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Sample records for arthroplasty bildgebung bei

  1. Imaging of hip joint arthroplasty; Bildgebung bei Hueftgelenkendoprothesen

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    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C. [Univ.-Klinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Wien (Austria)

    2009-05-15

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [German] Dem Hueftgelenk als groesstem Gelenk des menschlichen Koerpers kommt eine besondere Bedeutung in der muskuloskelettalen Radiologie zu. Entsprechend wichtig ist auch die radiologische Beurteilung von Hueftgelenkendoprothesen, die z. B. infolge degenerativer Gelenkerkrankungen, einer Hueftkopfnekrose oder einer Fraktur eingesetzt werden. Die Projektionsradiographie ist weiterhin die primaere Modalitaet zur Beurteilung von Hueftgelenkendoprothesen, direkt postoperativ und zur laengerfristigen Verlaufskontrolle. Diese Methode erlaubt in der Mehrzahl der Faelle eine suffiziente Antwort auf die Frage nach Lockerung, periprothetischer Fraktur oder Prothesenmaterialbruch, Luxation, Infektion und Weichteilkalzifikation

  2. Molecular imaging in neurological diseases; Molekulare Bildgebung bei neurologischen Erkrankungen

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    Reimold, M.; Fougere, C. la [Universitaetsklinikum Tuebingen, Abteilung Nuklearmedizin und Klinische Molekulare Bildgebung, Department Radiologie, Tuebingen (Germany)

    2016-07-15

    In neurodegeneration and in neuro-oncology, the standard imaging procedure, magnetic resonance imaging (MRI), shows limited sensitivity and specificity. Molecular imaging with specific positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) tracers allows various molecular targets and metabolic processes to be assessed and is thus a valuable adjunct to MRI. Two important examples are referred to here: amino acid transport for neuro-oncological issues, and the recently approved PET tracers for detecting amyloid depositions during the preclinical stage of Alzheimer's disease. This review discusses the clinical relevance and indications for the following nuclear medicine imaging procedures: amyloid PET, {sup 18}F-fluorodeoxyglucose (FDG)-PET, and dopamine transporter (DaT)-SPECT for the diagnosis of dementia and the differential diagnosis of Parkinson's disease, in addition to amino acid PET for the diagnosis of brain tumors and somatostatin receptor imaging in meningioma. (orig.) [German] Die Magnetresonanztomographie (MRT) weist als Standardverfahren bei neurodegenerativen und neuroonkologischen Fragestellungen eine eingeschraenkte Sensitivitaet und Spezifitaet auf. Die nuklearmedizinische molekulare Bildgebung mit spezifischen Positronenemissionstomographie(PET)- und single-photon-emission-computed-tomography(SPECT)-Tracern ermoeglicht die Darstellung verschiedener molekularer Targets bzw. Stoffwechselprozesse und stellt damit eine wichtige Ergaenzung zur MRT dar. Hier sei exemplarisch auf die Darstellung des Aminosaeuretransports im Rahmen neuroonkologischer Fragestellungen verwiesen, sowie auf die bereits im praeklinischen Stadium der Alzheimer-Demenz nachweisbaren Amyloidablagerungen mit hierfuer seit Kurzem zugelassenen PET-Tracern. Dieser Uebersichtsbeitrag bespricht die klinische Bedeutung bzw. die Indikationen der folgenden nuklearmedizinischen Untersuchungsverfahren: der Amyloid-PET, der {sup 18}F

  3. Imaging of nasopharyngeal diseases; Bildgebung bei Erkrankungen des Nasopharynx

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    Koesling, S.; Hofmockel, T. [Martin-Luther-Universitaet Halle-Wittenberg, Klinik und Poliklinik fuer Diagnostische Radiologie, Halle (Germany); Knipping, S. [Martin-Luther-Universitaet Halle-Wittenberg, Klinik und Poliklinik fuer Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Halle (Germany)

    2009-01-15

    This article gives an overview about the main nasopharyngeal pathologies and incidental findings, which a radiologist could be confronted with in daily practice. These include nasopharyngeal cysts, lymphoid hyperplasia, juvenile angiofibroma, carcinomas and non-Hodgkin lymphoma. Typical radiological findings, possibilities for making a specific diagnosis, differential diagnosis and description of the spread of a neoplasm are the central points. Investigation techniques and clinical signs are briefly summarized. (orig.) [German] Dieser Beitrag gibt einen Ueberblick ueber nasopharyngeale Erkrankungen und Zufallsbefunde, mit denen der Radiologe haeufig und weniger haeufig konfrontiert werden kann. Dazu zaehlen zystische Raumforderungen, die hyperplastische Rachenmandel, das juvenile Nasenrachenfibrom, Nasopharynxkarzinom und Non-Hodgkin-Lymphom. Im Vordergrund stehen dabei das radiologische Erscheinungsbild, Moeglichkeiten einer artdiagnostischen Zuordnung, differenzialdiagnostische Aspekte und bei Neoplasien Aussagen zur Ausbreitungsdiagnostik. Untersuchungstechnische und klinische Aspekte sowie die Diagnosesicherung werden kurz erwaehnt. (orig.)

  4. Preclinical imaging in animal models of radiation therapy; Praeklinische Bildgebung im Tiermodell bei Strahlentherapie

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    Nikolaou, K.; Cyran, C.C.; Reiser, M.F.; Clevert, D.-A. [Klinikum der Ludwig-Maximilians-Universitaet, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Lauber, K. [Klinikum der Ludwig-Maximilians-Universitaet, Klinik und Poliklinik fuer Strahlentherapie, Muenchen (Germany)

    2012-03-15

    -funktionelle Informationen ueber den Tumor zur Verfuegung gestellt werden. Die dynamische kontrastmittelverstaerkte MRT-, CT- oder ultraschallbasierte Perfusionsbildgebung sowie Hybridverfahren wie PET/CT oder MRT/PET haben das Potenzial, vitale und/oder perfundierte Tumoranteile zu identifizieren und abzugrenzen, um so eine gezielte Strahlentherapie zu optimieren. Ziel ist eine genauere Abgrenzung und Behandlung des Tumors bei gleichzeitiger Reduzierung der Dosis und Schonung des umliegenden gesunden Gewebes. In der Entwicklung neuer bildgebender Methoden fuer die Planung einer individualisierten Strahlentherapie kommt der praeklinischen, wissenschaftlichen Bildgebung und Forschung eine besondere Rolle zu, da nur in einem praeklinischen Setting, also in tierexperimentellen Tumormodellen, die Moeglichkeiten einer multimodalen Bildgebung ausreichend genau evaluiert und weiterentwickelt werden koennen. Neue funktionelle bildgebende Methoden werden fuer die Ueberwachung einer fruehen Therapieantwort (''early response'') unter Strahlentherapie oder fuer die Darstellung der Wertigkeit neuer Kombinationstherapien (z. B. Antiangiogenese plus Strahlentherapie) eine zunehmende Rolle spielen. (orig.)

  5. Hochaufgelöste Magnetresonanz-Bildgebung der Mäuseaorta zur Bestimmung der Dynamik funktioneller Parameter durch Laufrad-Training bei ApoE-Knock-Out-Mäusen

    OpenAIRE

    Offenberger, Wolfgang

    2009-01-01

    Einführung: Atherosklerose ist eine führende Ursache von Morbidität und Mortalität weltweit. Die ApoE-Knock-Out-Maus (ApoE-/-) ist das wichtigste Tiermodell für das Studium der Atherosklerose und von Interventionen auf diese Erkrankung. Mittels hochaufgelöster Magnet-Resonanz-Bildgebung ist es möglich, eine nicht-invasive in-vivo Gefäß-Charakterisierung bei Mäusen durchzuführen. In dieser Arbeit wurden die Auswirkungen von Sport auf die Gefäßfunktion der Aorta ascendens und abdominalis bei Ap...

  6. Molecular imaging of head and neck cancers. Perspectives of PET/MRI; Molekulare Bildgebung bei Kopf-ï]¿Hals-Tumoren. Perspektive der PET-MRT

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    Stumpp, P.; Kahn, T. [Universitaetsklinikum Leipzig AoeR, Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Purz, S.; Sabri, O. [Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Leipzig (Germany)

    2016-07-15

    Therapieansprechen liefern. Derzeit wird die {sup 18}F-FDG-PET-CT in der diagnostischen Genauigkeit bei Kopf-Hals-Tumoren von der PET-MRT nicht uebertroffen. Der additive Wert der PET-MRT durch die multiparametrische Bildgebung muss weiter erforscht werden. (orig.)

  7. Multimodal diagnosis of multiple and heterogeneous liver lesions in a young patient; Multimodale Bildgebung multipler Leberlaesionen bei einem jungen Patienten

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    Kiessling, F.; Schlemmer, H.-P. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg (Germany). Abteilung fuer onkologische Diagnostik und Therapie

    2005-10-01

    The classification of liver lesions is often problematic in particular if they are multiple and show an heterogeneous shape. Here we report of a young patient with multiple liver lesions of up to 3 cm size. Using ultrasound, the lesions were hyper-, hypoechogen or mixed. In serial contrast enhanced CT scans some of the lesions showed the typical enhancement pattern of hemangiomas, however, the diagnosis could still not be faithfully determined for all lesions. Therefore, the patient was conducted to contrast enhanced MRI (Gd-DTPA and MnDPDP). While with Gd-DTPA some of the lesions showed a strong enhancement, they remained hypointense after administration of MnDPDP. Finally to exclude a metastatic disease a {sup 99m}Tc-erythrocyte SPECT was performed confirming the diagnosis of hemangiomas for most of the lesions. Diagnosis was not assessed by biopsy because this would only clarify the diagnosis for one or few of the lesions. The patient was subsequently followed up for 3 years and all lesions remained unchanged. This case clearly illustrates the difficulty to get a certain diagnosis of multiple liver lesions with heterogeneous appearance despite the multimodal diagnostic conduct. (orig.) [German] Bei einer Routineuntersuchung wurden bei einem jungen Patienten sonographisch multiple Leberrundherde mit hyper-, hypoechogener und gemischter Echogenitaet detektiert. Auch mittels triphasischer kontrastmittelverstaerkter CT gelang nur bei einem Teil der Herde die Einstufung als Haemangiome anhand ihres Irisblendenphaenomens. MRT-Untersuchungen unter Verwendung von Gd-DTPA und MnDPDP wurden angeschlossen. Mit Gd-DTPA zeigten einige Herde ein kraeftiges Enhancement, unter Verwendung von MnDPDP jedoch blieben sie hypointens. Auf eine Biopsie wurde verzichtet, da diese nur bei einem oder wenigen Herden die Diagnose liefern wuerde, die anderen Herde aber unter Beruecksichtigung ihrer Heterogenitaet unklar geblieben waeren. Eine Sicherung der Diagnose gelang fuer die meisten

  8. Imaging of demyelinating and neoplastic diseases of the spinal cord; Bildgebung bei demyelinisierenden und tumoroesen Erkrankungen des Rueckenmarks

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    Mueller-Mang, C. [Institut fuer CT und MRT Gaenserndorf, Gaenserndorf (Austria)

    2010-12-15

    The clinical symptoms of myelopathy are variable and non-specific. Demyelinating as well as neoplastic spinal cord diseases can cause paresthesia, progressive sensomotoric deficits and bowel and bladder dysfunction. Imaging of the spine, especially with magnetic resonance imaging (MRI), is an essential component in the diagnostic assessment of myelopathy and makes a substantial contribution to achieving the correct diagnosis. Although intramedullary neoplasms are far less common than demyelinating spinal cord diseases, radiologists should be familiar with the three most common entities, astrocytoma, ependymoma and hemangioblastoma, which represent over 70% of all spinal cord neoplasms. An early diagnosis and therapy is essential with neoplastic and demyelinating spinal cord diseases to hold residual neurological deficits as low as possible. (orig.) [German] Die klinische Symptomatik von Myelopathien ist aeusserst variabel und unspezifisch. Sowohl demyelinisierende als auch tumoroese Rueckenmarkerkrankungen koennen Paraesthesien, progrediente sensomotorische Ausfaelle und eine Sphinkterdysfunktion hervorrufen. Bildgebende Untersuchungen, und hier allen voran die MRT, sind ein unerlaesslicher Bestandteil zur Abklaerung von Myelopathien und tragen wesentlich zur korrekten Diagnose bei. Intramedullaere Tumoren sind zwar weitaus seltener als demyelinisierende Rueckenmarkerkrankungen, dennoch sollte der Radiologe mit den Bildmerkmalen der 3 haeufigsten Tumorarten, dem Astrozytom, Ependymom und Haemangioblastom vertraut sein, die ueber 70% aller Rueckenmarktumoren verursachen. Eine moeglichst fruehe Diagnostik und Therapie sind bei tumoroesen und demyelinisierenden Rueckenmarkerkrankungen essenziell, um bleibende neurologische Defizite moeglichst gering zu halten. (orig.)

  9. 31P MR spectroscopic imaging in preoperative embolization therapy of meningiomas; Phosphor-31-MR-spektroskopische Bildgebung bei praeoperativer Embolisationstherapie von Meningeomen

    Energy Technology Data Exchange (ETDEWEB)

    Blankenhorn, M. [Psychiatrische Universitaetsklinik, Ulm (Germany). Abteilung III; Bachert, P.; Kaick, G. van [Deutsches Krebsforschungszentrum Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik; Semmler, W. [Freie Univ. Berlin (Germany). Inst. fuer Diagnostikforschung; Ende, G. [Zentralinstitut fuer Seelische Gesundheit, Mannheim (Germany). NMR-Forschung in der Psychiatrie; Tronnier, V. [Neurochirurgische Klinik, Klinikum der Universitaet, Heidelberg (Germany); Sartor, K. [Neurologische Klinik, Klinikum der Universitaet, Heidelberg (Germany). Abt. Neuroradiologie

    1999-06-01

    Purpose: {sup 31}P MR spectroscopic imaging ({sup 31}P SI) was evaluated in a clinical study as a method for monitoring presurgical devascularization of meningiomas. The aim was to assess noninvasively metabolic alterations in tumor and in healthy brain tissue before and after embolization. Methods: Localized {sup 31}P MR spectra of the brain were obtained by means of 2D-SI (voxel size: 36 cm{sup 3}) using a 1,5-T whole-body MR tomograph. Results: Eleven of 19 patients with intracranial meningiomas examined in this study underwent preoperative embolization therapy; eight patients were examined before and after treatment. After embolization, alterations of pH and of the concentrations of high-energy phosphates (nucleoside-5`triphosphate=NTP, phosphocreatine=PCr), inorganic phosphate (P{sub i}), and membrane constituents were observed in the tumors. A tendency of [P{sub i}] increase and decrease of [NTP], [PCr], and pH predominated, which is explained by ischemic processes after tumor devascularization. Conclusion: {sup 31}P SI is applicable in clinical studies and detects alterations of phosphate metabolism in a meningioma after embolization. (orig.) [Deutsch] Ziel: Die {sup 31}P-MR-spektroskopische Bildgebung ({sup 31}P-SI) wurde im Rahmen der praeoperativen Embolisationstherapie von Patienten mit Meningeomen als Methode zur Therapieverlaufskontrolle klinisch geprueft. Ziel der Studie war die nichtinvasive Erfassung von Veraenderungen im Metabolismus der Tumoren vor und nach Embolisation im Vergleich zum gesunden Hirngewebe. Methoden: Lokalisierte {sup 31}P-MR-Spektren des Gehirns wurden mit 2D-SI (Voxelgroesse: 36 cm{sup 3}) an einem 1,5-T-Ganzkoerper-MR-Tomographen aufgenommen. Ergebnisse: Elf von insgesamt 19 untersuchten Patienten unterzogen sich einer praeoperativen Embolisation, bei acht Patienten konnte eine Verlaufskontrolle durchgefuehrt werden. Nach Embolisation wurden Veraenderungen des pH und der Konzentrationen von energiereichen Phosphaten (Nukleosid

  10. Imaging in smoldering (asymptomatic) multiple myeloma. Past, present and future; Bildgebung bei ''smoldering'' (asymptomatischem) multiplem Myelom. Vergangenheit, Gegenwart und Zukunft

    Energy Technology Data Exchange (ETDEWEB)

    Bhutani, M.; Landgren, O. [Center for Cancer Research, National Cancer Institute, National Institutes of Health, Multiple Myeloma Section, Lymphoid Malignancies Branch, Bethesda, MD (United States)

    2014-06-15

    imaging techniques need to be validated in prospective clinical trials assessing the SMM to multiple myeloma transition, with the aim of enabling appropriate management decisions. Efforts are also needed to improve the costs and availability of whole-body MRI and/or FDG PET/CT, in order to facilitate their widespread adoption as first-line detection modalities. Future clinical trials of therapeutic agents using earlier detection strategies will have to be carefully designed and take into consideration the risk of lead-time and length-time biases, which might falsely demonstrate longer overall survival. The English full text version of this article is available at SpringerLink (under ''Supplemental''). (orig.) [German] Aktuelle klinische Studien sprechen fuer eine Therapie des ''smoldering multiple myeloma'' (SMM) mit hohem Progressionsrisiko schon bei der Diagnosestellung und nicht erst zum Zeitpunkt der Progression in ein symptomatisches multiples Myelom (MM). Die Frueherkennung einer Knochen- und/oder Knochenmarkbeteiligung durch entsprechende sensitive Bildgebungsverfahren kann zur Ermittlung von SMM-Patienten mit hohem Risiko fuer eine Progression beitragen. Nach aktuellen Konsensusleitlinien (2011) ist die Roentgenuntersuchung des Skeletts ein Grundpfeiler der Beurteilung einer Knochenbeteiligung bei Diagnosestellung und in Verlaufskontrollen wegen eines SMM. Jedoch hat die Roentgenuntersuchung des Skeletts eine geringe Sensitivitaet fuer Knochenlaesionen und liefert keine Informationen zu Knochenmarkveraenderungen. Moderne bildgebende Verfahren wie die Fluordeoxyglukose-Positronenemissionstomographie-Computertomographie (FDG-PET-CT) und die Magnetresonanztomographie (MRT) liefern zusammen mit innovativen Funktionsuntersuchungen eine bessere Einschaetzung allgemeiner Veraenderungen im Knochenmark- und im Knochenkompartiment. Mit diesen Verfahren kann die beginnende Progression vom SMM zum MM quantitativ objektiviert werden

  11. {sup 1}H-MR-spectroscopic imaging in patients with Alzheimer`s disease; {sup 1}H-MR-spektroskopische Bildgebung bei Patienten mit klinisch gesichertem Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Block, W [Radiogische Klinik der Univ. Bonn (Germany); Traeber, F [Radiogische Klinik der Univ. Bonn (Germany); Kuhl, C K [Radiogische Klinik der Univ. Bonn (Germany); Fric, M [Psychiatrische Universitaetsklinik, Bonn (Germany); Keller, E [Radiogische Klinik der Univ. Bonn (Germany); Lamerichs, R [Philips Medical Systems, Best (Netherlands); Rink, H [Radiogische Klinik der Univ. Bonn (Germany); Moeller, H J [Psychiatrische Universitaetsklinik, Bonn (Germany); Schild, H H [Radiogische Klinik der Univ. Bonn (Germany)

    1995-09-01

    To detect regional differences in accompanying metabolic changes, {sup 1}H-Magnetic Resonance Spectroscopic Imaging was performed in 16 patients with Alzheimer`s disease (AD); the clinical diagnosis was based upon DSM-III-R and NINCDS-ADRDA guidelines. In the hippocampal region metabolic maps of the local distribution of N-acetylaspartate (NAA), choline (Cho), creatine compounds (P(Cr)) and lactate were determined. Ratios of Cho/NAA, (P)Cr/NAA and Cho/(P)Cr calculated from selected hippocampal spectra were compared to those from healthy volunteers (n=17). AD patients demonstrated an increase of Cho/NAA and (P)Cr/NAA ratios caused by increased choline compounds and decreased NAA. These alterations were observed in 11/12 cases in the hippocampal and in 7/12 in the temporo-occipital region. Hippocampal Cho/NAA ratios (0.56{+-}0.19) were significantly elevated compared with controls. The observed elevation of choline compounds in the hippocampus supports the hypothesis that alterations in the cholinergic system play an important role in Alzheimer`s disease. The observed reduction of NAA is due to neuronal degeneration. (orig./MG) [Deutsch] Zur Darstellung von regionalen metabolischen Veraenderungen bei Morbus Alzheimer wurden mit dem Verfahren des {sup 1}H-Magnetic-Resonance-Spectroscopic-Imaging 16 Patienten untersucht, deren Diagnose klinisch entsprechend DSM-III-R- und NINCDS-ADRDA-Kriterien gestellt wurde. In Hoehe des Hippocampus wurden transaxiale ``Metabolitenkarten`` der regionalen Verteilung von N-Acetyl-Aspartat (NAA), cholinhaltiger Verbindungen (Cho), Gesamtkreatin (P(Cr)) und Laktat erstellt. Zur Quantifizierung der Unterschiede zum Normalkollektiv (n=17) wurden die Metabolitenquotienten Cho/NAA, (P)Cr/NAA und Cho/(P)Cr, insbesondere aus der Hippocampusregion, ermittelt. Das Krankheitsbild des M. Alzheimer stellte sich durch eine Erhoehung der Quotienten Cho/NAA und Cho/(P)Cr dar, wobei neben einer Cholinerhoehung die Reduktion des Neurotransmitters NAA

  12. Combined functional and morphological imaging of sarcomas. Significance for diagnostics and therapy monitoring; Kombinierte funktionelle und morphologische Bildgebung bei Sarkomen. Stellenwert fuer Diagnostik und Therapiemonitoring

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, N.; Rist, C.; Reiser, M.F.; Berger, F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Schlemmer, M.; Issels, R. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Medizinische Klinik und Poliklinik III, Muenchen (Germany)

    2010-04-15

    . Ein Staging von Sarkompatienten einschliesslich der Erfassung von Lungenmetastasen ist damit in einem Untersuchungsgang moeglich. Die PET/CT wird bei Patienten mit primaer ossaeren und Weichteilsarkomen zur Diagnosestellung, zum Staging und Restaging, zum ''metabolischen Tumorgrading'', zur Biopsieplanung, zum Rezidivnachweis sowie zum Therapiemonitoring eingesetzt. Es konnte gezeigt werden, dass der FDG-Uptake des Tumors vor Therapie sowie die Aenderungen im FDG-Uptake nach Therapie signifikant mit der histopathologischen Response und dem Ueberleben der Patienten korrelieren. Damit ermoeglichen PET und PET/CT auch prognostische Aussagen. Neue Perspektiven der Hybridbildgebung mit der PET/CT ergeben sich durch die Etablierung neuer Radiotracer sowie durch die kombinierte Untersuchung von Tumormetabolismus und -perfusion. Die hochaufloesende MRT bleibt fuer die lokale Primaerdiagnostik sowie zur praeoperativen Planung mit Klaerung der exakten anatomischen Situation und moeglicher Infiltration vaskulaerer oder nervaler Strukturen weiter unverzichtbar. Die kontrastverstaerkte MRT ist ein wichtiges und gut verfuegbares Alternativverfahren zur Rezidivdiagnostik, ganz besonders fuer nichthypermetabole Tumoren. Dynamische, kontrastverstaerkte MRT-Sequenzen gewinnen fuer das Therapiemonitoring zunehmend an Bedeutung und sollten in prospektiven Studien mit der FDG-PET/CT korreliert werden. (orig.)

  13. Lokale Bildgebung der Prostata

    NARCIS (Netherlands)

    Walz, J.; Loch, T.; Salomon, G.; Wijkstra, H.

    2013-01-01

    In den letzten Jahren wurden neue Verfahren für die Bildgebung der Prostata entwickelt, um die Diagnostik des Prostatakarzinoms zu verbessern. Hierbei wurde v. a. der transrektale Ultraschall (TRUS) zum sog. „enhanced ultrasound" weiterentwickelt. Die Elastographie zeigt in mehreren Studien gute

  14. Migration measurement of acetabular components in cementless total hip arthroplasty; Messung der Pfannenwanderung bei zementfreien Hueftimplantaten

    Energy Technology Data Exchange (ETDEWEB)

    Eckardt, A.; Karbowski, A.; Schwitalle, M.; Vogel, J.; Boden, F.; Seeleitner, C. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Schunk, K. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Mayrhofer, P. [Innsbruck Univ. (Austria). Inst. fuer Mathematik und Geometrie

    1998-08-01

    Migration measurements of acetabular components using a special computer aided method (EBRA = abbrevation for the German term ``Ein-Bild-Roentgenanalyse``) were performed to evaluate early results of the implants and predict aseptic loosening. Methods: Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes lengitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. Results: 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e. osteoporosis of the acetabular bone stock or problems concerning the surgical technique which means malposition of the cup or insufficient reaming of the bone. There were some patients with severe congenital dysplasia of the hip and in some cases the inclination angle of the cup was too great. Conclusion: The technique applied for measuring migration of acetabular components can be useful for evaluating early instability of the implant and can be helpful in detecting problems concerning the surgical technique. (orig.) [Deutsch] Mittels der Ein-Bild-Roentgenanalyse wurden Pfannenwanderungen nach Implantation von zementfreien, sphaerischen Hueftgelenkspfannen erfasst, um Praediktoren fuer die langfristige Prognose der Implantate zu evaluieren. Methoden: Nach Markierung von Referenzpunkten in den Beckenuebersichtsaufnahmen wurden diese digitalisiert, vom Programm verrechnet und die Wanderung des Implantats im Verlauf angegeben. Bei 71 Patienten wurden von 74 Pfannen ueber einen Mindestnachuntersuchungszeitraum von 12 Monaten Migrationsmessungen durchgefuehrt. Das Konfidenzintervall der Methode liegt bei <1 mm. Bei jedem dieser Patienten fanden sich Hinweise entweder auf ein schlechtes Knochenlager, auf operationsbedingte Probleme, wenn keine ausreichende Primaerstabilitaet der Pfanne

  15. {sup 31}P-MR spectroscopy of all regions of the human heart at 1.5 T with acquisition-weighted chemical shift imaging; P-MR-Spektroskopie aller Wandabschnitte des menschlichen Herzens bei 1,5 T mit akquisitionsgewichteter Chemical-shift-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Koestler, H.; Beer, M.; Buchner, S.; Sandstede, J.; Pabst, T.; Kenn, W.; Hahn, D. [Wuerzburg Univ. (Germany). Abt. fuer Roentgendiagnostik; Landschuetz, W.; Kienlin, M. von [Wuerzburg Univ. (Germany). Physikalisches Inst.; Neubauer, S. [Dept. of Cardiovascular Medicine, John Radcliffe Hospital, Oxford (United Kingdom)

    2001-12-01

    Aim: Aim of this study was to show whether or not acquisition-weighted chemical shift imaging (AW-CSI) allows the determination of PCr and ATP in the lateral and posterior wall of the human heart at 1.5 T. Methods: 12 healthy volunteers were examined using a conventional chemical shift imaging (CSI) and an AW-CSI. The sequences differed only in the number of repetitions for each point in k space. A hanning function was used as filter function leading to 7 repetitions in the center of the k space and 0 in the corners. Thus, AW-CSI had the same resolution as the CSI sequence. The results for both sequences were analyzed using identically positioned voxels in the septal, anterior, lateral and posterior wall. Results: The determined averaged AW-CSI signal to noise ratios were higher for PCr by a factor of 1.3 and for ATP by 1.4 than those of CSI. The PCr/ATP ratios were higher by a factor of 1.2 - 1.3 and showed a smaller standard deviation in all locations for AW-CSI. The mean PCr/ATP ratios determined by AW-CSI of septal, lateral and posterior wall were almost identical (1.72 - 1.76), while it was higher in the anterior wall (1.9). Conclusions: The reduced contamination in AW-CSI improves the signal to noise ratio and the determination of the PCr/ATP ratio in cardiac {sup 31}P spectroscopy compared to CSI with the same resolution. The results in volunteers indicate that AW-CSI renders {sup 31}P spectroscopy of the lateral and posterior wall of the human heart feasible for patient studies at 1.5 T. (orig.) [German] Ziel: Ziel der Arbeit war es zu untersuchen, ob die akquisitionsgewichtete Chemical-shift-Bildgebung (AW-CSI) die Bestimmung von PCr und ATP in der Seiten- und Hinterwand des menschlichen Herzens an einem klinischen 1,5 T MR-Tomographen erlaubt. Methoden: 12 gesunde Probanden wurden jeweils mit einer chemical shift imaging (CSI) und einer AW-CSI-Sequenz untersucht. Die Sequenzen unterschieden sich lediglich in der Anzahl der Wiederholungen der einzelnen

  16. Importance of SPECT/CT for knee and hip joint prostheses; Stellenwert der SPECT/CT bei Knie- und Hueftgelenkprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Strobel, K.; Steurer-Dober, I.; Huellner, M.W.; Veit-Haibach, P.; Allgayer, B. [Luzerner Kantonsspital (Switzerland). Institut fuer Nuklearmedizin und Roentgendiagnostik

    2012-07-15

    Complications, such as loosening or infections are common problems after hip or knee arthroplasty. If conventional X-rays are equivocal bone scintigraphy is the classical second-line imaging modality. Single photon emission computed tomography/computed tomography (SPECT/CT) offers metabolic and morphologic information in one imaging step and is becoming increasingly more available in larger hospitals. The SPECT/CT procedure is a promising method and is increasingly being used in daily routine to evaluate joint arthroplasty. The additional benefit compared with classical conventional bone scintigraphy has to be evaluated in further prospective studies. In our hospital SPECT/CT regularly gives important additional information regarding prosthetic joint complications. SPECT/CT is increasingly being used as the second step imaging standard modality if conventional X-rays are equivocal. (orig.) [German] Komplikationen wie Lockerung und Infekt stellen ein haeufiges Problem nach Hueft- und Kniegelenkprothesen dar. Wenn die konventionelle Roentgenaufnahme nicht zum Ziel fuehrt, ist die klassische konventionelle Skelettszintigraphie die am haeufigsten verwendete ''Second-line''-Bildgebung. Die ''single photon emission computed tomography''/CT (SPECT/CT) bietet metabolische und morphologische Informationen bzgl. Prothesenkomplikationen in einem Untersuchungsgang und ist zunehmend in groesseren Kliniken verfuegbar. Die SPECT/CT ist eine viel versprechende Methode und wird im klinischen Alltag bei der Evaluation von Gelenkprothesen zunehmend eingesetzt. Es sind noch mehr prospektive Studien noetig, um die Leistungsfaehigkeit und den Zusatznutzen gegenueber der klassischen Szintigraphie zu evaluieren. In unserer Klinik wird die Knochenszintigraphie bei der Abklaerung von Prothesenkomplikationen zumeist mit einer SPECT/CT kombiniert und liefert regelmaessig wichtige Zusatzinformationen. Die SPECT/CT entwickelt sich zunehmend zum Standard

  17. Arthroplasty of the rheumatoid hand. Pre- and postoperative imaging with special consideration of biomechanical and pathobiomechanical aspects and its radiological evaluation; Arthroplastik der rheumatischen Hand. Prae- und postoperative Bildgebung mit besonderer Beruecksichtigung der Biomechanik und Pathobiomechanik und ihrer Evaluation am Roentgenbild

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, O.J. [Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhuegel, Zentralroentgeninstitut mit Schnittbildzentrum, Wien (Austria); Sekyra, K. [Medizinische Universitaet Innsbruck/Oesterreich, Klinik fuer Orthopaedie (Austria)

    2006-09-15

    Radiology plays a key role when the indications for arthroplasties of the hand and finger joints are determined and for the postoperative follow-up. On the one hand, the degree of inflammatory changes in all affected compartments is to be evaluated and graded; on the other hand, conventional radiograms allow for a first assessment of possible joint instability and impaired biomechanics. Both aspects influence the choice of the proper surgical therapeutic strategy. Osteolysis, deformity, fracture, prosthesis loosening or failure, heterotopic ossification, and foreign body-associated formation of granulation tissue are complications which can be detected on follow-up radiographs early on. (orig.) [German] Bei der Indikationsstellung und Verlaufskontrolle von Arthroplastien der Hand kommt der Radiologie eine wesentliche Rolle zu. Einerseits ist das Ausmass der entzuendlichen Veraenderungen in allen Kompartimenten umfassend zu beurteilen und graduieren, andererseits lassen sich bereits im konventionellen Roentgenbild Rueckschluesse auf etwaige Instabilitaet oder gestoerte Biomechanik ziehen. Beide Aussagen wirken sich auf die operative Therapieentscheidung massgeblich aus. Osteolyse, Deformitaet, Fraktur, Implantatlockerung oder -versagen, heterotope Knochenneubildung und fremdkoerperassoziierte Granulationsgewebebildung sind Komplikationen, die in den postoperativen Verlaufskontrollen fruehzeitig erfasst werden koennen. (orig.)

  18. Optische Bildgebung der Autoimmunarthritis mit DiD markierten Leukozyten

    OpenAIRE

    Kau, Julia

    2008-01-01

    Zielsetzung: Ziel der vorliegenden Studie war es, zu untersuchen, ob die Optische Bildgebung nach Injektion von ex vivo DiD markierten Leukozyten, in der Lage ist, eine Entzündung der Synovialmembran in Ratten mit einer Antigen-induzierten Monoarthritis des rechten Kniegelenkes aufzudecken. Die Optische Bildgebung wurde auf ihre Fähigkeit zur Unterscheidung zwischen arthritischen und gesunden Kniegelenken und zwischen nichttherapierten und Kortison-therapierten Kniegelenken unt...

  19. Hemato-oncological imaging. Importance of hybrid procedures; Haematoonkologische Bildgebung. Stellenwert der Hybridverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Mayerhoefer, M.E. [Univ.-Klinik fuer Radiologie und Nuklearmedizin, Abteilung fuer Allgemeine und Kinderradiologie, Medizinische Universitaet Wien, Wien (Austria); Haug, A. [Univ.-Klinik fuer Radiologie und Nuklearmedizin, Abteilung fuer Nuklearmedizin, Medizinische Universitaet Wien, Wien (Austria)

    2016-07-15

    Lugano-Klassifikation verankert. Bei multiplen Myelomen ist die Suche nach dem optimalen Tracer, welcher auch Fruehformen der Erkrankung erfassen kann, hingegen noch im Gange. Funktionelle MR-Techniken wie die diffusionsgewichtete Bildgebung (DWI), perfusionsgewichtete Sequenzen sowie dynamische kontrastmittelgestuetzte Sequenzen konnten sowohl bei Lymphomen als auch bei multiplen Myelomen ebenfalls interessante Ergebnisse erzielen. Eine PET-MR kann diese unterschiedlichen Informationen aufgrund ihres multiparametrischen Ansatzes sinnvoll kombinieren. Die PET-MR koennte sich bei haematoonkologischen Erkrankungen moeglicherweise zukuenftig als bevorzugtes Hybridverfahren durchsetzen. (orig.)

  20. Modern imaging of liver metastases; Moderne Bildgebung der Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, J.; Pones, M.; Wengert, G.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Allgemeines Krankenhaus, Wien (Austria)

    2015-01-01

    The liver is the second most common location of metastases following the lymph nodes. The accurate characterization of focal liver lesions in oncology patients is especially important because of the high prevalence of benign liver lesions and the possibility of co-existing benign and malignant lesions. The exact interpretation of these lesions is crucial for therapeutic decisions and thus for the prognosis of the patient. It is essential to detect all focal liver lesions and to distinguish benign from malignant lesions, especially in the management of oncology patients. Numerous imaging modalities are available for these challenges in the daily routine. An extensive understanding of the advantages and limitations of the various imaging modalities and knowledge of the morphology and the typical and atypical appearances of the different metastases is important. This review explains the radiological criteria for various metastases in different modalities. To evaluate the individual prognosis and risk assessment preoperatively, functional imaging is necessary. These personalized pretherapeutic diagnostics are discussed. (orig.) [German] Die Leber stellt nach den Lymphknoten die zweithaeufigste Lokalisation von Metastasen dar. Aufgrund der hohen Praevalenz gutartiger Leberlaesionen ist die genaue Charakterisierung fokaler Leberlaesionen bei Patienten mit bekanntem Malignom besonders wichtig, da maligne und benigne Tumoren koexistieren koennen. Die eindeutige Zuordnung dieser Laesionen ist entscheidend fuer die Therapie und somit die Prognose des Patienten. Insbesondere fuer das Management onkologischer Patienten ist es daher essenziell, alle fokalen Leberlaesionen zu detektieren und zwischen benignen und malignen zu differenzieren. Um dieser Anforderung im radiologischen Alltag nachzukommen, stehen derzeit zahlreiche Bildgebungsmodalitaeten zur Verfuegung. Daher sind sowohl ein tiefgreifendes Verstaendnis der Vorteile und Limitationen der verschiedenen diagnostischen

  1. Cerebral MR imaging of malignant melanoma; Zerebrale MR-Bildgebung beim malignen Melanom

    Energy Technology Data Exchange (ETDEWEB)

    Breckwoldt, M.; Bendszus, M. [Universitaetsklinikum Heidelberg, Abteilung Neuroradiologie, Neurologische Klinik, Heidelberg (Germany)

    2015-01-16

    even in asymptomatic patients. Stage IV requires quarterly MRI examinations. Melanotic and amelanotic metastases show different MRI characteristics. The differentiation between metastasis and microbleeding can be impossible and might require a follow-up scan. Susceptibility-weighted imaging increases the sensitivity of metastases detection but lacks specificity. It can help to differentiate between different metastatic entities. (orig.) [German] Das maligne Melanom (MM) ist nach dem Bronchial- und Mammakarzinom die dritthaeufigste Tumorentitaet, die in das ZNS metastasiert. Haeufig geschieht dies frueh im Krankheitsverlauf, was fuer die Prognose entscheidend ist. Zehn bis 40 % aller Patienten sterben an einer intrakraniellen Metastasierung, wobei die Inzidenz von Hirnmetastasen noch deutlich hoeher liegt (50-75 %). Praedilektionsstelle ist das subkortikale Marklager. Das Signalverhalten von Melanommetastasen kann sehr unterschiedlich sein und sich im Krankheitsverlauf, abhaengig von Melaningehalt, Akkumulation paramagnetischer Ionen und Einblutungen, aendern. Die neuen spezifischen Therapien (Immuntherapien und Kinaseinhibitoren) stellen auch fuer die Bildgebung eine Herausforderung dar, weil bislang nicht ausreichend geklaert ist, inwieweit diese das Signalverhalten von Metastasen in der MR-Bildgebung aendern. Zudem koennen unter den neuen Therapien immunassoziierte Pathologien (Hypophysitis bei ca. 5 % der Patienten unter Ipilimumab-Therapie) und granulomatoese Erkrankungen (Neurosarkoidose) auftreten. In der CT stellen sich Melanommetastasen haeufig nativ hyperdens dar. In der MRT sind T2w-Fluid-attenuated-inversion-recovery(FLAIR)-, native T1w- sowie T1w-Sequenzen nach Kontrastmittelgabe obligat. Mehrere Schnittebenen sollten akquiriert werden. Die suszeptibilitaetsgewichtete Bildgebung (SWI) ist eine neue sensitive Methode zur Detektion von Melanommetastasen bei jedoch eingeschraenkter Spezifitaet. Etwa 66 % der Melanommetastasen zeigen ausgepraegte intratumorale

  2. Functional MRI 2.0. {sup 23}Na and CEST imaging; Funktionelle MRT 2.0. {sup 23}Na- und CEST-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Haneder, S. [Uniklinik Koeln, Institut fuer Diagnostische und Interventionelle Radiologie, Koeln (Germany); Konstandin, S. [Universitaet Bremen, MR-Bildgebung und -Spektroskopie, Fachbereich 1 (Physik/Elektrotechnik), Bremen (Germany); Fraunhofer MEVIS, Institut fuer Bildgestuetzte Medizin, Bremen (Germany)

    2016-02-15

    gewinnen. In diesem Uebersichtsartikel werden 2 MR-Techniken vorgestellt, welche physiologische Prozesse im menschlichen Koerper erfassen koennen. Im Gegensatz zu allen anderen funktionellen MR-Methoden, welche Wasserstoffprotonen fuer die Bildgebung verwenden, nutzt die erste vorgestellte Technik den Spin anderer Kerne fuer die Bildgebung und ermoeglicht hierdurch eine gaenzlich differente Einsicht in den menschlichen Koerper. Der Fokus dieses Artikels liegt hierbei auf der {sup 23}Na-MRT, da sie aufgrund der MR-guenstigen Eigenschaften des Natriumkerns momentan den Schwerpunkt der Forschung im Bereich der sogenannten X-Kern-Bildgebung darstellt. Bei der zweiten Technik handelt es sich um ein relativ neuartiges MR-Verfahren, die Chemical-exchange-saturation-transfer(CEST)-Bildgebung, welche Austauschprozesse zwischen Protonen in Metaboliten und Protonen in freiem Wasser detektieren kann. Im ersten Teil dieses Artikels werden die technischen Grundlagen, Probleme, Vor- und Nachteile und im zweiten Teil die potenziellen klinischen Anwendungen dieser Techniken beleuchtet. Anwendungsbeispiele kommen aus dem Gebiet der zerebralen Bildgebung (z. B. Schlaganfall, Tumoren), der muskuloskelettalen Bildgebung (z. B. Arthrose, degenerative Prozesse) und der abdominellen Bildgebung (z. B. Niere, Hypertension). Beide Techniken bieten ein unglaubliches Potenzial fuer die Zukunft, stehen aber bislang noch an der Schwelle zum klinischen Einsatz und werden aktuell nur in ausgewaehlten universitaeren Zentren evaluiert. (orig.)

  3. Multiparametric and molecular imaging of breast tumors with MRI and PET/MRI; Multiparametrische und molekulare Bildgebung von Brusttumoren mit MRT und PET-MRT

    Energy Technology Data Exchange (ETDEWEB)

    Pinker, K. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria); Memorial Sloan-Kettering Cancer Center, Department of Radiology, Molecular Imaging and Therapy Service, New York (United States); State University of Florida, Department of Scientific Computing in Medicine, Florida (United States); Marino, M.A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria); Policlinico Universitario G. Martino, University of Messina, Department of Biomedical Sciences and Morphologic and Functional Imaging, Messina (Italy); Meyer-Baese, A. [State University of Florida, Department of Scientific Computing in Medicine, Florida (United States); Helbich, T.H. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria)

    2016-07-15

    wertvolle Information ueber die Schluesselprozesse der Krebsentstehung und Progression liefern und sowohl Diagnostik als auch Therapieplanung von Brustkrebs verbessern kann. Die multiparametrische und molekulare Bildgebung der Brust umfasst derzeit die kontrastmittelverstaerkte MRT (KM-MRT), diffusionsgewichtete Bildgebung (DWI) und Protonenspektroskopie ({sup 1}H-MRSI) sowie radiologisch-nuklearmedizinisch kombinierte Verfahren (PET-CT, MP-PET-MRT) unter Verwendung des Radiotracers Fluordesoxyglukose (FDG). Die multiparametrischen Bildgebung der Brust kann bei unterschiedlichen Feldstaerken durchgefuehrt werden (1,5-7 T). Die multiparametrische und molekulare Bildgebung in der Mammadiagnostik ist ein sich rapide entwickelndes Forschungsfeld mit neuen vielversprechenden Techniken wie der Natriumbildgebung ({sup 23}Na-MRT), der Phosphorspektroskopie ({sup 31}P-MRSI), der Chemical-Exchange-Saturation-Transfer(CEST)-, Blood-Oxygen-Level-Dependent(BOLD)- und der hyperpolarisierten MRT sowie neuen zielgerichteten Radiotracern. In den letzten Jahren hat sich die multiparametrische und molekulare Bildgebung in der Mammadiagnostik etabliert. Die multiparametrische Bildgebung der Brust ist jedoch ein sich konstant weiter entwickelndes Forschungsfeld, deren Einfluss in den naechsten Jahren weiter zunehmen und so eine verbesserte Diagnose, Staging und zielgerichtete Therapie ermoeglichen wird. (orig.)

