of 72 tendons. In 48 tendons we found pain and local or diffuse swelling in the Achilles tendon region (sensitivity 0.58, specificity 0.79). After a follow-up of 48 ± 8 months, 7 tendons had ruptured spontaneously. Analysis of the sonograms of the patients taken prior to the rupture showed a high-grade thickening in 4 cases, moderate thickening in 2 cases, and a diameter between 6 and 8 mm in one patient. In no case did we find a rupture of a tendon primarily classified as normal. Patients without sonographic changes exhibited a significantly better clinical outcome following conservative treatment. Sonography was found to be a valuable tool for determination of the tendon’s thickness and echotexture. In 28% of our patients with thickening, circumscribed lesions of the echotexture, and chronic pain, a spontaneous rupture occurred.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004020050060
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  • 8
    Digitale Medien
    Digitale Medien
    Effect of Long-Term Growth-Hormone Substitution Therapy on Bone Mineral Density and Parameters of Bone Metabolism in Adult Patients with Growth Hormone Deficiency (1998)
    Springer
    Calcified tissue international 62 (1998), S. 40-46 
    Details
    ISSN: 1432-0827
    Schlagwort(e): Key words: Growth hormone deficiency — GH substitution therapy — Bone mineral density — Bone metabolism — Osteoporosis.
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Medizin , Physik
    Notizen: Abstract. Reduced bone mineral density (BMD) and the prevalence for osteoporotic vertebral fractures are symptoms of growth hormone deficiency (GHD) syndrome, and GH replacement therapy is now available for GH-deficient adults. We investigated the long-term effects of GH replacement therapy on bone mineral density (BMD) and bone metabolism in 19 adult patients with GHD over a period of 18 months. In response to GH treatment, the initially decreased IGF-I concentrations rose significantly during 18 months of therapy to levels within the normal range (matched for sex and age) (mean change 158.1 ± 50.8 ng/ml, P 〈 0.001). Parameters of bone formation such as osteocalcin (OC) and procollagen I-C-Peptide (PICP) showed a significant increase in the first 6 months of therapy, followed by a slight decrease in the next months. Markers of bone resorption (CrosslapsR and deoxypyridinoline (D-Pyr) also increased significantly with a peak value after 6 months and all parameters except PICP remained above baseline values after 18 months. BMD of the femoral neck (FN) showed an increase after 18 months of therapy (mean change 0.01 ± 0.03 g/cm2 after 18 months, n.s.). However, the increase in BMD was significant only in the lumbar spine (LS) (mean change 0.03 ± 0.04 g/cm2, P 〈 0.05 after 18 months). We conclude that GH replacement therapy in adult patients with GHD over a period of 18 months causes a pronounced increase in bone turnover mainly during the first 12 months of therapy and increases BMD of the lumbar spine and the femoral neck after 18 months.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002239900392
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  • 9
    Digitale Medien
    Digitale Medien
    Colour doppler imaging of partial subclavian steal syndrome (1993)
    Springer
    Neuroradiology 35 (1993), S. 293-295 
    Details
    ISSN: 1432-1920
    Schlagwort(e): Partial subclavian steal syndrome ; Colour Doppler imaging ; Subclavian artery stenosis ; Angioplasty
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The case of a 67-year-old woman with symptoms related to the vertebro-basilar system and blood pressure difference of the upper extremities is presented. Colour-Doppler imaging (CDI) with additional spectral tracing revealed partial subclavian steal syndrome with retrograde flow in the left vertebral artery during systole, which could be significantly enhanced by reactive hyperemia after of arm exercise. Angiography confirmed a highgrade stenosis of the proximal subclavian artery and balloon angioplasty was performed. Nonivasive follow-up by CDI demonstrated regular antegrade vertebral artery flow at rest, but minimal retrograde systolic flow after left arm exercise.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00602619
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  • 10
    Digitale Medien
    Digitale Medien
    Rheumatische Erkrankungen des Sprunggelenkes und der Fußwurzel (1999)
    Springer
    Der Radiologe 39 (1999), S. 60-67 
    Details
    ISSN: 1432-2102
    Schlagwort(e): Schlüsselwörter Kalkaneus ; Talus ; Gelenkinstabilität ; Radiologische Diagnostik ; Ultraschall ; Magnetresonanztomographie ; Sprunggelenk ; Synovialmembran ; Arthritis ; Diagnose ; Bildgebende Diagnostik ; Key words Calcaneus ; Joint instability ; Plain film radiography ; Ultrasonography ; Magnetic resonance imaging ; Subtalar joint ; Ankle joint ; Arthritis ; Synovial membrane ; Synovitis ; Diagnosis ; Differential ; Diagnostic imaging ; Rheumatic disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Summary Diseases of the hindfoot are associated with considerable functional impairment and therefore may hamper patients’ movements during gait considerably. Because of biomechanical overload, articular structures, tendons and ligaments are prone to early degenerative changes during the course of rheumatic diseases as visible with plain film radiography, sonography (US), or magnetic resonance imaging (MRI). Findings may occur as arthritis of major joints or in the form of fibroostitis and bursitis of the os calcis. Despite the progressive course of rheumatic diseases and characteristic imaging findings, high variability of X-ray signs may occur. Plain film radiograms and high-resolution ultrasonography play a key role in imaging rheumatic diseases of the hindfoot. MRI supports imaging diagnosis in selected cases. The principal goals of diagnostic imaging are precise and reproducible documentation of morphologic abnormalities and differentiated analysis for planning proper conservative or surgical treatment.
    Notizen: Zusammenfassung Erkrankungen des Sprunggelenks und der Fußwurzel sind, da mit einer deutlichen Einschränkung der Beweglichkeit dieser Region einhergehend, für den Patienten meist sehr belastend. Bei rheumatischen Krankheitsbildern steht neben der Funktionseinschränkung vor allem in späteren Stadien die Destruktion biomechanisch stark beanspruchter Strukturen (hyaliner Knorpel, subchondraler Knochen, Bänder und Sehnen) im Vordergrund des klinischen wie auch des radiologischen Bildes. Grundsätzlich sind Arthritiden der großen Gelenke und die Calcaneopathia rheumatica zu beobachten. Trotz des meist stadienhaften Verlaufes mit charakteristischem Befallsmuster ist die bildgebende Diagnostik wegen der großen Formvariabilität der unterschiedlich ausgeprägten Veränderungen oft schwierig. Zusätzlich zu nativröntgenologischen Aufnahmen gehören die hochauflösende Sonographie, ergänzt durch die MRT, mit denen Gelenke und Sehnen direkt darstellbar sind, heute zur Standarddiagnostik. Ziel der Diagnostik ist einerseits die präzise reproduzierbare Dokumentation morphologischer Veränderungen zur Verlaufskontrolle, andererseits ihre möglichst differenzierte Analyse zur Einleitung adäquater konservativer oder operativer Therapiemaßnahmen, um Patienten zu einer aktiveren Lebensweise verhelfen zu können.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001170050478
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