  4. Neuroimaging of cerebral vasculitis; Bildgebung zerebraler Vaskulitiden

    Energy Technology Data Exchange (ETDEWEB)

    Wengenroth, M. [Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Institut fuer Neuroradiologie, Luebeck (Germany); Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer klinische Radiologie, Muenchen (Germany); Saam, T. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer klinische Radiologie, Muenchen (Germany); Haehnel, S. [Universitaetsklinikum Heidelberg, Abteilung Neuroradiologie, Heidelberg (Germany)

    2016-01-15

    Cerebral vasculitis can have a variety of origins. Furthermore, there are no vasculitis-specific symptoms or imaging signs and vasculitis of the CNS can mimic many other neurological diseases, which require different treatment approaches. Thus, the clinical and radiological diagnosis of cerebral vasculitis is challenging. Magnetic resonance imaging (MRI) and MR angiography (MRA) should be the radiological imaging methods of choice to assess the degree of parenchymal damage and to detect vessel wall changes. If the results are unclear digital subtraction angiography (DSA) should be pursued in order to also detect changes in medium sized vessels. Vasculitis of small vessels cannot be detected by vascular imaging and requires brain or leptomeningeal biopsy. In this review we present the current diagnostic approach and a variety of imaging findings in cerebral vasculitis and discuss the main radiological differential diagnoses. (orig.) [German] Die zerebrale Vaskulitis kann viele Ursachen haben. Daher ist die klinische und radiologische Diagnose schwierig, auch weil es etliche vaskulitistypische Symptome und MR-Befunde bei anderen Erkrankungen gibt. Die ZNS-Vaskulitis kann zahlreiche andere neurologische Erkrankungen imitieren, die unterschiedlicher Therapie beduerfen. MRT und MR-Angiographie (MRA) sind die Verfahren der Wahl, mit denen die radiologische Diagnostik begonnen werden sollte, um den Parenchymschaden und den Gefaessbefall zu beurteilen. Bei unklaren Befunden kann eine digitale Subtraktionsangiographie (DSA) ergaenzt werden, um auch mittelgrosse Gefaesse beurteilen zu koennen. Der Befall kleiner Gefaesse kann nur bioptisch nachgewiesen werden. In der folgenden Uebersicht stellen wir das diagnostische Herangehen bei zerebraler Vaskulitis vor, praesentieren zahlreiche Befunde und diskutieren die wichtigsten radiologischen Differenzialdiagnosen. (orig.)

  5. Pneumonia in immunosuppressed patients; Pneumonien bei immunsupprimierten Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Solyanik, O.; Gaass, T.; Hellbach, K. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Dinkel, J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Comprehensive Pneumology Center Munich (CPC-M), Muenchen (Germany)

    2017-01-15

    Pulmonary infections are a common complication in immunosuppressed patients with a frequently fatal prognosis despite modern prophylactic therapy. An early and correct diagnosis is important for initiation of the appropriate therapy. Chest radiography is the preferred initial imaging examination but is not accurate enough for the detection of pulmonary infections in immunosuppressed patients. Pneumonia is caused by a broad spectrum of pathogens in immunocompromised patients. In addition to imaging, the clinical history and epidemiology also play an important role in the diagnostics. Using epidemiological and anamnestic information, computed tomography (CT) shows a significantly better sensitivity and specificity particularly for the diagnosis of atypical forms of pneumonia. Due to the exact imaging of the different infiltration patterns CT provides an increased sensitivity with respect to the etiological classification of pulmonary infections. This article reviews in particular the radiological findings of commonly occurring pulmonary infections in immunosuppressed patients. (orig.) [German] Pneumonien bei immunsupprimierten Patienten sind haeufige Komplikationen, die trotzt moderner Prophylaxe toedlich verlaufen koennen. Eine korrekte Diagnose ist daher von entscheidender Bedeutung, um die richtige Therapie einleiten zu koennen. Die Roentgenthoraxaufnahme ist selten spezifisch genug fuer die genaue Einordnung atypischer Pneumonien in Folge einer Immunsuppression. Pneumonien unter Immunsuppression werden durch ein sehr breites Erregerspektrum verursacht. Eine wichtige Rolle bei der Diagnosefindung spielen neben der Bildgebung auch die klinische Anamnese und Epidemiologie. Mithilfe der klinischen Anamnese und Epidemiologie bietet die Computertomographie (CT) bei immunsupprimierten Patienten zum einen eine erhoehte Sensitivitaet bei der Detektion insbesondere atypischer Pneumonien. Zum anderen weist die CT durch die exakte Abbildung unterschiedlicher Infiltratmuster

  6. MRI in dementia-type diseases; MRT bei demenziellen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Bodea, S.V.; Muehl-Benninghaus, R. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg (Germany)

    2015-05-01

    Dementia-inducing conditions represent a leading cause of disability and are a major health concern in industrialized countries. The burden these conditions put on society is certain to rise in the context of an ever-increasing elderly population. As these conditions feature an insidious onset and overlapping clinical features, imaging is a powerful tool in refining the diagnosis and assessing the progression of dementing conditions. The radiologist needs to be aware of and be able to detect underlying pathologies which could be reversible. Furthermore, imaging is important not only in excluding other pathologies but also in improving diagnostic accuracy. This article presents the typical clinical presentations as well as magnetic resonance imaging (MRI) features of the degenerative and the non-degenerative causes of dementia. The focus is on the core knowledge for MRI diagnostics in dementing conditions and a brief presentation of the latest MRI techniques which may become a part of standard imaging protocols in the future. (orig.) [German] Demenzielle Erkrankungen gehoeren in den Industrielaendern zu den haeufigsten Ursachen fuer Beeintraechtigungen im Alltag. Durch eine stetig alternde Population nimmt auch die Belastung fuer die Gesellschaft immer weiter zu. Bei haeufig schleichendem Symptombeginn sowie sich ueberlappender Klinik mit anderen Krankeitsbildern kann die Bildgebung ein gutes Werkzeug zur Praezisierung der Diagnose und Beurteilung eines Progresses sein. Der Radiologe sollte andere und reversible Pathologien erkennen und von demenztypischen Veraenderungen abgrenzen koennen. Dieser Artikel beschreibt typische klinische Symptome und auch bildmorphologische Veraenderungen verschiedener Demenzformen, die durch neurodegenerative und nichtdegenerative Ursachen bedingt sein koennen. Ausserdem werden aktuellste MRT-Techniken vorgestellt. Diese koennten kuenftig im Standartprotokoll zur Bildgebung bei der Abklaerung demenzieller Syndrome verankert sein. (orig.)

  7. Emphysema. Imaging for endoscopic lung volume reduction; Lungenemphysem. Bildgebung bei endoskopischer Lungenvolumenreduktion

    Energy Technology Data Exchange (ETDEWEB)

    Storbeck, B. [LungenClinic Grosshansdorf (Germany). Dept. of Radiology; Schroeder, T.H. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); Oldigs, M.; Rabe, K.F. [LungenClinic Grosshansdorf (Germany). Dept. of Pulmonology; Weber, C. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); University Medical Center Hamburg-Eppendorf (Germany). Diagnostic and Interventional Radiology

    2015-07-15

    Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type (''bronchitis'') on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thin-section reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

  8. Imaging of precursor lesions of the female breast; Bildgebung und Vorgehen bei praeinvasiven Laesionen der Mamma

    Energy Technology Data Exchange (ETDEWEB)

    Weigel, Stefanie [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Universitaetsklinikum Muenster (Germany). Referenzzentrum Mammografie; Decker, Thomas [Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg (Germany). Inst. fuer Pathologie; Heindel, Walter [Universitaetsklinikum Muenster (Germany). Referenzzentrum Mammografie; Muenster Univ. (Germany). Medizinische Fakultaet

    2012-06-15

    Precursor lesions of the breast are biologically and clinically heterogeneous neoplastic lesions with a varying risk for progression to an invasive breast cancer. This review presents definitions, diagnostic criteria and concepts for the clinical management of the following lesions: ductal carcinoma in situ (DCIS), atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), lobular neoplasia (LN). (orig.)

  9. Nuclear medicine imaging in cerebrovascular disorders; Nuklearmedizinische Bildgebung bei zerebrovaskulaeren Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Barthel, H. [Universitaetsklinikum Leipzig A.oe.R. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leipzig Univ. (Germany). Translationszentrum fuer Regenerative Medizin; Hesse, S.; Sabri, O. [Universitaetsklinikum Leipzig A.oe.R. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2007-09-15

    For diagnosing cerebrovascular disorders, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) employing blood flow and oxygen consumption markers is applied. Currently, competing imaging techniques which do not rely on radiotracers are more dominant in clinical routine. However, brain SPECT and PET substantially contribute towards diagnosis and therapy monitoring in acute and chronic cerebral ischemia. Furthermore, cerebral vasculitis, vasospasm after subarachnoid hemorrhage, brain tolerance during balloon occlusion tests and brain death can be accurately diagnosed. (orig.)

  10. Neuroimaging of affect processing in schizophrenia; Funktionelle Bildgebung von emotionalem Verhalten und Erleben bei schizophrenen Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Habel, U. [Universitaetsklinikum Aachen (Germany). Klinik fuer Psychiatrie und Psychotherapie; Universitaetsklinikum, Klinik fuer Psychiatrie und Psychotherapie, Aachen (Germany); Kircher, T.; Schneider, F. [Universitaetsklinikum Aachen (Germany). Klinik fuer Psychiatrie und Psychotherapie

    2005-02-01

    Functional imaging of normal and dysfunctional emotional processes is an important tool for a better understanding of the pathophysiology of affective symptoms in schizophrenia patients. These symptoms are still poorly characterized with respect to their neural correlates. Comparisons of cerebral activation during emotional paradigms offered the possibility for a better characterization of cerebral dysfunctions during emotional processing in schizophrenia. Abnormal activation patterns reveal a complex dysfunctional subcortical-cortical network. This is modulated by respective genotypes as well as psycho- and pharmacotherapy. (orig.) [German] Die funktionell bildgebende Untersuchung emotionaler Prozesse und ihrer Dysfunktionen ist fuer ein besseres Verstaendnis der Pathophysiologie emotionaler Stoerungen wesentlich. Schizophrene Patienten zeigen eine Reihe affektiver Symptome, die klinisch relevant, aber nur unzureichend bzgl. ihrer neurobiologischen Korrelate bekannt sind. Der Vergleich zerebraler Aktivierung zwischen gesunden und schizophrenen Patienten waehrend unterschiedlicher emotionaler Paradigmen hat dazu beigetragen, zerebrale Dysfunktionen naeher zu charakterisieren. So weisen auffaellige Aktivierungsmuster auf eine komplex gestoerte subkortikal-kortikale Netzwerkstruktur hin. Deren Modulation durch genetische Faktoren und durch psycho- wie auch pharmakologische therapeutische Interventionen konnte mittlerweile nachgewiesen werden. (orig.)

  11. Neuroendocrine tumors of the pancreas; Multimodale Bildgebung bei neuroendokrinen Tumoren des Pankreas

    Energy Technology Data Exchange (ETDEWEB)

    Holzapfel, Konstantin; Rummeny, Ernst J. [Technische Univ. Muenchen (Germany). Inst. fuer Radiologie; Gaertner, Florian C. [Technische Univ. Muenchen (Germany). Nuklearmedizinische Klinik

    2011-12-15

    Neuroendocrine tumors (NET) of the pancreas are rare entities. Functioning tumors tend to present early with specific symptoms and typical abnormalities in laboratory values. In contrast, non-functioning NET are often diagnosed with delay and become evident by tumor-related symptoms like pain, weight-loss or jaundice. The role of imaging is to localize and delineate the primary tumor and to detect metastases. In the diagnosis of NET radiologic techniques like computed tomography (CT) and magnetic resonance imaging (MRI) are applied. In certain cases nuclear medicine techniques like somatostatin receptor scintigraphy (SRS) and positron emission tomography (PET) using radioactively labelled somatostatin analogues are used. The present article reviews characteristic imaging findings of both functioning and non-functioning NET of the pancreas. (orig.)

  12. Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, K. [Technische Universitaet Muenchen (Germany). Institut fuer Roentgendiagnostik

    2010-05-15

    Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.) [German] Ueberkopfsportarten stellen grosse Anforderungen an das Schultergelenk. Schulterbeschwerden bei Ueberkopf- und Wurfsportlern koennen in der Mehrzahl der Faelle auf eine chronische Ueberlastung von Sehnen und Kapsel-Band-Strukturen oder auf die Folgen einer Mikroinstabilitaet und sekundaerer Impingementsyndrome zurueckgefuehrt werden. Wegen ihres grossen Einflusses auf die Therapieentscheidung stellt die Bildgebung bei Athleten mit unklaren Schulterbeschwerden eine Herausforderung dar. Die MR-Arthrographie ist in diesem Zusammenhang als Schnittbildverfahren der ersten Wahl anzusehen, da sie den Nachweis bzw. Ausschluss pathologischer Veraenderungen aller relevanten Gelenkstrukturen mit ausreichender Sicherheit ermoeglicht. Dieser Artikel gibt eine Uebersicht ueber biomechanische und klinische Aspekte sowie MR-arthrographische Befunde der haeufigsten Schultergelenkpathologien bei Ueberkopfsportlern, wie Bizepstendinopathie, Superior-labral-anterior-posterior- (SLAP-)Laesionen, Laesionen der

  13. Pulmonary manifestations in collagen vascular diseases; Pulmonale Manifestationen bei Kollagenosen

    Energy Technology Data Exchange (ETDEWEB)

    Vogel, M.N.A. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kreuter, M. [Thoraxklinik, Universitaetsklinikum Heidelberg, Zentrum fuer interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kauczor, H.U. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Heussel, C.P. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany)

    2016-10-15

    gewoehnlichen interstitiellen Pneumonie (UIP) als direkte Lungenmanifestation einer rheumatoiden Arthritis mit einer Sensitivitaet von 45 % und einer Spezifitaet von 96 % identifiziert werden. Sowohl die direkte Lungenmanifestation als auch die Medikamententoxizitaet sowie manche Infektionen koennen bei verschiedenen Kollagenosen auf der Duennschicht-MDCT ein aehnliches Bild abgeben. Die Kenntnis von Mustern und Ursachen traegt zur diagnostischen Sicherheit bei. Bei Erstdiagnose einer Erkrankung aus dem rheumatischen Formenkreis und pulmonalen Symptomen empfiehlt sich eine Duennschicht-MDCT. Zusaetzlich wird je nach CT-Befund alle 6 bis 12 Monate eine klinische, lungenfunktionelle und bildgebende Verlaufskontrolle empfohlen. In jedem Fall muessen die einzelnen CT-morphologischen Muster der Lungenbeteiligung identifiziert werden. Die Kombination von Informationen zur Anamnese, zu klinischen Befunden und Bildgebung ist Voraussetzung fuer ein adaequates Krankheitsmanagement. (orig.)

  14. BEI Resource Repository

    Data.gov (United States)

    U.S. Department of Health & Human Services — BEI Resources provides reagents, tools and information for studying Category A, B, and C priority pathogens, emerging infectious disease agents, non-pathogenic...

  15. Imaging of patellofemoral instability; Bildgebung der patellofemoralen Instabilitaet

    Energy Technology Data Exchange (ETDEWEB)

    Waldt, S.; Rummeny, E.J. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institut fuer diagnostische und interventionelle Radiologie, Muenchen (Germany)

    2012-11-15

    Patellofemoral instability remains a diagnostic and therapeutic challenge due to its multifactorial genesis. The purpose of imaging is to systematically analyze predisposing factors, such as trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove (TT-TG) distance, rotational deformities of the lower limb and patellar tilt. In order to evaluate anatomical abnormalities with a sufficient diagnostic accuracy, standardized measurement methods and implementation of various imaging modalities are necessary. Diagnosis of acute and often overlooked lateral patellar dislocation can be established with magnetic resonance imaging (MRI) because of its characteristic patterns of injury. Damage to the medial patellofemoral ligament (MPFL) has a significance just as high as the predisposing risk factors in relation to the cause of chronic instability. (orig.) [German] Die patellofemorale Instabilitaet stellt aufgrund ihrer multifaktoriellen Genese eine diagnostische und therapeutische Herausforderung dar. Aufgabe der Bildgebung ist es, anlagebedingte Risikofaktoren wie Trochleadysplasie, Patellahochstand, Torsionsfehlstellungen der unteren Extremitaet, TTTG-Abstand und Patellatilt systematisch zu analysieren. Um die aetiologischen Faktoren mit einer ausreichenden diagnostischen Genauigkeit zu bewerten, sind standardisierte und umfangreich evaluierte Messverfahren sowie der gezielte Einsatz verschiedener bildgebender Modalitaeten erforderlich. Die Diagnose einer traumatischen, oftmals klinisch inapparenten Patellaluxation kann anhand der charakteristischen Befundkonstellation in der MRT gestellt werden. Der Schaedigung des medialen patellofemoralen Ligaments (Elogantion/Ruptur) im Rahmen einer akuten Luxation wird, aehnlich wie den anlagebedingten Risikofaktoren, eine grosse Bedeutung im Hinblick auf die Entstehung einer chronischen Instabilitaet beigemessen. (orig.)

  16. Future of mammography-based imaging; Zukunft mammographiebasierter Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Schulz-Wendtland, R.; Brehm, B.; Meier-Meitinger, M.; Uder, M. [Klinikum der Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Gynaekologische Radiologie, Radiologisches Institut, Erlangen (Germany); Wittenberg, T. [Fraunhofer-Institut fuer Integrierte Schaltkreise IIS, Erlangen (Germany); Michel, T.; Anton, G. [Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen Centre for Astroparticle Physics, Erlangen (Germany); Hartmann, A. [Klinikum der Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Institut fuer Pathologie, Erlangen (Germany); Beckmann, M.W.; Rauh, C.; Jud, S.M.; Fasching, P.A. [Klinikum der Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN, Erlangen (Germany)

    2014-03-15

    Mammography is the central diagnostic method for clinical diagnostics of breast cancer and the breast cancer screening program. In the clinical routine complementary methods, such as ultrasound, tomosynthesis and optional magnetic resonance imaging (MRI) are already combined for the diagnostic procedure. Future developments will utilize investigative procedures either as a hybrid (combination of several different imaging modalities in one instrument) or as a fusion method (the technical fusion of two or more of these methods) to implement fusion imaging into diagnostic algorithms. For screening there are reasonable hypotheses to aim for studies that individualize the diagnostic process within the screening procedure. Individual breast cancer risk prediction and individualized knowledge about sensitivity and specificity for certain diagnostic methods could be tested. The clinical implementation of these algorithms is not yet in sight. (orig.) [German] Die Mammographie ist die zentrale diagnostische Methode der klinischen symptombezogenen Abklaerung von Brusterkrankungen und des Brustkrebsscreenings. In der klinischen Diagnostik wird sie heute schon oft durch zusaetzliche Untersuchungsmethoden wie dem Ultraschall, der Tomosynthese und ggf. auch der MRT-Bildgebung unterstuetzt. Zukuenftige Entwicklungen gehen in die Richtung, dass diese Kombination aus 2 oder mehr Untersuchungsverfahren entweder in Hybrid- (Aufnahme mehrerer unterschiedlicher Bildmodalitaeten in einem einzigen Geraet) oder in Fusionsmethoden (Zusammenfuehrung und Registrierung von Bilddaten aus verschiedenen Modalitaeten) technisch professionalisiert werden. Des Weiteren koennten an subgruppenbezogene Erkrankungsrisiken und individuelle Sensitivitaeten und Spezifitaeten angepasste Diagnostikkombinationen fuer eine Screeningdiagnostik Gegenstand kuenftiger Studien sein. Wir stellen die aktuellen Entwicklungen auf diesen Gebieten und deren momentane Relevanz fuer die klinische Praxis und

  17. Postoperative imaging of knee, hip and shoulder arthroplasty; Postoperative Bildgebung nach Gelenkersatz. Knie, Huefte, Schulter

    Energy Technology Data Exchange (ETDEWEB)

    Saupe, Nadja; Zanetti, Marco [Klinik Hirslanden, Zuerich (Switzerland). Zentrum fuer Muskuloskelettale Radiologie; Romero, Jose [Endoclinic Zuerich (Switzerland). Knie-Chirurgische Kompetenz-Praxis; Hersche, Otmar [Klinik Hirslanden, Zuerich (Switzerland). Endoclinic

    2017-12-15

    Numerous joint prostheses are used in orthopedic practice. This article reviews the current status of knee, hip and shoulder replacement and the expected radiographic appearances. Different types and techniques of replacement, various designs of hardware, the imaging appearance of complications of replacement and of revisions will be discussed. This article will also acknowledge some of the basic principles to reduce metal-induced susceptibility artifacts originate in MR images. Common ways to reduce or modify artifacts will be presented too.

  18. Biogenic Emission Inventory System (BEIS)

    Science.gov (United States)

    Biogenic Emission Inventory System (BEIS) estimates volatile organic compound (VOC) emissions from vegetation and nitric oxide (NO) emission from soils. Recent BEIS development has been restricted to the SMOKE system

  19. Principles and applications of susceptibility weighted imaging; Grundlagen und Anwendungen der suszeptibilitaetsgewichteten Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, F.T.; Ziener, C.H. [Deutsches Krebsforschungszentrum, Radiologie E010, INF 280, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, INF 400, Heidelberg (Germany); Freitag, M.; Schlemmer, H.P. [Deutsches Krebsforschungszentrum, Radiologie E010, INF 280, Heidelberg (Germany); Bendszus, M. [Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, INF 400, Heidelberg (Germany)

    2016-02-15

    Susceptibility-weighted imaging (SWI), initially developed to provide an improved method for cerebral magnetic resonance (MR) venography, is now an integral part of neuroradiological diagnostics and is steadily gaining importance in non-cerebral imaging. Tissue-inherent susceptibility differences generate a local magnetic field in which the dephasing of signal-producing protons occurs. This leads to a characteristic phase shift that can be used as a means to enhance contrast in the well-known T2*-weighted imaging. Many medically relevant pathologies induce tissue alterations that also influence the magnetic properties of tissue. Thus, the detection of blood residues and calcifications in SWI is superior to conventional MR sequences. New techniques, such as quantitative susceptibility mapping (QSM) and susceptibility tensor imaging (STI) allow improved differentiation between blood residues and calcifications and provide an alternative imaging method for fiber tractography with respect to diffusion tensor imaging. (orig.) [German] Die suszeptibilitaetsgewichtete Bildgebung (SWI), urspruenglich entwickelt als verbessertes Verfahren fuer die zerebrale MR-Venographie, ist inzwischen ein fester Bestandteil der neuroradiologischen Diagnostik und gewinnt zunehmend an Bedeutung in der nichtzerebralen Bildgebung. Gewebespezifische Suszeptibilitaetsunterschiede erzeugen ein lokales Magnetfeld, in dem die Dephasierung der signalgebenden Protonen stattfindet. Dabei kommt es zu einer charakteristischen Phasenverschiebung, die als Kontrastverstaerkung in der bekannten T2*-Bildgebung genutzt werden kann. Viele medizinisch relevante Pathologien erzeugen Veraenderungen im Gewebe, die auch die magnetischen Eigenschaften beeinflussen. So koennen Blutungen und Verkalkungen in der SWI besser identifiziert werden als mit konventionellen MR-Sequenzen. Neuere Techniken wie die quantitative Suszeptibilitaetskartierung (QSM) bzw. die Suszeptibilitaets-Tensor-Bildgebung (STI) ermoeglichen

  20. Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology; Ausgewaehlte klinisch etablierte und wissenschaftliche Techniken der diffusionsgewichteten MRT. Im Kontext der onkologischen Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Freitag, M.T.; Bickelhaupt, S.; Ziener, C.; Mosebach, J.; Schlemmer, H.P. [Deutsches Krebsforschungszentrum, Abteilung fuer Radiologie, Heidelberg (Germany); Meier-Hein, K. [Deutsches Krebsforschungszentrum, Abteilung fuer medizinische Informatik, Heidelberg (Germany); Radtke, J.P. [Deutsches Krebsforschungszentrum, Abteilung fuer Radiologie, Heidelberg (Germany); Universitaetsklinik Heidelberg, Abteilung fuer Urologie, Heidelberg (Germany); Kuder, T.A.; Laun, F.B. [Deutsches Krebsforschungszentrum, Abteilung fuer Medizinische Physik in der Radiologie, Heidelberg (Germany)

    2016-02-15

    werden durch Schaltung einer speziellen Gradientenabfolge mithilfe echoplanarer Auslesetechnik mehrere, mindestens jedoch 2 Bilderserien akquiriert, die die Diffusionseigenschaften des Gewebes wiedergeben. Eine der ersten klinisch etablierten Anwendungen ist die DWI bei der Prostata-MRT, die in den international anerkannten PI-RADS- und ESUR-Leitlinien bereits fest integriert ist. In naher Zukunft wird die klinische Etablierung der DWI auch fuer die Mamma-MRT erwartet, hier wurden Spezifitaetswerte und negative praediktive Werte von 94 bzw. 92 % berichtet. Die DWI kann auch als Ganzkoerperbildgebung fuer Patienten mit systemischen Knochenmarkerkrankungen wie dem multiplen Myelom oder zur Frage nach dem Ausmass der Skelettmetastasierung zuverlaessig eingesetzt werden. Neue Techniken der DWI, wie die ''intravoxel incoherent motion DWI'', die Kurtosis-Bildgebung oder histogrammbasierte Auswertungen stellen vielversprechende und innovative Verfahren dar, um Tumordetektion oder Therapieansprechen zunehmend quantitativer durchfuehren zu koennen. (orig.)

  1. Computed tomography for imaging of pediatric congenital heart disease; Die Computertomographie bei der Bildgebung von Kindern mit kongenitalen Herzvitien

    Energy Technology Data Exchange (ETDEWEB)

    Glaser-Gallion, N.; Stinn, B.; Wildermuth, S.; Leschka, S. [Kantonsspital St.Gallen, Universitaet Zuerich, Institut fuer Radiologie, St. Gallen (Switzerland); Alkadhi, H. [Universitaetsspital Zuerich, Institut fuer Diagnostisch und Interventionelle Radiologie, Zuerich (Switzerland); Lell, M. [Universitaetsklinikum Erlangen, Institut fuer Radiologie, Erlangen (Germany); Goo, H.W. [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology, Seoul (Korea, Republic of); Paul, J.F. [Marie Lannelongue Hospital, Radiology Unit, Plessis Robinson (France)

    2011-01-15

    Congenital heart diseases are the most common congenital abnormalities of development. In general, echocardiography and cardiac catheter angiography are considered the gold standard for the evaluation of congenital heart disease. Cardiac magnetic resonance imaging has become an important supplementary imaging modality because of its ability to provide an accurate morphological and functional evaluation. The role of cardiac computed tomography in the imaging of patients with congenital heart disease is becoming increasingly more important due to the development of low radiation dose protocols and improvements in the spatial and temporal resolution. In the preoperative depiction and follow-up after surgical repair of congenital heart diseases, cardiac computed tomography provides detailed information of the heart, the venous and arterial pulmonary circulation as well as systemic arteries. This article reviews the technical aspects of cardiac CT and the modification of examination protocols according to the expected pathology and patient age. The potentials and limitations of the various radiation dose reduction strategies are outlined. (orig.) [German] Kongenitale Herzfehler sind die haeufigsten kongenitalen Fehlbildungen. Echokardiographie und Katheterangiographie gelten allgemein als Goldstandard zur Abklaerung angeborener Herzerkrankungen. Die Magnetresonanztomographie ist aufgrund ihrer Faehigkeit, Herzvitien morphologisch und funktionell zu charakterisieren, als ein wichtiges ergaenzendes Verfahren anzusehen. Durch mehr und mehr dosissparende Untersuchungsprotokolle der neuesten Geraetegenerationen und eine gleichzeitig bessere zeitliche und raeumliche Aufloesung findet die Computertomographie zunehmend Eingang in die Abklaerung kongenitaler Herzfehler. In der praeoperativen Planung und der postoperativen Kontrolle erlaubt sie eine uebersichtliche Darstellung komplexer Fehlbildung nicht nur des Herzens, sondern auch der pulmonalvenoesen und -arteriellen Zirkulation sowie des systemischen Kreislaufs. Dieser Beitrag gibt eine Uebersicht ueber die technischen Aspekte der kardialen CT und die Anpassung des Untersuchungsprotokolls an die zu erwartende Pathologie und das Alter des Kindes. Zudem werden die Moeglichkeiten und Limitationen der unterschiedlichen dosissparenden Protokolle erlaeutert. (orig.)

  2. Multimodal imaging in neurofibromatosis type 1-associated nerve sheath tumors; Multimodale Bildgebung bei Neurofibromatose-Typ-1-assoziierten Nervenscheidentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Salamon, J.; Adam, G. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Mautner, V.F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Neurology; Derlin, T. [Hannover Medical School, Hannover (Germany). Dept. of Nuclear Medicine

    2015-12-15

    Neurofibromatosis type 1 (NF1) is a neurogenetic disorder. Individuals with NF1 may develop a variety of benign and malignant tumors of which peripheral nerve sheath tumors represent the most frequent entity. Plexiform neurofibromas may demonstrate a locally destructive growth pattern, may cause severe symptoms and may undergo malignant transformation into malignant peripheral nerve sheath tumors (MPNSTs). Whole-body magnetic resonance imaging (MRI) represents the reference standard for detection of soft tissue tumors in NF1. It allows for identification of individuals with plexiform neurofibromas, for assessment of local tumor extent, and for evaluation of whole-body tumor burden on T2-weighted imaging. Multiparametric MRI may provide a comprehensive characterization of different tissue properties of peripheral nerve sheath tumors, and may identify parameters associated with malignant transformation. Due to the absence of any radiation exposure, whole-body MRI may be used for serial follow-up of individuals with plexiform neurofibromas. {sup 18}F-fluorodeoxyglucose positron-emission-tomography (FDG PET/CT) allows a highly sensitive and specific detection of MPNST, and should be used in case of potential malignant transformation of a peripheral nerve sheath tumor. PET/CT provides a sensitive whole-body tumor staging. The use of contrast-enhanced CT for diagnosis of peripheral nerve sheath tumors is limited to special indications. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of peripheral nerve sheath tumors are required.

  3. Knochenstoffwechsel bei malignen Erkrankungen

    Directory of Open Access Journals (Sweden)

    Keck A-V

    2003-01-01

    Full Text Available Bei malignen Erkrankungen, wie dem Mammakarzinom, dem Prostatakarzinom, dem Bronchialkarzinom oder dem multiplen Myelom ist der Knochen eines der am häufigsten von Metastasen betroffenen Organe. Das klinische Beschwerdebild ist durch das Auftreten pathologischer Frakturen, Schmerzen und Hyperkalzämien gekennzeichnet. Eine erhöhte Knochenresorptionsrate und Verlust an Knochenmasse im Sinne von osteoporoseartigen Veränderungen bedingt durch eine inadäquat überschießende Osteoklastendifferenzierung und -aktivierung sind ursächlich dafür verantwortlich. Durch jüngst publizierte Ergebnisse diverser Studien und Untersuchungen konnten die genauen Mechanismen der Rekrutierung und Aktivierung von Osteoklasten weiter aufgeklärt werden. Receptor activator of nuclear factor-kappa-B ligand (RANKL, ein Mitglied der Tumor necrosis factor (TNF Superfamilie konnte als entscheidender Faktor in der Osteoklastengenese identifiziert werden. Die Interaktion von RANKL mit seinem Rezeptor RANK (receptor activator of nuclear factor-kappa-B induziert die Entwicklung der osteoklastären Reihe aus dem hämatopoetischen Kompartment und fördert weiters die Differenzierung zu Osteoklastenvorstufen und die Aktivierung reifer Osteoklasten, ebenso wird eine verzögert einsetzende Apoptose bewirkt. Neben RANK und RANKL ist Osteoprotegerin (OPG als dritte Komponente in der Regulation der Knochenresorption involviert. Als Mitglied der TNF-Superfamilie bindet OPG an RANKL und blockiert somit alle stimulierenden Effekte von RANK auf die Osteoklastenentwicklung und neutralisiert so alle biologischen Effekte von RANKL. Diverse Hormone und Zytokine üben durch die Modifikation der Ratio von RANKL zu OPG einen regulatorischen Effekt auf die Knochenresorption aus. Diese ist bei osteolytischen Knochenmetastasen, beim multiplen Myelom und bei der malignen Hyperkalzämie erhöht. Das Gleichgewicht knochenaufbauender wie -abbauender Mechanismen scheint somit durch die Ratio von

  4. Diagnostic evaluatuin of gastrointestinal tumors; Diagnostik bei Tumoren im Gastrointestinaltrakt

    Energy Technology Data Exchange (ETDEWEB)

    Linke, R.; Tatsch, K. [Ludwig-Maximilians-Univ. Muenchen (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    1998-07-01

    neuere radiologische Verfahren auch den Nachweis von Laesionen <1 cm erlaubt. Die PET weist hier ebenfalls eine hohe Sensitivitaet auf, da sich bei einem gesteigerten Glukosemetabolismus auch sehr kleine Herde darstellen lassen. Das sensitivste Verfahren zum Nachweis von Pankreastumoren ist die Endosonographie. Die Frage der Dignitaet kann meist mit der ERCP geklaert werden, aber auch die PET hat hier ihren Stellenwert, insbesondere bei der schwierigen Differentialdiagnose zwischen chronischer Pankreatitis und dem Pankreaskarzinom. Zur OP-Planung ist die konventionelle radiologische Bildgebung unerlaesslich. Bei der Beurteilung der Resektabilitaet kommt es mit der CT oder MRT jedoch in bis zu 40% der Faelle zu Fehleinschaetzungen. Die PET hat auch hier eine wesentlich hoehere Sensitivitaet im Metastasennachweis. (orig.)

  5. Imaging of extradural spinal lesions; Bildgebung extraduraler Raumforderungen

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F.; Schulte-Altedorneburg, G.; Naumann, N.; Reith, W. (Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar); Nabhan, A. (Universitaetsklinikum des Saarlandes, Homburg/Saar, Klinik fuer Allgemeine und Spezielle Neurochirurgie)

    2006-12-15

    There is a wide variety of spinal extradural tumors. In addition to real neoplasms, degenerative diseases, congenital abnormalities and inflammatory disorders can be causes of extradural masses. Due to the bony boundary of the spinal canal, both benign as well as malignant masses can cause progressive neurological deficits including paraplegia. Most of the spinal tumors are benign (hemangioma of the vertebral body, degenerative diseases). In younger patients congenital abnormalities and primary tumors of the spine have to be considered, whereas in adults the list of differential diagnoses should include secondary malignancies such as metastases and lymphomas as well as metabolic disorders such as osteoporotic vertebral compression fracture and Paget's disease. Cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine often help to make a specific diagnosis of extradural spinal lesions and represent important tools for tumor staging and preoperative evaluation. (orig.) Das Spektrum der spinalen extraduralen Tumoren ist sehr gross. Neben echten Neoplasien koennen auch degenerative Veraenderungen und Anlagestoerungen sowie entzuendliche Veraenderungen Ursachen einer extraduralen Raumforderung sein. Aufgrund der knoechernen Begrenzung des Spinalkanals koennen neben Malignomen auch benigne Tumoren und degenerative spinale Veraenderungen zu progredienten neurologischen Ausfallsymptomen (einschliesslich Querschnittsymptomatik) fuehren. Die ueberwiegende Mehrzahl der extraduralen Raumforderungen der Wirbelsaeule ist benigne (Haemangiom des Wirbelkoerpers, degenerative Erkrankungen). Bei jungen Patienten sind Anlagestoerungen und primaere Wirbelsaeulentumoren zu beruecksichtigen, wogegen beim Erwachsenen an sekundaere Malignome, wie Metastasen und Lymphome sowie eine metabolische Erkrankung, wie die osteoporotische Wirbelkoerpersinterungsfraktur oder der Morbus Paget, differenzialdiagnostisch gedacht werden

  6. Imaging of blunt chest trauma; Bildgebung des stumpfen Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, H. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Negrin, L. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Unfallchirurgie, Wien (Austria)

    2014-09-15

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [German] Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditaet und Mortalitaet einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden koennen. Zur Abklaerung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenroentgen und die Computertomographie bewaehrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklaert werden, ob bei dem Patienten ein therapiebeduerftiger Pneumothorax, Haematoperikard oder Haematothorax vorliegen. Auch das Lungenroentgen wird zur Diagnose eines Pneumothorax oder Haematothorax eingesetzt, wenngleich seine Sensitivitaet deutlich eingeschraenkt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaeren. (orig.)

  7. Modern imaging technology for childhood urinary tract infection; Moderne Bildgebung beim Harnweginfekt im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M.; Fotter, R. [Radiologische Universitaetsklinik Graz (Germany). Abteilung Kinderradiologie

    2005-12-01

    Imaging in childhood urinary tract infection (UTI) is still a matter of debate. There are established guidelines, however new knowledge and the changed medical environment have enhanced this ongoing discussion. These new insights have impacted therapy and consequently the imaging algorithm. Modern imaging methods - particularly MRI and modern ultrasound (US) - are less invasive with a lower radiation burden. Additionally, it has been shown that VUR is a poor predictor for renal scarring out, which affects long-term results. Furthermore, the majority of UT malformations is depicted by prenatal US. The most crucial aspect of improving long-term outcome appears to be the early and reliable depiction of UTI and effective treatment to prevent renal scarring. This review tries to present this new knowledge and to discuss the potential of modern imaging. Recent changes in imaging algorithms are highlighted and an outcome-oriented algorithm that addresses these recent developments is proposed, without lightly abandoning established standards. It consists of an orienting US and - for depiction of renal involvement - amplitude coded color Doppler sonography or renal static scintigraphy (considered the gold standard, particularly for evaluating scars); in future MRI may play a role. Based on this concept, only patients with renal damage as well as patients with complex urinary tract malformations or intractable recurrent UTI may have to undergo VCUG. (orig.) [German] Die bildgebende Diagnostik beim kindlichen Harnweginfekt (HWI) wird weiterhin heftig diskutiert. Zwar existieren etablierte Bildgebungsalgorithmen, insbesondere fuer das Kleinkindesalter; neue Erkenntnisse bzw. Aufgabenstellungen haben aber zu einer Aenderung des Therapiekonzepts mit Auswirkungen auf die Bildgebung gefuehrt. Zusaetzlich haben technische (Weiter)Entwicklungen das Potenzial der Bildgebung erweitert; v. a. MRT und moderne Ultraschallverfahren versprechen eine weniger invasive und strahlenfreie

  8. Strahlungsfeldbedingungen bei der Ionisationsdosimetrie

    Science.gov (United States)

    Krieger, Hanno

    Bei der Dosimetrie von Photonenstrahlungen mit luftgefüllten Ionisationskammern werden in diesem Kapitel zwei Grenzfälle unterschieden. Der eine Fall ist die Bedingung des so genannten Sekundärelektronengleichwichts im Kammervolumen. In diesem Fall bestimmen ausschließlich die Photonen im Messvolumen die dosimetrische Anzeige. Der zweite Grenzfall ist gegeben, wenn das Luftvolumen und die Kammer das Strahlungsfeld im Phantom so wenig stören, dass der Sekundärelektronenfluss unverändert bleibt. Diese Bedingungen nennt man BRAGG-GRAY-Bedingungen. Beide Grenzfälle sind in der Praxis nur näherungsweise zu verwirklichen. Abweichungen müssen durch entsprechende Korrekturen oder Kalibrierungen berücksichtigt werden.

  9. Die Bandscheibenprothese bei schmerzhafter Diskusdegeneration

    Directory of Open Access Journals (Sweden)

    Ogon M

    2004-01-01

    Full Text Available Bandscheibenprothesen sind indiziert bei Patienten mit einer schmerzhaften Bandscheibendegeneration, einer sogenannten DDD (degenerative disc disease, bei gut erhaltenen Facettengelenken. Kontraindikationen stellen eine Instabilität, eine Spondylarthrose, eine spinale Stenose und eine Osteoporose dar. Bei 19 Patienten mit einem Follow-up von mindestens 12 Monaten fand sich eine durchschnittliche Verbesserung des Oswestry Disability Index von präoperativ 50,8 auf 19,8. Der SF-36 Score zur Erfassung der Lebensqualität besserte sich von 31,5 auf 48,8 (Physical Component Summary Score bzw. von 37,8 auf 44,5 (Mental Component Summary Score im 1-Jahres-Follow-up. Nachhaltige Komplikationen traten nicht auf. Bandscheibenprothesen können heute bei Patienten mit therapieresistenten Kreuzschmerzen als gute Alternative zu einer Wirbelfusion angesehen werden.

  10. Mehrfacheffekt-Feuchtluftdestillation bei Umgebungsdruck

    OpenAIRE

    Müller-Holst, Hendrik

    2007-01-01

    Ein neuartiges Verfahren zur Feuchtluftdestillation mittels Verdunstung und Kondensation in einer einzigen Kammer wurde im Rahmen der Arbeit umfassend analysiert. Das Verfahren arbeitet bei Umgebungsdruck; der dadurch bei Temperaturen unter dem Siedepunkt verringerte Stoffübergang wird durch große Austauschflächen mit hoher Packungsdichte kompensiert. Der Transport der im Verdunster beladenen Feuchtluft zum Kondensator erfolgt innerhalb einer optimierten geometrischen Anordnung der Baueinheit...

  11. Craniocerebral trauma. Magnetic resonance imaging of diffuse axonal injury; Schaedel-Hirn-Trauma. MRT bei diffuser axonaler Verletzung

    Energy Technology Data Exchange (ETDEWEB)

    Mallouhi, A. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Abteilung fuer Neuro- und Muskuloskelettale Radiologie, Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2014-09-15

    fuer Behinderung oder Tod. Es fuehrt haeufig zu einer axonalen Scherverletzung. Die daraus resultierende Pathologie wird als diffuse axonale Verletzung (''diffuse axonal injury'', DAI) bezeichnet. Die DAI-assoziierten Laesionen treten bilateral und verteilt auf und werden in der oberflaechlichen und in der tiefen weissen Substanz beobachtet. Sie finden sich sowohl in der Naehe als auch weit entfernt von der Aufprallstelle. Bei klinischem Verdacht auf eine diffuse axonale Verletzung ist die Magnetresonanztomographie (MRT) zur weiteren Abklaerung die Methode der Wahl, dies insbesondere bei Patienten mit einer unauffaelligen Computertomographie des Schaedels. Zur Abklaerung des Gehirns nach einem Schaedel-Hirn-Trauma (SHT) wird ein multimodales MR-Verfahren angewendet, das in 2 Kategorien unterteilt werden kann: strukturelle und funktionelle MR-Bildgebung. Fuer die strukturelle MRT kommen hauptsaechlich die Fluid-attenuated-inversion-recovery(FLAIR)-Gewichtung und die suszeptibilitaetsgewichtete Bildgebung (SWI) zum Einsatz. Die SWI ist ausserordentlich auf Blutabbauprodukte empfindlich, welche als kleine Signalausloeschungen an 3 typischen Lokalisationen (an der Rinden-Mark-Grenzzone, im Corpus callosum und im Hirnstamm) zur Darstellung kommen. Die funktionelle MRT umfasst eine Gruppe staendig in Entwicklung befindlicher Techniken, welche ein grosses Potenzial zur optimalen Evaluierung der weissen Substanz bei Patienten nach einem SHT haben. Diese modernen bildgebenden Verfahren ermoeglichen die Visualisierung der mit Scherverletzungen assoziierten Veraenderungen, wie die Funktionsbeeintraechtigung der Axone, die verminderte Durchblutung und abnormale metabolische Aktivitaet der betroffenen Gehirnanteile. Die multimodale MR-Abklaerung bei Patienten mit DAI fuehrt zu einer detaillierteren und differenzierteren Darstellung der zugrunde liegenden pathophysiologischen Veraenderungen der verletzten Nervenbahnen und traegt zur Verbesserung der

  12. [Patellofemoral arthroplasty].

    Science.gov (United States)

    Cotic, M; Forkel, P; Imhoff, A B

    2017-02-01

    Isolated resurfacing of the trochlea using an inlay prosthesis without changing the complex kinematics of the patellofemoral joint. Symptomatic, isolated patellofemoral osteoarthritis or isolated osteochondral lesions, failed conservative and cartilage regeneration procedures. No or concurrently corrected ligament instability, tibiofemoral and patellofemoral malalignment. Symptomatic patellofemoral osteoarthritis, inflammatory joint disease, chondrocalcinosis, chronic pain syndromes, active infections or knee ankylosis. Following a medial arthrotomy, coronal and sagittal curvatures of the trochlea are measured. Based on these measurements, corresponding surface reamers create an implant bed by removing damaged cartilage of the trochlea. A central fixation screw is placed to the desired depth and the inlay prosthesis is tapped carefully onto it. Final placement of the prosthesis is targeted slightly recessed to the surrounding joint surface. Free passive range of motion exercises of the knee joint are recommended starting on postoperative day 1. Depending on symptoms (e.g., pain and joint effusion), partial weight-bearing of 20 kg is allowed during postoperative weeks 1 and 2, which is increased by 20 kg/week thereafter. In a prospective study of 29 patients (mean age: 42 years) treated with inlay arthroplasty, 2‑year follow-up results showed significant improvements (p patellofemoral overstuffing using a more physiological placement of the inlay prosthesis.

  13. Imaging of primary muscular diseases. What do neurologists expect from radiologists?; Bildgebung primaerer Muskelerkrankungen. Was erwartet der Neurologe vom Radiologen

    Energy Technology Data Exchange (ETDEWEB)

    Wattjes, M.P. [Medizinische Hochschule Hannover, Institut fuer Diagnostische und Interventionelle Neuroradiologie, Hannover (Germany); Fischmann, A. [Hirslanden Klinik St. Anna, Luzern (Switzerland); Fischer, D. [Universitaets-Kinderspital beider Basel, Abteilung fuer Neuropaediatrie, Basel (Switzerland)

    2017-12-15

    Imaging, in particular magnetic resonance imaging (MRI), has in recent years increasingly become a crucial tool for the diagnostics of inherited and acquired muscular diseases. The aim of imaging in neuromuscular disorders goes beyond the detection and quantification of degenerative muscular changes, such as fatty degeneration and includes recognition of very early signs of muscular pathologies presenting as muscular edema. Therefore, imaging is a valuable diagnostic method to support the clinical diagnosis and to narrow down the differential diagnoses, leading to specific additional diagnostic tests in order to establish the correct diagnosis. Although advances in MRI hardware and technology have led to a faster, more accurate and advanced image acquisition allowing whole body examination in a feasible fashion, the standardization of image acquisition and interpretation remains a challenge. The aim of this review article is to address the important and clinically relevant issues concerning the role of imaging of neuromuscular diseases in order to facilitate a good interdisciplinary management for the diagnostics and monitoring of neuromuscular diseases. (orig.) [German] Die Bildgebung, insbesondere die Magnetresonanztomographie (MRT), hat in den letzten Jahren zunehmend an Bedeutung fuer die Diagnostik angeborener und erworbener Muskelerkrankungen gewonnen. Die Bildgebung ist dabei nicht nur in der Lage, Muskeldegeneration (z. B. fettige Degeneration) zu erfassen und zu quantifizieren, sondern auch sehr fruehe Stadien von Muskelerkrankungen mit dem Nachweis von oedematoesen Muskelveraenderungen zu erkennen. Die Bildgebung ist somit eine wertvolle diagnostische Modalitaet, um die klinische Diagnose zu unterstuetzen, die Differenzialdiagnose einzugrenzen und somit eine zielgerichtete weiterfuehrende Diagnostik zu ermoeglichen. Obgleich die technischen Weiterentwicklungen, insbesondere der MRT, eine schnellere, genauere und erweiterte (z. B. Ganzkoerperuntersuchungen

  14. Use of MRI in interventions in head and neck surgery; Die Nutzung der Magnetresonanztomographie bei Interventionen auf dem Gebiet der HNO-Heilkunde

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, T.; Schneider, J.P.; Schmidt, F.; Kahn, T. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie; Bootz, F.; Weber, A. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer HNO-Heilkunde; Weidenbach, H. [Leipzig Univ. (Germany). Inst. fuer Pathologie; Heinke, W. [Leipzig Univ. (Germany). Klinik fuer Anaesthesie und Intensivmedizin; Koehler-Brock, A. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie

    2001-05-01

    moeglich. Schlussfolgerungen: das chirurgische Risiko und die postoperative Morbiditaet sind im Vergleich zu anderen Verfahren an der Schaedelbasis und in der Kopf-Hals-Region bei der Verwendung intraoperativer Bildgebung geringer. Interventionelle MRT optimiert minimal invasive, operative Zugaenge zu schwer erreichbaren Laesionen bei Katheterplatzierungen und zur petroclivalen Region. (orig.)

  15. Importance of diffusion imaging in liver metastases; Bedeutung der Diffusionsbildgebung bei Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Riffel, P.; Schoenberg, S.O.; Krammer, J. [Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Institut fuer Klinische Radiologie und Nuklearmedizin, Universitaetsmedizin Mannheim, Mannheim (Germany)

    2017-05-15

    Detection and characterization of focal liver lesions. Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response. (orig.) [German] Detektion und Charakterisierung fokaler Leberlaesionen. Die MRT ist aufgrund des exzellenten Weichteilkontrasts, der Verfuegbarkeit leberspezifischer Kontrastmittel und der Moeglichkeit funktioneller Bildgebung die Methode der Wahl zur Abklaerung fokaler Leberlaesionen. Die diffusionsgewichtete Bildgebung (''diffusion-weighted imaging'', DWI) ermoeglicht es, neben den rein morphologischen auch funktionelle Informationen ueber die Mikrostruktur eines Gewebes zu

  16. Unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter

    2007-01-01

    This thesis concerns technical aspects of unicompartmental knee arthroplasty. Recent years have witnessed a resurgence of interest in unicompartmental arthroplasty, particularly with the introduction of the minimally invasive technique. In the light of the excellent long-term results of the total

  17. Neurofunctional MRI at high magnetic fields; Neurofunktionelle MRT bei hohen Feldern

    Energy Technology Data Exchange (ETDEWEB)

    Speck, O. [Fakultaet fuer Naturwissenschaften, Otto-von-Guericke Universitaet Magdeburg, Abteilung Biomedizinische Magnetresonanz, Institut fuer Experimentelle Physik, Magdeburg (Germany); Leibniz Institut fuer Neurobiologie, Magdeburg (Germany); Deutsches Zentrum fuer Neurodegenerative Erkrankungen (DZNE), Magdeburg (Germany); Center for Behavioral Brain Sciences (CBBS), Magdeburg (Germany); Turner, R. [MPI fuer Kognitions- und Neurowissenschaften, Abteilung Neurophysik, Leipzig (Germany)

    2013-05-15

    group data without the need for voxel-based congruence. (orig.) [German] fMRT-Untersuchungen sind durch den geringen aktivierungsinduzierten Signalunterschied in ihrer Sensitivitaet limitiert und innerhalb kurzer tolerierbarer Messzeiten ist die raeumliche Aufloesung limitiert. fMRT bei 1,5 und mehr noch bei 3 T ist ein zuverlaessiges Werkzeug in der Neurowissenschaft und fuer klinische Anwendungen, wie etwa die praechirurgische Funktionslokalisierung. Die fMRT-Sensitivitaet steigt stark (mehr als linear) mit hoeherer Magnetfeldstaerke. Dies war seit Jahren einer der Hauptgruende fuer die Entwicklung zu hoeheren Feldern wie etwa 7 T. Der Sensitivitaetsgewinn von 7 gegenueber 3 T ist bei hoher raeumlicher Aufloesung am groessten und die fMRT mit sehr hoher isotroper Submillimeteraufloesung wird moeglich. Bisherige Resultate zeigen, dass die Blood-oxygenation-level-dependent(BOLD)-Lokalisierung deutlich praeziser ist als bislang angenommen. Mittels Hochfeld-fMRT werden nicht nur quantitativ bessere Ergebnisse erzielt, sondern Informationen neuer Qualitaet zugaenglich wie etwa die kolumnare und schichtabhaengige Struktur des Kortex. Somit wird der Weg zu weiteren Informationen, wie etwa die Richtung kortikaler Verbindungen, eroeffnet. Diese Moeglichkeiten bergen jedoch auch neue Herausforderungen. So muessen neue Verfahren zur Prozessierung derart hochaufgeloester Daten entwickelt werden, welche z. B. ohne Glaettung auskommen, um den Informationsgehalt der Daten nicht zu reduzieren. Standardaufloesungen von 2-3 mm sind weiterhin bei 3 T ''gut aufgehoben'' und profitieren von geringeren Signalausloeschungen, weniger Verzerrungen und geringerer Lautstaerke. Zum Erreichen hoechster Aufloesung bei 7 T sind parallele Bildgebung und Verzerrungskorrektur essenziell und ermoeglichen eine gute Uebereinstimmung mit anatomischen Aufnahmen. Die Echozeit sollte bei 7 T auf ca. 20-25 ms angepasst und die Datenauswertung fuer einzelne Probanden oder Patienten ohne

  18. PET and SPECT investigations in Alzheimer's disease; Nuklearmedizin und Demenz - Anwendung bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Asenbaum, S. [Universitaetsklinik fuer Nuklearmedizin, Universitaetsklinik fuer Neurologie, Wien (Austria); Abteilung fuer klinische Neurologie, Universitaetsklinik fuer Neurologie, Waehringer Guertel 18-20, 1090, Wien (Austria)

    2003-07-01

    Nuclear medicine offers a wide range of possibilities to investigate dementia. Various SPECT and PET tracers will be introduced in this article first. Different questions concerning evaluation of dementia are discussed taking Alzheimer's disease (AD) as an example. It is important to perform nuclear medicine investigations on high technical level, using standardized methods as statistical parametric mapping (SPM) for evaluation. If neuroprotective therapies are available, an early diagnosis, the determination of risk factors and longitudinal investigations will be the focus of interest and the main goal of nuclear medicine. Apart from measuring cerebral perfusion and glucose metabolism the development of new ligands, concerning the cholinergic system and the visualization of amyloid plaques, is of great importance. (orig.) [German] Nuklearmedizin bietet bei der Erfassung und Beurteilung eines dementiellen Prozesses eine Vielzahl von Untersuchungsmoeglichkeiten. Anhand des Morbus Alzheimer (DAT) werden in dem vorliegenden Artikel neben einer kurzen Schilderung der zur Verfuegung stehenden Methoden die verschiedenen nuklearmedizinisch relevante Fragestellungen angefuehrt, zu deren Beantwortung die funktionelle Bildgebung Informationen liefern kann. Durch den Einsatz bestimmter, standardisierter Auswerteverfahren wie statistical parametric mapping (SPM) ist es moeglich, entscheidende Hinweise zur Diagnose und Differenzialdiagnose der DAT zu erlangen. In Zukunft werden, insbesondere bei einer Verfuegbarkeit neuroprotektiver Therapien, eine moeglichst fruehe Diagnosestellung und die Erfassung von Risikofaktoren sowie die Moeglichkeit einer Verlaufsbeobachtung in den Mittelpunkt des Interesses und in das Zentrum nuklearmedizinischer Untersuchungen ruecken. Vor allem fuer diese Anforderungen ist neben der qualitaetsvollen Untersuchung von zerebraler Perfusion und Glukosestoffwechsel eine Weiterentwicklung spezieller Liganden v. a. das cholinerge System betreffend und

  19. Imaging of knee arthroplasty

    International Nuclear Information System (INIS)

    Miller, Theodore T.

    2005-01-01

    Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty

  20. Imaging of knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021 (United States)]. E-mail: TMiller@NSHS.edu

    2005-05-01

    Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty.

  1. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  2. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...

  3. Imaging and therapy of a chondroblastoma; Bildgebung und Therapie eines Chondroblastoms

    Energy Technology Data Exchange (ETDEWEB)

    Nickel, J.; Meyer, D.R.; Geufke, P.; Andresen, R. [Krankenhaus Guestrow, Akademisches Lehrkrankenhaus der Universitaet Rostock (Germany)

    2002-07-01

    ] Das Chondroblastom ist eine seltene lytische ossaere Laesion, welche typischerweise in den Epiphysen der langen Roehrenknochen zu finden ist. Wir praesentieren die differentialdiagnostische Bildgebung und die opterative Therapie kasuistisch an einem Chondroblastom der proximalen Tibiaepiphyse. In der traumatologischen Ambulanz stellte sich ein 16 jaehriger Patient mit unklarem, seit Monaten zunehmenden Kniegelenksschmerz vor. Ein akutes Trauma war nicht erinnerlich. Zur weiteren Abklaerung erfolgte eine konventionelle Roentgenaufnahme in zwei Ebenen, ein Duennschicht CT, ein multiplanares MRT vor und nach Gd-DTPA und eine 3-Phasen-Skelettszintigrafie. Die konventionelle Roentgendiagnostik zeigt eine glattbegrenzte, osteolytische, exzentrische Laesion mit Randsklerosierung, welche die Epiphysenfuge der proximalen Tibia nicht ueberschreitet. In der Duennschicht-CT findet sich eine exzentrische Osteolyse mit typischen, schmalen Sklerosierungssaum und zentralen Verkalkungen. In der hochaufloesenden MRT zeigen die T2 gewichteten Sequenzen eine lokal begrenzte, epiphysaere, lobulierte Laesion mit einem heterogenen z.T. angehobenen Signal, eine weitere Signalanhebung zeigt sich in den T1 gewichteten Sequenzen nach Gabe von Gd-DTPA. Perifokal findet sich ein epiphysaeres Oedem und diskrete Fluessigkeit im Kniebinnenraum. In der Skelettszintigrafie kommt es zu einer starken fokalen und diffusen Mehrbelegung der proximalen, lateralen Tibiaepiphyse. Nach Diagnosestellung wurde eine Kuerettage des Defektes durchgefuehrt und anschliessend nach histologischer Bestaetigung der Diagnose die komplettierende Kuerettage und Spongiosaplastik vorgenommen. Unter Beruecksichtigung der Tumorlokalisation und des Alters des Patienten laesst sich bereits mit der konventionellen Bildgebung eine praktisch sichere Diagnose stellen. Eine ergaenzende MRT oder CT kann zur endgueltigen Abklaerung hilfreich sein, eine 3-Phasen-Skelettszintigrafie ist ueberfluessig. Die Therapie der Wahl ist die

  4. Functional brain imaging - baric and clinical questions; Funktionelle Bildgebung in der Psychiatrie - Fragestellungen der Klinik und der Forschung

    Energy Technology Data Exchange (ETDEWEB)

    Mager, T. [Psychiatrische Klinik und Poliklinik, Klinikum Innenstadt, Muenchen Univ. (Germany); Moeller, H.J. [Psychiatrische Klinik und Poliklinik, Klinikum Innenstadt, Muenchen Univ. (Germany)

    1997-06-01

    The advancing biological knowledge of disease processes plays a central part in the progress of modern psychiatry. An essential contribution comes from the functional and structural brain imaging techniques (CT, MRI, SPECT, PET). Their application is important for biological oriented research in psychiatry and there is also a growing relevance in clinical aspects. This development is taken into account by recent diagnostic classification systems in psychiatry. The capabilities and limitations of functional brain imaging in the context of research and clinic will be presented and discussed by examples and own investigations. (orig.) [Deutsch] Der Fortschritt in der Psychiatrie der letzten Jahre ist eng verknuepft mit neuen biologischen Erkenntnissen ueber Krankheitsprozesse. Einen wesentlichen Beitrag hierzu leistet die moderne funktionelle und strukturelle Bildgebung, deren Anwendung ein wichtiger Bestandteil biologischer Forschung ist und zunehmend auch an klinischer Bedeutung gewinnt. In den neuen Klassifikationssystemen der Psychiatrie wird diese Entwicklung beruecksichtigt. Moeglichkeiten und Grenzen funktioneller Bildgebung fuer die Psychiatrie werden mit Blick auf die Klinik und wissenschaftliche Fragestellungen im folgenden anhand von Beispielen und eigenen Untersuchungen skizziert und diskutiert. (orig.)

  5. Value of radiographic examination of the knee joint for the orthopedic surgeon; Wertigkeit der radiologischen Bildgebung beim Kniegelenk fuer den Orthopaeden

    Energy Technology Data Exchange (ETDEWEB)

    Pietsch, M.; Hofmann, S. [Allgemeines und Orthopaedisches LKH Stolzalpe (Austria). Abteilung fuer Orthopaedie und orthopaedische Chirurgie

    2006-01-01

    Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [German] Die erweiterte Roentgendiagnostik bietet gute Moeglichkeiten der Diagnose und Therapieplanung beim Kniegelenk. Das Ganzbeinroentgen ist unabdingbar zur Achsvermessung bei der Planung einer Umstellungsosteotomie oder der Implantation einer Knietotalendoprothese (KTEP). Varus-/Valgusaufnahmen unter Bildwandler gestatten die Ueberpruefung der Mechanik einer liegenden KTEP. Sonographische Untersuchungen des Kniegelenks sind weitgehend durch die Magnetresonanztomographie (MRT) ersetzt. Die MRT ist die Methode der Wahl zur Beurteilung der Kniebinnenstrukturen (Meniskus, Baender, Knorpel) und der umgebenden Weichteile. Zur Bestimmung der Torsion von Femur und Tibia sowie der Rotation der Komponenten einer KTEP ist die Computertomographie (CT) am besten geeignet. Die Beurteilung des Femorpatellargelenks (Patellainstabilitaet) ist schwierig, am vielversprechendsten erscheint die CT in Kombination mit streng seitlichen Roentgenbildern. (orig.)

  6. Value of magnetic resonance imaging in diffuse liver diseases; Stellenwert der MRT bei diffusen Lebererkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, N.; D' Anastasi, M.; Reiser, M.F.; Zech, C.J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2012-08-15

    Diffuse liver diseases show an increasing prevalence. The diagnostic gold standard of liver biopsy has several disadvantages. There is a clinical demand for non-invasive imaging-based techniques to qualitatively and quantitatively evaluate the entire liver. Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used. Steatosis: chemical shift and frequency selective imaging, MR spectroscopy (MRS). Hemochromatosis: MR-based iron quantification. Fibrosis: MR elastography, diffusion, intravoxel incoherent motion (IVIM) and MR perfusion. T1-weighted in and opposed phase imaging is the clinically most frequently used MR technique to noninvasively detect and quantify steatosis. New methods for quantification that are not influenced by confounders like iron overload are under investigation. The most sensitive method to measure the fat content of the liver is MRS. As data acquisition and analysis remain complex and there is no whole organ coverage, MRS of the liver is not a routine method. With an optimized protocol incorporating T2* sequences, MRI is the modality of choice to quantify iron overload in hemochromatosis. Standard MR sequences cannot depict early stages of liver fibrosis. Advanced MR techniques (e.g. elastography, diffusion, IVIM and perfusion) for noninvasive assessment of liver fibrosis appear promising but their role has to be further investigated. (orig.) [German] Die Praevalenz diffuser Lebererkrankungen nimmt zu. Der klinische Goldstandard, die Leberbiopsie, hat zahlreiche Nachteile. Es besteht ein Bedarf an bildgebenden Verfahren zur nichtinvasiven qualitativen und quantitativen Beurteilung der gesamten Leber bei diesen Erkrankungen. Hier sind Ultraschall, CT und MRT zu nennen. Steatosis: Chemical-shift- und frequenzselektive Bildgebung, MR-Spektroskopie (MRS) zur Fettquantifizierung. Haemochromatose: MR-basierte Eisenquantifizierung. Fibrose: MR-Elastographie, Diffusion, ''intravoxel incoherent motion

  7. Arthroplasty register for Germany

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-10-01

    Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and

  8. Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon; Achillodynie. Radiologische Bildgebung bei akuten und chronischen Ueberlastungsschaeden der Achillessehne

    Energy Technology Data Exchange (ETDEWEB)

    Syha, R.; Springer, F.; Grosse, U. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Tuebingen Univ. (Germany). Section on Experimental Radiology; Ketelsen, D.; Kramer, U.; Horger, M. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Ipach, I. [University Hospital Tuebingen (Germany). Orthopaedic Surgery; Schick, F. [Tuebingen Univ. (Germany). Section on Experimental Radiology

    2013-11-15

    In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

  9. Image findings in central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM); Bildgebung bei zentraler pontiner Myelinolyse (CPM) und extrapontiner Myelinolyse (EPM)

    Energy Technology Data Exchange (ETDEWEB)

    Oergel, Anja; Hauser, Till-Karsten; Naegele, T.; Horger, Marius [Univ. Hospital Tuebingen (Germany). Dept. of Radiology

    2017-02-15

    CT and NMR Image findings in central pontine myelinolysis (CPM) and extrapontine myelinolysis were compared with histological results. The clinical appearance and diagnosis using CT and NMR imaging are related to therapy decisions and outcome.

  10. Die Dankesrede bei der Preisverleihung

    Directory of Open Access Journals (Sweden)

    Elenmari Pletikos Olof

    2012-12-01

    Full Text Available Festliche Preisverleihungen sind Gelegenheiten, bei denen von den Preisträgerneine kurze Rede erwartet wird. Obwohl die Dankesrede eine kleinere Randgattung innerhalb des epideiktischen Genres ist, steht sie im Mittelpunkt des Ereignisses. Rhetorikhandbücher geben zahlreiche Ratschläge, wie eine gute Festrede vorbereitet werden soll, um zu unterhalten, zu bewegen und zu belehren. Ziel dieser Untersuchung ist es festzustellen, welche Eigenschaften der Dankesrede die Zuhörer als erwünscht oder unerwünscht wahrnehmen und welche Charakteristika am meisten zur Qualität festlicher Dankesreden beitragen. Das Korpus der gesprochenen Texte bilden 30 Dankesreden anlässlich kroatischer Preisverleihungen in den Bereichen Schauspiel, Sport, Musik, Fernsehen, Literatur und Wirtschaft. Die Audio-Aufnahmen der Dankesreden wurden einer Gruppe von Hörern zur Bewertung in folgenden Kategorien vorgelegt: interessant, geistreich, hoher Sprachstil, feierlich, emotiv, persönlich, originell, bescheiden, vorbereitet und spontan. Zusätzlich wurde zu jeder Rede die offene Frage gestellt, was dem Zuhörer an der Rede gefallen oder nicht gefallen habe. Die Resultate der Perzeptionsanalye lassen erkennen, dass die Interessantheit einer Rede mit der Eigenschaft des Geistreichen, des Originellen, des Emotionalen und des Persönlichen in Verbindung gebracht wird und die Eigenschaft des Festlichen im Wesentlichen nur mit dem hohen Sprachstil und der Vorbereitetheit des Textes korreliert. Einige Eigenschaften können sowohl erwünscht als auch unerwünscht sein, z. B. Dialekt, Persönliches und Kürze. Die besten Dankesreden haben Eigenschaften, die im Grunde schwer miteinander zu verbinden sind: Einerseits soll der Text vorbereitet sein (hoher Stil, Wortwahl, Figuren, Originalität der Geschichte, Humor, andererseits wird bei der Ausführung Spontaneität (Aufrichtigkeit, Emotionalität, Persönlichkeit erwartet.

  11. Advances in Patellofemoral Arthroplasty.

    Science.gov (United States)

    Strickland, Sabrina M; Bird, Mackenzie L; Christ, Alexander B

    2018-06-01

    To describe current indications, implants, economic benefits, comparison to TKA, and functional and patient-reported outcomes of patellofemoral arthroplasty. Modern onlay implants and improved patient selection have allowed for recent improvements in short- and long-term outcomes after patellofemoral joint replacement surgery. Patellofemoral arthroplasty has become an increasingly utilized technique for the successful treatment of isolated patellofemoral arthritis. Advances in patient selection, implant design, and surgical technique have resulted in improved performance and longevity of these implants. Although short- and mid-term data for modern patellofemoral arthroplasties appear promising, further long-term clinical studies are needed to evaluate how new designs and technologies will affect patient outcomes and long-term implant performance.

  12. Radiological aspects of Arthroplasties

    International Nuclear Information System (INIS)

    Garcia, Sara Eugenia; Barragan, John Henry; Narvaez, Jorge Andres

    2008-01-01

    The development of new surgical techniques, of new prosthetic materials, and the increase in life expectancy with greater coverage of health services has ugmented the performance of hip replacements in our country. The radiologist should be familiar with the different surgical techniques and prosthetic devices, the evaluation of its components and associated complications. The most frequently performed arthroplasties are: shoulder, elbow, hip and knee replacement. This article reviews the most frequent prosthetic devices used, the radiological aspects of arthroplasties and their most common complications.

  13. Functional imaging of neurocognitive dysfunction in attention deficit hyperactivity disorder; Bildgebende Darstellung neurokognitiver Dysfunktionen bei der Aufmerksamkeitsdefizit-/Hyperaktivitaetsstoerung

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, I [Klinik fuer Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universitaet Heidelberg, Zentralinstitut fuer Seelische Gesundheit, Mannheim (Germany); NMR-Forschung der Universitaet Heidelberg (Germany). Klinik fuer Psychiatrie und Psychotherapie; Klinik fuer Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut fuer Seelische Gesundheit, Mannheim (Germany); Tost, H; Ruf, M; Ende, G [NMR-Forschung der Universitaet Heidelberg (Germany). Klinik fuer Psychiatrie und Psychotherapie; Schmidt, M H [Klinik fuer Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universitaet Heidelberg, Zentralinstitut fuer Seelische Gesundheit, Mannheim (Germany)

    2005-02-01

    vorwiegend vererbte neurobiologisch begruendete Erkrankung hinweisen. Die Entwicklung nichtinvasiver bildgebender Verfahren in den letzten 15 Jahren hat die paediatrische Forschung auf diesem Gebiet entscheidend bereichert. Funktionell bildgebende Studien konnten deutliche Hinweise auf die neurobiologischen Korrelate gestoerter Exekutivfunktionen, mangelhafter Impulskontrolle und auffaelliger Psychomotorik erbringen. Die hierbei gefundenen Dysfunktionen frontostriataler Regelkreise stehen in Einklang mit den frueher beschriebenen Volumenminderungen frontaler Hirnstrukturen und pathologischer Veraenderungen der Basalganglien und des Cerebellums. Insbesondere die Steuerung visueller Aufmerksamkeit ist von Stoerungen dieser beschriebenen Hirnregionen beeintraechtigt. Aktuelle Untersuchungen konnten zeigen, dass bei ADHS-Kranken ebenfalls haeufig eine mangelhafte Kontrolle visuomotorischer Faehigkeiten vorliegt. Die vorliegende Arbeit gibt einen Ueberblick zum aktuellen Forschungsstand funktioneller Bildgebung bei ADHS und geht dabei speziell auf okulomotorische Dysfunktionen und deren Erfassung bei kernspintomographischen Untersuchungen ein. (orig.)

  14. Grading sacroiliitis with emphasis on MRI imaging; Grading der Sakroiliitis mit Betonung der MRT-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Jurik, A.G.; Egund, N. [The Department of Radiology R, Aarhus Kommunehospital (Denmark)

    2004-03-01

    Cross-sectional imaging techniques play a decisive role in identification, localization, and characterization of alterations in the sacroiliac joint during the early stage of seronegative spondylarthropathy (SpA). Although several studies showed that the diagnostic capabilities of MRI and CT are superior to those of conventional radiography, they have not yet become established and accepted as methods for evaluating the grade of ankylosing spondylitis (AS) in contrast to conventional radiography. The lack of acceptance for MRI and/or CT methods for evaluating and grading changes in the sacroiliac joint makes it difficult to include the results of these procedures in classifying the grade of SpA. Moreover, grading the changes in the sacroiliac joint in SpA with a method more sensitive than conventional radiography will be of prime importance in assessing treatment, e.g., the efficacy of new biological therapeutic agents directed against the tumor necrosis factor-alpha (TNF-{alpha}). An overview of the available grading methods is provided and MRI and CT techniques are presented. (orig.) [German] Schnittbildverfahren spielen bei der Identifizierung, Lokalisation und Charakterisierung von Veraenderungen des Sakroiliakalgelenks (SIG) im Fruehstadium der seronegativen Spondylarthropathie (SpA) eine entscheidende Rolle. Obwohl mehrere Studien zeigten, dass der diagnostische Wert der MRT und CT jenem der konventionellen Radiographie ueberlegen ist, hat sich das Schnittbildverfahren als Mittel zur Evaluierung des Grades der ankylosierenden Spondylitis (AS) im Gegensatz zur konventionellen Radiographie noch nicht etabliert und durchgesetzt. Dieses Fehlen eines akzeptierten MRT- und/oder CT-Verfahrens zur Evaluierung und zum Grading der Veraenderungen am SIG macht es schwierig, die Ergebnisse dieser Verfahren bei der Einstufung des Grades der AS-Veraenderungen und Erarbeitung von Diagnosekriterien fuer andere Formen der SpA einzubeziehen. Ausserdem wird das Grading der SIG

  15. Elbow arthroplasty in perspective

    NARCIS (Netherlands)

    Heijink, A.

    2017-01-01

    This thesis focuses on the effect of biomechanical aspects of prosthesis design and outcome after radial head and total elbow arthroplasty. First, we examine the available evidence regarding the role of several unfavorable biomechanical conditions about the elbow in the development of

  16. Radiological imaging of osteoarthritis of the knee; Radiologische Bildgebung der Kniegelenkarthrose

    Energy Technology Data Exchange (ETDEWEB)

    Wick, M.C.; Jaschke, W.; Klauser, A.S. [Medizinische Universitaet Innsbruck, Department Radiologie, Innsbruck (Austria)

    2012-11-15

    , die zu typischer Knorpeldegradierung und verminderter Gelenkbeweglichkeit fuehrt. Bei 70- bis 74-Jaehrigen liegt die Praevalenz einer Kniegelenkarthrose bei ueber 90%. Die demographische Altersentwicklung der westlichen Industrielaender prognostiziert einen deutlichen Anstieg der Arthroseinzidenz fuer die naechsten Jahrzehnte. Nach wie vor stellt die konventionelle projektionsradiographische Roentgenbildanalyse die einfachste und guenstigste radiologische Modalitaet bei der Beurteilung und Verlaufskontrolle der Kniegelenkarthrose dar. Das Roentgenbild birgt zunehmend in zahlreichen klinischen und wissenschaftlichen Situationen signifikante Limitierungen, welche durch moderne bildgebende Methoden wie der Magnetresonanztomographie (MRT) und Sonographie ueberwunden werden koennen. Intravitale Knorpelbeurteilungen anhand spezieller bildgebender MRT-Methoden werden zunehmend in der Diagnostik und Verlaufskontrolle der Arthrose eingesetzt und koennten bei breiter klinischer Anwendung zukuenftig zu einem Paradigmenwechsel bei der Behandlung arthrotischer Knorpelschaeden fuehren. In diesem Uebersichtsartikel sollen die wichtigsten radiologischen diagnostischen Merkmale der Kniegelenkarthrose und deren radiologisch Beurteilung dargestellt werden. Die demographische Altersentwicklung der westlichen Industrielaender prognostiziert einen deutlichen Anstieg der Arthroseinzidenz fuer die naechsten Jahrzehnte. Die systematische radiologische Beurteilung der Kniegelenkarthrose umfasst die Bestimmung der Gelenkkapselstrukturen, Synovia, Knorpeldicke, des Knorpelvolumens, eventueller Knorpeldefekte, des makromodularen Netzwerks des hyalinen Gelenkknorpels, eines Knochenmarkoedems, der Menisken und der artikulaeren Gelenkbaender. Moderne bildgebende Methoden wie die MRT und Sonographie sind in der Lage, die Schwaechen der Projektionsradiographie zu eliminieren und das Kniegelenk mit seinen knoechernen, knorpeligen, ligamentoesen und weichteildichten Strukturen detailliert abzubilden

  17. MR imaging of the kidneys: new diagnostic strategies; MR-Bildgebung der Nieren. Neue Ansaetze in der Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Floemer, F.; Essig, M.; Hawighorst, H.; Kaick, G. van [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik; Kallinowski, F. [Heidelberg Univ. (Germany). Chirurgische Universitaetsklinik; Just, A. [Heidelberg Univ. (Germany). 1. Physiologisches Inst.; Laub, G. [Siemens AG, Erlangen (Germany). Unternehmensbereich Medizinische Technik; Prince, M.R [Michigan Univ., Ann Arbor, MI (United States). Dept. of Radiology

    1999-05-01

    Aim: New diagnostic strategies for evaluation of the kidney by fast MR imaging of renal morphology, multiphase 3D gadolinium MR angiography, MR urography and MR flow measurements. A signal MR examination is designed to grade renovascular disease and assess the hemodynamic and functional significance, detect and characterize renal lesions and evaluate the urinary tract. Results: The combined analysis of morphologic and functional data allows reliable assessment of renal artery stenosis, benign and malignant renal masses and diseases of the renal collecting system and ureters, as well as congenital abnormalities in good agreement to the results of conventional imaging modalities. The improved tissue contrast and additional functional information compensates for the disadvantage of a lower spatial resolution. Conclusion: Combined morphologic and functional MR examination represents a reliable, non-invasive and cost-effective alternative imaging modality for comprehensive diagnostic evaluation of renal disease. (orig.) [Deutsch] Fragestellung: Darstellung neuer diagnostischer Moeglichkeiten im Bereich der Niere mittels schneller Magnetresonanz (MR)-Bildgebung. Methodik: Vorgestellt wird ein kombiniertes morphologisches und funktionelles Untersuchungskonzept bestehend aus schneller morphologischer Bildgebung, multiphasischer 3D-Gadolinium-MR-Angiographie, MR-Urographie und MR-Flussmessung. In einer einzigen MR-Untersuchung sollen vaskulaere Erkrankungen erfasst, eingestuft und auf ihre haemodynamische und funktionelle Signifikanz ueberprueft werden, renale Laesionen detektiert und differenziert sowie die Harnabflusswege beurteilt werden. Ergebnisse: Durch Integration der gewonnenen morphologischen und funktionellen Daten lassen sich Nierenarterienstenosen, benigne und maligne renale Tumoren, Harnabflussstoerungen und kongenitale Fehlbildungen mit aehnlicher Genauigkeit wie in den konventionellen radiologischen Verfahren erfassen. Der Nachteil der geringeren raeumlichen

  18. [Sports participation after joint arthroplasty].

    Science.gov (United States)

    Dauty, M; Letenneur, J

    2007-12-01

    To recommand sports activities after joint arthroplasty from the literature analysis, the French surgeon's opinion and wish patients. From the Medline data base interrogation according to keywords: Sports, Arthroplasty, Athletics, Physical training, two different readers, an orthopedic surgeon and a Physical Medicine and Rehabilitation physician selected articles in French or English language according to the level of proofs of the french classification of the Accreditation and Health Evaluation National Agency (Anaes). Professional practices were estimated by the interrogation of 30 orthopedic surgeons members of the french West Orthopaedics Society (SOO). The demand of sports practice was studied with patients recently operated for a primary total knee arthroplasty (TKA) after gonarthrosis. Twenty-two articles were selected from 305 articles obtained by the search according to keywords. Ten literature reviews are limited by the absence of prospective randomized study. A level II study and eleven level IV articles are reported. According to the subjective orthropedic surgeon's opinion, the objective results based on the joint load studied and the percentage of arthroplasty revision, sport is beneficial for the individual health but perhaps not for the arthroplasty survey. However, aerobic and leisure activities are recommended (walking, swimming, cycling) in agreement with the demand of the patients recently operated with a TKA. TKA differs from Total Hip Arthroplasty for jogging because of knee joint constraints during the knee flexion. A single study reports sports possibilities after shoulder arthroplasty and ankle arthroplasty and no study reports results after elbow arthroplasty.

  19. MR-Guided vacuum biopsy of 206 contrast-enhancing breast lesions; MRT-gefuehrte Vakuumbiopsie bei 206 Kontrastmittel anreichernden Laesionen der Mamma

    Energy Technology Data Exchange (ETDEWEB)

    Perlet, C.; Schneider, P.; Sittek, H.; Reiser, M.F. [Klinikum der Universitaet Grosshadern, Muenchen (Germany). Inst. fuer Klinische Radiologie; Amaya, B.; Grosse, A.; Heywang-Koebrunner, S.H. [Martin-Luther-Universitaet, Halle (Germany). Klinik fuer Diagnostische Radiologie

    2002-01-01

    -Defekt n=1), so dass insgesamt 206 VB durchgefuehrt wurden. In 4 Faellen (2%) war die VB nicht erfolgreich. Da dies auf den postinterventionellen Aufnahmen sofort erkannt wurde, entstand keine Fehldiagnose. Maligne Befunde und atypisch duktale Hyperplasien (ADH) sind durch Nachexzision bestaetigt, benigne Befunde durch Korrelation der VB-Histologie mit prae- und postinterventioneller Bildgebung sowie durch weitere Nachkontrollen. Ergebnisse: Bei den 202 erfolgreich biopsierten Laesionen wurden 51 maligne Tumoren, 7 ADH und 144 benigne Befunde diagnostiziert. Ein DCIS wurde mit der VB als ADH interpretiert. In allen uebrigen Faellen bestaetigten sich die malignen und benignen Diagnosen. Schlussfolgerung: Die MRT-gefuehrte VB bietet eine gute Moeglichkeit fuer die histologische Abklaerung auch kleiner anreichernder Laesionen, die mit anderen bildgebenden Verfahren nicht dargstellt werden koennen. (orig.)

  20. Analysis of image acquisition, post-processing and documentation in adolescents with spine injuries. Comparison before and after referral to a university hospital; Bildgebung bei wirbelsaeulenverletzten Kindern und jungen Erwachsenen. Eine Analyse von Umfeld, Standards und Wiederholungsuntersuchungen bei Patientenverlegungen

    Energy Technology Data Exchange (ETDEWEB)

    Lemburg, S.P.; Roggenland, D.; Nicolas, V.; Heyer, C.M. [Berufsgenossenschaftliches Universitaetsklinikum Bergmannshell, Bochum (Germany). Inst. fuer Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin

    2012-09-15

    Purpose: Systematic evaluation of imaging situation and standards in acute spinal injuries of adolescents. Materials and Methods: Retrospective analysis of imaging studies of transferred adolescents with spinal injuries and survey of transferring hospitals (TH) with respect to the availability of modalities and radiological expertise and post-processing and documentation of CT studies were performed. Repetitions of imaging studies and cumulative effective dose (CED) were noted. Results: 33 of 43 patients (77 %) treated in our hospital (MA 17.2 years, 52 % male) and 25 of 32 TH (78 %) were evaluated. 24-hr availability of conventional radiography and CT was present in 96 % and 92 % of TH, whereas MRI was available in only 36 %. In 64 % of TH, imaging expertise was guaranteed by an on-staff radiologist. During off-hours radiological service was provided on an on-call basis in 56 % of TH. Neuroradiologic and pediatric radiology expertise was not available in 44 % and 60 % of TH, respectively. CT imaging including post-processing and documentation matched our standards in 36 % and 32 % of cases. The repetition rate of CT studies was 39 % (CED 116.08 mSv). Conclusion: With frequent CT repetitions, two-thirds of re-examined patients revealed a different clinical estimation of trauma severity and insufficient CT quality as possible causes for re-examination. A standardization of initial clinical evaluation and CT imaging could possibly reduce the need for repeat examinations. (orig.)

  1. New aspects of MRI for diagnostics of large vessel vasculitis and primary angiitis of the central nervous system; Neue Aspekte der MRT-Bildgebung zur Diagnostik der Grossgefaessvaskulitiden sowie der primaeren Angiitis des zentralen Nervensystems

    Energy Technology Data Exchange (ETDEWEB)

    Saam, T.; Habs, M.; Cyran, C.C.; Grimm, J.; Reiser, M.F.; Nikolaou, K. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Pfefferkorn, T. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Neurologie, Muenchen (Germany); Schueller, U. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Zentrum fuer Neuropathologie, Muenchen (Germany)

    2010-10-15

    Vasculitis is a rare disease and clinical symptoms are often unspecific. Accurate and early diagnosis is mandatory in order to prevent complications, such as loss of vision or stroke. Imaging techniques can contribute to establishing a definite diagnosis and to evaluate disease activity and the extent of the disease in various vascular regions. Conventional imaging methods, such as computed tomography (CT) and magnetic resonance (MR) angiography, as well as digital subtraction angiography allow the vessel lumen but not the vessel wall to be depicted. However, vasculitis is a disease which primarily affects the vessel wall, therefore conventional imaging modalities often fail to make a definite diagnosis. Recently black-blood high resolution MR in vivo imaging has been used to visualize cervical and intracranial vasculitis. This review article presents imaging protocols for intracranial and cervical black-blood MR imaging and clinical cases with large vessel vasculitis and vasculitis of the central nervous system. Furthermore the current literature, examples of the most common differential diagnoses of cervical and cranial arteriopathy and the potential of other imaging modalities, such as PET/CT and ultrasound will be discussed. (orig.) [German] Vaskulitiden sind seltene Erkrankungen, deren klinische Symptome oft unspezifisch sind und deren genaue und fruehzeitige Diagnose daher eine besondere Herausforderung fuer jeden Kliniker darstellt. Hierzu kann die Bildgebung einen wertvollen Beitrag leisten und ist insbesondere in der Lage, das Ausmass der Erkrankung und die Anzahl der betroffenen Gefaesse zu bestimmen. Die klassischen bildgebenden Verfahren wie CT- (CTA) oder MR-Angiographie (MRA) sowie die digitale Subtraktionsangiographie (DSA) fokussieren dabei hauptsaechlich auf Veraenderungen des Lumendurchmessers, die Gefaesswand wird mit diesen Verfahren in der Regel nur unzureichend dargestellt. Ultraschalluntersuchungen lassen zwar eine Beurteilung des Lumens und

  2. Entwicklungstrends bei landwirtschaftlichen Applikationen - ein Zwischenfazit

    Directory of Open Access Journals (Sweden)

    Christa Hoffmann

    2014-10-01

    Full Text Available Globalisierung, volatile Märkte und der vermehrte Rückzug der Agrarpolitik aus der Marktregulierung sorgen dafür, dass die Entscheidungsfindungsprozesse auf landwirtschaftlichen Betrieben an Komplexität zunehmen. Applikationen bieten durch ihre Mobilität und individuellen Ausgestaltungsmöglichkeiten Optionen, um den Landwirt bei seiner täglichen Arbeit zu unterstützen. In diesem Kontext nimmt diese Arbeit eine Bestandsaufnahme und Kategorisierung nativer Applikationen mit landwirtschaftlichem Bezug vor. Die Ergebnisse zeigen unter anderem einen Angebotsschwerpunkt im Produktionszweig Pflanzenbau und bei den Funktionen bestimmte häufig auftretende bedarfsbedingte Kombinationen (z. B. Planung und Analyse.

  3. MRI of interstitial lung diseases. What is possible?; MRT bei interstitiellen Lungenerkrankungen. Was ist moeglich

    Energy Technology Data Exchange (ETDEWEB)

    Biederer, J. [Kreisklinik Gross-Gerau, Radiologie Darmstadt, Gross-Gerau (Germany); Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Deutsches Zentrum fuer Lungenforschung (DZL), Translational Lung Research Center (TLRC) Heidelberg, Heidelberg (Germany); Thoraxklinik, Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Wielpuetz, M.O.; Jobst, B.J.; Dinkel, J. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Deutsches Zentrum fuer Lungenforschung (DZL), Translational Lung Research Center (TLRC) Heidelberg, Heidelberg (Germany); Thoraxklinik, Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany)

    2014-12-15

    interstitieller Lungenerkrankungen die groesste Herausforderung dar. Zusammenfassung des aktuellen Stands zu Moeglichkeiten und Perspektiven der MRT fuer die Diagnostik interstitieller Lungenerkrankungen. Zusammenfassung einer aktuellen Literaturrecherche und Bewertung der Ergebnisse vor dem Hintergrund eigener Erfahrungen mit der Lungen-MRT. Allein aufgrund der geringeren Detailaufloesung und der deutlich groesseren Anfaelligkeit fuer Artefakte ist die MRT der CT bei der Diagnostik interstitieller Lungenerkrankungen (''interstitial lung diseases'', ILD) bei feinen Mustern (feinnetzige Fibrose, Mikronoduli) unterlegen, kann aber groebere Fibrosen (Honigwabenmuster) detektieren. Zudem wurde an kleinen Fallgruppen gezeigt, dass die MRT diagnostisch wertvolle Informationen zur regionalen Lungenfunktion (Ventilation, Perfusion, mechanische Eigenschaften) und Entzuendungsaktivitaet (natives Signal, Kontrastmitteldynamik) liefern kann. Aktuell kann die morphologische Lungen-MRT ergaenzend zur kardialen Diagnostik bei Sarkoidose fuer die umfassende kardiothorakale Bildgebung in einer Sitzung oder fuer Verlaufsbeobachtungen eingesetzt werden. Wenn sich die Moeglichkeiten der MRT-basierten Lungenfunktionsdiagnostik und Beurteilung der Entzuendungsaktivitaet klinisch robust umsetzen lassen, ist von einer deutlichen Erweiterung des Anwendungsspektrums auszugehen. (orig.)

  4. Total hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....

  5. Pilzinfektionen des Zentralnervensystems bei immunkompetentem Wirt

    NARCIS (Netherlands)

    Tintelnot, K.; de Hoog, G.S.; Haase, G.

    2014-01-01

    Die Mehrzahl von Pilzinfektionen, die zu mykotischen Tumoren führen und bei Patienten ohne jegliche prädisponierende Vorerkrankung auftreten, wird durch Cryptococcus gattii bzw. C. neoformans oder durch Schwärzepilze, insbesondere durch Cladophialophora bantiana, Ramichloridium mackenziei, Exophiala

  6. KRITIK SOSIAL DALAM KOMIK STRIP PAK BEI

    Directory of Open Access Journals (Sweden)

    Yudhi Novriansyah

    2016-08-01

    Full Text Available This research aimed to do interpret the marking which flange social criticism and know laboring ideology in story of Comic Strip Pak Bei. Research based on theory of structural semiotic according to Ferdinand De Saussure. Using analysis of Syntagmatic as first level of meaning to the text network and also picture, and analysis of Paradigmatic as second level of meaning or implicit meaning (connota-tion, myth, ideology Analysis done to six Comic choice edition of Strip Pak Bei period of November 2004 - Februari 2005 which tend to flange social criticism. At band of syntagmatic, result of research indicate that story theme lifted from social problems that happened in major society. The fact clear progressively when connected by Intertextual with information and texts which have preexisted. At band of Paradigmatic, social criticism tend to emerge dimly, is not transparent. Because of Comic Strip Pak Bei expand in the middle of Java cultural domination that developing myth of criticize as action menacing compatibility and orderliness of society. Story of Comic Strip Pak Bei also confirm dominant ideology in Java society culture, namely ideology of Patriarkhi and Feudalism which still go into effect until now. This prove ideology idea according to Louis Althusser which not again opposition between class, but have been owned and practiced by all social class.

  7. Multiple myoma: current recommendations for imaging; Multiples Myelom: Aktuelle Empfehlungen fuer die Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Hillengass, J. [Medizinische Universitaetsklinik, Abteilung fuer Haematologie, Onkologie und Rheumatologie, Heidelberg (Germany); Deutsches Krebsforschungszentrum, Abteilung Radiologie E010, Heidelberg (Germany); Delorme, S. [Deutsches Krebsforschungszentrum, Abteilung Radiologie E010, Heidelberg (Germany)

    2012-04-15

    zur Erfassung umschriebener Knochendestruktionen, von Osteoporose oder Frakturen. Die Ganzkoerper-low-dose-CT und Ganzkoerper-MRT ermoeglichen eine Darstellung sowohl des mineralisierten Knochens als auch des Knochenmarks mit einer hoeheren Sensitivitaet, hoeherem Patientenkomfort und im Falle der MRT ohne Strahlenbelastung. Nach den Ergebnissen der Literatur sind Schnittbildverfahren dem Roentgenskelettstatus signifikant ueberlegen, wobei die Ganzkoerper-MRT fuer den Nachweis insbesondere eines diffusen Knochenmarkbefalls signifikant besser ist als die Ganzkoerper-CT. Praktisch jeder osteodestruktive Herd ist in der MRT sichtbar. Allerdings ist fuer die Beurteilung der Osteodestruktion selbst wiederum eine CT erforderlich. Die Sensitivitaeten von PET/CT und MRT sind vergleichbar. Wie bereits in einigen Zentren insbesondere in Deutschland umgesetzt, sollten bei Verfuegbarkeit das Ganzkoerper-MRT und das Ganzkoerper-CT den konventionellen Roentgenskelettstatus ersetzen. Bei Erstdiagnose bzw. Verdacht auf eine monoklonale Gammopathie unklarer Signifikanz (MGUS), ''smoldering multiple myeloma'' und symptomatisches multiples Myelom sollten sowohl eine Ganzkoerper-MRT als auch eine Ganzkoerper-CT durchgefuehrt werden. Bei asymptomatischem Myelom oder MGUS waere die Ganzkoerper-MRT bis zur Detektion des ersten umschriebenen Myelomherdes ausreichend. Beim symptomatischen Myelom mit Knochenlaesionen sollten in der Regel die Ganzkoerper-CT und fuer spezielle Fragestellungen die MRT eingesetzt werden. (orig.)

  8. Actual approaches in diagnosis and therapy of malignant lymphoma; Staging und Therapiekontrolle bei Lymphomen

    Energy Technology Data Exchange (ETDEWEB)

    Moog, F. [LMU, Muenchen (Germany). Klinik fuer Nuklearmedizin; Roemer, W. [Technische Univ. Muenchen (Germany). Klinik fuer Nuklearmedizin

    1998-07-01

    Actual molecular strategies in therapy of lymphoma attempt to utilize the immune system to target and eliminate residual lymphoma cells after first line therapy. Therefore lymphoma-specific vaccines are used. Therapy was already successful in vitro, in vivo studies are planned for the near future. In the past two decades, prognosis of lymphoma patients has improved due to advances in staging as well as in therapy control. The introduction of duplex sonography allows the decision on dignity of suspicious lymph nodes not only by size criteria but also by different perfusion pattern. Similar advances have been made in cross sectional imaging like computed tomography and magnetic resonance imaging. The development of lymph node specific contrast agents present new tools for further investigation. In nuclear medicine, functional imaging using positron-emission tomography presents new perspectives especially in diagnosis and treatment control of malignant lymphoma. The visualization of the glucose metabolism using the radiolabeled glucose analogue fluorodeoxyglucose (FDG) allows the detection of involved lymph nodes independent of arbitrary criteria such as lesion diameter. First studies on the use of FDG-PET in staging and restaging of lymphoma patients show promising results. (orig.) [Deutsch] Das 2. Muenchner Nuklearmedizin-Symposium hatte unter anderem das Staging und die Therapiekontrolle bei malignen Lymphomen zum Thema. Neben molekular- und zellbiologischen Ansaetzen zur Lymphomvakzinierung wurde der aktuelle Stand der Moeglichkeiten beim Staging und der Therapiekontrolle aus der Sicht des Radiologen und des Nuklearmediziners vorgetragen. Moderne molekularbiologische Strategien basieren auf einer Modifikation der Immunantwort mit dem Ziel, minimale Tumorreste nach einer konventionellen Therapie zu eleminieren. Dabei kommt in erster Linie das Prinzip der `Tumorimpfung` zum Einsatz. Tumorzellen werden spezifisch ueber einen virusassoziierten Gentransfer oder einen

  9. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff

    2016-01-01

    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...

  10. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  11. Chronic infections in hip arthroplasties

    DEFF Research Database (Denmark)

    Lange, Jeppe; Troelsen, Anders; Thomsen, Reimar W

    2012-01-01

    Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisi......Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two......-stage revisions for chronic infection in hip arthroplasties....

  12. Krafttraining bei älteren "frail" Personen

    Directory of Open Access Journals (Sweden)

    Kapan A

    2013-01-01

    Full Text Available Aufgrund der demographischen Entwicklung in den westlichen Industrieländern kann bei einem Ausbleiben adäquater Präventionsmaßnahmen davon ausgegangen werden, dass in Österreich im Jahr 2050 356.000 gebrechliche („frail“ und 1,5 Millionen Personen mit Vorstufen erwartet werden können. Im Alter von 50–70 Jahren kann auch bei gesunder Ernährung und körperlicher Aktivität die Muskelkraft um bis zu 30 % nachlassen. Für den Erhalt der Mobilität und um dem Muskelabbau entgegenzuwirken nimmt das körperliche Training, vor allem das Krafttraining, einen wichtigen Stellenwert ein.

  13. Pasireotid: Eine neue Therapieoption bei Morbus Cushing

    Directory of Open Access Journals (Sweden)

    Luger A

    2012-01-01

    Full Text Available Im Behandlungsalgorithmus des Morbus Cushing war bisher keine zugelassene pharmakologische Behandlungsmöglichkeit verfügbar. Mit dem Multirezeptor-Somatostatinanalogon Pasireotid steht nun mit der im April 2012 erfolgten Zulassung die erste, spezifisch für die Therapie dieses Krankheitsbildes entwickelte Substanz zur Verfügung. Die Studienevidenz belegt eine schnelle und nachhaltige Reduktion der ACTH- und Kortisolproduktion mit klinischer Besserung bei einem Großteil der Patienten.

  14. MR-guided biopsies of undetermined liver lesions: technique and results; MRT-gezielte perkutane Biopsie bei unklaren fokalen Leberlaesionen: Technik und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Zangos, S.; Kiefl, D.; Eichler, K.; Engelmann, K.; Heller, M.; Herzog, C.; Mack, M.G.; Jacobi, V.; Vogl, T.J. [Inst. fuer Diagnostische und Interventionelle Radiologie, Johann-Wolfgang-Goethe-Univ. Frankfurt (Germany)

    2003-05-01

    Purpose: To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques. Materials and Methods: In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70 ) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90 ) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex{sup *}). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated. Results: All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors. Conclusion: MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies. (orig.) [German] Zielsetzung: Evaluierung der Sicherheit und Genauigkeit MRT-gezielter Leberbiopsien unter Verwendung verschiedener Sequenzen. Methoden: Bei 47 Patienten mit unklaren Leberlaesionen wurden in einem offenen 0,2-Tesla-MR-System (Magnetom Open, Siemens) bildgesteuerte Biopsien unter Verwendung von zwei verschiedenen Sequenzen durchgefuehrt. Die Bildgebung erfolgte bei allen Patienten mittels T

  15. Stemless shoulder arthroplasty: current status.

    Science.gov (United States)

    Churchill, R Sean

    2014-09-01

    Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  16. Imaging of postarthroscopic complications after knee injuries; Bildgebung postarthroskopischer Komplikationen nach Knieverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C. [Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und muskuloskelettale Radiologie, Klinik fuer Radiodiagnostik, Wien (Austria); Skrbensky, G. von [Medizinische Universitaet Wien, Klinik fuer Orthopaedie, Wien (Austria)

    2012-11-15

    The most common joint injuries in professional and recreational sports participants and also in the total population are knee injuries. Arthroscopy is indicated if this modality will improve the patient outcome and potential long-term complications can be avoided. Although uncommon, complications following arthroscopy are mostly evaluated by magnetic resonance imaging (MRI). For planning further therapy strategies following postarthroscopic complications, e.g. if anterior cruciate ligament (ACL) reconstruction is required, digital radiographs and computed tomography (CT) are helpful. This article provides an overview of the different procedures for surgical treatment which are a prerequisite for the analysis of postarthroscopic images. In addition typical complications after treatment of meniscal and chondral injuries as well as after ACL reconstruction are described and typical signs in MRI, radiography and CT are explained in detail. (orig.) [German] Kniegelenkverletzungen sind nicht nur bei Profisportlern, sondern auch in der Gesamtbevoelkerung die haeufigsten Gelenkverletzungen. Die Indikation zur arthroskopischen Operation wird gestellt, wenn im Vergleich zur konservativen Therapie ein besseres Ergebnis postarthroskopisch zu erwarten ist und potenzielle Spaetkomplikationen verhindert werden koennten. Die selten aber dennoch auftretenden postarthroskopischen Komplikationen werden zumeist mit der Magnetresonanztomographie (MRT) abgeklaert. Zur weiteren Therapieplanung nach Komplikationen, z. B. wenn eine Kreuzbandrevision notwendig ist, sind die digitale Projektionsradiographie und die Computertomographie (CT) hilfreich. Dieser Artikel bietet eine kurze Uebersicht ueber die unterschiedlichen Operationstechniken, die eine Voraussetzung fuer das Verstaendnis der bildgebenden postoperativen Veraenderungen sind. Weiter wird auf die haeufigsten Komplikationen nach Meniskus- und Knorpeloperationen sowie nach vorderer Kreuzbandrekonstruktion und den damit

  17. Neurogenic myopathies and imaging of muscle denervation; Neurogene Myopathien und Bildgebung der Muskeldenervation

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, M. [Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, Heidelberg (Germany); Wolf, C. [Reha-Zentrum Gernsbach, Neurologie, Gernsbach (Germany); Weber, M.A. [Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany)

    2017-12-15

    , chronische Kompressionen sowie neurodegenerative, inflammatorische, metabolische und neoplastische Prozesse. Anamnese, klinisch-neurologische Untersuchung und elektrophysiologische Tests einschliesslich Elektromyographie (EMG) und Testung der Nervenleitgeschwindigkeit sind notwendig. Die EMG stellt den Goldstandard in der Diagnose von Muskeldenervierung dar. Ergaenzende bildgebende Methoden, vor allem die Magnetresonanztomographie (MRT) koennen teils sinnvolle Informationen liefern. Bei akuter und subakuter Denervierung weist die Muskulatur in der MRT Oedeme, ADC(''apparent diffusion coefficient'')-Erhoehung und gesteigerte Perfusion auf. Die mittels MRT nachweisbaren Veraenderungen denervierter Muskulatur sind relativ unspezifisch, erreichen aber eine vergleichbar hohe Sensitivitaet wie die EMG. Mittels dezidierter MR-Neurographie kann oft auch die ursaechliche Schaedigung des/der innervierenden Nerven visualisiert werden. Abgesehen von der mit der EMG vergleichbaren Sensitivitaet eignet sich die MRT zur Beurteilung von Muskeln, die einer Nadelelektromyographie nicht zugaenglich sind. Aufgrund ihres nichtinvasiven Charakters ist die MRT auch ideal fuer Verlaufsuntersuchungen. Oft ergaenzt die MRT die Diagnostik neurogener Myopathien sinnvoll. Ausmass und Verteilungsmuster der muskulaeren Veraenderungen lassen haeufig auf die Lokalisation der ursaechlichen Nervenschaedigung schliessen. Oft ermoeglichet die MRT eine korrekte Diagnosestellung oder zumindest eine Eingrenzung moeglicher Differenzialdiagnosen. (orig.)

  18. Functional-anatomic evaluation of dilated uropathies in children using combined MR-nephrography and MR-urography compared to renal scintigraphy; Funktionell-anatomische Diagnostik dilatierter Uropathien bei Kindern mit kombinierter MR-Nephrographie und MR-Urographie im Vergleich zur renalen Isotopennephrographie

    Energy Technology Data Exchange (ETDEWEB)

    Reither, M. [Abt. fuer bildgebende Diagnostik am Kinderkrankenhaus Park Schoenfeld, Kassel (Germany); Tuerkay, S. [GE Medical Systems Deutschland GmbH, Solingen (Germany)

    2004-02-01

    ,95). Wegen technischer Fehler konnten die Studien bei 8 Kindern nicht ausgewertet werden. Beim Vergleich des Obstruktionsgrades gab es eine Uebereinstimmung bei 57 von 62 Patienten, 3 Faelle wurden ueber-, 2 unterbewertet. Bis auf eine liessen sich alle primaer sonographisch gestellten und im Verlauf durch weitere Bildgebung ergaenzten morphologischen Diagnosen MR-urographisch bestaetigen. Obwohl korrekt dargestellt, gab es bei einer Doppelanlage mit Ureterozele und funktionsloser oberer Anlage zunaechst eine Fehlinterpretation. (orig.)

  19. Wirksamkeit der Hypnose auf Schmerzen bei Erwachsenen: systematische Literaturreview

    OpenAIRE

    Pfaffen, Céline; Z`Brun-Schnyder, Silvia

    2018-01-01

    Das Ziel dieser systematischen Literaturreview ist es, die Wirksamkeit der Hypnose auf Schmerzen bei Erwachsenen zu überprüfen. Daraus ergibt sich folgende Forschungsfrage: "Wie wird die Wirksamkeit der Hypnose auf Schmerzen bei Erwachsenen in der wissenschaftlichen Literatur beschrieben?"

  20. MRI for myocarditis; MRT bei Myokarditis

    Energy Technology Data Exchange (ETDEWEB)

    Gutberlet, M.; Luecke, C.; Krieghoff, C.; Hildebrand, L.; Steiner, J.; Adam, J.; Grotthoff, M.; Lehmkuhl, L. [Herzzentrum, Universitaet Leipzig, Abteilung fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Lurz, P.; Eitel, I.; Thiele, H. [Herzzentrum, Universitaet Leipzig, Abteilung Kardiologie, Leipzig (Germany)

    2013-01-15

    Cardiovascular magnetic resonance imaging (CMRI) has become the primary tool for the non-invasive assessment in patients with suspected myocarditis, especially after exclusion of acute coronary syndrome (ACS) for the differential diagnosis. Various MRI parameters are available which have different accuracies. Volumetric and functional ventricular assessment and the occurrence of pericardial effusion alone demonstrate only a poor sensitivity and specificity. The calculation of the T2-ratio (edema assessment), the early or global relative myocardial enhancement (gRE) and the late gadolinium enhancement (LGE), which represents irreversibly injured myocardium, are more specific parameters. All MRI parameters demonstrate the best accuracy in infarct-like acute myocarditis, whereas in chronic myocarditis sensitivity and specificity are less accurate. Therefore, a multisequential (at least two out of three parameters are positive) approach is recommended. The assessment of the value of newer, more quantitative MRI sequences, such as T1 and T2-mapping is still under investigation. (orig.) [German] Die kardiale MRT stellt die primaere nichtinvasive bildgebende Modalitaet bei Verdacht auf Myokarditis dar, insbesondere auch nach Ausschluss eines akuten Koronarsyndroms (ACS) zur Differenzialdiagnose. Verschiedene MR-Parameter mit unterschiedlicher Wertigkeit stehen zur Verfuegung. Die Beurteilung der Volumetrie und Ventrikelfunktion weisen ebenso wie der Nachweis eines Perikardergusses alleine nur eine geringe Sensitivitaet und Spezifitaet auf. Die spezifischeren MRT-Inflammationsparameter stellen die T2-Ratio (Oedemnachweis), die fruehe Kontrastmittelanreicherung bzw. das globale relative Enhancement (gRE) und die spaete Kontrastmittelanreicherung, das so genannte Late-Gadolinium-Enhancement (LGE) als Zeichen eines irreversiblen Myokardschadens dar. Alle MR-Parameter zeigen die beste diagnostische Genauigkeit bei einer ''infarktaehnlichen'' akuten

  1. Probleme bei der Digitalisierung analoger Messwerte

    Science.gov (United States)

    Plaßmann, Wilfried

    Messwerte liegen häufig in analoger Form als Spannungswerte vor. Sie werden in eine digital kodierte Form umgesetzt, wenn eine (nahezu) fehlerfreie Übertragung erforderlich ist, wenn Signalverläufe gespeichert werden sollen, wenn eine Weiterverarbeitung erfolgen soll oder wenn Messungen mit sehr geringem Messfehler notwendig sind. Hier soll auf einige Probleme, die durch die Umsetzung entstehen, aus messtechnischer Sicht eingegangen werden. Stichworte: Fehler bei der Digitalisierung; Signal-Quantisierungsgeräusch-Abstand; Verbesserung des Signal-Rausch-Verhältnisses; Abtast-Halte-Glied; Aliasing; Erfassung von Momentanwerten.

  2. Rezidivierende Endometriose bei Kinderwunsch: Operieren oder stimulieren?

    Directory of Open Access Journals (Sweden)

    Brunbauer M

    2012-01-01

    Full Text Available Kurzfassung: Endometriose ist neben dem Tubenverschluss und dem PCO-Syndrom eine der Hauptursachen für reduzierte Fertilität bei der Frau. Zur eindeutigen Diagnosesicherung ist die operative Diagnostik Standard. Eine Sanierung ist in vielen Fällen in der gleichen Sitzung möglich. Um nichts unnötig zu (zer- stören, sei die Maxime: eher weniger als mehr. Ein Rezidiv bedeutet eine weitere Reduktion der Schwangerschaftsrate. Eine Zweitoperation kann zwar Beschwerden lindern, verbessert aber die Spontan-Schwangerschaftsrate nur gering. Der Zweiteingriff ist also bezüglich der reinen Schwangerschaftsrate einer modernen IVF-Behandlung eindeutig unterlegen.

  3. Instability after total hip arthroplasty

    Science.gov (United States)

    Werner, Brian C; Brown, Thomas E

    2012-01-01

    Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Non-operative management is often successful if the components are well-fixed and correctly positioned in the absence of neurocognitive disorders. If conservative management fails, surgical options include revision of malpositioned components; exchange of modular components such as the femoral head and acetabular liner; bipolar arthroplasty; tripolar arthroplasty; use of a larger femoral head; use of a constrained liner; soft tissue reinforcement and advancement of the greater trochanter. PMID:22919568

  4. Reverse hybrid total hip arthroplasty

    DEFF Research Database (Denmark)

    Wangen, Helge; Havelin, Leif I.; Fenstad, Anne M

    2017-01-01

    Background and purpose - The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty....... Patients and methods - From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk...

  5. Tc-99m-bicisate (ECD)-brain-SPECT in rapidly progressive dementia; Hirn-SPECT mit Tc-99m-Bicisat (ECD) bei rasch progredientem dementiellen Syndrom

    Energy Technology Data Exchange (ETDEWEB)

    Marienhagen, J.; Eilles, C. [Regensburg Univ. (Germany). Abt. fuer Nuklearmedizin; Weingaertner, U.; Blaha, L. [Bezirkskrankenhaus Mainkofen (Germany). Psychiatrische Klinik; Zerr, I.; Poser, S. [Goettingen Univ. (Germany). Klinik und Poliklinik fuer Neurologie

    1999-07-01

    We present a 61-year-old male patient with progressive dementia. A brain SPECT with Tc-99m-bicisate was performed for confirmation of clinically suspected Alzheimer-dementia. At the time of the SPECT-investigation marked apraxia and aphasia besides severe dementia were present. Electrophysiological as well as anatomical neuroimaging findings showed non-diagnostic alterations. SPECT revealed distinct perfusion defects, which made Alzheimer Dementia unlikely. The further course of the patient was determined by rapidly progressive deterioration with development of akinetic mutism. Thereafter, increased levels of neuron-specific enolase as well as 14-3-3 proteins were found in the cerebro-spinal fluid (CSF). The patient finally died with signs of cerebral decortication. Due to the clinical course and the CSF-findings the patient's final diagnosis was Creutzfeld-Jakob-disease, nevertheless no autopsy was performed. The presented case report underscores the clinical utility of perfusion brain SPECT in the differential diagnosis of dementias. (orig.) [German] Wir berichten ueber einen 61jaehrigen Patienten mit progredientem dementiellen Syndrom, der unter der Verdachtsdiagnose einer Demenz vom Alzheimer-Typ (DAT) zur Hirn-SPECT-Untersuchung mit TC-99m-Bicisat (ECD) vorgestellt wurde. Zum Untersuchungszeitpunkt bestanden neben dem Vollbild einer Demenz eine ausgepraegte Apraxie und Aphasie bei unspezifischen Veraenderungen im EEG sowie der neuroradiologischen Bildgebung. In der Hirn-SPECT-Untersuchung fanden sich fuer eine DAT untypische ausgedehnte, vorwiegend rechtshemisphaerische Perfusionsstoerungen. Im weiteren Verlauf rasche Progredienz des Krankheitsbildes mit Entwicklung eines akinetischen Mutismus sowie Nachweis erhoehter Werte der neuronspezifischen Enolase und des 14-3-3-Proteins im Liquor. Der Patient verstarb schliesslich unter dem Bild einer Decortication. Aufgrund des klinischen Verlaufs sowie der Liquorbefunde wurde, da eine autoptische Befundsicherung

  6. Characterization of adrenal masses: can image replace biopsy?; Charakterisierung von Nebennierenraumforderungen. Kann die Bildgebung die Biopsie ersetzen?

    Energy Technology Data Exchange (ETDEWEB)

    Heinz-Peer, G.; Hoenigschnabel, S.; Lechner, G. [Universtaetsklinik fuer Radiodiagnostik, Abt. Chirurgische Faecher, Wien (Austria)]|[Ludwig Boltzmann-Inst. fuer Radiologische Tumorforschung, Wien (Austria); Niederle, B. [Universitaetsklinik fuer Chirurgie, Univ. Wien (Austria)

    1999-07-01

    This paper describes the diagnostic value of new imaging techniques in characterization of adrenal masses and evaluates the role of adrenal biopsy. For differentiation of benign and malignant adrenal lesions, sensitivities and specificities of 85-100% can be reached by unenhanced computed tomography (CT) methods, chemical shift techniques in magnetic resonance imaging (MRI), delayed enhanced CT techniques, and by evaluation of wash-out curves in contrast-enhanced CT. The diagnostic value of all CT techniques depends on threshold values. The value of dynamic contrast-enhanced MRI is under discussion and should be reevaluated by using delayed enhance series. Biochemical and scintigraphic methods (NP 59 iodine iodomethyl-norcholesterol and MIBG meta-iodobenzylguanidine scintigrams) are valuable for the diagnosis of functional adrenal masses; however, they do not allow differentiation of benign and malignant tumors. According to excellent results of new imaging techniques in characterization of adrenal masses, the indications for fine-needle aspiration biopsy have already regressed, as have complications associated with this invasive technique. (orig.) [Deutsch] Diese Arbeit beschreibt die Moeglichkeiten der Charakterisierung von Nebennierenlaesionen durch die Bildgebung von neuen Untersuchungstechniken und evaluiert den geaenderten Stellenwert der Nebennierenbiopsie. Mittels der nativen Computertomographie (CT), der Chemical-Shift-Technik der Magnetresonanztomographie (MRT) oder Dichtemessungen in CT-Kontrastmittelspaetserien bzw. der Bestimmung des prozentuellen Dichteverlustes in CT-Kontrastmittelserien koennen in der Differenzierung von benignen und malignen Nebennierenlaesionen Sensitivitaeten und Spezifitaeten von 85%-100% erreicht werden. Die diagnostische Wertigkeit der CT-Techniken ist abhaengig von der Definition eines Schwellenwertes. Die Wertigkeit der dynamischen KM-verstaerkten MRT wird derzeit unterschiedlich beurteilt und sollte anhand verbesserter

  7. Progress of BeiDou time transfer at NTSC

    Science.gov (United States)

    Guang, Wei; Dong, Shaowu; Wu, Wenjun; Zhang, Jihai; Yuan, Haibo; Zhang, Shougang

    2018-04-01

    Time transfer using global navigation satellite system (GNSS) is a primary method of remote atomic clock comparisons. As of today, there are four operational GNSS systems, namely GPS, GLONASS, Galileo and BeiDou Navigation Satellite System (BDS or BeiDou). All of them can continuously provide position, navigation and time services. This paper mainly focuses on the progress of BeiDou time transfer at the National Time Service Center, Chinese Academy of Sciences (NTSC). In order to realize the BeiDou common view (CV) time comparison, we developed the Rinex2CGGTTS software according to the guidelines of the Common GNSS Generic Time Transfer Standard, Version 2E (CGGTTS V2E). By comparing the solutions of the Rinex2CGGTTS software to the solutions of the sbf2cggtts software provided by the manufacturer of our multi-GNSS receiver, we found the sbf2cggtts (version 1.0.5) solutions contained biases in measurements to different BeiDou satellites. The biases are most likely caused by sbf2cggtts’ timing group delay corrections in data processing. The noise of the observation data is analyzed by code multipath and common clock difference. Finally, the BeiDou CV results are compared to the GPS/GLONASS/Galileo CV results between NTSC and three European UTC(k) laboratories, including Royal Observatory of Belgium (ORB), Real Institute y Observatory de la Armada (ROA), Research Institutes of Sweden (RISE or SP). For the comparisons of each baseline, we aligned the BeiDou/Galileo/GLONASS links to the calibrated GPS link with the double-difference method. The results show that the performance of BeiDou CV is correlated to the number of BeiDou satellites available in common view. With the current BeiDou constellation, the standard deviation of the differences between all BeiDou CV satellites averaging result and the GPS PPP result is 2.03 ns, 2.90 ns and 4.06 ns for ORB-NTSC, SP-NTSC and ROA-NTSC links respectively.

  8. Osteoporose bei Spondylitis ankylosans - Einfluß von Lebensgewohnheiten

    Directory of Open Access Journals (Sweden)

    Aglas F

    2004-01-01

    Full Text Available Krankheitsbedingte Artefakte können bei der SpA (Spondylitis ankylosans; Mb. Bechterew die Sensitivität einer Knochendichtemessung im Lumbalbereich beeinträchtigen. Das bei dieser rheumatischen Erkrankung bekannte Osteoporoserisiko ist neben genetischen Faktoren und Entzündungsmechanismen auch von verschiedenen exogenen Einflüssen abhängig. An 47 SpA-Patienten wurde mittels DEXA eine vergleichende Knochendichtemessung (BMD an der Hüfte (Schenkelhals und Ward'sches Dreieck sowie im Bereich der Wirbelsäule (L1-L4 vorgenommen. Zusätzlich erfolgte eine Erhebung der Lebens-Ernährungsgewohnheiten der SpA-Patienten in bezug auf die BMD, um exogene Einflüsse erfassen zu können. Die Knochendichtemessungen ergaben an der LWS wesentlich häufiger eine BMD im Normbereich als am proximalen Femur. Besonders deutliche Unterschiede traten im höheren Lebensalter auf, bei dem aufgrund von Kalzifizierungsvorgängen und Syndesmophyten an der LWS fälschlicherweise eine Dichtezunahme vorgetäuscht wird. Es kann daher bei SpA empfohlen werden, die wesentlich sensitivere Dichtemessung am Schenkelhals durchzuführen. Die über einen Zeitraum von 3 Jahren beobachteten, signifikant erhöhten, medianen CRP-Spiegel zeigen, daß eine permanente Aktivierung von Entzündungsprozessen bei SpA auch einen negativen Faktor betreffend des Knochenmasseverlustes darstellt. Die Analyse der Lebensgewohnheiten ergab, daß SpA-Patienten mit normaler BMD ausnahmslos regelmäßig kalziumreiche Nahrungsmittel zu sich nehmen; bei verminderter BMD wurde in der Mehrheit ein fehlender Konsum an Milchprodukten beobachtet. Leider war auch mit abnehmender BMD eine Verminderung der bei SpA empfohlenen Bewegungsübungen festzustellen. Aufgrund der Resultate ergibt sich eine generelle Empfehlung zu regelmäßigen Bewegungsübungen plus Osteoporosediät bei allen Bechterew-Patienten.

  9. Overcoming the Challenges of BeiDou Receiver Implementation

    Directory of Open Access Journals (Sweden)

    Mohammad Zahidul H. Bhuiyan

    2014-11-01

    Full Text Available Global Navigation Satellite System (GNSS-based positioning is experiencing rapid changes. The existing GPS and the GLONASS systems are being modernized to better serve the current challenging applications under harsh signal conditions. These modernizations include increasing the number of transmission frequencies and changes to the signal components. In addition, the Chinese BeiDou Navigation Satellite system (BDS and the European Galileo are currently under development for global operation. Therefore, in view of these new upcoming systems the research and development of GNSS receivers has been experiencing a new upsurge. In this article, the authors discuss the main functionalities of a GNSS receiver in view of BDS. While describing the main functionalities of a software-defined BeiDou receiver, the authors also highlight the similarities and differences between the signal characteristics of the BeiDou B1 open service signal and the legacy GPS L1 C/A signal, as in general they both exhibit similar characteristics. In addition, the authors implement a novel acquisition technique for long coherent integration in the presence of NH code modulation in BeiDou D1 signal. Furthermore, a simple phase-preserved coherent integration based acquisition scheme is implemented for BeiDou GEO satellite acquisition. Apart from the above BeiDou-specific implementations, a novel Carrier-to-Noise-density ratio estimation technique is also implemented in the software receiver, which does not necessarily require bit synchronization prior to estimation. Finally, the authors present a BeiDou-only position fix with the implemented software-defined BeiDou receiver considering all three satellite constellations from BDS. In addition, a true multi-GNSS position fix with GPS and BDS systems is also presented while comparing their performances for a static stand-alone code phase-based positioning.

  10. Positron emission tomography in urological cancer; Positronenemissionstomographie bei urologischen Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Wit, M. de [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. Onkologie/Haematologie, Medizinische Klinik; Kotzerke, J. [Universitaetsklinikum Ulm (DE). Radiologie III (Nuklearmedizin)

    2000-09-01

    In staging cancer of the urinary bladder, the kidneys and the prostate and of testicular cancer there is a need for detecting tumor involvement of the lymph nodes to avoid surgical exploration. Positron emission tomography (PET) using fluorodeoxyglucose (FDG) can detect tumorous lymph nodes (sensitivity: 70%, specificity: 85%) which is helpful for several patients. In carcinoma of the prostate, other radiotracers than FDG (e.g. C-11-choline) might be more sensitive to detect tumorous lymph nodes. Up to now no diagnostical benefit of PET in germ cell tumors could be demonstrated in the published small series. In principle FDG-PET is useful in diagnosis of recurrence. In germ cell cancer FDG-PET seems to identify effectively persistent vital tumor tissue after chemotherapy. A multicenter study was initiated to demonstrate the potential of FDG-PET in a sufficient number of patients with germ cell tumor. (orig.) [German] Bei Harnblasen-, Nieren-, Prostata- und Hodenkarzinomen besteht aus klinischer Sicht ein Bedarf an verbessertem Lymphknoten-Staging, um die operative Evaluation zu vermeiden. Die Positronenemissionstomographie (PET) mit Fluordeoxyglukose (FDG) kann daher im Einzelfall bei Harnblasen- und Nierenkarzinomen hilfreich sein (bei Sensitivitaet um 70% und Spezifitaet um 85%). Beim Prostatakarzinom koennten sich andere Radiotracer (z.B. C-11-Cholin) bei der Detektion von tumoroesen Lymphknoten ueberlegen erweisen. Bei Keimzelltumoren konnte ein Nutzen der PET im primaeren Staging bei den bisher publizierten kleinen Studien nicht nachgewiesen werden. Fuer die Rezidivdiagnostik ist bei den genannten Tumoren aus grundsaetzlicher Ueberlegung der Einsatz von DFG-PET sinnvoll. Die Erkennung von vitalem malignen Tumorgewebe nach Chemotherapie erscheint bei Keimzelltumoren mit FDG-PET weitgehend sicher zu gelingen. Eine multizentrische Studie wurde begonnen, die hierueber Aufschluss geben wird. (orig.)

  11. Radiologic assessment of the outcome of Keller and Brandes arthroplasty for hallux rigidus; Hallux rigidus operiert nach Keller und Brandes: Radiologische Erfolgs- und Prognoseparameter

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M.J. [Abt. fuer Osteologie, Universitaetsklinik fueer Radiodiagnostik und Besondere Klinische Einrichtung Magnet Resonanz, Wien (Austria)]|[Ludwig-Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Toma, C.D. [Universitaetsklinik fuer Orthopaedie, Wien (Austria); Gottsauner-Wolf, F. [Universitaetsklinik fuer Orthopaedie, Wien (Austria); Imhof, H. [Abt. fuer Osteologie, Universitaetsklinik fueer Radiodiagnostik und Besondere Klinische Einrichtung Magnet Resonanz, Wien (Austria)]|[Ludwig-Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria)

    1996-06-01

    The aim of this study was to evaluate the pre- and postoperative radiographic findings of hallux rigidus treated with Keller and Brandes arthroplasty to determine the radiographic outcome and to identify a prognostic marker. 83 patients with a total of 121 cases of hallux rigidus operated using Keller and Brandes arthroplasty were followed up (mean 9.7 y). A comparison of the pre- and postoperative radiographs, the clinical and subjective findings was predicated on a five point scale: 1. Percentage of proximal phalanx resected (<33%, 33-50%, >50%), 2. joint space, 3. ratio of the length of the first and second metatarsals, 4. first intermetatarsal angle, and 5. hallux valgus angle. In the patient group which had 33-50% of the proximal phalanx excised (n=67. 55%) the highest patient satisfaction was observed (96%). If resection of the proximal phalanx exceeded 50% (n=13. 11%), non physiologic dorsiflexion of the toe occurred and patients were unsatisfied (62%). Excision of less than 33% of the hallux (n=41. 34%) was associated with a recurrent hallux rigidus. No other evaluated radiological parameter proved to be of significance. The most important radiological parameter in the evaluation of the outcome of Keller and Brandes arthroplasty as the percentage of the proximal phalanx which had ben excised. (orig.) [Deutsch] Ziel der Studie war es, auf prae- und postoperativen Roentgenbildern des Hallux rigidus radiologische Parameter zu ermitteln, die den Erfolg der Arthroplastik nach Keller und Brandes abschaetzen und von prognostischer Relevanz sind. 121 Hallux-rigidus-Operationen bei 83 Patienten wurden nachuntersucht (9,7 a). 5 Kriterien wurden an den prae- und postoperativen Roentgenbildern ausgewertet: 1. Anteil der Grosszehengrundgliedresektion in Prozent (<33%, 33-50%, >50%), 2. Gelenkspaltbreite, 3. Laengenverhaeltnis von erstem und zweitem Metartasalknochen, 4. erster Intermetatarsalwinkel und 5. Hallux-valgus-Winkel und mit den klinischen Ergebnissen

  12. Imaging in syndrome complex diabetes mellitus. Current standards and future perspectives; Bildgebung im Syndromkomplex Diabetes mellitus. Stellenwert und Chancen

    Energy Technology Data Exchange (ETDEWEB)

    Hetterich, H.; Schafnitzel, A. [Klinikum der Ludwig-Maximilians-Universitaet, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Bamberg, F. [Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany)

    2015-04-01

    Diabetes mellitus is a highly prevalent multisystemic disorder with numerous potential complications and substantial socioeconomic consequences. In many cases, the patient history, physical examination and laboratory tests are not sufficient for a comprehensive evaluation of complicating disorders. Imaging modalities, such as sonography, computed tomography (CT) and magnetic resonance imaging (MRI) are of major significance in the evaluation of complicating disorders of diabetes according to current guidelines. Examples include assessment of coronary artery disease, peripheral artery disease, stroke and diabetic foot syndrome. Technical developments allow a substantial reduction in radiation dose and scan time in CT and MRI, respectively and could therefore justify a broader application in this patient population. In the future CT and MRI could also be used for the early detection of diabetic complications. Furthermore, they could also be used for risk stratification, e.g. measurement of hepatic fat content and evaluation of atherosclerosis in whole body MRI. Prior to widespread application of advanced imaging techniques in this patient population, improved outcomes with respect to survival, quality of life and cost-effectiveness need to be demonstrated. Diagnostic imaging modalities for the evaluation of the syndrome complex of diabetic disorders should be used according to the current guidelines but the use is predicted to increase given the high potential in this population. (orig.) [German] Diabetes mellitus ist eine hochpraevalente Multisystemerkrankung mit zahlreichen Komplikationen und bedeutenden soziooekonomischen Konsequenzen. Die Folgeerkrankungen koennen oft nicht abschliessend mittels Anamnese, koerperlicher Untersuchung und laborchemischen Verfahren evaluiert werden. Radiologische Verfahren wie die Sonographie, Computertomographie (CT) und Magnetresonanztomographie (MRT) haben gemaess verschiedener Leitlinien einen festen Stellenwert bei der

  13. Precise Point Positioning with the BeiDou Navigation Satellite System

    Directory of Open Access Journals (Sweden)

    Min Li

    2014-01-01

    Full Text Available By the end of 2012, China had launched 16 BeiDou-2 navigation satellites that include six GEOs, five IGSOs and five MEOs. This has provided initial navigation and precise pointing services ability in the Asia-Pacific regions. In order to assess the navigation and positioning performance of the BeiDou-2 system, Wuhan University has built up a network of BeiDou Experimental Tracking Stations (BETS around the World. The Position and Navigation Data Analyst (PANDA software was modified to determine the orbits of BeiDou satellites and provide precise orbit and satellite clock bias products from the BeiDou satellite system for user applications. This article uses the BeiDou/GPS observations of the BeiDou Experimental Tracking Stations to realize the BeiDou and BeiDou/GPS static and kinematic precise point positioning (PPP. The result indicates that the precision of BeiDou static and kinematic PPP reaches centimeter level. The precision of BeiDou/GPS kinematic PPP solutions is improved significantly compared to that of BeiDou-only or GPS-only kinematic PPP solutions. The PPP convergence time also decreases with the use of combined BeiDou/GPS systems.

  14. Precise point positioning with the BeiDou navigation satellite system.

    Science.gov (United States)

    Li, Min; Qu, Lizhong; Zhao, Qile; Guo, Jing; Su, Xing; Li, Xiaotao

    2014-01-08

    By the end of 2012, China had launched 16 BeiDou-2 navigation satellites that include six GEOs, five IGSOs and five MEOs. This has provided initial navigation and precise pointing services ability in the Asia-Pacific regions. In order to assess the navigation and positioning performance of the BeiDou-2 system, Wuhan University has built up a network of BeiDou Experimental Tracking Stations (BETS) around the World. The Position and Navigation Data Analyst (PANDA) software was modified to determine the orbits of BeiDou satellites and provide precise orbit and satellite clock bias products from the BeiDou satellite system for user applications. This article uses the BeiDou/GPS observations of the BeiDou Experimental Tracking Stations to realize the BeiDou and BeiDou/GPS static and kinematic precise point positioning (PPP). The result indicates that the precision of BeiDou static and kinematic PPP reaches centimeter level. The precision of BeiDou/GPS kinematic PPP solutions is improved significantly compared to that of BeiDou-only or GPS-only kinematic PPP solutions. The PPP convergence time also decreases with the use of combined BeiDou/GPS systems.

  15. Imaging of hip joint arthroplasty

    International Nuclear Information System (INIS)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

    2009-01-01

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

  16. Humeral windows in revision total elbow arthroplasty.

    Science.gov (United States)

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  17. Simultaneous and staged bilateral total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik

    2013-01-01

    Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...

  18. CT and MRI of hip arthroplasty

    International Nuclear Information System (INIS)

    Cahir, J.G.; Toms, A.P.; Marshall, T.J.; Wimhurst, J.; Nolan, J.

    2007-01-01

    Plain films are the initial imaging method of choice for evaluation of hip arthroplasty. Recent advances in technology and imaging techniques have largely overcome the problems of beam hardening in computed tomography (CT) and magnetic susceptibility artefact in magnetic resonance imaging (MRI). CT and MRI have now become useful imaging techniques in the assessment of hip arthroplasty

  19. Long-term outcomes of patellofemoral arthroplasty.

    NARCIS (Netherlands)

    Jonbergen, J.P.W. van; Werkman, D.M.; Barnaart, L.F.; Kampen, A. van

    2010-01-01

    The purpose of this study was to correlate the long-term survival of patellofemoral arthroplasty with primary diagnosis, age, sex, and body mass index. One hundred eighty-five consecutive Richards type II patellofemoral arthroplasties were performed in 161 patients with isolated patellofemoral

  20. Transfemoral amputation after failure of knee arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...

  1. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  2. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...

  3. Development and Evaluation of the Biogenic Emissions Inventory System (BEIS) Model v3.6

    Science.gov (United States)

    We have developed new canopy emission algorithms and land use data for BEIS v3.6. Simulations with BEIS v3.4 and BEIS v3.6 in CMAQ v5.0.2 are compared these changes to the Model of Emissions of Gases and Aerosols from Nature (MEGAN) and evaluated the simulations against observati...

  4. Failure of aseptic revision total knee arthroplasties.

    Science.gov (United States)

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-02-01

    In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

  5. UMA PROSPOSTA DEDUTIVISTA PARA PRINCÍPIOS CONTÁBEIS

    OpenAIRE

    Paulo Schmidt

    2009-01-01

    A proposta deste estudo a apresentar um breve relato sobre a evolução do pensamento cientifico ocorrida na física com a substituição dos princípios contábeis e filosófico, desde a Antiguidade grega ate os dias de hoje, como forma de fundamentar o posicionamento contrario ao raciocínio indutivo para o estabelecimento de uma estrutura conceitual para a contabilidade e para o desenvolvimento dos princípios contábeis. Apos essa incursão pelo campo filosófico, será aduzido um dos trabalhos d...

  6. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty

    Science.gov (United States)

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-01-01

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties. PMID:26601055

  7. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  8. Cervical disc arthroplasty: Pros and cons.

    Science.gov (United States)

    Moatz, Bradley; Tortolani, P Justin

    2012-01-01

    Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

  9. POSTERIOR APPROACH FOR HIP ARTHROPLASTY: A SINGLE ...

    African Journals Online (AJOL)

    postulated advantages and disadvantages. Objective: Presentation of a case series of primary and revision arthroplasty utilizing the posterior approach. ... Centre over a period of one year were queried and data extracted and recorded.

  10. Nagelbefall kann bei Patienten mit Psoriasis auf eine Enthesiopathie hinweisen.

    Science.gov (United States)

    Castellanos-González, Maria; Joven, Beatriz Esther; Sánchez, Julio; Andrés-Esteban, Eva María; Vanaclocha-Sebastián, Francisco; Romero, Pablo Ortiz; Díaz, Raquel Rivera

    2016-11-01

    Obwohl subklinische Enthesiopathie ein gut etabliertes diagnostisches Merkmal der Psoriasisarthritis (PsA) ist, wird sie häufig übersehen, da viele Patienten asymptomatisch sind. Gäbe es klinische Hinweise auf das Vorliegen einer Enthesiopathie, würde dies den Klinikern die Möglichkeit eröffnen, eine PsA frühzeitig zu diagnostizieren. Es wurde eine monozentrische prospektive Studie mit insgesamt 90 Psoriasis-Patienten durchgeführt, um mittels Ultraschall das Vorliegen von Enthesenanomalien zu untersuchen und eine Korrelation mit dem Befall der Nägel festzustellen. Enthesenanomalien wurden bei 23 Patienten (25,5 %) gefunden, von denen 19 (82,6 %) Nagelbefall aufwiesen. Bei 4 Patienten waren die Nägel nicht betroffen. Enthesiopathie lag bei 31,1 % (19/61) der Patienten mit Onychopathie vor, von den Patienten ohne Nagelbefall litten nur 13,8 % (4/29) an Enthesiopathie (p = 0,07). Zwischen dem Target-NAPSI-Score und dem Vorliegen einer Enthesiopathie bestand eine signifikante Korrelation. Eine signifikante Korrelation bestand darüber hinaus auch zwischen dem Vorliegen einer Enthesiopathie und der Anzahl der betroffenen Nägel (p = 0,035). Klinische Belege für eine Onychopathie können der Schlüssel für die frühe Diagnose einer Enthesiopathie bei Psoriasis-Patienten sein. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  11. Innovative Development and Forecast of BeiDou System

    Directory of Open Access Journals (Sweden)

    TAN Shusen

    2017-10-01

    Full Text Available Due to the strong demand for satellite applications and rapid development of new space technology,the cross-integration of space-based radio systems has become a trend.BeiDou system started from two satellites to build China's first generation satellite navigation and positioning system with the features of fast location reporting(RDSSand short message communication(MSSservice.Then BeiDou technology frame combined with RNSS continuous navigation and RDSS location report,was constructed in eight years,and the coverage in Asia-Pacific was completed.Through effective satellite radio frequency compatible design and international coordination,BeiDou system is the first radio satellite system which includes RNSS,RDSS,MSS three major services,approved by International Telecommunication Union(ITUin the world.This paper expounds the development process,technical frame,main features and prospect of BeiDou system with three major services and four key functions,in the concept of innovation and transcendence.

  12. Untersuchungen zum Fettsäurestoffwechsel bei koronarer Herzkrankheit

    OpenAIRE

    Richter, Wolf-Stefan

    2001-01-01

    Die nicht-invasive bildgebende Diagnostik hat bei koronarer Herzkrankheit einen wichtigen Stellenwert für die Diagnosestellung und Therapieplanung. In diesem Zusammenhang liefern nuklearmedizinische Verfahren wichtige Daten zur Gewebsperfusion und erlauben die bildliche Darstellung und Quantifizierung relevanter Details des kardiomyozytären Stoffwechsels. Die quantitativ bedeutendste Methode der nuklearmedizinischen Herzdiagnostik ist die Perfusionsszintigraphie mit Tl-201 oder einem der Tc-9...

  13. Contributions on biomedical imaging, with a side-look at molecular imaging; Beitraege zur biomedizinischen Bildgebung mit einem Seitenblick auf Molecular Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, G. (ed.)

    2004-05-01

    This report is intended as a brief introduction to the emerging scientific field of biomedical imaging. The breadth of the subject is shown and future fields of research are indicated, which hopefully will serve as a guide to the identification of starting points for the research in 'Biomedical and/or Molecular Imaging' at the GSF-National Research Center for Environment and Health. The report starts with a brief sketch of the history. Then a - necessarily incomplete - list of research topics is presented. It is organized in two parts: the first one addresses medical imaging, and the second one is concerned with biological point aspects of the matter. (orig.) [German] In diesem Bericht sind einige Beitraege zum Gebiet 'Bildgebende Verfahren in Biologie und Medizin' zusammengestellt. Sie stammen saemtlich aus dem Institut fuer Biomathematik und Biometrie, IBB, am Forschungszentrum fuer Umwelt und Gesundheit, GSF, in Muenchen/Neuherberg, und seinem engeren Umfeld. Ziel war es, zu sichten, was in und um diesen Themenkreis herum an Wissen und sonstiger Kompetenz hier vorhanden ist. Einige am IBB etablierte Gebiete wie Roentgen-Mammographie oder funktionelle Magnetresonanztherapie wurden ausgeblendet. Der Grund ist die Fokussierung auf ein nicht exakt definierbares, neues Gebiet der Bildgebung, das unter dem Namen 'Molecular Imaging' kursiert und derzeit Furore macht macht. (orig.)

  14. Contributions on biomedical imaging, with a side-look at molecular imaging; Beitraege zur biomedizinischen Bildgebung mit einem Seitenblick auf Molecular Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, G [ed.

    2004-05-01

    This report is intended as a brief introduction to the emerging scientific field of biomedical imaging. The breadth of the subject is shown and future fields of research are indicated, which hopefully will serve as a guide to the identification of starting points for the research in 'Biomedical and/or Molecular Imaging' at the GSF-National Research Center for Environment and Health. The report starts with a brief sketch of the history. Then a - necessarily incomplete - list of research topics is presented. It is organized in two parts: the first one addresses medical imaging, and the second one is concerned with biological point aspects of the matter. (orig.) [German] In diesem Bericht sind einige Beitraege zum Gebiet 'Bildgebende Verfahren in Biologie und Medizin' zusammengestellt. Sie stammen saemtlich aus dem Institut fuer Biomathematik und Biometrie, IBB, am Forschungszentrum fuer Umwelt und Gesundheit, GSF, in Muenchen/Neuherberg, und seinem engeren Umfeld. Ziel war es, zu sichten, was in und um diesen Themenkreis herum an Wissen und sonstiger Kompetenz hier vorhanden ist. Einige am IBB etablierte Gebiete wie Roentgen-Mammographie oder funktionelle Magnetresonanztherapie wurden ausgeblendet. Der Grund ist die Fokussierung auf ein nicht exakt definierbares, neues Gebiet der Bildgebung, das unter dem Namen 'Molecular Imaging' kursiert und derzeit Furore macht macht. (orig.)

  15. MR imaging of osteonecrosis using frequency selective chemical shift sequences; Neue Aspekte in der MR-Diagnostik der Osteonekrose: Selektive Fett/Wasser-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Duda, S H [Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Laniado, M [Abt. fuer Radiologische Diagnostik, Tuebingen Univ. (Germany); Schick, F [Inst. fuer Physik, Tuebingen Univ. (Germany)

    1994-12-31

    The MR appearance of osteonecrosis was assessed on selective fat- and water images to further evaluate the nature of double-line sign. Conventional T1- and T2-weighted SE and frequency selective chemical shift images of eight patients with avascular necrosis of the femoral head and three patients with bone infarcts were retrospectively reviewed. Eight of 11 patients showed a double-line sign on T2-weighted SE images. In these cases, correlation with selective water images revealed that a chemical shift artifact contributed to appearance and location of the hyperintense line. The authors conclude that chemical shift imaging improves our understanding of the nature of the double-line sign. (orig.) [Deutsch] Das MR-tomographische Erscheinungsbild der Osteonekrose auf selektiven Fett- und Wasserbildern wurde analysiert, um das in der Literatur beschriebene Doppellinienzeichen naeher zu untersuchen. Hierfuer wurden sowohl die herkoemmlichen T1- und T2-gewichteten Spin-Echo-Sequenzen herangezogen, als auch frequenzselektive Bilder, die aufgrund chemischer Verschiebung gewonnen wurden (1,5 T). Es wurden die Untersuchungen von acht Patienten mit avaskulaerer Hueftkopfnekrose und von drei Patienten mit Knocheninfarkten retrospektiv ausgewertet. Acht von 11 Patienten zeigten ein Doppellinienzeichen auf den T2-gewichteten Bildern. Die Korrelation mit den selektiven Wasserbildern ergab, dass durch chemische Verschiebung bedingte Artefakte das Erscheinungsbild und den Ort der hyperintensen Linie beeinflussten. Die Bildgebung mit Hilfe der chemischen Verschiebung verbessert unser Verstaendnis der MRT-Charakteristika der Osteonekrose. (orig.)

  16. Robotics in Arthroplasty: A Comprehensive Review.

    Science.gov (United States)

    Jacofsky, David J; Allen, Mark

    2016-10-01

    Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Return to sports after shoulder arthroplasty

    Science.gov (United States)

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  18. Osteoporose bei Mb. Bechterew - neue Ansätze

    Directory of Open Access Journals (Sweden)

    Obermayer-Pietsch B

    1999-01-01

    Full Text Available Eine axiale Osteoporose und daraus resultierende vertebrale Kompressionsfrakturen sind häufige Symptome eines Mb. Bechterew (MbB, Spondylarthritis ankylosans. Als ein möglicher genetischer Faktor der Osteoporose wurde eine Assoziation der Knochendichte (BMD mit BsmI- und FokI-Polymorphismen im Vitamin D-Rezeptor-(VDR-Gen publiziert. In der vorliegenden Studie wurden die Beziehungen zwischen diesen Polymorphismen, Knochenstoffwechsel, BMD und Aktivitätsindizes bei Patienten mit MbB untersucht. Bei 47 MbB-Patienten wurden Aktivitätsindizes und morphologische Parameter sowie BMD-Messungen (Dual-Röntgen-Absorptiometrie an Wirbelsäule und Schenkelhals im Vergleich zu 52 gesunden, altersgleichen Personen erhoben. Die Laborbestimmungen umfaßten biochemische Aktivitätsparameter, HLA-Typisierung sowie Knochenan- und -abbaumarker. Aus peripheren Leukozyten wurde genomische DNA präpariert und mittels Polymerase-Kettenreaktion (PCR und anschließender FokI- und BsmI-Restriktion der VDR-Genotyp nach vorhandenen bzw. fehlenden Schnittstellen (f/b bzw. F/B bestimmt. Bei MbB-Patienten fand sich eine Osteoporose deutlich häufiger als in der Kontrollgruppe. Eine Zuordnung von Aktivitätsindizes, BMD und Knochenstoffwechselparametern zu den Genotypen zeigte bei männlichen MbB-Patienten sowohl eine Assoziation der WS-Knochendichte als auch der Entzündungsmarker mit FokI-, nicht jedoch mit BsmI-Genotypen des VDR. Die pathophysiologischen Mechanismen dieser Assoziation, insbesondere mit der entzündlichen Aktivität des Mb. Bechterew, sind noch ungeklärt. Eine frühzeitige Erfassung des Osteoporoserisikos bei MbB-Patienten mittels molekularbiologischer Tests könnte eine rechtzeitige Prophylaxe und Therapie dieser Komplikation ermöglichen.

  19. Clinical outcome after treatment of infected primary total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jensen, Tim Toftgaard

    2002-01-01

    Twenty-six consecutive cases of infected primary total knee arthroplasties were treated at our institution from 1989 through 2000. Eleven patients had debridement and irrigation performed within 2 months of index arthroplasty or hematogenous spread; only one infection was eradicated. Twenty......-five patients had their prostheses removed; 17 had two-stage revision arthroplasty, following which infection was eradicated in 15; one had a permanent spacer, 7 had arthrodesis (following failed revision arthroplasty in one) and 2 had a femur amputation (following failed revision arthroplasty in one) at follow......-up of mean 24 months. Infections were cured equally well with revision arthroplasty and arthrodesis. Among the 15 patients who ended up with revision arthroplasty, 11 had a better range of motion compared to the index arthroplasty, but 8 had daily pain. We present our treatment protocol, which eradicated 15...

  20. Instability following total knee arthroplasty.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos

    2011-10-01

    Background Knee prosthesis instability (KPI) is a frequent cause of failure of total knee arthroplasty. Moreover, the degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated. Questions This review aims to define the problem, analyze risk factors, and review strategies for prevention and treatment of KPI. Methods A PubMed (MEDLINE) search of the years 2000 to 2010 was performed using two key words: TKA and instability. One hundred and sixty-five initial articles were identified. The most important (17) articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed and provided solutions to the diagnosis and treatment of KPI. Results Patient-related risk factors predisposing to post-operative instability include deformity requiring a large surgical correction and aggressive ligament release, general or regional neuromuscular pathology, and hip or foot deformities. KPI can be prevented in most cases with appropriate selection of implants and good surgical technique. When ligament instability is anticipated post-operatively, the need for implants with a greater degree of constraint should be anticipated. In patients without significant varus or valgus malalignment and without significant flexion contracture, the posterior cruciate ligament (PCL) can be retained. However, the PCL should be sacrificed when deformity exists particularly in patients with rheumatoid arthritis, previous patellectomy, previous high tibial osteotomy or distal femoral osteotomy, and posttraumatic osteoarthritis with disruption of the PCL. In most cases, KPI requires revision surgery. Successful outcomes can only be obtained if the cause of KPI is identified and addressed. Conclusions Instability following TKA is a common cause of the need for revision. Typically, knees with deformity, rheumatoid arthritis, previous patellectomy or high tibial osteotomy, and

  1. the choice of arthroplasty implants in a developing country

    African Journals Online (AJOL)

    The use of arthroplasty in end stage arthritis in Kenya is now established. Arthroplasty is now carried out in a number of the main city hospitals, particularly in the private sector and in some mission hospitals. Some patients travel out of the country, particularly to India in search of arthroplasty. There is, also, an increasing.

  2. Cryotherapy on postoperative rehabilitation of joint arthroplasty.

    Science.gov (United States)

    Ni, Sheng-Hui; Jiang, Wen-Tong; Guo, Lei; Jin, Yu-Heng; Jiang, Tian-Long; Zhao, Yuyan; Zhao, Jie

    2015-11-01

    The effectiveness of cryotherapy on joint arthroplasty recovery remains controversial. This systematic review was conducted to assess the effectiveness of cryotherapy in patients after joint arthroplasty. Comprehensive literature searches of several databases including Cochrane Library (2013), MEDLINE (1950-2013), and Embase (1980-2013) were performed. We sought randomised controlled trials that compared the experimental group received any form of cryotherapy with any control group after joint arthroplasty. The main outcomes were postoperative blood loss, adverse events, and pain. Analyses were performed with Revman 5.0. Results were shown as mean differences (MD) and standard deviations or as risk difference and 95 % confidence intervals (CIs). Ten trials comprised 660 total knee arthroplastys and three trials comprised 122 total hip arthroplastys (THAs) met the inclusion criteria. Blood loss was significantly decreased by cryotherapy (MD = -109.68; 95 % CI -210.92 to -8.44; P = 0.03). Cryotherapy did not increase the risk of adverse effect (n.s.). Cryotherapy decreased pain at the second day of postoperative (MD = -1.32; 95 % CI -2.37 to -0.27; P = 0.0003), but did not decreased pain at the first and third day of postoperative (n.s.). Cryotherapy appears effective in these selected patients after joint arthroplasty. The benefits of cryotherapy on blood loss after joint arthroplasty were obvious. However, the subgroup analysis indicated that cryotherapy did not decreased blood loss after THA. Cryotherapy did not increase the risk of adverse effect. Cryotherapy decreased pain at the second day of postoperative, but did not decreased pain at the first and third day of postoperative. II.

  3. PET in cerebrovascular disease; PET bei zerebrovaskulaeren Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Herholz, K. [Neurologische Universitaetsklinik der Univ. Koeln (Germany)]|[Max-Planck-Institut fuer Neurologische Forschung, Koeln (Germany)

    1997-03-01

    Tissue viability is of particular interest in acute cerebral ischemia because it may be preserved if reperfusion can be achieved rapidly, e.g. by acute thrombolysis. Measurements of regional cerebral blood flow (CBF) and oxygen consumption by PET can assess tissue viability, and they have substantially increased our knowledge of th pathophysiology of ischemic stroke and the associated penumbra. Widerspread clinical application in acute stroke, however, is unlikely because of the large logistic and personnel resources required. In chronic cerebrovascular disease, measurement of regional CBF and glucose metabolism, which is usually coupled, provide detailed insights in disturbance of cortical function, e.g. due to deafferentiation, and contribute to differentiation of dementia types. Chronic misery perfusion, i.e. reduced perfusion that does not match the metabolic demand of the tissue, can be demonstrated by PET. It may be found in some patients with high-grade arterial stenoses. Less severe impairment of brain perfusion can be demonstrated by measurement of the cerebrovascular reserve capacity. The most frequent clinical situations can be assessed by less demanding procedures, e.g. by SPECT. In conclusion, PET has its role in cerebrovascular disease primarily within scientific studies, where high resolution and absolute quantitation of physiological variables are essential. (orig.). 65 refs. [Deutsch] Beim akuten ischaemischen Insult ist die Vitalitaet des Gewebes von besonderem Interesse, da sie durch rasche Reperfusion, z.B. durch Thrombolyse, erhalten bleiben kann. Messungen der zerebralen Durchblutung und des Sauerstoffumsatzes mittels PET geben darueber wesentliche Aufschluesse, und sie sind wichtig fuer das Verstaendnis der Pathophysiologie ischaemischer Infarkte und der Penumbra mit kritischer Perfusion beim Menschen. Ihre breitere Anwendung in der klinischen Patientenversorgung kommt allerdings wegen des hohen Aufwandes derzeit kaum in Betracht. Bei

  4. No clinical difference between large metal-on-metal total hip arthroplasty and 28-mm-head total hip arthroplasty?

    NARCIS (Netherlands)

    Zijlstra, Wierd P; van den Akker-Scheek, Inge; Zee, Mark J M; van Raay, Jos J A M

    2011-01-01

    PURPOSE: We aimed to test the claim of greater range of motion (ROM) with large femoral head metal-on-metal total hip arthroplasty. METHODS: We compared 28-mm metal-on-polyethylene (MP) total hip arthroplasty with large femoral head metal-on-metal (MM) total hip arthroplasty in a randomised clinical

  5. Functional MR mapping of higher cognitive brain functions; Neurofunktionelle MR-Bildgebung hoeherer kognitiver Leistungen des menschlichen Gehirns

    Energy Technology Data Exchange (ETDEWEB)

    Bellemann, M E [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie; Spitzer, M [Psychiatrische Universitaetsklinik, Heidelberg (Germany). Sektion Experimentelle Psychopathologie; Brix, G [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie; Kammer, T [Psychiatrische Universitaetsklinik, Heidelberg (Germany). Sektion Experimentelle Psychopathologie; Loose, R [Heidelberg Univ., Mannheim (Germany). Inst. fuer Klinische Radiologie; Schwartz, A [Heidelberg Univ., Mannheim (Germany). Neurologische Klinik; Gueckel, F [Heidelberg Univ., Mannheim (Germany). Inst. fuer Klinische Radiologie

    1995-04-01

    Probanden erfasst. Der Zeitverlauf der kortikalen Aktivierung wurde in einer Serie von stark T{sub 2}*-gewichteten Gradientenechobildern gemessen. Die fMRT-Daten zeigten einen subtilen (2-5%), aber statistisch signifiakten Signalanstieg waehrend der Phasen mit induzierter Hirnaktivitaet. Bei der Beurteilung von Wortpaaren hinsichtlich ihrer semantischen Verwandtschaft wurden selektiv Kortexareale im linken Frontal- und Temporallappen aktiviert. Die Staerke der neuronalen Aktivierung nahm - parallel zu den entsprechenden Reaktionszeiten - im Laufe der Praesentation des semantischen Stimulus signifikant ab. Nur durch den Einsatz psychometrisch optimierter Aktivierungsparadigmen konnten die Hirnareale, die in die Bearbeitung semanitischer Begriffe involviert sind, eindeutig identifiziert werden. Die Reaktionszeitdaten zeigten einen selektiven Lerneffekt beim semantischen Paradigma und erleichterten damit die Interpretation der fMRT-Bilder. (orig.)

  6. Radiological imaging of the upper gastrointestinal tract. Pt. 1. The esophagus; Radiologische Bildgebung des oberen Gastrointestinaltrakts. T. 1. Oesophagus

    Energy Technology Data Exchange (ETDEWEB)

    Hansmann, J.; Grenacher, L. [Radiologische Universitaetsklinik, Abteilung Radiodiagnostik, Heidelberg (Germany)

    2006-12-15

    - und andere Pulsationsdivertikel sollten einer funktionellen Untersuchung zugefuehrt werden. Die Sooroesophagitis imponiert im Breischluck mit charakteristischen Ulzerationen. Oesophagogastrale Hernien werden mit Breischluck genauer dargestellt als endoskopisch. Ein gastrooesophagealer Reflux kann radiologisch diagnostiziert werden, diskrete Entzuendungen und Epitheldysplasien sind wesentlich besser mit endoskopischen Techniken zu untersuchen. Bei Oesophagustumoren ergaenzt die Radiologie die endoskopisch-endosonographischen Befunde. (orig.)

  7. MR imaging in chronic epicondylitis humeri radialis at 1.0 T: is Gd-DTPA administration useful?; MRT bei chronischer Epicondylitis humeri radialis an einem 1,0 T-Geraet - Kontrastmittelgabe notwendig?

    Energy Technology Data Exchange (ETDEWEB)

    Herber, S.; Kalden, P.; Kreitner, K.-F.; Thelen, M. [Tuebingen Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Riedel, C.; Rompe, J.D. [Klinik und Poliklinik fuer Orthopaedie Johannes-Gutenberg-Univ. Mainz (Germany)

    2001-05-01

    eine Flash 2D-Sequenz. Au paragraph erdem wurde eine T{sub 1}-gewichtete, fettsupprimierte SE-Sequenz vor und nach i.v. KM-Gabe angefertigt. Ergebnisse: In 39/42 Faellen wurden pathologische Veraenderungen der Extensorensehnen beobachtet. Eine pathologische Verdickung oder eine Ruptur respektive Partialruptur des Lig. collaterale radiale zeigte sich in 15/42 Faellen, ein Knochenmarkoedem am lateralen Epicondylus wiesen 6 Patienten und einen Gelenkerguss 18/42 auf. Nach KM-Gabe zeigte sich in der T{sub 1}-gewichteten SE-Sequenz in 29/42 Faellen ein durchschnittlicher Anstieg des Signal-zu-Rausch-Verhaeltnisses um den Faktor 1,5. Zusatzinformationen durch Kontrastmittelgabe wurden im Vergleich zur Nativdiagnostik nicht gewonnen. Schlussfolgerung: Im Rahmen der MRT-Bildgebung bei chronischer Epicondylitis kann auf die i.v. Gabe von Gadolinium-DTPA bei fehlendem diagnostischen Zugewinn verzichtet werden. (orig.)

  8. [Sport activity after hip and knee arthroplasty].

    Science.gov (United States)

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

  9. Analytische Betrachtung des Quantisierungsfehlers bei grundlegenden Rechenoperationen der digitalen Signalverarbeitung

    Directory of Open Access Journals (Sweden)

    W. Schlecker

    2005-01-01

    Full Text Available Bei der Realisierung digitaler Schaltungen mit einem ASIC oder FPGA kann die Wortbreite der Berechnungen frei gewählt werden. Um die Fläche bzw. die benötigte Hardware zu minimieren, wird versucht, die Berechnungen mit minimaler Wortbreite zu implementieren. Dabei muss jedoch das Quantisierungsrauschen, das durch das Beschränken der Wortbreite entsteht, berücksichtigt werden. Häufig wird hierzu eine worst-case Abschätzung des Fehlers gemacht oder mit Simulationen die benötigte Wortbreite bestimmt. Der vorliegende Beitrag betrachtet die Auswirkungen der Quantisierung analytisch. Dabei wird von gleichverteilten Eingangssignalen ausgegangen. Es wird das Quantisierungsrauschen in Abhängigkeit von der Eingangs- und Ausgangswortbreite bei der Multiplikation und beim Skalarprodukt betrachtet. Die Untersuchungen wurden für Runden und für Abschneiden analytisch durchgeführt und durch Simulation bestätigt.

  10. Endokrinologische Behandlung der Geschlechtsdysphorie bei Menschen mit Geschlechtsinkongruenz

    Directory of Open Access Journals (Sweden)

    Flütsch N

    2015-01-01

    Full Text Available Es gibt Menschen, die die innere Gewissheit besitzen, dass ihre Geschlechtsidentität nicht zu ihrem biologischen Ursprungsgeschlecht passt. Durch die Entwicklungen in der Medizin in den letzten hundert Jahren ist es möglich geworden, die körperlichen Geschlechtsmerkmale an das innerlich erlebte Geschlecht anzupassen. Die Zahl der Hilfesuchenden in den ärztlichen Ambulanzen und Privatpraxen hat in den vergangenen Jahren deutlich zugenommen. Das Vorgehen bei der Diagnostik und Therapieeinleitung erlebt zurzeit eine deutliche Veränderung hin zu mehr Patientenzentriertheit und Individualisierung des Transitionsprozesses. Dabei bildet die geschlechtsangleichende Hormontherapie ein wesentliches Standbein in der körperlichen Angleichung an das Gegengeschlecht. Unter Beachtung von bestimmten Sicherheitsaspekten ist eine Hormontherapie mit Sexualhormonen sicher und einfach durchzuführen. Regelmäßige Verlaufskontrollen sowie der offene und affirmative Umgang mit den Betroffenen tragen zudem wesentlich zur Sicherheit in der Behandlung bei.

  11. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen. Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  12. Kulturspezifische Elemente und ihre Problematik bei der Filmsynchronisierung

    Directory of Open Access Journals (Sweden)

    Prof. Dr. Carmen Cuéllar Lázaro

    2013-07-01

    Full Text Available Bei der Untersuchung der Übersetzungsproblematik von kulturspezifischen Elementen geht es darum, diese Konzepte begrifflich abzugrenzen, inhaltlich und sprachlich zu klassifizieren sowie die Problematik ihrer Übersetzung zu beschreiben. Bei der Filmsynchronisierung sind außerdem die Merkmale und besonderen Bedingungen des Mediums und des audiovisuellen Textes zu berücksichtigen.   Die Zielsetzung dieser Studie ist, die Übersetzung von kulturspezifischen Elementen der Filmsynchronisierung (Deutsch-Spanisch zu analysieren. Wir schlagen ein Zwei-Ebenen-Modell vor: Die erste Ebene berücksichtigt die Art der erfahrenen sprachlichen Bearbeitung. Auf der zweiten Ebene wird die kulturelle Orientierung der Ergebnisse untersucht. Danach werden einige Schlussfolgerungen aus der spanischen Synchronfassung gezogen.

  13. Osteoporose bei Mb. Bechterew - neue Ansätze

    OpenAIRE

    Obermayer-Pietsch B; Aglas F; Hermann J; Leb G; Tauber G

    1999-01-01

    Eine axiale Osteoporose und daraus resultierende vertebrale Kompressionsfrakturen sind häufige Symptome eines Mb. Bechterew (MbB, Spondylarthritis ankylosans). Als ein möglicher genetischer Faktor der Osteoporose wurde eine Assoziation der Knochendichte (BMD) mit BsmI- und FokI-Polymorphismen im Vitamin D-Rezeptor-(VDR-)Gen publiziert. In der vorliegenden Studie wurden die Beziehungen zwischen diesen Polymorphismen, Knochenstoffwechsel, BMD und Aktivitätsindizes bei Patienten mit MbB untersuc...

  14. MR spectroscopy in dementia; MR-Spektroskopie bei Demenz

    Energy Technology Data Exchange (ETDEWEB)

    Hauser, T.; Gerigk, L.; Giesel, F.; Schuster, L.; Essig, M. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung E010, Radiologie, Heidelberg (Germany)

    2010-09-15

    With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia. (orig.) [German] Angesichts einer immer aelter werdenden Bevoelkerung sind wir mit dem Problem einer zunehmenden Zahl an Demenzerkrankungen konfrontiert. Neben klinischen, neuropsychologischen und laborchemischen Verfahren spielt die MRT zur Fruehdiagnostik einer Demenz eine wichtige Rolle. Morphologische Veraenderungen wie auch verschiedene funktionelle Verfahren helfen bei der Diagnostik und Differenzialdiagnostik einer Demenz. Insgesamt kann mittels MR-spektroskopischer Parameter die Diagnostik einer Demenz verbessert werden. In diesem Artikel soll auf MR-spektroskopische Veraenderungen im Rahmen des physiologischen Alterungsprozesses eingegangen werden. Ferner werden speziell Veraenderungen bei leichter kognitiver Beeintraechtigung, einer Vorform der Alzheimer-Demenz, bei Alzheimer-, frontotemporaler, vaskulaerer und Lewy-Koerper-Demenz eroertert. (orig.)

  15. Die Rolle von RANK-Ligand und Osteoprotegerin bei Osteoporose

    Directory of Open Access Journals (Sweden)

    Hofbauer LC

    2004-01-01

    Full Text Available Receptor activator of nuclear factor (NF- κB ligand (RANKL, sein zellulärer Rezeptor RANK und der Decoy-Rezeptor Osteoprotegerin (OPG stellen ein essentielles Zytokinsystem für die Zellbiologie von Osteoklasten dar. Verschiedene Untersuchungen belegen die Bedeutung von Störungen des OPG/RANKL/RANK-Systems bei der Pathogenese metabolischer Knochenerkrankungen. In dieser Arbeit werden die wichtigsten Störungen des OPG/RANKL/RANK-Systems bei verschiedenen Osteoporoseformen dargestellt. Östrogenrezeptor- (ER- Agonisten wie 17 β-Östradiol, Raloxifen und Genistein stimulieren die osteoblastäre Produktion von OPG durch Aktivierung von ER- α in vitro, während Lymphozyten von Patientinnen mit Östrogenmangel RANKL überexprimieren. Die parenterale Gabe von OPG vermag den mit Östrogenmangel assoziierten Knochenverlust im Tiermodell und in einer kleineren klinischen Studie zu verhindern. Glukokortikoide und Immunsuppressiva steigern gleichzeitig die RANKL-Expression und hemmen die OPG-Produktion in osteoblastären Zellen in vitro. Glukokortikoide sind auch in vivo imstande, die OPG-Serumspiegel deutlich zu reduzieren. Dagegen hemmen biomechanische Reize in vitro die RANKL-Produktion und steigern die OPG-Produktion. Ein Fehlen dieser biomechanischen Reize bei längerer Immobilisierung kann daher den RANKL/OPG-Quotienten steigern, während die tierexperimentelle Immobilisierungs-Osteoporose durch die parenterale Gabe von OPG gemildert werden kann.

  16. Imaging patellar complications after knee arthroplasty

    International Nuclear Information System (INIS)

    Melloni, Pietro; Valls, Rafael; Veintemillas, Maite

    2008-01-01

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious

  17. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  18. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...... of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...

  19. Assessment of axonal degeneration in Alzheimer's disease with diffusion tensor MRI; Diffusion tensor imaging zur Erfassung axonaler Degeneration bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Stahl, R. [Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen (Germany); Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen, Marchioninistr. 15, 81377, Muenchen (Germany); Dietrich, O.; Reiser, M.F.; Schoenberg, S.O. [Institut fuer Klinische Radiologie - Grosshadern, Klinikum der Universitaet Muenchen (Germany); Teipel, S.; Hampel, H. [Klinik fuer Psychiatrie und Psychotherapie, Klinikum der Universitaet Muenchen (Germany)

    2003-07-01

    degenerativen Veraenderungen der weissen Substanz. Es soll untersucht werden, inwieweit die hierdurch resultierende erhoehte Beweglichkeit von Wassermolekuelen in verschiedenen Regionen mittels diffusion tensor imaging (DTI) erfasst und eingestuft werden kann. Dabei soll ueberprueft werden, ob die parallele Bildgebung (iPAT-Technik) zu verzerrungsfreieren Bildern fuehrt. Wir untersuchten 9 AD-Patienten mit milder Form der AD-Demenz und 10 gesunde Kontrollprobanden. DTI-Messungen wurden an einem 1,5-Tesla-System (Siemens Magnetom Sonata) mit iPAT-Technik und einer EPI-Diffusionssequenz mit TE/TR 71 ms/6000 ms durchgefuehrt. Wir verwendeten eine 8-Kanal-Phased-array-Kopfspule und einen GRAPPA-Rekonstruktionsalgorithmus mit einem iPAT-Beschleunigungsfaktor von 2. Aus dem Tensor wurden der effektive Diffusionskoeffizient (ADC), die fraktionelle (FA) und die relative (RA) Anisotropie in verschiedenen Arealen der weissen Substanz berechnet. Die AD-Patienten wiesen im Genu des Corpus callosum signifikant kleinere (p <0,05) FA- sowie tendenziell groessere (p=0,06) ADC-Werte als die Kontrollen auf. Innerhalb des Spleniums, perikallosal, in der Capsula interna, im Frontal-, Okzipital-, Temporal- und Parietallappen zeigten sich keine signifikanten Unterschiede. Durch die iPAT-Technik ergaben sich deutlich weniger suszeptibilitaetsinduzierte Verzerrungen. Mit DTI koennen bereits in Stadien der milden AD Veraenderungen der weissen Substanz erfasst werden. Die veraenderten FA- und ADC-Werte bei AD-Patienten sind mutmasslich Ausdruck mikroskopisch kleiner axonaler Degenerationen in der weissen Substanz. Durch die verbesserte Bildqualitaet mit iPAT-Technik kann der Tensor praeziser berechnet werden. (orig.)

  20. Shoulder arthroplasty for sequelae of poliomyelitis.

    Science.gov (United States)

    Werthel, Jean-David; Schoch, Bradley; Sperling, John W; Cofield, Robert; Elhassan, Bassem T

    2016-05-01

    Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. UMA PROSPOSTA DEDUTIVISTA PARA PRINCÍPIOS CONTÁBEIS

    Directory of Open Access Journals (Sweden)

    Paulo Schmidt

    2009-09-01

    Full Text Available A proposta deste estudo a apresentar um breve relato sobre a evolução do pensamento cientifico ocorrida na física com a substituição dos princípios contábeis e filosófico, desde a Antiguidade grega ate os dias de hoje, como forma de fundamentar o posicionamento contrario ao raciocínio indutivo para o estabelecimento de uma estrutura conceitual para a contabilidade e para o desenvolvimento dos princípios contábeis. Apos essa incursão pelo campo filosófico, será aduzido um dos trabalhos de D. R. Scott, ex-professor da Universidade de Michigan, que já na década de 1930 defendia o processo de raciocínio dedutivo e a necessidade de coerência e unidade para o estabelecimento dos princípios contábeis. Este estudo justifica-se, principalmente, porque ainda existem pesquisadores da área contábil que defendem o método indutivo com único procedimento cientifico capaz de levar a certeza, Como defendia Descartes. Alem disso, mesmo apos a revolução cientifica princípios teóricos de Newton, pelos princípios da teoria da relatividade de Einstein, alguns pesquisadores defendem a imutabilidade dos princípios contábeis, como sendo verdades indubitáveis, não aceitando o permanente desenvolvimento da teoria contábil e sua continua adaptabilidade a nova realidade ambiental. A contabilidade, assim como toda disciplina do conhecimento humano que postula um patamar cientifico, deve estruturar-se com base em um conjunto de princípios racionalmente dispostos. Diante desse panorama, faz-se mister inquirir se os princípios contábeis podem ser oniscientes e impassíveis as mudanças do mundo?

  2. Radiology in Gerard uncemented double cup arthroplasty

    International Nuclear Information System (INIS)

    Willems, W.J.; Rozing, P.M.; Obermann, W.R.

    1988-01-01

    A radiological follow-up was performed on 109 Gerard (uncemented) double cup arthroplasties, with special emphasis on shift of the femoral cup and protrusion of the acetabular cup, for which a new formula was introduced. Varus shift or axial collapse of the femoral cup played a major role in the failure of these cups. Fluoroscopic examination with video-tape recording seemed to be most helpful in determining abnormalities in this kind of arthroplasty. This examination revealed one normal and two abnormal types of movement, either between both cups or between acetabular cup and acetabular cavity. Those hips with normal movement showed a significantly better clinical score. 16 refs.; 6 figs

  3. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  4. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...

  5. Hip arthroplasty today and tomorrow.

    Science.gov (United States)

    Amstutz, H C

    1987-12-01

    Acrylic-fixed total hip and surface replacement arthroplasty have been very effective in affording immediate relief of pain and providing improved function. Complications have been reduced by improvements in design, materials, and especially technique. They are now very low in the elderly, and the stem type acrylic-fixed design remains the procedure of choice. The failure rates in youthful patients and those with bone-stock deficiencies have been high in both THR and surface types, although the latter had the advantage of preserving femoral stock. On the femoral side, the new "macro" femoral designs from Europe and "micro" femoral porous designs have shown promise, but thigh pain, incomplete and difficult to predict bone ingrowth patterns, coupled with removal problems have influenced design and technique changes. Both press-fit stem types and porous surface replacements have produced promising initial results with less potential downside risks. On the acetabular side, both the cementless hemispherical with screw-type adjuvant fixation, or the chamfered cylinder designs, used primarily with the UCLA porous surface replacements, but also with stem-type devices, appear to achieve best short-term results, while the entire variety of screw rings are disappointing. The future will bring further refinements in technique and specific indications for certain types of replacement stem in specific types of bone stock deficiencies. The all ceramic-ceramic and ceramic-polyethylene bearings show promise of reducing wear and, hence, should improve longevity of implant fixation.

  6. A Method for Estimating BeiDou Inter-frequency Satellite Clock Bias

    Directory of Open Access Journals (Sweden)

    LI Haojun

    2016-02-01

    Full Text Available A new method for estimating the BeiDou inter-frequency satellite clock bias is proposed, considering the shortage of the current methods. The constant and variable parts of the inter-frequency satellite clock bias are considered in the new method. The data from 10 observation stations are processed to validate the new method. The characterizations of the BeiDou inter-frequency satellite clock bias are also analyzed using the computed results. The results of the BeiDou inter-frequency satellite clock bias indicate that it is stable in the short term. The estimated BeiDou inter-frequency satellite clock bias results are molded. The model results show that the 10 parameters of model for each satellite can express the BeiDou inter-frequency satellite clock bias well and the accuracy reaches cm level. When the model parameters of the first day are used to compute the BeiDou inter-frequency satellite clock bias of the second day, the accuracy also reaches cm level. Based on the stability and modeling, a strategy for the BeiDou satellite clock service is presented to provide the reference of our BeiDou.

  7. "Updates to Model Algorithms & Inputs for the Biogenic Emissions Inventory System (BEIS) Model"

    Science.gov (United States)

    We have developed new canopy emission algorithms and land use data for BEIS. Simulations with BEIS v3.4 and these updates in CMAQ v5.0.2 are compared these changes to the Model of Emissions of Gases and Aerosols from Nature (MEGAN) and evaluated the simulations against observatio...

  8. Total hip arthroplasty for giant cell tumour.

    Directory of Open Access Journals (Sweden)

    Kulkarni S

    1996-07-01

    Full Text Available A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

  9. Recurrent hemarthrosis after total knee arthroplasty

    NARCIS (Netherlands)

    Rukavina, A.; Kerkhoffs, G.M.M.J.; Schneider, P.; Kuster, M.S.

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed

  10. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  11. Knee arthroplasty: are patients' expectations fulfilled?

    DEFF Research Database (Denmark)

    Nilsdotter, Anna K; Toksvig-Larsen, Sören; Roos, Ewa

    2009-01-01

    to pain and physical function after knee arthroplasty. PATIENTS AND METHODS: 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction...

  12. Magnetic resonance tomography in eclampsia; Magetresonanztomographie bei Eklampsie

    Energy Technology Data Exchange (ETDEWEB)

    Uhlig, U. [St.-Vincentius-Krankenhaeuser, Karlsruhe (Germany). Radiologische Klinik

    1995-05-01

    Eclampsia is a rare but severe complication during the course of a pregnancy. The CT-findings at the brain are well known. Reports on MRT-findings are limited, however, especially in German literature. We describe the MRT picture of the cerebral changes caused by eclampsia and discuss the advantages of MRT in comparison with CT. The use of contrast agents with MRT shows breakdown of blood-brain barrier but does not provide any information of therapeutical consequences and should be avoided during pregnancy. An early and targeted use of MRT in any case of unclear or suspicious neurological symptoms during pregnancy is recommended. MRT supports differential diagnosis regarding non pregnancy-related cerebral disease and can be helpful for therapy planning in cases of preeclampsia. Additionally, MRT offers the possibility to control the effect of therapy with regard to brain damage. (orig.) [Deutsch] Die Eklampsie ist eine seltene aber erhebliche Komplikation im Verlauf einer Schwangerschaft. Die computertomographischen Veraenderungen im Gehirn sind bekannt. Mitteilungen von kernspintomographischen Befunden finden sich vor allem in der deutschen Literatur noch selten. Wir beschreiben das kernspintomographische Bild der zerebralen Veraenderungen bei Eklampsie und diskutieren die Vorteile der MRT im Vergleich zur CT. Die Gabe von Kontrastmittel bei der MRT weist zwar die Blut-Hirn-Schrankenstoerung nach, bringt aber keine therapeutisch relevanten Informationen. Sie sollte waehrend der Schwangerschaft vermieden werden. Ein frueher und gezielter Einsatz der MRT bei unklaren oder verdaechtigen neurologischen Symptomen waehrend der Schwangerschaft ist sinnvoll. Die MRT unterstuetzt die Differentialdiagnose in bezug auf nicht schwangerschaftsbezogene zerebrale Leiden und kann fuer die Therapie richtungweisend sein, wenn die Gestose noch nicht ausgepraegt ist. (orig.)

  13. Taxonomia de distorções contábeis

    OpenAIRE

    José Humberto da Cruz Cunha; Rogério Henrique de Araújo Júnior

    2017-01-01

    http://dx.doi.org/10.5007/1518-2924.2017v22n49p127 Discute o uso de uma taxonomia de distorções contábeis provenientes de erros e fraudes, voltada para o uso dos auditores na análise dos riscos e escolha dos procedimentos de auditoria. Sua elaboração segue as orientações conceituais da classificação facetada, por meio de levantamento conceitual em pesquisa bibliográfica. A taxonomia apresentada possui como categorias fundamentais as fases da informação, aspectos essenciais, afirmações, ci...

  14. Imaging of the lumbosacral plexus. Diagnostics and treatment planning with high-resolution procedures; Bildgebung des Plexus lumbosacralis. Diagnostik und Therapieplanung mithilfe hochaufgeloester Verfahren

    Energy Technology Data Exchange (ETDEWEB)

    Jengojan, S.; Schellen, C.; Bodner, G.; Kasprian, G. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2017-03-15

    Technical advances in magnetic resonance (MR) and ultrasound-based neurography nowadays facilitate the radiological assessment of the lumbosacral plexus. Anatomy and imaging of the lumbosacral plexus and diagnostics of the most common pathologies. Description of the clinically feasible combination of magnetic resonance imaging (MRI) and ultrasound diagnostics, case-based illustration of imaging techniques and individual advantages of MRI and ultrasound-based diagnostics for various pathologies of the lumbosacral plexus and its peripheral nerves. High-resolution ultrasound-based neurography (HRUS) is particularly valuable for the assessment of superficial structures of the lumbosacral plexus. Depending on the examiner's experience, anatomical variations of the sciatic nerve (e. g. relevant in piriformis syndrome) as well as more subtle variations, for example as seen in neuritis, can be sonographically depicted and assessed. The use of MRI enables the diagnostic evaluation of more deeply located nerve structures, such as the pudendal and the femoral nerves. Modern MRI techniques, such as peripheral nerve tractography allow three-dimensional depiction of the spatial relationship between nerves and local tumors or traumatic alterations. This can be beneficial for further therapy planning. The anatomy and pathology of the lumbosacral plexus can be reliably imaged by the meaningful combination of MRI and ultrasound-based high resolution neurography. (orig.) [German] Durch technische Fortschritte im Bereich der magnetresonanz- (MR-) und ultraschallbasierten Neurographie ist der Plexus lumbosacralis heute der radiologischen Abklaerung zugaenglich. Anatomie und Bildgebung des Plexus lumbosacralis, Abklaerung der haeufigsten Pathologien. Erlaeuterung der klinisch sinnvollen Kombination von MR- und Ultraschalldiagnostik, Darstellung der Untersuchungstechniken und der jeweiligen Vorteile von MRT und Ultraschall anhand fallbasierter Praesentation unterschiedlicher

  15. Advances in Proximal Interphalangeal Joint Arthroplasty: Biomechanics and Biomaterials.

    Science.gov (United States)

    Zhu, Andy F; Rahgozar, Paymon; Chung, Kevin C

    2018-05-01

    Proximal interphalangeal (PIP) joint arthritis is a debilitating condition. The complexity of the joint makes management particularly challenging. Treatment of PIP arthritis requires an understanding of the biomechanics of the joint. PIP joint arthroplasty is one treatment option that has evolved over time. Advances in biomaterials have improved and expanded arthroplasty design. This article reviews biomechanics and arthroplasty design of the PIP joint. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    Science.gov (United States)

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

  17. Taxonomia de distorções contábeis

    Directory of Open Access Journals (Sweden)

    José Humberto da Cruz Cunha

    2017-05-01

    Full Text Available http://dx.doi.org/10.5007/1518-2924.2017v22n49p127 Discute o uso de uma taxonomia de distorções contábeis provenientes de erros e fraudes, voltada para o uso dos auditores na análise dos riscos e escolha dos procedimentos de auditoria. Sua elaboração segue as orientações conceituais da classificação facetada, por meio de levantamento conceitual em pesquisa bibliográfica. A taxonomia apresentada possui como categorias fundamentais as fases da informação, aspectos essenciais, afirmações, ciclos de recursos, subciclos de recursos, distorções contábeis e afirmações (objetivos de auditoria. É apresentada a metodologia de elaboração da taxonomia, bem como a sua aplicabilidade na auditoria contábil como instrumento de organização da informação e do conhecimento. Conclui que, a partir dos exemplos utilizados, é possível afirmar que a taxonomia orienta a análise das distorções como uma trilha de auditoria, padronizando os conceitos identificados na linguagem natural em uma estrutura de classificação padronizada.

  18. Die Rolle von Osteoklasten bei der arthritischen Knochenerosion

    Directory of Open Access Journals (Sweden)

    Schett G

    2003-01-01

    Full Text Available Knöcherne Erosionen stellen eine wesentliche Ursache für die funktionelle Einschränkung von Patienten mit rheumatoider Arthritis dar. Bis vor kurzem war über den Pathomechanismus dieser Veränderungen nur wenig bekannt. Dieser Review faßt die letzten Erkenntnisse über die Ausbildung einer Knochenschädigung bei entzündlichen Gelenkerkrankungen zusammen und fokussiert insbesondere die Rolle von Osteoklasten. Es wird ein Überblickzu den Hinweisen für eine Präsenz von Osteoklasten im entzündlich veränderten Gelenk gegeben. Weiters werden die Faktoren diskutiert, die die Osteoklastogenese im Rahmen einer Gelenkentzündung aktivieren können. Hier wird im besonderen auf die Rolle von Receptor-Activator of Nuclear Factor Kappa B Ligand (RANKL eingegangen. Im weiteren werden die Auswirkungen einer Osteoklastenhemmung in den verschiedenen Arthritismodellen zusammengefaßt und Möglichkeiten einer therapeutischen Nutzung bei rheumatoider Arthritis diskutiert.

  19. Radiotherapy of degenerative joint disorders. Indication, technique and clinical results; Radiotherapie bei schmerzhaften degenerativ-entzuendlichen Gelenkerkrankungen. Indikation, Technik und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, L.; Sauer, R. [Erlangen-Nuernberg Univ. (Germany). Strahlentherapeutische Klinik und Poliklinik; Seegenschmiedt, M.H. [Erlangen-Nuernberg Univ. (Germany). Strahlentherapeutische Klinik und Poliklinik]|[Alfred-Krupp-Krankenhaus, Essen (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    1998-05-01

    From 1984 to 1994, 85 patients with painful osteoarthritis were treated. The mean follow-up was 4 (1 to 10) years. Seventy-three patients (103 joints) were available for long-term analysis: 17 patients (27 joints) with omarthrosis, 19 (20 joints) with rhizarthrosis, 31 (49 joints) with osteoarthritis of the knee and 6 patients (7 joints) with osteoarthritis of the hip. All patients were intensively pretreated over long time. Mean symptom duration prior to radiotherapy was 4 (1 to 10) years. Orthovoltage or linac photons were applied using some technical modifications depending upon the joint. Two radiotherapy series (6 x 1 Gy, total dose: 12 Gy, 3 weekly fractions) were prescribed. The interval between the 2 series was 6 weeks. The subjective pain profil was assessed prior to and 6 months after radiotherapy and at last follow-up. Forty-six (63%) patients (64 joints) achieved a reduction of pain symptoms; 16 of those had a `major pain relief` and 14 `complete pain relief`. Large joints - knee and hip - responded better (64% each) than the rhizarthrosis (53%). All pain categories and grades and their combined pain score were significantly reduced. The pain reduction was mostly pronounced for the symptom `pain at rest`. The orthopedic score correlated well with the subjective response of the patients. The thumb score improved in 11 (57%) joints, the shoulder score of Constant and Murley in 16 (59%), the Japonese knee score of Sasaki et al. in 33 (67%), the hip score of Harris in 5 (71%) joints. Only 9 of 19 patients which were treated to avoid surgery, had to be operated, and 3 of those received a total arthroplasty of the hip or knee. In multivariate analysis for the endpoint `complete` or `major pain relief` only the criterion `symptom duration {>=}2 years prior to radiotherapy` was an independent negative prognostic parameter. (orig./MG) [Deutsch] Von 1984 bis 1994 wurden 85 Patienten wegen schmerzhaft arthrotischer Gelenkerkrankungen bestrahlt. 73 Patienten (103

  20. An intercomparison of biogenic emissions estimates from BEIS2 and BIOME: Reconciling the differences

    Energy Technology Data Exchange (ETDEWEB)

    Wilkinson, J.G. [Alpine Geophysics, Pittsburgh, PA (United States); Emigh, R.A. [Alpine Geophysics, Boulder, CO (United States); Pierce, T.E. [Atmospheric Characterization and Modeling Division/NOAA, Research Triangle Park, NC (United States)

    1996-12-31

    Biogenic emissions play a critical role in urban and regional air quality. For instance, biogenic emissions contribute upwards of 76% of the daily hydrocarbon emissions in the Atlanta, Georgia airshed. The Biogenic Emissions Inventory System-Version 2.0 (BEIS2) and the Biogenic Model for Emissions (BIOME) are two models that compute biogenic emissions estimates. BEIS2 is a FORTRAN-based system, and BIOME is an ARC/INFO{reg_sign} - and SAS{reg_sign}-based system. Although the technical formulations of the models are similar, the models produce different biogenic emissions estimates for what appear to be essentially the same inputs. The goals of our study are the following: (1) Determine why BIOME and BEIS2 produce different emissions estimates; (2) Attempt to understand the impacts that the differences have on the emissions estimates; (3) Reconcile the differences where possible; and (4) Present a framework for the use of BEIS2 and BIOME. In this study, we used the Coastal Oxidant Assessment for Southeast Texas (COAST) biogenics data which were supplied to us courtesy of the Texas Natural Resource Conservation Commission (TNRCC), and we extracted the BEIS2 data for the same domain. We compared the emissions estimates of the two models using their respective data sets BIOME Using TNRCC data and BEIS2 using BEIS2 data.

  1. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  2. Cost Analysis in Shoulder Arthroplasty Surgery

    Directory of Open Access Journals (Sweden)

    Matthew J. Teusink

    2012-01-01

    Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

  3. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.

    1989-01-01

    The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....

  4. Soft-tissue tension total knee arthroplasty.

    Science.gov (United States)

    Asano, Hiroshi; Hoshino, Akiho; Wilton, Tim J

    2004-08-01

    It is far from clear how best to define the proper strength of soft-tissue tensioning in total knee arthroplasty (TKA). We attached a torque driver to the Monogram balancer/tensor device and measured soft-tissue tension in full extension and 90 degrees flexion during TKA. In our surgical procedure, when we felt proper soft-tissue tension was being applied, the mean distraction force was noted to be 126N in extension and 121N in flexion. There was no significant correlation between soft-tissue tension and the postoperative flexion angle finally achieved. To the best of our knowledge, this is the first study to assess the actual distraction forces in relation to soft-tissue tension in TKA. Further study may reveal the most appropriate forces to achieve proper soft-tissue tension in the wide variety of circumstances presenting at knee arthroplasty.

  5. Endotoxins in surgical instruments of hip arthroplasty

    OpenAIRE

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

  6. Analysis of the unicompartmental knee arthroplasty results

    Directory of Open Access Journals (Sweden)

    S. A. Firsov

    2015-01-01

    Full Text Available In 2012-2014 total 67 unicompartmental arthroplasty surgeries with use of Oxford knee meniscal bearing were performed. The surgeries were performed by a single surgeon. Minimally invasive approach was used. All patients were evaluated clinically, radiographically and with Oxford Knee score scale, Knee Society score scale and functional scale. Obtained data was processed with nonparametric Mann-Whitney-Wilcoxon test. Results were processed using the statistical analysis application package SPSS, version 10.07. Analysis of of mid-term results showed that the average for Oxford Knee score increased from 16.4 (95% CI 9-23 to 41.3 (95% CI 29-47. Average for Knee Society score scale increased from 42.7 (95% CI 31-55 to 88.6 (95% CI 73-100. No occurrence of early postoperative complications have been reported. Statistically significant improvements of knee function in patients after unicompartmental arthroplasty have been observed. Unicompartmental arthroplasty currently can be considered as an advanced treatment option for medial knee joint pathology. Meniscal bearing cemented prostheses such as Oxford III are preferable.

  7. TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY.

    Science.gov (United States)

    Cury, Ricardo de Paula Leite; Cinagawa, Eduardo Hitoshi Tsuge; Camargo, Osmar Pedro Arbix; Honda, Emerson Kiyoshi; Klautau, Giselle Burlamaqui; Salles, Mauro José Costa

    2015-01-01

    To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010. In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

  8. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...

  9. Fast-track knee arthroplasty – status and future challenges

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Thienpont, Emmanuel

    2013-01-01

    Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee...... arthroplasty....

  10. Perioperative blood saving measures in total hip and knee arthroplasty

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

    This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total

  11. Distraction Arthroplasty of the Trapeziometacarpal Joint Without Trapeziectomy

    Directory of Open Access Journals (Sweden)

    Kin Weng Wong

    2011-01-01

    Conclusion: Our technique (distraction arthroplasty without trapeziectomy preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

  12. Patient-reported outcome after fast-track knee arthroplasty

    DEFF Research Database (Denmark)

    Larsen, Kristian; Hansen, Torben B; Søballe, Kjeld

    2012-01-01

    PURPOSE: The purpose of this study was to describe patient-related functional outcomes after fast-track total knee arthroplasty and unicompartmental knee arthroplasty. Furthermore, we wanted to assess physical areas where an additional need for rehabilitation could be identified, and finally, we...

  13. The Warwick patellofemoral arthroplasty trial: a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint

    Directory of Open Access Journals (Sweden)

    Odumenya Michelle

    2011-11-01

    Full Text Available Abstract Background Severe arthritis of the knee is a disabling condition, with over 50,000 knee replacements performed each year in the UK. Isolated patellofemoral joint arthritis occurs in over 10% of these patients with the treatment options being patellofemoral arthroplasty or total knee arthroplasty. Whilst many surgeons believe total knee arthroplasty is the 'gold standard' treatment for severe knee arthritis, patellofemoral arthroplasty has certain potential advantages. Primarily, because this operation allows the patient to keep the majority of their own knee joint; preserving bone-stock and the patients' own ligaments. Patellofemoral arthroplasty has also been recognised as a less 'invasive' operation than primary total knee arthroplasty, facilitating a more rapid recovery. There are currently no published results of randomised clinical trials comparing the two arthroplasty techniques. The primary objective of the current study is to assess whether there is a difference in functional knee scores and quality of life outcome assessments at one year post-operation between patellofemoral arthroplasty and total knee arthroplasty. The secondary objective is to assess the complication rates for both procedures. Methods/design Patients who are deemed suitable, by an Orthopaedic Consultant, for patellofemoral arthroplasty and medically fit for surgery are eligible to take part in this trial. The consenting patients will be randomised in a 1:1 allocation to a total knee or patellofemoral arthroplasty. The randomisation sequence will be computer generated and administered by a central independent randomisation service. Following consent, all participants will have their knee function, quality of life and physical activity level assessed through questionnaires. The assigned surgery will then be performed using the preferred technique and implant of the operating surgeon. The first post-operative assessments will take place at six weeks, followed by

  14. Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity.

    Science.gov (United States)

    Fournier, Matthew N; Hallock, Justin; Mihalko, William M

    2016-08-01

    Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Suche nach Charginos in 4 Jet Ereignissen bei LEP2

    CERN Document Server

    AUTHOR|(CDS)2086503

    1997-01-01

    Zum heutigen Tag sind der Hochenergiephysik einige Hundert Teilchen und Teilchenzustände bekannt, die dem Anschein nach auf sehr komplexe Weise wechselwirken und so die beobachtbare Welt konstituieren. Bei näherer Betrachtung sind jedoch nur wenige Teilchen und Wechselwirkungen elementar, in dem Sinne, dass die übrigen sich als aus ihnen zusammengesetzt ansehen lassen. Die Frage, wie man diese elementaren Teilchen und ihre fundamentalen Wechselwirkungen systematisch beschreiben kann, beantwortet das Standardmodell der Elementarteilchenphysik. Es verwendet das Spektrum der fundamentalen Materie, die inneren Symmetrieeigenschaften dieses Spektrums und das Eichprinzip, um eine Beschreibung im Rahmen der Quantenfeldtheorie zu formalisieren. Das Standardmodell leistet so eine prinzipielle Beschreibung der bis heute betrachteten Hochenergiephysik. Dabei treten allerdings einige Probleme auf, die es attraktiv erscheinen lassen, das Standardmodell um eine weitere Symmetrieeigenschaft zu erweitern, nämlich um die ...

  16. Berechnung verkehrlicher Substitutionseffekte im Personenverkehr bei Online-Shopping

    Science.gov (United States)

    Nerlich, Mark R.; Schiffner, Felix; Vogt, Walter; Rauh, Jürgen; Breidenbach, Petra

    Für Güter des täglichen, mittelfristigen und langfristigen Bedarfs sowie für das Beispiel Baumarktartikel wird das Potenzial für Personenverkehrsaufwand von Einkaufsaktivtäten quantitativ abgeschätzt. Die entwickelten Algorithmen behandeln die einkaufsvorbereitende Information und den eigentlichen Einkauf, d.h. den Erwerb eines Gutes, separat. Informationsaktivitäten haben insbesondere bei höherwertigen Gütern einen hohen Stellenwert und damit auch verkehrliche Relevanz. Wie Berechnungen zeigen, spart Online-Shopping Informations- und Einkaufsverkehrsaufwand im Pkw-Verkehr ein. Die notwendigen Eingangsdaten wie differenzierte Informations- und Einkaufshäufigkeiten sowie verkehrliche Parameter zu Verkehrsmittelwahl, Entfernungen und Wegekopplungen wurden aus eigenen Erhebungen gewonnen.

  17. Cryotherapy in rheumatic disorders; Kryotherapie bei rheumatischen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Soerensen, H. [Rheumaklinik Immanuel-Krankenhaus, Berlin (Germany). Innere Rheumatologische Abt.

    1994-12-31

    When applied locally, cold therapy (cryotherapy) has the effect of inhibiting inflammation, occluding blood vessels, and stopping bleeding. Active rheumatic inflammation, activated arthrosis, and swelling after injury can be alleviated by local cold application, while heat application would worsen the situation. In whole-body cryotherapy the whole patient, wearing only a bathing suit, is exposed to a temperature of -100 C. The present paper descrcribes the cold room of the Immanuel Hospital in Berlin-Wannsee. (BWI) [Deutsch] Kaeltetherapie (Kryotherapie) wirkt lokal angewendet entzuendungshemmend, blutgefaessabdichtend und blutstillend. Eine aktive rheumatische Entzuendung, aktivierte Arthrose und Schwellungsreaktionen bei Verletzungen werden durch lokale Kaelteanwendungen gedaempft, wogegen Waerme den akuten Zustand verschlimmern wuerde. In der Ganzkoerperkaeltetherapie wird der ganze Mensch in Badebekleidung einer realen Temperatur von -100 C ausgesetzt. Der vorliegende Beitrag beschreibt die Kaeltekammer des Immanuel Krankenhauses in Berlin Wannsee. (BWI)

  18. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

    Science.gov (United States)

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-02-18

    To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

  19. Digital versus analogue preoperative planning of total hip arthroplasties - A randomized clinical trial of 210 total hip arthroplasties

    NARCIS (Netherlands)

    The, Bertram; Verdonschot, Nico; van Horn, Jim R.; van Ooijen, Peter M. A.; Diercks, Ron L.

    The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized

  20. Initial assessment of the COMPASS/BeiDou-3: new-generation navigation signals

    Science.gov (United States)

    Zhang, Xiaohong; Wu, Mingkui; Liu, Wanke; Li, Xingxing; Yu, Shun; Lu, Cuixian; Wickert, Jens

    2017-10-01

    The successful launch of five new-generation experimental satellites of the China's BeiDou Navigation Satellite System, namely BeiDou I1-S, I2-S, M1-S, M2-S, and M3-S, marks a significant step in expanding BeiDou into a navigation system with global coverage. In addition to B1I (1561.098 MHz) and B3I (1269.520 MHz) signals, the new-generation BeiDou-3 experimental satellites are also capable of transmitting several new navigation signals in space, namely B1C at 1575.42 MHz, B2a at 1176.45 MHz, and B2b at 1207.14 MHz. For the first time, we present an initial characterization and performance assessment for these new-generation BeiDou-3 satellites and their signals. The L1/L2/L5 signals from GPS Block IIF satellites, E1/E5a/E5b signals from Galileo satellites, and B1I/B2I/B3I signals from BeiDou-2 satellites are also evaluated for comparison. The characteristics of the B1C, B1I, B2a, B2b, and B3I signals are evaluated in terms of observed carrier-to-noise density ratio, pseudorange multipath and noise, triple-frequency carrier-phase ionosphere-free and geometry-free combination, and double-differenced carrier-phase and code residuals. The results demonstrate that the observational quality of the new-generation BeiDou-3 signals is comparable to that of GPS L1/L2/L5 and Galileo E1/E5a/E5b signals. However, the analysis of code multipath shows that the elevation-dependent code biases, which have been previously identified to exist in the code observations of the BeiDou-2 satellites, seem to be not obvious for all the available signals of the new-generation BeiDou-3 satellites. This will significantly benefit precise applications that resolve wide-lane ambiguity based on Hatch-Melbourne-Wübbena linear combinations and other applications such as single-frequency precise point positioning (PPP) based on the ionosphere-free code-carrier combinations. Furthermore, with regard to the triple-frequency carrier-phase ionosphere-free and geometry-free combination, it is found

  1. Therapeutische Überlegungen bei sensomotorischer diabetischer Neuropathie

    Directory of Open Access Journals (Sweden)

    Bührlen M

    2013-01-01

    Full Text Available Der Begriff der sensomotorischen diabetischen Neuropathie beschreibt einen heterogenen Beschwerdekomplex, der auf einer diabetesbedingten Schädigung des peripheren Nervensystems beruht. Bis zu 50 % der Menschen mit Diabetes mellitus leiden im Verlauf ihrer Erkrankung an Symptomen einer sensomotorischen Neuropathie. Chronische Schmerzen, Dysund Parästhesien sowie die Komplikation des diabetischen Fußsyndroms stellen für die Betroffenen gravierende Folgen dar. Die Optimierung der metabolischen Kontrolle stellt eine wichtige Basismaßnahme dar. Andere, zweifelsfrei gesicherte Möglichkeiten der Prävention oder kausalen Therapie sind nicht bekannt. Bei Auftreten einer schmerzhaften Neuropathie sollte eine gezielte analgetische Therapie möglichst früh begonnen werden. Mit den trizyklischen Antidepressiva, Duloxetin, Gabapentin und Pregabalin stehen Wirkstoffe zur Verfügung, die eine spezifische Therapie neuropathischer Schmerzen ermöglichen. Dabei ist zu beachten, dass in der Regel keine Schmerzfreiheit erreicht werden kann. Entscheidend ist das Erreichen eines für den Patienten tolerablen Schmerzniveaus unter Minimierung medikamentenassoziierter Nebenwirkungen. Das individuelle Ansprechen auf ein Medikament und die optimale Dosis können nicht vorhergesagt, sondern müssen individuell erprobt werden. Bei leichten Schmerzen können die Nicht-Opioid- Analgetika Paracetamol und Metamizol eingesetzt werden. Fehlen Therapiealternativen, dann stellen Opioide eine weitere Möglichkeit der Therapie starker Schmerzen dar. Aufgrund einer zusätzlichen Monoamin-Wiederaufnahmehemmerwirkung nehmen Tramadol und Tapentadol in dieser Gruppe eine Sonderstellung ein. In der Risiko- Nutzen-Abwägung darf das Nebenwirkungs- und Abhängigkeitspotenzial der Opioide in der Langzeittherapie nicht unterschätzt werden. Für andere medikamentöse Therapien oder alternative Therapiemethoden liegt keine ausreichende wissenschaftliche Evidenz vor. Sie können aber im

  2. Pathophysiologie des Kollagenstoffwechsels bei Patienten mit Induratio penis plastica (IPP

    Directory of Open Access Journals (Sweden)

    Lahme S

    2000-01-01

    Full Text Available Die Pathogenese der IPP ist bis heute nicht geklärt. Histopathologische Untersuchungen zeigen, daß der Kollagenstoffwechsel eine Rolle spielt. Dies veranlaßte uns zur genauen Analyse der Kollagenstoffwechselparameter bei IPP. Bei 11 Patienten mit IPP und 11 Kontrollpersonen wurden Kollagenstoffwechselparameter (Prokollagen III [PIIIP], PMN-Elastase [PMN-E], Fibronektin [FN], Fibronektinrezeptor [FN-R] und alpha1-Proteinase-Inhibitor [alpha1-PI] im cavernösen und peripheren Blut bestimmt. PMN-E, PIIIP, FN und FN-R waren in den beiden Untersuchungsgruppen nicht unterschiedlich. Die peripher venösen unterschieden sich nicht von den cavernösen Blutproben. Sowohl im peripher venös (158,55 mg/dl als auch im cavernös entnommenen Blut (168,29 mg/dl war die Konzentration des a1-PI signifikant niedriger als in der Kontrollgruppe (214,82 mg/dl. An einem zweiten Kollektiv von 23 Patienten wurden Analysen des Phänotyps für alpha1-PI im Hinblick auf das Vorliegen von genetisch determinierten Mangelallelen vorgenommen. Hier zeigte sich kein signifikanter Unterschied zu einem Kontrollkollektiv von 19 gesunden Probanden. Die alpha1-PI Erniedrigung der IPP-Patienten ist signifikant und liegt unterhalb des Normalwertbereichs für die gesunde Population. Ein Mangel an alpha1-PI kann zur Aktivitätserhöhung der Proteasen und zum Umbau des Kollagengewebes führen. Möglicherweise kommt es zusammen mit einem lokal wirksamen Einflußfaktor schließlich zur dystrophen Kalzifikation. Die humangenetischen Untersuchungen sprechen nicht für eine genetische Determinierung des alpha1-PI-Mangels, sondern legen eine erworbene hepatische Störung nahe.

  3. Tryptophanabhängige Synthese von indolhaltigen Pigmenten bei verschiedenen humanpathogenen Asco- und Basidiomyceten

    OpenAIRE

    Nies, Silke Marie

    2006-01-01

    Der Begriff "Pigment" beschreibt in erster Linie farbige Substanzen. Pigmente sind aber darüber hinaus für wichtige metabolische oder physiologische Prozesse verantwortlich. Im Reich der Pilze gibt es eine Vielzahl von Pigmenten. Zu ihnen zählen die Melanine, die Carotenoide, die Naphthoquinone, die Phenoxazine, die Flavonoide sowie indolhaltige Pigmente. Gewisse Indolderivate wurden von einer Arbeitsgruppe um Prof. Mayser 1998 erstmals bei der Hefe Malassezia furfur beschrieben, bei der ...

  4. Untersuchungen zum Riechvermögen bei Patienten mit schizophrenen Störungen

    OpenAIRE

    Minovi, A; Dombrowski, T; Brüne, M; Dazert, S; Juckel, G

    2014-01-01

    Einleitung: Riechstörungen werden bei Patienten mit einer Schizophrenie in vielen Studien beschrieben. Im Rahmen einer prospektiv angelegten Studie untersuchten wir das Riechvermögen von 18 Patienten mit einer Schizophrenie im Vergleich zu einer Kontrollgruppe (n=13). Weiterhin erfolgte eine immunhistochemische Untersuchung der Riechschleimhaut bei 8 Patienten mit einer Schizophrenie.Methoden: Die Riechprüfung erfolgte mit Hilfe der erweiterten Sniffin' Sticks-Testbatterie. Nach Biopsie der...

  5. Evolution und Funktionsvariabilität von bunodonten Molaren bei Primaten

    OpenAIRE

    Menz, Ulrike Maria (Doktor)

    2017-01-01

    In der vorliegenden Arbeit werden funktionale Details der Okklusion während der Mastikation bei ausgewählten fossilen und rezenten Primaten quantitativ vergleichend untersucht. Dazu wurden die Okklusionsflächen von antagonistischen Molarenpaaren mit modernen virtuellen Verfahren eingescannt und anhand von 3D Kronenmodellen kartiert und funktional ausgewertet. Die in der Forschergruppe DFG FOR 771 entwickelte Software „Occlusal Fingerprint Analyser“ (OFA) kam erstmals bei einer großen Stichpro...

  6. Einflussfaktoren auf den persönlichen Stress bei Studienanfängern in der Humanmedizin

    OpenAIRE

    Schulze, Johannes; Duderstadt, Monika; Hodjat, Beheshta; Wu, Yue-Ying

    2013-01-01

    Die derzeitige Regelung der Zulassung zum Medizinstudium berücksichtigt die Abiturnote und Wartezeiten; universitäre Parameter können diese Kriterien modifizieren. Hierzu zählen z.B. die Leistungskurswahl, wie es an der Goethe-Universität Frankfurt gehandhabt wird. Im Rahmen der Untersuchung zu Stress und Resilienz bei Medizinstudenten haben wir bei den Studenten des 1. vorklinischen Semesters soziodemographische Daten erhoben, die einen Kohortenvergleich erlauben. Die chronische Stressbelast...

  7. TOTAL HIP ARTHROPLASTY IN CHILDREN WHO HAVE UNDERGONE ARTHROPLASTY WITH DEMINERALIZED BONE-CARTILAGE ALLOCUPS

    Directory of Open Access Journals (Sweden)

    Vladimir E. Baskov

    2017-03-01

    Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

  8. Total hip arthroplasty in children who have undergone arthroplasty with demineralized bone-cartilage allocups

    Directory of Open Access Journals (Sweden)

    Vladimir E. Baskov

    2017-03-01

    Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

  9. Kontrastmittelverstärkte Magnet-Resonanz-Urographie unter forcierter Diurese - Stellenwert in der Differentialdiagnostik bei Obstruktionen des oberen Harntraktes

    Directory of Open Access Journals (Sweden)

    Jung P

    2001-01-01

    Full Text Available Die Magnet-Resonanz-Urographie (MRU ist ein relativ neues Verfahren in der Diagnostik des oberen Harntraktes. Das Ziel dieser Studie war der Vergleich der Aussagefähigkeit der MRU unter Gabe von Gadolinium und Furosemid und dem konventionellen Urogramm (IVU in der Diagnostik der Ursache von Obstruktionen im Bereich des Harnleiters. 82 Patienten mit im IVU nachgewiesener Obstruktion des oberen Harntraktes oder urographisch stummer Niere bei sonographisch nachgewiesener Dilatation wurden der MRU zugeführt. Die Bilder beider Untersuchungsmethoden wurden von voneinander unabhängigen Untersuchern befundet. Zwei Urologen befundeten die IVU-Bilder, zwei Radiologen die MRU-Bilder, die Radiologen kannten die IVU-Diagnose nicht. Bei unklarer Diagnose wurden weitere Untersuchungen wie Computertomographie, retrograde Pyelographie oder Ureteroskopie durchgeführt. Die Diagnosen waren: Harnleitersteine bei 72 Patienten, Harnleitertumore bei 8 Patienten und extraureterale Tumore bei 2 Patienten. Eine richtige Diagnose bei den Steinpatienten wurde durch IVU bei 49 von 72 Patienten und durch MRU bei 64 von 72 Patienten gestellt. In dieser Patientengruppe wurden durch die MRU zwei falsche Diagnosen gestellt. Fehlende Kontrastmittelausscheidung war der Hauptgrund für Versagen der IVU. 3 der 8 Patienten mit Harnleitertumoren wurden durch die IVU richtig dignostiziert, bei dreien wurde eine falsche Diagnose gestellt. Durch die MRU konnten in dieser Gruppe 7 von 8 Patienten korrekt diagnostiziert werden, es wurde keine falsche Diagnose erhoben. IVU wird zunächst die Standarduntersuchungstechnik zur Darstellung des oberen Harntraktes bleiben, aber durch diese Studie konnte die Möglichkeit gezeigt werden, die in der MRU in Kombination mit Gadolinium und Furosemid liegt. Die größte Bedeutung dieser Untersuchung liegt in der urographisch stummen Niere, bei Untersuchungen in der Schwangerschaft, bei Kindern und bei Patienten mit Kontrastmittelunverträglichkeit.

  10. Hip arthroplasty in failed intertrochanteric fractures in elderly

    Directory of Open Access Journals (Sweden)

    Javahir A Pachore

    2013-01-01

    Full Text Available Background: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. Materials and Methods: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. Results: The average followup was 20 months (range 6-48 months. Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. Conclusion: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.

  11. Risk factors for blood transfusion after shoulder arthroplasty.

    Science.gov (United States)

    Padegimas, E M; Clyde, C T; Zmistowski, B M; Restrepo, C; Williams, G R; Namdari, S

    2016-02-01

    Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy. We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient's records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve. Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level. We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion. The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (transfusion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  12. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  13. A protocol avoiding allogeneic transfusion in joint arthroplasties.

    Science.gov (United States)

    Suh, You-Sung; Nho, Jae-Hwi; Choi, Hyung-Suk; Ha, Yong-Chan; Park, Jong-Seok; Koo, Kyung-Hoi

    2016-09-01

    Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol. The target of preoperative hemoglobin was more than 10 g/dL. When preoperative hemoglobin was lower than 10 g/dL, 4000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) were administered until the hemoglobin reached 10 g/dL. When the preoperative hemoglobin was higher than 10 g/dL, 4000 U erythropoietin and 100 mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10 g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes. From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2 %), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3 and 10.3 g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived. Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.

  14. Contemporary pain management in total knee arthroplasty.

    Science.gov (United States)

    Khanasuk, Yutthana; Ngarmukos, Srihatach

    2012-10-01

    Pain management has become a very important part of postoperative care for total knee arthroplasty patients. Contemporary pain control has evolved from high-dose opioid in the past to state-of-the-art multimodal regimens. These include multiple non-opioid medication such as NSAIDs, COX-2 inhibitors, and gabapentinoid, and novel anesthetic techniques such as preemptive analgesia and ultrasound-guided peripheral nerve blocks. Another method which is gaining popularity is intraarticular injection of anesthetic cocktail during surgery. Pre-op education can also help patients cope with their pain better.

  15. Postoperative pain treatment after total knee arthroplasty

    DEFF Research Database (Denmark)

    Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa

    2017-01-01

    INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication......), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low. CONCLUSION: A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation...

  16. Periprosthetic osteolysis after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2014-01-01

    Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose...... of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been...

  17. Tibial rotation kinematics subsequent to knee arthroplasty

    Science.gov (United States)

    Collins, Duane J.; Khatib, Yasser H.; Parker, David A.; Jenkin, Deanne E.; Molnar, Robert B.

    2015-01-01

    Background The use of computer assisted joint replacement has facilitated precise intraoperative measurement of knee kinematics. The changes in “screw home mechanism” (SHM) resulting from Total Knee Arthroplasty (TKA) with different prostheses and constraints has not yet been accurately described. Methods A pilot study was first completed. Intraoperative kinematic data was collected two groups of 15 patients receiving different prostheses. Results On average, patients lost 5.3° of ER (SD = 6.1°). There was no significant difference between the prostheses or different prosthetic constraints. Conclusions There significant loss of SHM after TKA. Further research is required to understand its impact on patient function. PMID:25829754

  18. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    Directory of Open Access Journals (Sweden)

    S. O'hEireamhoin

    2011-01-01

    Full Text Available Children affected by mucopolysaccharidosis (MPS type IH (Hurler Syndrome, an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disorders. We present the case of a 23-year-old woman with a diagnosis of Hurler syndrome with a satisfactory result following uncemented total hip arthroplasty.

  19. Bilateral simultaneous total hip arthroplasty in a fast track setting

    DEFF Research Database (Denmark)

    Otte, Kristian S; Husted, Henrik; Ørsnes, Thue

    2011-01-01

    and low complication rates when performed in a fast-track setting. We believed it would be useful to assess hip arthroplasty in this context, and we report 50 consecutive fast-track simultaneous bilateral hip arthroplasty procedures. The median length of stay was 4 days. Mortality within 90 days was 4......% and 8% required a further operative procedure. The overall complication rate was 22%. 55% of the complications were considered to be caused by failures in surgical technique and 45% by other factors. Bilateral simultaneous hip arthroplasty may have a high complication rate in a fast-track setting...

  20. Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT; Radiologische Bildgebung beim Polytrauma: Dosisvergleich von Ganzkoerper-MSCT und konventionellem Roentgen mit organspezifischer CT

    Energy Technology Data Exchange (ETDEWEB)

    Wedegaertner, U.; Lorenzen, M.; Weber, C.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Nagel, H.D. [Philips Medizin Systeme GmbH, Hamburg (Germany)

    2004-07-01

    Purpose: To compare the radiation dose of whole-body multislice CT (MSCT) and conventional radiography with organ-specific CT in polytrauma. Materials and Methods: The whole-body MSCT encompassing brain, neck and midface, chest, abdomen and pelvis was performed on a Somatom Volume Zoom (Siemens). Conventional radiography consisted of chest and cervical, thoracic and lumbar spine in two views as well as pelvis. Polymat, Siemens. Three combinations of organ specific CT were chosen: CT examination of (1) head and cervical spine, (2) head, cervical spine and chest, (3) head, cervical spine and abdomen. The effective doses of whole-body MSCT and conventional radiography with organ-specific CT were calculated. Results: Effective doses were 20 mSv for whole-body MSCT, 2 mSv for conventional x-ray, and 5 mSv for combination (1), 8 mSv for combination (2) and (3) 16 mSv for combination (3) of the organ-specific CT. The ratio of radiation dose between whole-body MSCT and radiography was 10: 1. This ratio was reduced to 3: 1, 2: 1 and 1: 1 when a combination of radiography and CT was performed. Conclusions: Whole-body MSCT in polytrauma compared to conventional radiography with organ-specific CT induces a threefold increased dose in unfavorable situations and no increased dose in favorable situations. Nevertheless, routine use of whole-body MSCT should be critically evaluated and should be adapted to the clinical benefit. (orig.) [German] Ziel: Dosisvergleich von Ganzkoerper-MSCT und konventioneller Basisdiagnostik mit organspezifischen Ct-Untersuchungen beim Polytrauma. Material und Methoden: Die Ganzkoerper-MSCT-Untersuchung von Schaedel, Mittelgesicht, HWS sowie Thorax, Abdomen und Becken erfolgte an einem Somatom-Volume-Zoom (Siemens). Die konventionelle Bildgebung, bestehend aus Thorax, Becken, HWS, BWS und LWs, wurde an einem Siemens-Polymat durchgefuehrt. Fuer die organspezifischen CT-Untersuchungen wurden 3 Kombinationen ausgewaehlt: (1) CCT + HWS, (2) CCT + HWS

  1. Calculation and Analysis of Differential Corrections for BeiDou

    Science.gov (United States)

    Yang, Sainan; Chen, Junping; Zhang, Yize

    2015-04-01

    BeiDou Satellite Navigation System has been providing service forAsia-Pacific area. BeiDou uses observations of regional monitoring network to determine satellite orbit, which limits the satellite orbit accuracy. And the satellite clock error is produced by time synchronization system. The time synchronization delay of antenna device is general obtained through prior Calibration, and the residual calibration error is included in the satellite clock, which affects the prediction accuracy of satellite clock error. In this paper, we study the algorithms of Beidou differential corrections to improve the accuracy of satellite signals to improve the user positioning accuracy. In this algorithm, both pseudo-range and phase observations are used to calculate differential corrections. We process pseudo-range observations to obtain equivalent satellite clock error, which include satellite clock errors and orbit radial errors, as well as the average projection of orbit tangential and normal errors in combination. And the epoch-difference of phase observations are processed to eliminate the ambiguity which simplifies algorithms and ensure the relative accuracy (corrections variety between the epochs). Observations more than 10 stations in China are processed, and the equivalent clock error calculation results are analyzed, which shows that the satellite UDRE are significantly reduced and user location accuracy improves when the equivalent clock error corrections are applied. The residuals deducting equivalent satellite clock error contains the projection difference of satellite orbit error in all station (tangential and normal errors are main). We utilize the residuals to solve the tangential and normal orbit errors which cause the projection difference. The same observation data is processed. The results show that after calculating three-dimensional corrections, the satellite UDRE doesn't improve significantly compared to equivalent satellite clock error corrections and user

  2. The Cruciate Ligaments in Total Knee Arthroplasty.

    Science.gov (United States)

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  3. [Total hip endoprosthesis following resection arthroplasty].

    Science.gov (United States)

    Engelbrecht, E; Siegel, A; Kappus, M

    1995-08-01

    From 1976 to December 1994, a total of 347 patients underwent implantation of a hip prosthesis at the ENDO-Klinik for treatment of an unsatisfactory condition following resection arthroplasty. From 1976 to 1987, 143 patients were treated and in 1989 the results obtained in these patients were analysed: 99 of them were available for a follow-up examination in 1989, and 64 for a further examination in 1995. In 130 cases infection had been the reason for joint resection. At the time of the prosthesis operation (1-20 years later) intraoperative biopsy revealed that infection was still present in 41 cases (31.5%). Only 15 of these infections had been detected preoperatively by joint aspiration. This shows that the value of resection arthroplasty as a method of treating periprosthetic infection is limited and lends support to the one-stage exchange operation, which is the method we prefer in cases of infected hip prostheses. The operative technique and preparation for implantation of the prosthesis are described, as are septic and aseptic complications and the measures that can be taken to treat them. In spite of the patients' generally poor initial condition and with due consideration for the further revision operations, the medium-term results finally obtained are poor in only 9%.

  4. Radiographic analysis of shoulder anatomical arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Merolla, Giovanni [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)], E-mail: gmerolla@shouldertech.it; Di Pietto, Francesco; Romano, Stefania [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, Naples (Italy); Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)

    2008-10-15

    Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 deg. in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and 'bone stock', prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 deg. of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

  5. Expectations in patients with total knee arthroplasty.

    Science.gov (United States)

    Tekin, Burcu; Unver, Bayram; Karatosun, Vasfi

    2012-01-01

    The primary objective of total knee arthroplasty (TKA) is to decrease pain and restore functional knee joint. Current hypotheses indicate higher knee flexion is required in terms of life style, culture and expectations in Eastern communities. Therefore, society-specific features related to life style and cultural habits are needed. The objective of this study was to investigate the expectations of patients undergoing TKA. The study included 131 patients (18 male, 113 female; mean age: 66.2 ± 8.3 years) who underwent cemented TKA due to knee osteoarthritis. All patients were operated by the same surgeon using the same implant and surgical technique. Patients were evaluated using the Hospital for Special Surgery (HSS) knee score, a 15-item clinical knee assessment questionnaire and the HSS knee arthroplasty expectation questionnaire. Mean HSS score for the right knee was 89.2 ± 10.5 and for the left knee was 89.6 ± 9.4. The two most expected outcomes were improvements in pain (99.2%) and gait (96.2%) and the two least expected outcomes were improvements in psychological well-being (22.9%) and communicative skills (35.1%). Expectations were not affected by education and working conditions. Patients' most expected outcomes were improvement in pain and restoration of function (gait, climbing stairs and no need of assistive devices), similar to Western and American communities.

  6. Successful total knee arthroplasty in the presence of sporotrichal arthritis.

    NARCIS (Netherlands)

    Koeter, S.; Jackson, R.W.

    2006-01-01

    Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of

  7. Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Richard Henry

    2012-01-01

    Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.

  8. Is cold therapy really efficient after knee arthroplasty?

    Directory of Open Access Journals (Sweden)

    Ersin Kuyucu

    2015-12-01

    Conclusion: After knee arthroplasty, the preoperative and postoperative use of cryotherapy is effective in terms of the pain control and functional knee scores without a significant change in surgical blood loss.

  9. The Optimal Analgesic Block for Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bendtsen, Thomas Fichtner; Moriggl, Bernhard; Chan, Vincent W

    2016-01-01

    Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography...

  10. Total knee arthroplasty in patients with a previous patellectomy.

    Science.gov (United States)

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.

  11. Gas hydrates in gas storage caverns; Gashydrate bei der Gaskavernenspeicherung

    Energy Technology Data Exchange (ETDEWEB)

    Groenefeld, P. [Kavernen Bau- und Betriebs-GmbH, Hannover (Germany)

    1997-12-31

    Given appropriate pressure and temperature conditions the storage of natural gas in salt caverns can lead to the formation of gas hydrates in the producing well or aboveground operating facilities. This is attributable to the stored gas becoming more or less saturated with water vapour. The present contribution describes the humidity, pressure, and temperature conditions conducive to gas hydrate formation. It also deals with the reduction of the gas removal capacity resulting from gas hydrate formation, and possible measures for preventing hydrate formation such as injection of glycol, the reduction of water vapour absorption from the cavern sump, and dewatering of the cavern sump. (MSK) [Deutsch] Bei der Speicherung von Erdgas in Salzkavernen kann es unter entsprechenden Druck- und Temperaturverhaeltnissen zur Gashydratbildung in den Foerdersonden oder obertaegigen Betriebseinrichtungen kommen, weil sich das eingelagerte Gas mehr oder weniger mit Wasserdampf aufsaettigt. Im Folgenden werden die Feuchtigkeits-, Druck- und Temperaturbedingungen, die zur Hydratbildung fuehren erlaeutert. Ebenso werden die Verringerung der Auslagerungskapazitaet durch die Hydratbildung, Massnahmen zur Verhinderung der Hydratbildung wie die Injektion von Glykol, die Verringerung der Wasserdampfaufnahme aus dem Kavernensumpf und die Entwaesserung der Kavernensumpfs selbst beschrieben.

  12. Outcomes of an anatomic total shoulder arthroplasty with a contralateral reverse total shoulder arthroplasty.

    Science.gov (United States)

    Cox, Ryan M; Padegimas, Eric M; Abboud, Joseph A; Getz, Charles L; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Horneff, John G

    2018-06-01

    It is common for patients to require staged bilateral shoulder arthroplasties. There is a unique cohort of patients who require an anatomic total shoulder arthroplasty (TSA) and a contralateral reverse shoulder arthroplasty (RSA). This study compared the outcomes of patients with a TSA in 1 shoulder and an RSA in the contralateral shoulder. Our institutional database was queried to identify all patients with a TSA and a contralateral RSA. Data collection included patient demographics, preoperative and latest follow-up shoulder range of motion, radiographic analysis, and postoperative complications. Identified patients were assessed at follow-up visits or contacted by phone for functional outcome scores. Nineteen patients met our inclusion/exclusion criteria. There was statistically significant greater internal rotation in the TSA shoulder (P= .044) but no significant difference in forward elevation (P = .573) or external rotation (P= .368). There was no radiographic evidence of humeral or glenoid component loosening of any arthroplasty implants. There were no significant differences between TSA and RSA shoulders for the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (P= .381), Simple Shoulder Test (P = .352), Single Assessment Numerical Evaluation (P = .709), and visual analog scale satisfaction (P= .448) or pain scores (P= .305). Thirteen patients (68.4%) preferred the RSA side, 1 patient (5.3%; z = 4.04, P < .001) patient preferred the TSA side, and 5 patients expressed no preference. Despite known limitations and differences between TSA and RSA designs, patients who have received both implants are highly satisfied with both. The only parameter in which the TSA had superior outcomes was internal rotation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. Physical activity of elderly patients after total hip arthroplasty.

    Science.gov (United States)

    Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna

    2007-01-01

    Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.

  14. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  15. Can an arthroplasty risk score predict bundled care events after total joint arthroplasty?

    Directory of Open Access Journals (Sweden)

    Blair S. Ashley, MD

    2018-03-01

    Full Text Available Background: The validated Arthroplasty Risk Score (ARS predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS, discharge disposition, and episode-of-care cost (EOCC. Methods: We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation. Results: ARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, P = .002. There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, P = .003. Increased ARS correlated with increased EOCC (P = .003. Conclusions: Implementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models. Keywords: Bundled payments, Risk stratification, Arthroplasty

  16. Comparison of cemented and uncemented fixation in total knee arthroplasty.

    Science.gov (United States)

    Brown, Thomas E; Harper, Benjamin L; Bjorgul, Kristian

    2013-05-01

    As a result of reading this article, physicians should be able to :1. Understand the rationale behind using uncemented fixation in total knee arthroplasty.2.Discuss the current literature comparing cemented and uncemented total knee arthroplasty3. Describe the value of radiostereographic analysis in assessing implant stability.4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options. Copyright 2013, SLACK Incorporated.

  17. Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

    Science.gov (United States)

    Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

    2016-02-01

    Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively.

  18. Comparing return to sport activities after short metaphyseal femoral arthroplasty with resurfacing and big femoral head arthroplasties.

    Science.gov (United States)

    Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G

    2017-07-01

    Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.

  19. Reoperations following proximal interphalangeal joint nonconstrained arthroplasties.

    Science.gov (United States)

    Pritsch, Tamir; Rizzo, Marco

    2011-09-01

    To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations. Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4. Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up. Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no

  20. Radiotherapy for treatment of induratio penis plastica; Strahlentherapie bei Induratio penis plastica

    Energy Technology Data Exchange (ETDEWEB)

    Bruns, F.; Kardels, B.; Schaefer, U.; Schoenekaes, K.; Willich, N. [Westfaelische Wilhelms-Univ., Muenster (Germany). Klinik und Poliklinik fuer Strahlentherapie-Radioonkologie

    1999-06-01

    Radiotherapy is shown to be an effective, low-cost and non-invasive modality for treatment of induratio penis plastica. Its efficiency could be proven especially for inflammatory stages of the disease, or as an alternative after failure of conventional treatment. A total dose of no more than 20-25 Gy was found to achieve clear improvements in two thirds of the patients treated, while avoiding at the same time cosmetically disadvantageous late effects. (orig./CB) [Deutsch] Die Strahlentherapie ist eine wirksame, kostenguenstige und nicht-invasive Behandlungsmoeglichkeit bei Induratio penis plastica. Ihren Stellenwert konnte sie insbesondere im inflammatorischen Stadium und nach Versagen anderer konservativer Therapieansaetze zeigen. Eine Gesamteinstrahldosis von 20-25 Gy reicht aus, um bei 2/3 der Patienten eine deutliche Besserung der Symptomatik zu erzielen bei gleichzeitiger Vermeidung kosmetisch relevanter Spaetnebenwirkungen. (orig.)

  1. Kyphoplastie als palliative Therapieoption bei pathologischen Frakturen der Brust- und Lendenwirbelsäule

    Directory of Open Access Journals (Sweden)

    Hartwig E

    2004-01-01

    Full Text Available Bedingt durch Fortschritte in der Behandlung von Tumoren hat sich die Lebenserwartung von Krebspatienten deutlich verbessert. Jedoch steigt hiermit auch die Inzidenz von Knochenmetastasen. Mit wenigen Ausnahmen, die primären Knochentumoren betreffend, ist die Art der Behandlung dieser Läsionen in der Regel palliativ. Durch operatives Intervenieren muß bei diesen Patienten ein maximaler palliativer Effekt bei minimaler Morbidität und Mortalität erzielt werden. Die vorwiegenden Ziele sind Schmerzreduktion unter Erhalt der Stabilität und Funktion. Durch die Kyphoplastie wurden Zementierungsverfahren an der Wirbelsäule auch für pathologische Frakturen auf dem Boden metastatischer Manifestationen elegibel. In einer telefonischen Evaluation von 10 Patienten konnte die Wertigkeit des Verfahrens in der palliativen Situation bei Patienten mit Wirbelsäulenmetastasen gezeigt werden.

  2. Tribology of total hip arthroplasty prostheses

    Science.gov (United States)

    Rieker, Claude B.

    2016-01-01

    Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis. A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient. Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations. All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface. Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004. PMID:28461928

  3. Quality of life after total knee arthroplasty.

    Science.gov (United States)

    Canovas, F; Dagneaux, L

    2018-02-01

    Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports. Copyright © 2017. Published by Elsevier Masson SAS.

  4. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were......, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls...

  5. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier......Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007...

  6. A new approach to knee joint arthroplasty.

    Science.gov (United States)

    Zarychta, P

    2018-04-01

    The main aim of this new approach dedicated to knee arthroplasty is to provide an automated method for determining the cutting planes of both the head of femur and the head of tibia in knee replacement surgery. This paper shows a new approach differing from standard procedures associated with manual determination of the mechanical axis of the lower extremity (during surgery) and replacing them with a procedure based on the imprints (with selected cutting planes) of the two heads of bones. Both these imprints have been performed on the basis of the toposcan of the lower limb (before surgery). This methodology has been implemented in MATLAB and tested in clinical CT images of the lower limb in the coronal and transverse planes (61 studies) and in clinical MRI studies of the knee joint in coronal plane (107 studies). Correct results were obtained for about 90% cases. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Endotoxins in surgical instruments of hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vania Regina Goveia

    2016-06-01

    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  8. Magnetic resonance imaging of dilated cardiomyopathy; MRT bei dilatativen Kardiomyopathien

    Energy Technology Data Exchange (ETDEWEB)

    D' Anastasi, M. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Greif, M. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Medizinische Klinik und Poliklinik I, Muenchen (Germany); Reiser, M.F.; Theisen, D. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Deutsches Zentrum fuer Herzkreislaufforschung (DZHK), Muenchen (Germany)

    2013-01-15

    Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy with a prevalence of 1 out of 2,500 in adults. Due to mild clinical symptoms in the early phase of the disease, the true prevalence is probably even much higher. Patients present with variable clinical symptoms ranging from mild systolic impairment of left ventricular function to congestive heart failure. Even sudden cardiac death may be the first clinical symptom of DCM. The severity of the disease is defined by the degree of impairment of global left ventricular function. Arrhythmias, such as ventricular or supraventricular tachycardia, atrioventricular (AV) block, ventricular extrasystole and atrial fibrillation are common cardiac manifestations of DCM. Magnetic resonance imaging (MRI) plays an important role in the exact quantification of functional impairment of both ventricles and in the evaluation of regional wall motion abnormalities. With its excellent ability for the assessment of myocardial structure, it is becoming increasingly more important for risk stratification and therapy guidance. (orig.) [German] Die dilatative Kardiomyopathie (DCM) ist die haeufigste Form der Kardiomyopathie mit einer Praevalenz von 1/2500 Erwachsenen. Aufgrund der zunaechst milden klinischen Symptomatik ist jedoch von einer relativ hohen Dunkelziffer auszugehen. Die klinische Praesentation ist variabel, die Schwere der Erkrankung wird vom Ausmass der systolischen Funktionseinschraenkung bestimmt. Herzrhythmusstoerungen, wie ventrikulaere oder supraventrikulaere Tachykardien, AV-Blockierungen, ventrikulaere Extrasystolen und Vorhofflimmern sind moegliche klinische Manifestationen. Bei manchen Patienten ist der ploetzliche Herztod die erste klinische Manifestation der Erkrankung. Die kardiale MRT spielt eine bedeutende Rolle fuer die Beurteilung des Ausmasses der ventrikulaeren Dilatation, Dysfunktion und fuer die Beurteilung regionaler Wandbewegungsstoerungen. Darueber hinaus kann sie zur Anwendung kommen

  9. Total hip arthroplasty at the rothman institute.

    Science.gov (United States)

    Austin, Matthew S; Higuera, Carlos A; Rothman, Richard H

    2012-07-01

    Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

  10. PC-BEIS: a personal computer version of the biogenic emissions inventory system

    International Nuclear Information System (INIS)

    Pierce, T.E.; Waldruff, P.S.

    1991-01-01

    The US Environmental Protection Agency's Biogenic Emissions Inventory System (BEIS) has been adapted for use on IBM-compatible personal computers (PCs). PC-BEIS estimates hourly emissions of isoprene, α-pinene, other monoterpenes, and unidentified hydrocarbons for any county in the contiguous United States. To run the program, users must provide hourly data on ambient temperature, relative humidity, wind speed, cloud cover, and a code that identifies the particular county. This paper provides an overview of the method used to calculate biogenic emissions, shows an example application, and gives information on how to obtain a copy of the program

  11. Working memory in volunteers and schizophrenics using BOLD fMRI; Das Arbeitsgedaechtnis bei Gesunden und bei Schizophrenen: Untersuchungen mit BOLD-fMRT

    Energy Technology Data Exchange (ETDEWEB)

    Giesel, F.L. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (Germany); Deutsches Krebsforschungszentrum (DKFZ), Abteilung Radiologie, Heidelberg (Germany); Hohmann, N. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (Germany); Psychiatrische Universitaetsklinik Heidelberg, Sektion Gerontopsychiatrie (Germany); Seidl, U.; Kress, K.R.; Schoenknecht, P.; Schroeder, J. [Psychiatrische Universitaetsklinik Heidelberg, Sektion Gerontopsychiatrie (Germany); Kauczor, H.-U.; Essig, M. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (Germany)

    2005-02-01

    Functional magnetic resonance imaging uses the blood oxygen level-dependent effect (BOLD MRI) for noninvasive display of cerebral correlatives of cognitive function. The importance for the understanding of physiological and pathological processes is demonstrated by investigations of working memory in schizophrenics and healthy controls. Working memory is involved in processing rather than storage of information and therefore is linked to complex processes such as learning and problem solving. In schizophrenic psychosis, these functions are clearly restricted. Training effects in the working memory task follow an inverse U-shape function, suggesting that cerebral activation reaches a peak before economics of the brain find a more efficient method and activation decreases. (orig.) [German] Die funktionelle Magnetresonanztomographie (fMRT) nutzt den ''blood oxygen level dependent effect'' (BOLD-Effekt) zur nichtinvasiven Darstellung zerebraler Korrelate kognitiver Funktionen. Die Bedeutung dieses Verfahrens fuer das Verstaendnis physiologischer und pathologischer Prozesse wird anhand von Untersuchungen zum Arbeitsgedaechtnis bei Schizophrenen und gesunden Kontrollpersonen verdeutlicht. Das Arbeitsgedaechtnis dient weniger der Speicherung, sondern vielmehr der Verarbeitung von Informationen und ist deshalb in komplexe Prozesse wie Lernen und Problemloesen eingebunden. Im Rahmen schizophrener Psychosen kommt es zu einer deutlichen Einschraenkung dieser Funktionen. Erwartungsgemaess zeigen sich unter Durchfuehrung eines Arbeitsgedaechtnisparadigmas Unterschiede in der zerebralen Aktivitaet, die jedoch bei den Erkrankten unter Therapie prinzipiell reversibel sind. Von Interesse sind auch Trainingseffekte bei Gesunden, wobei eine verminderte Aktivierung nach Training auf eine ''Oekonomisierung'' schliessen laesst. (orig.)

  12. The Synovial Lining and Synovial Fluid Properties after Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Michael Shang Kung

    2015-05-01

    Full Text Available The lubrication of the cartilaginous structures in human joints is provided by a fluid from a specialized layer of cells at the surface of a delicate tissue called the synovial lining. Little is known about the characteristics of the fluids produced after a joint arthroplasty procedure. A literature review was carried out to identify papers that characterized the synovial lining and the synovial fluids formed after total hip or knee arthroplasty. Five papers about synovial lining histology and six papers about the lubricating properties of the fluids were identified. The cells making up the re-formed synovial lining, as well as the lining of interface membranes, were similar to the typical Type A and B synoviocytes of normal joints. The synovial fluids around joint replacement devices were typically lower in viscosity than pre-arthroplasty fluids but the protein concentration and phospholipid concentrations tended to be comparable, suggesting that the lining tissue function was preserved after arthroplasty. The widespread, long-term success of joint arthroplasty suggests that the lubricant formed from implanted joint synovium is adequate for good clinical performance in the majority of joints. The role the fluid plays in component wear or failure is a topic for future study.

  13. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  14. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty.

    Science.gov (United States)

    Czech, Szymon; Hermanson, Jacek; Rodak, Piotr; Stołtny, Tomasz; Rodak, Łukasz; Kasperczyk, Sławomir; Koczy, Bogdan; Mielnik, Michał

    2017-12-01

    An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  15. Innovations for vehicle weight savings; Innovationen zur Gewichtseinsparung bei Kraftfahrzeugen

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, W.C. [Budd Technical Center, Auburn Hills, MI (United States)

    1999-04-01

    konventionellen Stahl ueber hoch- und hoechstfeste Staehle, Aluminiumguss, -blech und -strangpressprofile bis hin zu hochwertigen Kunststoffen, wie SMC und SRIM, werden Leichtbau-Problemloesungen fuer Karosserie und Fahrwerk entwickelt und der Automobilindustrie angeboten. Das Leichtbaupotential der diversen Werkstoffe wird darueber hinaus durch den Einsatz modernster Fertigungsverfahren, wie z.B. das Innenhochdruckumformen von Stahl und Aluminium, Tailored Blanks aus Stahl und die Klebetechnik bei Aluminium, weitgehend ausgeschoepft. (orig.)

  16. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 2007

    DEFF Research Database (Denmark)

    Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove

    2010-01-01

    The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip...

  17. Precise orbit determination and point positioning using GPS, Glonass, Galileo and BeiDou

    Directory of Open Access Journals (Sweden)

    Tegedor J.

    2014-04-01

    Full Text Available State of the art Precise Point Positioning (PPP is currently based on dual-frequency processing of GPS and Glonass navigation systems. The International GNSS Service (IGS is routinely providing the most accurate orbit and clock products for these constellations, allowing point positioning at centimeter-level accuracy. At the same time, the GNSS landscape is evolving rapidly, with the deployment of new constellations, such as Galileo and BeiDou. The BeiDou constellation currently consists of 14 operational satellites, and the 4 Galileo In-Orbit Validation (IOV satellites are transmitting initial Galileo signals. This paper focuses on the integration of Galileo and BeiDou in PPP, together with GPS and Glonass. Satellite orbits and clocks for all constellations are generated using a network adjustment with observation data collected by the IGS Multi-GNSS Experiment (MGEX, as well as from Fugro proprietary reference station network. The orbit processing strategy is described, and orbit accuracy for Galileo and BeiDou is assessed via orbit overlaps, for different arc lengths. Kinematic post-processed multi-GNSS positioning results are presented. The benefits of multiconstellation PPP are discussed in terms of enhanced availability and positioning accuracy.

  18. ANALISIS RASIO ALTMAN MODIFIKASI PADA PREDIKSI KEBANGKRUTAN PERUSAHAAN PROPERTY DAN REAL ESTATE YANG TERDAFTAR DI BEI

    OpenAIRE

    Anita Tri Widiyawati; Supri Wahyudi Utomo; Nik Amah

    2015-01-01

    Penelitian ini bertujuan untuk mengetahui pengaruh rasio Altman Modifikasi terhadap prediksi kebangkrutan. Jenis penelitian ini termasuk penelitian kuantitatif. Populasi dalam penelitian ini adalah perusahaan property dan real estate yang terdaftar di BEI. Teknik pengambilan sampel menggunakan purposive sampling sehingga diperoleh sampel sejumlah 32 perusahaan property dan real estate yang menerbitkan laporan keuangannya selama tahun 2011-2013. Teknik analisis data menggunakan regresi logisti...

  19. Spinal metastases of malignant gliomas; Spinale Metastasierung bei malignen Gliomen. Zwei Fallbeschreibungen

    Energy Technology Data Exchange (ETDEWEB)

    Materlik, B; Steidle-Katic, U; Feyerabend, T; Richter, E [Medizinische Univ. Luebeck (Germany). Klinik fuer Strahlentherapie und Nuklearmedizin; Wauschkuhn, B [Medizinische Univ. Luebeck (Germany). Klinik fuer Neurologie

    1998-09-01

    Purpose: Extracranial metastases of malignant gliomas are rare. We report 2 cases with spinal metastases in patients suffering from glioma. Patients and Method: Two patients (33 and 57 years old) developed spinal canal metastases of a glioblastoma multiforme and anaplastic astrocytoma Grade III respectively 25 and 9 months after surgical resection and radiotherapy. Both metastases were confirmed pathohistologically. Results: Intraspinal metastases were irradiated with a total dose of 12.6 Gy and 50 Gy. Treatment withdrawal was necessary in one patient due to reduced clinical condition. Regression of neurological symptoms was observed in the second patient. Conclusions: Spinal spread of malignant glioma should be considered during care and follow-up in glioma patients with spinal symptoms. (orig.) [Deutsch] Hintergrund: Maligne Gliome metastasieren aeusserst selten extrakraniell. Wir stellen zwei Faelle einer spinalen Filialisierung bei Gliompatienten vor. Patientengut und Methode: Zwei Patienten (33 und 57 Jahre alt) entwickelten 25 bzw. neun Monate nach Resektion und postoperativer Radiatio eines Glioblastoma multiforme und eines anaplastischen Astrozytoms WHO-Grad III histologisch gesicherte intraspinale Metastasen, welche durch Sensibilitaetsstoerungen der Beine symptomatisch wurden. Ergebnisse: Die intraspinalen Filiae wurden mit 12,6 Gy bzw. 50 Gy bestrahlt. Bei einem Patienten musste die Radiatio wegen zunehmender Verschlechterung des Allgemeinzustandes abgebrochen werden, bei dem zweiten Patienten besserte sich die neurologische Symptomatik. Schlussfolgerung: Bei der Betreuung von Gliompatienten sollte, insbesondere in der Nachsorge, an die Moeglichkeit der spinalen Metastasierung mit entsprechender Symptomatik gedacht werden. (orig.)

  20. Diagnostik der Fatigue bei Multipler Sklerose [Assessment of fatigue in multiple sclerosis

    NARCIS (Netherlands)

    Sander, C.; Voelter, H.U.; Schlake, H.P.; Eling, P.A.T.M.; Hildebrandt, H.

    2017-01-01

    Hintergrund: Fatigue ist eines der häufigsten Symptome bei Multipler Sklerose (MS) und hat deutliche Auswirkungen auf die Lebensqualität sowie die Berufstätigkeit. Die adäquate Messung der erlebten Fatigue ist aber auch heutzutage noch mit erheblicher Unsicherheit behaftet. Ziel der Arbeit: In dem

  1. Hollywood Megaplex cinema building at Pasching near Linz, Austria; Hollywood Megaplex. Grosskino in Pasching bei Linz

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1996-08-01

    The contribution describes the projecting and construction of a large cinema building at Pasching near Linz. It goes into detail about heating systems, air conditioning systems, and energy conservation measures. (HW) [Deutsch] Es wird berichtet ueber die Planung und die Ausfuehrung der Baumassnahmen Grosskino in Pasching bei Linz. Im Einzelnen: Heizungssysteme; Klimaanlage; Energiesparmassnahmen. (HW)

  2. Behandlung von Herzrhythmusstörungen mit Magnesium bei Patienten mit Herzinsuffizienz

    Directory of Open Access Journals (Sweden)

    Wink K

    2002-01-01

    Full Text Available Die medikamentöse Behandlung von Herzrhythmusstörungen ist unbefriedigend, da bei guter Wirksamkeit durch die Proarrhythmie eine Verbesserung der Prognose gefährdet und nicht gesichert ist. Man kann davon ausgehen, daß Magnesiumsalze keine arrhythmogene Effekte aufweisen. Bei Patienten mit einer Herzinsuffizienz besteht häufig ein Mg-Mangel, der durch gastrointestinale Störungen, neurohormonale Regulationen, aber auch durch die Therapie (Diuretika,Digitalisbedingt ist. An Patienten mit einer Herzinsuffizienz müßte sich demnach zeigen lassen, ob die Mg-Substitution einen antiarrhythmischen Effekt aufweist. In fünf placebokontrollierten Studien konnte gezeigt werden, daß sich teil weise signifikant und mit ausreichen der Aussagekraft (PowerArrhythmien bei Patienten mit Herzinsuffizienz durch orale und parenterale Gabe von Mg-Salzen reduzieren lassen. Trotz Einschränkungen wie z.B. inadäquates Design, fehlende Vermeidung von Bias, ungenügende Vergleichbarkeit der Behandlungsgruppen, inadäquate Auswertung und ungenügende Berücksichtigung der Spontanvariation läßt sich aufgrund der Ergebnisse der Studien die Hypothese aufstellen, daß Magnesiumsalze bei Patienten mit Herzinsuffizienz Herzrhythmusstörungen günstig beeinflussen können. Prospektive, randomisierte,verblindete und kontrollierte konfirmatorische Studien mit ausreichenden Fallzahlen sind jedoch notwendig, um diese Hypothese zu bestätigen.

  3. Mitbestimmung von Studierenden bei der Qualitätssicherung und Hochschulentwicklung

    DEFF Research Database (Denmark)

    Lippert, Ingmar

    2005-01-01

    Hochschule hat bestimmte Aufgaben. Sie soll durch Forschung und Lehre Wissen und Methoden in die Gesellschaft tragen. Sie soll auch direkt andere gesellschaftliche Institutionen beraten. Bei diesen Interaktionen soll aber – und das ist so spezifisch für Hochschulen – die gesellschaftliche Praxis ...

  4. Zeitlicher Verlauf der avaskulären Nekrose des Hüftkopfes bei Patienten mit Pemphigus vulgaris.

    Science.gov (United States)

    Balighi, Kamran; Daneshpazhooh, Maryam; Aghazadeh, Nessa; Saeidi, Vahide; Shahpouri, Farzam; Hejazi, Pardis; Chams-Davatchi, Cheyda

    2016-10-01

    Pemphigus vulgaris (PV) wird in der Regel mit systemischen Corticosteroiden und Immunsuppressiva behandelt. Avaskuläre Nekrose (AVN) des Hüftkopfes ist eine gut bekannte schwerere Komplikation einer Corticosteroid-Therapie. Die Charakteristika dieser schweren Komplikation bei PV sind nach wie vor unbekannt. Nicht kontrollierte, retrospektive Untersuchung aller PV-bedingten AVN-Fälle, die in einer iranischen Klinik für bullöse Autoimmunerkrankungen zwischen 1985 und 2013 diagnostiziert wurden. Anhand der Krankenakten von 2321 untersuchten PV-Patienten wurden 45 Fälle (1,93 %) von femoraler AVN identifiziert. Dreißig davon waren Männer. Das mittlere Alter bei der Diagnose der AVN betrug 47,4 ± 14,2 Jahre. Der mittlere Zeitraum zwischen der Diagnose des PV und dem Einsetzen der AVN lag bei 25,3 ± 18,3 Monaten. Mit Ausnahme von acht Fällen (17,8 %) setzte die AVN bei der Mehrheit der Patienten innerhalb von drei Jahren nach Diagnose des PV ein. Die mittlere kumulative Dosis von Prednisolon bei Patienten mit AVN betrug 13.115,8 ± 7041,1 mg. Zwischen der Prednisolon-Gesamtdosis und dem Zeitraum bis zum Einsetzen der AVN bestand eine starke Korrelation (p = 0,001). Bei Patienten mit Alendronateinnahme in der Vorgeschichte war dieser Zeitraum signifikant kürzer (p = 0,01). Die AVN ist eine schwere Komplikation einer Corticosteroid-Behandlung bei Patienten mit PV. Sie wird bei 2 % der Patienten beobachtet und tritt vor allem in den ersten drei Behandlungsjahren auf. Bei Patienten, die höhere Dosen von Prednisolon erhalten, setzt die AVN tendenziell früher ein. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  5. PET in diagnosing exocrine pancreatic cancer; PET bei Tumoren des exokrinen Pankreas

    Energy Technology Data Exchange (ETDEWEB)

    Bares, R.; Besenfelder, H.; Dohmen, B.M. [Abt. Nuklearmedizin, Radiologische Klinik des Universitaetsklinikums Tuebingen (Germany)

    2003-06-01

    Despite dramatic improvements in diagnostic imaging (ultrasonography, in particular endoscopic ultrasound, CT, MRI) treatment results of pancreatic cancer are still poor. Due to the lack of early symptoms, most tumors are diagnosed at an advanced stage of disease which excludes curative surgical treatment. FDG-PET has been shown to be effective in detecting pancreatic cancer as well as differentiating benign from malignant pancreatic tumors. Results might be further improved by applying quantitative analyses, in particular kinetic modelling of FDG metabolism. Nevertheless false negative as well as false positive findings may occur. Small lesions (lymphnode or liver metastases < 1 cm) might be missed, furthermore hyperglycemia often present in patients with pancreatic disease might reduce tumor uptake and subsequently tumor detectability by PET. False positive findings were reported in active pancreatitis and some benign tumors. Although PET proved to be superior to CT or ERCP in detecting cancer, clinical relevance of PET is limited due to the absence of therapeutic consequences to be derived from PET. As a consequence PET should only be used in patients with equivocal findings of morphological imaging (CT, ERCP) who are potential candidates for surgical treatment. (orig.) [German] Trotz verbesserter diagnostischer Moeglichkeiten (endoskopischer Ultraschall, Spiral-CT, MRT) sind die Behandlungsergebnisse bei Tumoren des exokrinen Pankreas nach wie vor unbefriedigend. Aufgrund der spaet einsetzenden klinischen Symptomatik wird die Diagnose meist erst bei lokaler Inoperabilitaet gestellt. Die FDG-PET has sich sowohl im Nachweis von Pankreaskarzinomen als auch bei der Differenzialdiagnose pankreatischer Raumforderungen bewaehrt und den etablierten bildgebenden Verfahren (Ultraschall, CT) als ueberlegen erwiesen. Weitere Verbesserungen erscheinen durch absolute Quantifizierung der FDG-Kinetik moeglich. Dennoch koennen falsch negative wie auch falsch positive Ergebnisse

  6. High risk for revision after shoulder arthroplasty for failed osteosynthesis of proximal humeral fractures

    DEFF Research Database (Denmark)

    Kristensen, Marc Randall; Rasmussen, Jeppe Vejlgaard; Elmengaard, Brian

    2018-01-01

    Background and purpose - It is unclear whether previous osteosynthesis is a risk factor for inferior outcome following shoulder arthroplasty for a proximal humeral fracture. We used data from the Danish Shoulder Arthroplasty Registry (DSR) to examine this question. Patients and methods - All 285...... patients treated with a shoulder arthroplasty after failed osteosynthesis of a proximal humeral fracture reported to DSR from 2006 to 2013 were included. Each case was matched with 2 controls (570) treated with a primary shoulder arthroplasty for an acute proximal humeral fracture. Patient reported outcome...... for a shoulder arthroplasty after failed osteosynthesis was 2 with a primary arthroplasty for fracture as reference. In a separate analysis of patients treated by locking plate the mean WOOS was 46 (24), with a relative risk of revision at 1.5 with a primary arthroplasty as reference. Interpretation - Compared...

  7. Mesenchymal abdominal tumors in children; Mesenchymale Tumoren des Abdomens bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Krombach, G.A. [Justus-Liebig Universitaet Giessen, Klinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Giessen, Giessen (Germany)

    2018-01-15

    Mesenchymal tumors in childhood comprise benign and malign entities and differ regarding typical sites of manifestation, age peak and clinical symptoms. In some cases biopsy is mandatory. If nephroblastoma is a possible diagnosis, biopsy must be avoided by all means in order to avoid biopsy tract metastasis. Imaging is used to narrow the differential diagnosis, describe the exact extent of the lesion and deliver complete staging. In pediatric patients sonography and MRI are the most important imaging modalities. Low-dose CT of the thorax serves for assessment of possible pulmonary metastases. (orig.) [German] Mesenchymale Tumoren im Kindesalter umfassen eine Reihe gutartiger und boesartiger Entitaeten, die sich hinsichtlich Praedilektionsort und Altersgipfel sowie bezueglich der klinischen Symptome voneinander unterscheiden. In manchen Faellen ist eine Biopsie unumgaenglich. Ist als Differenzialdiagnose ein Nephroblastom moeglich, darf auf keinen Fall biopsiert werden, um eine Zellverschleppung zu vermeiden. Aufgabe der Bildgebung ist die Eingrenzung der Differenzialdiagnose und die Bestimmung der Ausdehnung, einschliesslich des Stagings. Ultraschall und Magnetresonanztomographie (MRT) stellen diesbezueglich die wichtigsten Modalitaeten dar, die Niedrigdosis-Computertomographie des Thorax wird zum Ausschluss einer pulmonalen Metastasierung herangezogen. (orig.)

  8. Transfusion practice in hip arthroplasty - a nationwide study

    DEFF Research Database (Denmark)

    Jans, Øivind; Kehlet, H; Hussain, Zubair Butt

    2011-01-01

    ) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred......Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA...... thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71...

  9. The association between metal allergy, total knee arthroplasty, and revision

    DEFF Research Database (Denmark)

    Münch, Henrik J; Jakobsen, Stig Storgaard; Olesen, Jens T

    2015-01-01

    BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction...... to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test......, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated...

  10. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    Science.gov (United States)

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

  11. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  12. Use of massive structural allograft in revision septic hip arthroplasty

    International Nuclear Information System (INIS)

    Imran Ilyas; Morgan, F.; David, A.

    1999-01-01

    The reconstruction of failed septic hip arthroplasty with the use of massive osseous allograft segments is reported in ten patients. All of these patients had a two-stage procedure with an interval Girdlestone arthroplasty separating the initial demolition from the subsequent reconstruction. The mean follow-up was 58 months (range 36 to 98 months) and the most common pathogen isolated was Staphylococcus epidermidis. The mean preoperative modified Harris hip score was 27 points (range 9 to 58) and the mean postoperative score was 73 points (range 53 to 92). There was one patient who required an additional procedure not related to allograft use. There has been no case of recurrence of infection. We conclude that the revision of septic hip arthroplasty in the use of massive allografts do not have to be mutually exclusive events

  13. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Bohm, Eric; Franklin, Patricia

    2016-01-01

    The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use...... are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain...... should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before...

  14. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  15. Radiographic and scintigraphic evaluation of total knee arthroplasty

    International Nuclear Information System (INIS)

    Schneider, R.; Soudry, M.

    1986-01-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent

  16. Patient expectations predict greater pain relief with joint arthroplasty.

    Science.gov (United States)

    Gandhi, Rajiv; Davey, John Roderick; Mahomed, Nizar

    2009-08-01

    We examined the relationship between patient expectations of total joint arthroplasty and functional outcomes. We surveyed 1799 patients undergoing primary hip or knee arthroplasty for demographic data and Western Ontario McMaster University Osteoarthritis Index scores at baseline, 3 months, and 1 year of follow-up. Patient expectations were determined with 3 survey questions. The patients with the greatest expectations of surgery were younger, male, and had a lower body mass index. Linear regression modeling showed that a greater expectation of pain relief with surgery independently predicted greater reported pain relief at 1 year of follow-up, adjusted for all relevant covariates (P relief after joint arthroplasty is an important predictor of outcomes at 1 year.

  17. Laterale 10-fach-Biopsie der Prostata liefert bei Karzinomverdacht überlegene Detektionsraten

    Directory of Open Access Journals (Sweden)

    von Knobloch R

    2012-01-01

    Full Text Available Einleitung:Die Sextantenbiopsie der Prostata ist für eine verlässliche Karzinomdiagnostik nicht ausreichend. Vielerorts werden bereits bei der Erstbiopsie 12 Stanzen entnommen. In einer großen Serie von 10-fach-Biopsien unter bilateraler lokaler Leitungsanästhesie, wie bereits 2002 publiziert [1], überprüften wir die Qualität unserer Technik als Standard für die Erstbiopsie. Methode:Zwischen April 2005 und Dezember 2007 führten wir bei 736 Männern (Durchschnittsalter 67,5 ± 8,39 Jahre die Erstbiopsie der Prostata durch. Indikation für die Biopsie war entweder ein erhöhter PSA-Wert oder ein auffälliger Tastbefund. Bei allen Männern erfolgte die Biopsie der Prostata unter bilateraler lokaler Leitungsanästhesie. Es wurden nur Proben aus der peripheren Zone der Prostata unter transrektaler Ultraschallkontrolle entnommen. Ergebnisse:Durch die Biopsie wurde in 372 von 736 Fällen (50,5 % ein Karzinom identifiziert. Die Karzinomdetektionsrate war proportional zum PSA-Wert und indirekt proportional zum Organvolumen. Es zeigte sich eine eindeutige Korrelation zwischen der Anzahl positiver Stanzen bei der Biopsie mit dem pathologischen Stadium des Prostatektomiepräparates. 12 Männer (1,6 % mussten wegen akuter Prostatitis und 5 (0,7 % wegen rektaler Blutung wieder ins Krankenhaus eingewiesen werden. Von den 182 Patienten des Untersuchers R. v. K. wurde der durchschnittliche Schmerz der Biopsie mit 1,69 von maximal 10 angegeben. Die Detektions- und Komplikationsraten dieser Biopsietechnik unterschieden sich nicht nach Durchführung von Assistenz- oder Fachärzten. Schlussfolgerung: Die präsentierte Biopsietechnik liefert mit nur 10 Stanzen eine überlegene Detektionsrate und eine geringe Rate an Komplikationen. Sie sollte als Basis für die Definition eines Standards für die Erstbiopsie der Prostata bei Karzinomverdacht dienen.

  18. Treatment of malignant biliary obstructions via the percutaneous approach; Interventionen bei malignen Gallenwegstenosen

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, B.A.; Lopez-Benitez, R.; Hallscheidt, P.; Grenacher, L.; Libicher, M.; Richter, G.M.; Kauffmann, G.W. [Radiologische Klinik der Ruprecht-Karls-Universitaet Heidelberg (Germany). Abteilung fuer Radiodiagnostik

    2005-11-01

    This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected. (orig.) [German] Vorgelegt wird eine Uebersicht ueber den gegenwaertigen Stellenwert radiologischer Interventionen bei malignen Gallenwegstenosen, die nur bei 10-20% der Patienten heilbar sind. Wenn ein endoskopisch transpapillaerer Zugang nicht moeglich ist, z. B. bei hohen Obstruktionen oder nach frueheren Eingriffen, ermoeglichen die perkutane transhepatische Punktion und Implantation von Metallendoprothesen eine gute Palliation. Die perkutane Gallengangdrainage und Stentplatzierung sind fuer den erfahrenen, interventionell taetigen Radiologen wenig kompliziert und mit einer Erfolgsrate von 95-100% dem endoskopischen Vorgehen deutlich ueberlegen. Morbiditaet und Mortalitaet der endoskopischen Verfahren waren in aelteren Arbeiten noch geringer als die der perkutanen Methoden. Aktuellen Studien zufolge sind beide Verfahren gleichwertig, wahrscheinlich aufgrund technischer Verbesserungen der perkutanen Interventionen. Die technische Erfolgsrate bei der Stentapplikation liegt ueber 95%. Mittels perkutaner transhepatischer biliaerer Drainageneinlage (PTCD) eingelegte Metallstents bleiben haeufiger und laenger offen als Plastikstents. Bei entsprechender Lebenserwartung des Patienten ist ihr Einsatz daher

  19. Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures.

    Science.gov (United States)

    Clarke-Jenssen, John; Westberg, Marianne; Røise, Olav; Storeggen, Stein Arne Øvre; Bere, Tone; Silberg, Ingunn; Madsen, Jan Erik

    2017-11-01

    Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Activity and Quality of Life after Total Hip Arthroplasty.

    Science.gov (United States)

    Świtoń, Anna; Wodka-Natkaniec, Ewa; Niedźwiedzki, Łukasz; Gaździk, Tadeusz; Niedźwiedzki, Tadeusz

    2017-10-31

    Coxarthrosis is a chronic musculoskeletal condition that causes severe pain and considerable limi-tation of the patient's motor performance. Total hip arthroplasty is one of the most common and effective methods used in the treatment of advanced degenerative changes. The aim of the present study was to evaluate the activity and quality of life of patients after unilateral total hip arthroplasty. The study was conducted in a group of 189 patients who had undergone unilateral total hip arthroplasty. Goniometry was used to determine the range of motion of both hip joints. Patients' physical ability and pain severity were assessed based on the Harris Hip Score (HHS) questionnaire. The examination of the range of motion in the lower extremities revealed statistically significant diffe-rences in flexion (p<0.01), abduction (p=<0.01), adduction (p<0.01) and external rotation (p<0.01) between the operated and the healthy extremity. The greatest limitation of motion was demonstrated for external rotation (<14°). Approximately 14% of the patients were not able to perform this motion in their healthy hip joint, while 17.5% of them could not do so in the affected hip joint. Analysis of HHS results (mean = 79 pts) revealed that more than 50% of the patients described their functional ability and quality of life as good and excellent. It was demonstrated that 54% of patients did not suffer from pain, whereas minor or mild pain was noted in 35%. 1. A subjective clinical assessment of patients after total hip arthroplasty showed that their quality of life had improved. 2. It is necessary to perform physiotherapy after total hip arthroplasty, on both the operated and healthy side. 3. Exacerbation of pain and impaired activity in patients after total hip arthroplasty were associated with the female sex to a considerable extent.

  1. Trabecular metal acetabular components in primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Laaksonen, Inari; Lorimer, Michelle; Gromov, Kirill

    2018-01-01

    Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship...... of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were...

  2. Nurses' responsibilities in postoperative pain management following total hip arthroplasty

    OpenAIRE

    Dumolard, Pierre; Gök, Mustafa; Le, Ngoc

    2017-01-01

    Total hip arthroplasty is the replacement of a hip joint that has been severely damaged. The operation is recommended if other treatments have not responded adequately. As the nurses are the professionals who spend the most time with patients after the surgery, they play an important role in the patient’s pain management. The aim of the thesis is to define the nurse’s responsibilities in the care of total hip arthroplasty. The purpose of the thesis is to analyze existing research, which may s...

  3. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

    DEFF Research Database (Denmark)

    Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S

    2015-01-01

    BACKGROUND AND PURPOSE: There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision...... with adjustment for age, sex, and previous surgery. RESULTS: During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were...

  4. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  5. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  6. Avascular necrosis of the trapezoid bone following carpometacarpal arthroplasty.

    Science.gov (United States)

    Kane, Patrick; Waryasz, Greg; Katarincic, Julie

    2014-03-03

    A 58-year-old female developed avascular necrosis of her trapezoid approximately 3 months after undergoing carpometacarpal arthroplasty. The patient was treated conservatively with immobilization and had complete resolution of her clinical symptoms during her year of follow-up. Additionally, radiographic examination showed complete restoration of the height of her trapezoid approximately 1 year after the index procedure. Avascular necrosis of the trapezoid is extremely rare with very few cases described in the literature. This is the first description of avascular necrosis following carpometacarpal arthroplasty.

  7. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Koesters, A.; Poetzelsberger, B.; Dela, F.

    2015-01-01

    The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand of the inte......The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand...

  8. Early rehabilitation after elective total knee arthroplasty.

    Science.gov (United States)

    Lisi, Claudio; Caspani, Patrick; Bruggi, Marco; Carlisi, Ettore; Scolè, Donatella; Benazzo, Francesco; Dalla Toffola, Elena

    2017-10-18

    Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients. in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment. length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day. Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

  9. Emerging technologies in arthroplasty: additive manufacturing.

    Science.gov (United States)

    Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A

    2014-06-01

    Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. ARTHROPLASTY FEATURES IN OVERWEIGHT PATIENTS (REVIEW

    Directory of Open Access Journals (Sweden)

    A. I. Yousef

    2017-01-01

    Full Text Available The paper represents a review of modern foreign literature dedicated to joint replacement in patients with increased body mass index. The authors  examine the epidemiology,  pathogenesis features  of osteoarthritis (arthrosis in obesity. The majority  of experts  consider  the increased  body mass index an aggravating factor in the surgical treatment of large joints arthrosis.  There is also the opposite point of view, confirmed by many orthopedic surgeons.The analysis of publications in foreign scientific literature regarding the risk of intraand postoperative complications after arthroplasty in obese patients yields controversial results. The authors  regret  availability of only a few studies  on such an interesting and important topic  carried  out  in Russia. The  need for a detailed  study  of the  issues related  to treatment of patients with obesity is prompted by our time.

  11. LEAK study : design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty

    NARCIS (Netherlands)

    Löwik, Claudia A M; Wagenaar, Frank-Christiaan; van der Weegen, Walter; Poolman, Rudolf W; Nelissen, Rob G H H; Bulstra, Sjoerd K; Pronk, Yvette; Vermeulen, Karin M; Wouthuyzen-Bakker, Marjan; van den Akker-Scheek, Inge; Stevens, Martin; Jutte, Paul C

    2017-01-01

    INTRODUCTION: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On

  12. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review.

    Science.gov (United States)

    Nagra, Navraj S; Hamilton, Thomas W; Ganatra, Sameer; Murray, David W; Pandit, Hemant

    2016-10-01

    Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery. MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up. From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61-71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR -0.06, 95 % confidence interval -0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made. Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined. III.

  13. CURBSIDE CONSULTATION IN KNEE ARTHROPLASTY: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Craig J. Della Vale

    2008-12-01

    Full Text Available A user- friendly reference for decision making in complicated cases of knee arthroplasty desingned in a question and answers format composed of articles containing current concepts and preferences of experts in total knee replacement surgery, enhanced by several images, diagrams and references and written in the form of a casual advice by Craig J. Della Vale, MD. and his collaborators. PURPOSE By this practical reference of knee arthroplasty, the editor and the contributors have aimed providing straightforward and brief answers, evidence-based advices, their preference and opinions containing current concepts for unanswered questions about complicated cases in total knee replacement surgery which are often controversial and not addressed clearly in traditional knee arthroplasty references. FEATURES There are 49 subjects each written by a different expert designed in 4 sections in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected including indications, unicompartmental osteoarthritis of the knee, patient with vascular problems, donating blood, bilateral arthroplasty, patellar resurfacing, range of motion, bearing surface, contraindications, teaching class for patients prior surgery. The second section is about intraoperative questions including skin incision, patella femoral maltracking, femoral component rotation, tibial component rotation, lateral release, femoral component sizing, flexion instability, varus deformity, and valgus deformity, tightness in extension, iatrogenic MCL injury, antibiotic-loaded cement, and perioperative pain. The third section subjects postoperative questions including wound drainage, preventing tromboembolic events, vascular complications, foot drop, manipulation under anesthesia, patella fractures, supracondylar femur fractures, acute extensor mechanism disruptions. In the fourth

  14. Prognostische Bedeutung der physikalischen Streßechokardiographie bei 3329 ambulanten Patienten (5jährige Langzeitstudie)

    OpenAIRE

    Leischik R; Dworrak B; Gülker H; Littwitz H

    2005-01-01

    Hintergrund und Fragestellung: Die Risikoeinschätzung ambulanter Patienten mit thorakaler Schmerzsymptomatik ist ein wichtiges klinisches Problem. Über die prognostische Bedeutung der physikalischen Streßechokardiographie (SE) bei diesem Patientenkollektiv wurde bis jetzt nicht berichtet. Patienten und Methoden: Um die prognostische Bedeutung der physikalischen Streßechokardiographie bei rein ambulanten Patienten zu untersuchen, wurden 3329 Patienten bezüglich des Auftretens schwerer Erei...

  15. Magnetic resonance spectroscopy in schizophrenia. Possibilities and limitations; Magnetresonanzspektroskopie bei Schizophrenie. Moeglichkeiten und Grenzen

    Energy Technology Data Exchange (ETDEWEB)

    Wobrock, T. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Psychiatrie und Psychotherapie; Universitaetsklinikum des Saarlandes, Klinik fuer Psychiatrie und Psychotherapie, Homburg/Saar (Germany); Scherk, H.; Falkai, P. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Psychiatrie und Psychotherapie

    2005-02-01

    Magnetic resonance spectroscopy is a noninvasive investigative technique for in vivo detection of biochemical changes in neuropsychiatric disorders for which especially proton ({sup 1}H-MRS) and phosphorus ({sup 31}P-MRS) magnetic resonance spectroscopy have been used. In this review we explain the principles of MRS and summarize the studies in schizophrenia. A systematic literature review was carried out for {sup 1}H-MRS studies investigating schizophrenic patients compared to controls. The inconsistent results in the cited studies may be due to different study population, specific neuroimaging technique, and selected brain regions. Frequent findings are decreased PME and increased PDE concentrations ({sup 31}P-MRS) linked to altered metabolism of membrane phospholipids and decreased N-acetylaspartate (NAA) or NAA/choline ratio ({sup 1}H-MRS) linked to neuronal damage in frontal (DLPFC) or temporal regions in patients with schizophrenia. These results contribute to the disturbed frontotemporal-thalamic network assumed in schizophrenia and are supported by additional functional neuroimaging, MRI morphometry, and neuropsychological evaluation. The combination of the described investigative techniques with MRS in follow-up studies may provide more specific clues for understanding the pathogenesis and disease course in schizophrenia. (orig.) [German] Die Magnetresonanzspektroskopie (MRS) stellt ein nichtinvasives Verfahren dar, mit dem in vivo biochemische Veraenderungen spezifischer Hirnregionen bei verschiedenen psychiatrischen Erkrankungen untersucht werden koennen. Dabei werden insbesondere die Protonenmagnetresonanzspektroskopie ({sup 1}H-MRS) sowie die Phosphormagnetresonanzspektroskopie ({sup 31}P-MRS) verwendet. In der vorliegenden Uebersichtsarbeit werden die methodischen Grundlagen erlaeutert sowie die Befundlage bei der Schizophrenie referiert. Fuer die Darstellung der Studien zur {sup 1}H-MRS bei schizophrenen Patienten im Vergleich zu einer Kontrollgruppe

  16. Modification of the method of Figgie for determination of joint line shifting in total knee arthroplasty; Modifizierung der Messmethode nach Figgie zur Bestimmung der Gelenklinienverschiebung in der Knieendoprothetik

    Energy Technology Data Exchange (ETDEWEB)

    Classen, T.; Wegner, A.; Knoch, M. von [Universitaet Duisburg-Essen, Klinik fuer Orthopaedie, Essen (Germany)

    2009-06-15

    An important factor for a good result after total knee arthroplasty is the position of the patella in relation to the tibiofemoral joint line. The position of the patella itself is not influenced by arthroplasty, therefore any changes in the position of the tibiofemoral joint line are of special interest. The Figgie method to describe patella height delivers only absolute measurements, which makes it difficult to compare different radiographs. For this reason we developed a new JL/P quotient (JL: distance from the tibial plateau to the tibial tubercle, P: distance from the inferior pole of the patella to the tibial plateau) to enable better comparison. Furthermore, we modified the JL/P quotient and instead of taking the tibial plateau as the reference line, we constructed a tangent on the femoral condyle. With this modification, problems such as tibial inlays of different heights which have to be taken into account in the measurements, the slope of the tibial component or difficult assessment of the tibial joint surface in osteoarthritic knees do not arise. The JL/P quotient shows massive shift to cranialisation of the tibiofemoral joint line which does not correspond to reality. The modified method also shows cranialisation of the tibiofemoral joint line, but in a realistic way. Both methods show a minimal interobserver variability. The modified JL/P quotient seems to be a good method for determining the shift in the tibiofemoral joint line after total knee arthroplasty. (orig.) [German] Ein bedeutender Faktor fuer ein gutes postoperatives Ergebnis nach einer Knieendoprothesenimplantation ist die Stellung der Patella in Relation zur tibiofemoralen Gelenklinie. Da die Stellung der Patella durch den operativen Eingriff primaer nicht beeinflusst wird, liegt besonderes Augenmerk auf den Veraenderungen der Gelenklinie des Tibiofemoralgelenks. Die Messmethode zur Bestimmung der Patellahoehe nach Figgie liefert dafuer nur absolute Werte, was eine Vergleichbarkeit von

  17. Anwendung der extrakorporalen Stoßwellentherapie bei kalzifizierender Periathropathia humeroscapularis, Fersensporn und Epicondylitis humeri - Erfahrungsbericht aus dem Wilhelminenspital

    Directory of Open Access Journals (Sweden)

    Feyertag J

    2004-01-01

    Full Text Available Die Stoßwellentherapie wird bei verschiedenen Indikationen, die unter konservativen Therapien schwer zu schwer zu behandeln sind, eingesetzt. Dazu zählen die kalzifizierenden Schultererkrankungen (Tendinitis calcarea, Epicondylitis humeri (EHR und die plantare Fasciitis mit/ohne plantarem Fersensporn (FSP. Berichtet werden die Ergebnisse von 147 Patienten (102 Frauen/45 Männer, mittleres Alter betrug 57,8 Jahre, die mittels einer einmaligen extrakorporalen Stoßwellentherapie (ESWT (Tend. calc. 82 %, FSP 11 % oder EHR 7 % mittels eines HMT-ReflecTron therapiert wurden. Verabreicht wurden im Mittel 1.800 Stoßwellen. Untersucht wurde die subjektive Verbesserung der Schmerzen anhand einer visuellen Analogskala vor und 6 Wochen nach der Therapie bei allen Patienten. Bei Patienten mit Tendinitis calcarea wurde auch eine Verbesserung der Funktion sowie Veränderungen der Kalzifizierungen untersucht. Bei allen Patienten konnte eine statistisch signifikante Verbesserung der Schmerzen sowie des Bewegungsumfanges beobachtet werden (p 0,0001. Röntgenaufnahmen ergaben eine partielle Verkleinerung der Kalkdepots bei ca. 80 % der Patienten. Aufgrund der geringen Zahl der Patienten fand sich für die EHR keine signifikante Verbesserung der Schmerzsymptomatik. Eine einmalige ESWT kann zu einer deutlichen Verbesserung der Schmerzsymptomatik und zu einer Verbesserung des Bewegungsumfanges führen. Bei 80 % der Patienten mit einer Tendinitis calcarea findet sich weiter eine partielle Verkleinerung der Kalkdepots 6 Wochen nach Therapie.

  18. Knee arthroplasty and bleeding: when to remove drainages.

    Science.gov (United States)

    Ares, Oscar; Seijas, Roberto; Hernandez, Alberto; Castellet, Enric; Sallent, Andrea

    2013-02-01

    The aim of this study is an attempt to clarify the productive time of drainages as we find that the use of drains in knee arthroplasty is controversial, and there is no consensus regarding their length-time maintenance. We analysed the survival curve of bleeding within three surgical techniques for knee arthroplasty and the effect of two variables on survival curve. One hundred and eighty-eight out of 234 knees were included in the study, and patients were divided into three groups according to the surgical technique: conventional total knee arthroplasty (TKA), subvastus TKA and unicompartmental knee arthroplasty. Variables of study were type of surgery, number and placement of drains. Mean of survival curve for postoperative bleeding time was 16 h (95 % CI: 15.4; 16.6). The risk for longer bleeding increased 1.38-fold with each additional drain used (95 % CI 1.1; 1.8). According to the present study, drains can be safely removed at around 17 h postoperative. Bleeding time reduces as less drains are applied. Therapeutic study, Level III.

  19. FAST-TRACK HIP AND KNEE ARTHROPLASTY (LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    A. M. Ageenko

    2017-01-01

    Full Text Available In the present paper the authors discuss the history of fast-track formation, its development and current status. Fast-track advantages in comparison to other rehabilitation options are analyzed. The focus is placed on methods of accelerated rehabilitation after total hip and knee arthroplasty in the leading European and American clinics. Fast-track protocols of surgical centers of Denmark and Hospital for special surgery in the US are described, factors that determine time of hospital stay after total hip and knee arthroplasty are considered, predictors of hospital stay and patients satisfaction after the surgery are examined. The paper reflects the results of the comparison of frequency of thromboembolic and other complications as well as readmission rate after traditional rehabilitation and after fast-track. The paper considers fast-track in bilateral total knee replacement. The authors conclude that further research on acceleration of rehabilitation and reduction of hospital stay after total hip and knee arthroplasty needs to be focused on the optimization of pain relief, especially after discharge, blood preservation techniques, supplementation of fluids loss and strengthening of muscles. Literature analysis demonstrated that the implementation of the Protocol for accelerated recovery after joint arthroplasty in Russia is at an insufficient level. Data of foreign multicenter studies during recent years indicate a high efficacy and safety of this technique in different groups of patients.

  20. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill

    2015-01-01

    BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which ma...

  1. The Oxford unicompartmental knee arthroplasty: a radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Mukherjee, K. [Department of Orthopaedic Radiology, University Hospital of Wales, Cardiff (United Kingdom)], E-mail: kausik.mukherjee@cardiffandvale.wales.nhs.uk; Pandit, H. [North Hampshire Hospital, Basingstoke (United Kingdom); Nuffield Department of Orthopaedic Surgery, University of Oxford, Headington (United Kingdom); Dodd, C.A.F.; Ostlere, S. [Nuffield Orthopaedic Centre, Headington (United Kingdom); Murray, D.W. [Nuffield Department of Orthopaedic Surgery, University of Oxford, Headington (United Kingdom)

    2008-10-15

    Unicompartmental knee arthroplasty (UKA) is increasingly being performed in both specialist centres as well as district hospitals. The radiologists should be aware of the required preoperative imaging, the normal appearance, and complications of this procedure. Unfortunately, very little is available in the radiology literature. This review aims to provide a radiological perspective to an already widely used procedure.

  2. Early morbidity after simultaneous and staged bilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer Calov; Husted, Henrik

    2015-01-01

    PURPOSE: The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS: The Danish National Patient Registry was searched for all...

  3. Prospective psychometric characterization of hip and knee arthroplasty patients

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Fink-Jensen, Anders; Kehlet, Henrik

    2018-01-01

    BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study...

  4. Indications for knee arthroplasty have remained consistent over time

    DEFF Research Database (Denmark)

    Thomsen, Morten Grove; Husted, Henrik; Otte, Kristian Stahl

    2012-01-01

    Between 2004 and 2009, the incidence of primary total knee arthroplasty (TKA) in Denmark has almost doubled. It has been speculated that this increase may be a result of patients being operated on weaker indications. The purpose of this study was to compare preoperative degrees of osteoarthritis...

  5. Monoblock versus modular polyethylene insert in uncemented total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Mikkel Rathsach; Winther, Nikolaj; Lind, Thomas

    2016-01-01

    Background and purpose - Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial...

  6. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not

  7. Press-fit bipolar radial head arthroplasty, midterm results

    NARCIS (Netherlands)

    Kodde, Izaäk F.; Heijink, Andras; Kaas, Laurens; Mulder, Paul G. H.; van Dijk, C. Niek; Eygendaal, Denise

    2016-01-01

    Theoretical advantages of bipolar compared with monopolar radial head arthroplasty include better accommodation of radiocapitellar malalignment, reduction of capitellar abrasion, and reduction of stress at the bone-implant interfaces. Our purpose was to report the midterm results of press-fit

  8. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Kristensen, M.; Pötzelsberger, B.; Scheiber, P.

    2015-01-01

    We investigated the effect of alpine skiing for 12 weeks on skeletal muscle characteristics and biomarkers of glucose homeostasis and cardiovascular risk factors. Twenty-three patients with a total knee arthroplasty (TKA) were studied 2.9 ± 0.9 years (mean ± SD) after the operation. Fourteen...

  9. Delirium after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, L S; Hansen, T B

    2012-01-01

    hospital stay and medical morbidity. No data on PD are available in fast-track surgery. The aim of this study was to evaluate the incidence of PD after fast-track hip (THA) and knee arthroplasty (TKA) with anticipated length of stay (LOS) of In a prospective multicentre study to evaluate postoperative...

  10. Do patients care about higher flexion in total knee arthroplasty?

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Husted, Henrik; Otte, Kristian Stahl

    2013-01-01

    BACKGROUND: Little information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA). The purpose of this study was to investigate if the achievement of a higher degree of knee flexion after TKA would...

  11. The constraints on day-case total knee arthroplasty

    DEFF Research Database (Denmark)

    Thienpont, E; Lavand'homme, P; Kehlet, H

    2015-01-01

    Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day...

  12. The "July effect" in total shoulder arthroplasty.

    Science.gov (United States)

    Rao, Allison J; Bohl, Daniel D; Frank, Rachel M; Cvetanovich, Gregory L; Nicholson, Gregory P; Romeo, Anthony A

    2017-03-01

    New medical doctors enter their residency fields in July, a time in the hospital in which patient morbidity and mortality rates are perceived to be higher. It remains controversial whether a "July effect" exists in different areas of medicine and surgery, including in orthopedic surgery. The purpose of this study is to test for the July effect in patients undergoing primary total shoulder arthroplasty (TSA). Patients who underwent primary TSA from 2005-2012 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Cases were categorized as involving residents or fellows and as occurring during the first academic quarter. Rates of composite and any adverse event outcomes were compared between patient groups using multivariate logistic regression. A total of 1591 patients met the inclusion criteria. Of these cases, 711 (44.7%) had resident or fellow involvement and 390 (24.5%) were performed in the first academic quarter. There were few demographic and comorbidity differences between cases with and without residents or fellows or between cases performed during the first quarter and during the rest of the year. Overall, the rate of serious adverse events was 1.6% and the rate of any adverse events was 6.5%. Using one of the largest cohorts of primary TSA patients, this study could not provide evidence for a July effect. In the context of the recent growth in the volume of TSA procedures, these findings provide important reassurance to patients that it is safe to schedule their elective procedures at training institutions during the first part of the academic year. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. Total elbow arthroplasty for primary osteoarthritis.

    Science.gov (United States)

    Schoch, Bradley S; Werthel, Jean-David; Sánchez-Sotelo, Joaquín; Morrey, Bernard F; Morrey, Mark

    2017-08-01

    Primary osteoarthritis of the elbow is a less common indication for total elbow arthroplasty (TEA). Higher complication rates in younger, active patients may offset short-term improvements in pain and function. The purpose of this study was to determine pain relief, functional outcomes, complications, and survival of TEA in this population. Between 1984 and 2011, 20 consecutive TEAs were performed for primary elbow osteoarthritis. Two patients died before the 2-year follow-up. Mean age at surgery was 68 years (range, 51-85 years). Outcome measures included pain, motion, Mayo Elbow Performance Score, satisfaction, complications, and reoperations. Mean follow-up was 8.9 years (range, 2-20 years). Three elbows sustained mechanical failures. Complications included intraoperative fracture (n = 2), wound irrigation and débridement (n = 1), bony ankylosis (n = 1), humeral loosening (n = 1), humeral component fracture (n = 1), and mechanical failure of a radial head component (n = 1). Fifteen elbows without mechanical failure were examined clinically. Pain improved from 3.6 to 1.5 (P  .05), with preoperative flexion contractures not improving. Mayo Elbow Performance Scores were available for 13 elbows without mechanical failure, averaging 81.5 points (range, 60-100 points); these were graded as excellent (n = 5), good (n = 2), and fair (n = 6). Subjectively, all patients without mechanical failure were satisfied. TEA represents a reliable surgical option for pain relief in patients with primary osteoarthritis. However, restoration of extension is not always obtained, indicating that more aggressive soft tissue releases or bony resection should be considered. Complications occurred in a large number of elbows, but mechanical failure was low considering the nature of this population and the length of follow-up. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Immunological Responses to Total Hip Arthroplasty.

    Science.gov (United States)

    Man, Kenny; Jiang, Lin-Hua; Foster, Richard; Yang, Xuebin B

    2017-08-01

    The use of total hip arthroplasties (THA) has been continuously rising to meet the demands of the increasingly ageing population. To date, this procedure has been highly successful in relieving pain and restoring the functionality of patients' joints, and has significantly improved their quality of life. However, these implants are expected to eventually fail after 15-25 years in situ due to slow progressive inflammatory responses at the bone-implant interface. Such inflammatory responses are primarily mediated by immune cells such as macrophages, triggered by implant wear particles. As a result, aseptic loosening is the main cause for revision surgery over the mid and long-term and is responsible for more than 70% of hip revisions. In some patients with a metal-on-metal (MoM) implant, metallic implant wear particles can give rise to metal sensitivity. Therefore, engineering biomaterials, which are immunologically inert or support the healing process, require an in-depth understanding of the host inflammatory and wound-healing response to implanted materials. This review discusses the immunological response initiated by biomaterials extensively used in THA, ultra-high-molecular-weight polyethylene (UHMWPE), cobalt chromium (CoCr), and alumina ceramics. The biological responses of these biomaterials in bulk and particulate forms are also discussed. In conclusion, the immunological responses to bulk and particulate biomaterials vary greatly depending on the implant material types, the size of particulate and its volume, and where the response to bulk forms of differing biomaterials are relatively acute and similar, while wear particles can initiate a variety of responses such as osteolysis, metal sensitivity, and so on.

  15. Correction of Patellofemoral Malalignment With Patellofemoral Arthroplasty.

    Science.gov (United States)

    Valoroso, Marco; Saffarini, Mo; La Barbera, Giuseppe; Toanen, Cécile; Hannink, Gerjon; Nover, Luca; Dejour, David H

    2017-12-01

    The goal of patellofemoral arthroplasty (PFA) is to replace damaged cartilage and correct underlying deformities to reduce pain and prevent maltracking. We aimed to determine how PFA modifies patellar height, tilt, and tibial tuberosity-trochlear groove (TT-TG) distance. The hypothesis was that PFA would correct trochlear dysplasia or extensor mechanism malalignment. The authors prospectively studied a series of 16 patients (13 women and 3 men) aged 64.9 ± 16.3 years (range 41-86 years) who received PFA. All knees were assessed preoperatively and 6 months postoperatively using frontal, lateral, and "skyline" x-rays, and computed tomography scans to calculate patellar tilt, patellar height, and TT-TG distance. The interobserver agreement was excellent for all parameters (intraclass correlation coefficient >0.95). Preoperatively, the median patellar tilt without quadriceps contraction (QC) was 17.5° (range 5.3°-33.4°) and with QC was 19.8° (range 0°-52.0°). The median Caton-Deschamps index was 0.91 (range 0.80-1.22) and TT-TG distance was 14.5 mm (range 4.0-22.0 mm). Postoperatively, the median patellar tilt without QC was 0.3° (range -15.3° to 9.5°) and with QC was 6.1° (range -11.5° to 13.3°). The median Caton-Deschamps index was 1.11 (range 0.81-1.20) and TT-TG distance was 10.1 mm (range 1.8-13.8 mm). The present study demonstrates that beyond replacing arthritic cartilage, trochlear-cutting PFA improves patellofemoral congruence by correcting trochlear dysplasia and standardizing radiological measurements as patellar tilt and TT-TG. The association of lateral patellar facetectomy improves patellar tracking by reducing the patellar tilt. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

  17. [Restricted motion after total knee arthroplasty].

    Science.gov (United States)

    Kucera, T; Urban, K; Karpas, K; Sponer, P

    2007-10-01

    The aim of the study was to ascertain what proportion of patients undergoing total knee arthroplasty (TKA) complain of restricted knee joint motion, and to investigate options for improvement of this situation. Our evaluation included a group of 796 patients treated with TKA at our department in the period from January 1, 1990, to December 31, 2004. In all cases, a condylar implant with preservation of the posterior cruciate ligaments was used. In addition to medical history, the range of motion, knee joint malalignment and radiological findings were assessed before surgery. After THA, the type of implant and complications, if any, were recorded, and improvement in joint motion was followed up. Based on the results of Kim et al., flexion contracture equal to or higher than 15 degrees and/or flexion less than 75 degrees were made the criteria of stiffness after THA. Patients with restricted THA motion who had aseptic or septic implant loosening were not included. Of the 796 evaluated patients, 32 (4.14 %) showed restricted motion after total knee arthroplasty, as assessed by the established criteria. In 16 patients, stiffness defined by these criteria had existed before surgery, and three patients showed an excessive production of adhesions and heterotopic ossifications. In three patients, the implantation procedure resulted in an elevated level of the original joint line and subsequent development of patella infera and increased tension of the posterior cruciate ligament. Four patients declined physical therapy and, in six, the main cause of stiffness could not be found. Seventeen patients did not require surgical therapy for restricted motion; TKA provided significant pain relief and they considered the range of motion achieved to be sufficient. One patient underwent redress 3 months after surgery, but with no success. Repeated releases of adhesions, replacement of a polyethylene liner and revision surgery of the extensor knee structures were performed in 15

  18. Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis.

    Science.gov (United States)

    Large, Kate E; Page, Carolyn J; Brock, Kim; Dowsey, Michelle M; Choong, Peter F M

    2014-11-01

    With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement. This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1:2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12. There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P≤0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), Pphysiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. WHAT IS KNOWN ABOUT THE TOPIC?: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible

  19. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    International Nuclear Information System (INIS)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E.

    2017-01-01

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  20. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E., E-mail: jsilberzweig@chpnet.org [Mount Sinai Beth Israel, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2017-02-15

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  1. Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint.

    Science.gov (United States)

    Aynardi, Michael C; Atwater, Lara; Dein, Eric J; Zahoor, Talal; Schon, Lew C; Miller, Stuart D

    2017-05-01

    For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. Level IV, retrospective case series.

  2. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Czech Szymon

    2017-12-01

    Full Text Available An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  3. The Popularity of Outcome Measures for Hip and Knee Arthroplasties.

    Science.gov (United States)

    Lovelock, Thomas M; Broughton, Nigel S; Williams, Cylie M

    2018-01-01

    The optimal methods of determining outcomes following hip and knee arthroplasty remain controversial. The objectives of this study were to determine the most frequently used outcome measures in randomized controlled trials (RCT) and study protocols registered with clinical trials registries (CTR) on hip and knee arthroplasty. A systematic search strategy was undertaken to identify the outcome measures used in RCT and CTR following joint arthroplasty. Databases searched included Embase, Ovid MEDLINE (including In-Process), Cochrane Central Register of Controlled Trials, CINAHL Plus, clinicaltrials.gov, ISRCTN registry, and ANZCTR. Differences in the use of outcome measures between RCT and CTR were assessed using logistic regression. There were 291 RCT and 113 CTR on hip arthroplasty and 452 RCT and 184 CTR on knee arthroplasty that met the inclusion criteria. The most popular outcome measures were the Harris Hip Score and the Knee Society Score. Multiple outcome measures were used in greater than 50% of the included studies. The Oxford Hip Score, Oxford Knee Score, EuroQol-5D, and Knee Injury and Osteoarthritis Outcome Score (all P < .001) were used in significantly more CTR than RCT. There is a clear preference for the use of the Harris Hip Score and Knee Society Score, contrary to existing international guidelines and reviews on the topic. Both measures require clinician input, which potentially influences their validity and increases their overall administration cost. Some patient-reported outcome measures, such as the Oxford Hip and Knee Scores, EuroQol-5D, and KOOS, appear to be increasing in popularity. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The Design of Compass/BeiDou Navigation Satellite Terminal for Migrant Bird Research

    Directory of Open Access Journals (Sweden)

    Yaohui Li

    2014-01-01

    Full Text Available A terminal of Compass Navigation Satellite System (CNSS, which can not only support BeiDou-1 and BeiDou-2 but also support Global Positioning System (GPS, is designed to research the activities of the migrant birds, with our novel design of a multiband antenna. By a high-density integration, this terminal is designed with a compact size and light weight. When the terminal is assembled to a whooper swan, its flying trace is recorded by the CNSS, which is in agreement with that of GPS. The flying route map based on the CNSS is useful to check the situation and habit of the migrant bird, which is important for animal protection and bird flu outbreak prediction.

  5. Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled DEXA Study

    NARCIS (Netherlands)

    Smolders, J.M.H.; Pakvis, D.F.; Hendrickx, B.W.; Verdonschot, Nicolaas Jacobus Joseph; van Susante, J.L.C.

    2013-01-01

    A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt–chromium cup (n

  6. Long-term results of patellofemoral arthroplasty - A report of 56 arthroplasties with 17 years of follow-up

    NARCIS (Netherlands)

    Kooijman, HJ; Driessen, APPM; van Horn, [No Value

    We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or

  7. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    NARCIS (Netherlands)

    Hartel, B.P.; Alta, T.D.; Sewnath, M.E.; Willems, W.J.H.

    2015-01-01

    INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision

  8. HRCT of the lung in collagen vascular diseases; HRCT der Lunge bei Kollagenosen

    Energy Technology Data Exchange (ETDEWEB)

    Diederich, S. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany); Roos, N. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany); Schmitz-Linneweber, B. [Medizinische Klinik B, Westfaelische Wilhelms-Univ., Muenster (Germany); Gaubitz, M. [Medizinische Klinik B, Westfaelische Wilhelms-Univ., Muenster (Germany); Peters, P.E. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany)

    1996-07-01

    bei progressiver Systemsklerose (PSS, Sklerodermie), systemischem Lupus erythematodes (SLE), `mixed connective tissue disease` (MCTD, Sharp-Syndrom), Sjoegren-Syndrom, Mischkollagenose (`Overlap`syndrom) und rheumatoider Arthritis (RA) werden dargestellt. Ausserdem werden fuer die einzelnen Krankheitsbilder jeweils spezifische Phaenomene erlaeutert wie die Oesophagusbeteiligung bei PSS, akute Pneumonitis oder pulmonale Haemorrhagie bei SLE, lymphoproliferative Erkrankungen beim Sjoegren-Syndrom und nekrobiotische Rundherde bei RA. (orig.)

  9. Zur Konstruktion von ''Männlichkeit'' bei ''Ultras'' : eine empirische Untersuchung zur Fanszene in Bremen

    OpenAIRE

    Guth, Oliver

    2014-01-01

    ''Männliche'' Herrschaftsstrukturen sind innerhalb der gesamten Gesellschaft stark verbreitet. Dies spiegelt sich dementsprechend auch in Fußballfanszenen wider. Diese Arbeit untersucht daher die Konstruktion von Männlichkeit bei ''Ultras'', da diese mit ihrer starken Präsens und ihren aufwendigen Choreographien in Stadien großen Einfluss vor allem auf Jugendliche haben. Ziel der Untersuchung ist es, Mechanismen innerhalb der Fanszene aufzuzeigen um somit pädagogisch zu intervenieren, damit g...

  10. BNP ist ANP, Endothelin und Noradrenalin als Prognoseindikator bei chronisch herzinsuffizienten Patienten überlegen

    OpenAIRE

    Zugck C; Gerhards A; Haass M; Katz N; Kell R; Krüger C; Schellberg D

    2001-01-01

    Zu den etablierten Prognoseindikatoren bei Patienten mit chronischer Herzinsuffizienz zählen der Herz-Thorax-Quotient in der Röntgen-Thoraxaufnahme (HTQ), die linksventrikuläre Ejektionsfraktion (LVEF) und die maximale Sauerstoffaufnahme unter Belastung (VO2max). Darüber hinaus wird zahlreichen neurohumoralen Parametern eine prognostische Wertigkeit zugeschrieben. An 166 Patienten mit chronischer Herzinsuffizienz (Alter 54 ± 9 Jahre; 70 % dilatative Kardiomyopathie; 30 % KHK; LVEF 21 ± 9 %) ...

  11. Molekulargenetische Studie zur Verbreitung und Interaktion von PCV-2 bei Haus- und Wildschweinen

    OpenAIRE

    Bronnert, Bastian Balthasar Marcel

    2014-01-01

    Im Rahmen der vorliegenden Arbeit wurden Wild- und Hausschweingewebeproben aus den Jahren 2005 bis 2008 mittels nested PCR auf das Vorkommen von PCV-2 untersucht und die positiv getesteten Proben mittels Realtime PCR quantifiziert. Zusätzlich wurden die Proben im Institut für Pathologie der Justus-Liebig-Universität histologisch und immunhistologisch untersucht (Dissertation Hohloch). Ziel war es das Vorkommen von PCV-2 und die Häufigkeit von PCV-2 assoziierter Erkankungen bei Haus- und Wilds...

  12. Erkrankungen des Traumaspektrums bei ruandischen Waisen des Genozids : Epidemiologie und Behandlung

    OpenAIRE

    Schaal, Susanne

    2006-01-01

    Im Jahre 1994 kamen in Ruanda innerhalb von 100 Tagen fast eine Million Menschen auf brutalste Weise ums Leben. Vorliegende Studie untersuchte die Traumakonfrontation und mentalen Gesundheitseffekte dieses staatlich organisierten Genozids bei ruandischen Waisen (n = 118) 11 Jahre nach dem Völkermord. Die Stichprobe setzte sich aus Vollwaisen zusammen, die entweder in kindergeführten Haushalten oder in Waisenheimen der Hauptstadt Kigali lebten. Risikofaktoren wurden analysiert und die Wirksamk...

  13. Psychologie körperlicher Aktivität bei Patienten mit Rückenschmerzen

    OpenAIRE

    Leonhardt, Corinna

    2008-01-01

    Die vorliegende Arbeit setzt sich mit den psychologischen Determinanten und Fördermöglichkeiten von körperlicher Aktivität bei Rückenschmerzpatienten auseinander, wobei Daten einer multizentrischen cluster-randomisierten Studie (N= 1378) genutzt werden. Der theoretische Hintergrund aller Originalarbeiten gibt einen Überblick zu neuen Erkenntnissen zum Rückenschmerz und zur Aktivitätsförderung in der Gesundheitspsychologie und ...

  14. Retrospektive Studie zur Ermittlung der Effizienz sprechunterstützender Operationen bei velopharyngealer Insuffizienz

    OpenAIRE

    Wellmann, S.S. (Sandra)

    2013-01-01

    In der vorliegenden Studie wurde retrospektiv an einem Patientenkollektiv die Effizienz der vier sprechunterstützenden Operationen Velopharyngoplastik mit kaudal gestieltem Lappen (VPP kaudal), Push back - Verfahren, VPP kaudal und Push - back kombiniert und die Levatorplastik anhand der Hypernasalitaät prä - und postoperativ untersucht. Die durch die Logopäden ermittelten Erfolgsquoten lagen für VPP kaudal, VPP kaudal mit Push back, Push back und Levatorplastik bei 89%, 88%, 43% und 75% (p>...

  15. Determinanten der beruflichen Belastung bei jungen Lehrerinnen und Lehrern: Eine Längsschnittstudie

    OpenAIRE

    Candova, Antonia

    2005-01-01

    In der vorliegenden Arbeit wird geprüft, ob berufliche Belastung bei jungen Lehrerinnen und Lehrern von Personenmerkmalen (Top-down-Ansatz), Umweltmerkmalen (Bottom-up-Ansatz) und/oder der Interaktion zwischen Merkmalen der Person und Situation beeinflusst wird. Die Daten stammen aus der prospektiven Längsschnittsstudie "Berufsverläufe in der Mathematik", die sich mit der beruflichen Entwicklung von Mathematikabsolvierenden (Diplom und Lehramt) befasst. Hier werden Daten von 266 aktuell beruf...

  16. T-Zell-Zytokinexpression bei gestillten vs. nicht-gestillten Kindern

    OpenAIRE

    Aulenbach, Julia

    2015-01-01

    Das Bestreben, den Aufbau, die Funktion sowie die Entwicklung des Immunsystems zu verstehen, steht schon lange Zeit im Zentrum des Interesses vieler Forschungsarbeiten, insbesondere um auf Grundlage der gewonnenen Erkenntnisse neue Behandlungsansätze für immunologisch relevante Krankheitsbilder zu entwickeln. Stillen könnte ein wichtiger Faktor sein, der bei der Entwicklung und Differenzierung von T-Zell-Subpopulationen und Zytokinmustern im Säuglings- und Kindesalter eine bedeutende Roll...

  17. Vitex-agnus-castus-Extrakt (Ze 440 zur Symptombehandlung bei Frauen mit menstruellen Zyklusstörungen

    Directory of Open Access Journals (Sweden)

    Eltbogen R

    2015-01-01

    Full Text Available Ziel: Diese nichtinterventionelle Beobachtungsstudie (NIS wurde von Schweizer Gynäkologen und Allgemeinmedizinern im Rahmen der üblichen ärztlichen Grundversorgung durchgeführt. Das Ziel der NIS war es, die Wirksamkeit und Sicherheit von Vitex-agnus-castus-(VAC Extrakt (Ze 440: premens, Zeller Medical AG, Romanshorn, Schweiz bei Frauen, die unter menstruellen Zyklusstörungen wie Polymenorrhö, Oligomenorrhö oder Amenorrhö litten, zu untersuchen. Methode: Insgesamt 211 Patientinnen nahmen an dieser NIS teil. Symptome, die mit menstruellen Zyklusstörungen („menstrual cycle irregularities“ [MCIs] und der Menstruationsblutung in Verbindung stehen, wurden bei einer Erstuntersuchung („baseline visit“ [BV] und einer Kontrolluntersuchung („follow-up visit“ [FV] nach Behandlung mit VAC-Extrakt über einen Zeitraum von 3 aufeinanderfolgenden Menstruationszyklen beurteilt. Ergebnisse: Der Anteil der Patientinnen, bei denen eine Beschwerdefreiheit oder eine Besserung der MCIs (insgesamt und spezifischer Beschwerdebilder wie Polymenorrhö, Oligomenorrhö und Amenorrhö erzielt werden konnte, lag bei der FV bei 79–85 %. Bei Symptomen im Zusammenhang mit der Menstruationsblutung wie Dysmenorrhö, Zwischenblutungen, Hypermenorrhö, Menometrorrhagie, Ovulationsblutung, präoder postmenstrueller Blutung betrug der Anteil der Patientinnen, bei denen ein Rückgang oder eine Besserung festgestellt wurde, bei der FV zwischen 60 und 88 %. Von 53 Patientinnen, die bei der BV von einem unerfüllten Kinderwunsch berichteten, wurden 12 Frauen (23 % während der Behandlung mit VAC-Extrakt schwanger. Bei der FV waren 91 % der Ärzte und 92 % der Patientinnen mit den erzielten Behandlungsergebnissen „zufrieden“ oder „sehr zufrieden“ und 80 % der Patientinnen bestätigten, dass sie gerne mit der Behandlung mit VAC-Extrakt fortfahren wollen. Fazit: Diese Beobachtungsstudie im Bereich der ärztlichen Grundversorgung ergab, dass die Behandlung mit VAC

  18. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    Science.gov (United States)

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  19. The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty.

    Science.gov (United States)

    Chu, Janet N; Maselli, Judith; Auerbach, Andrew D; Fang, Margaret C

    2017-07-01

    Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. We compared rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip or knee arthroplasty, using data from a large US-based administrative database. We conducted a retrospective cohort study of 231,780 adults who underwent total knee arthroplasty and 110,621 who underwent total hip arthroplasty in 2009-2012 and who received pharmacologic VTE prophylaxis (aspirin or anticoagulant) within the first 7days after surgery. We compared the risk of post-operative VTE between patients receiving aspirin-only vs. anticoagulants, controlling for clinical and hospital characteristics using multivariable logistic regression with propensity score adjustment. Aspirin-only prophylaxis was administered to 7.5% of patients after knee arthroplasty and 8.0% after hip arthroplasty. Post-operative VTE was diagnosed in 2217 (0.96%) patients after knee arthroplasty and 454 (0.41%) after hip arthroplasty. Compared to anticoagulants, aspirin was not associated with a higher risk for post-operative VTE either after knee arthroplasty (adjusted odds ratio and 95% confidence interval [OR] 0.34 [0.24-0.48]) or hip arthroplasty (OR 0.82 [0.45-1.51]). Aspirin was uncommonly administered as the sole prophylactic agent after hip or knee arthroplasty in this study. However, patients who received aspirin-only had similar rates of post-operative VTE compared to patients who received anticoagulants. Further research should focus on distinguishing which patients benefit more from anticoagulants versus aspirin after arthroplasty. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Changes in collagen metabolites in serum after cemented hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Joerring, S; Jensen, L T

    1993-01-01

    Markers of types I and III collagen turnover were measured in serial blood samples collected preoperatively and 60 days after surgery in 13 patients undergoing cemented total hip arthroplasty and 11 patients undergoing cemented total knee arthroplasty. The markers were the carboxyterminal extension....... We suggest that the changes in serum PICP and serum PIIINP reflect collagen formation in healing soft connective tissue 60 days after cemented hip or knee arthroplasty....

  1. Preoperative prediction of potentially preventable morbidity after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Petersen, Morten Aa; Kehlet, Henrik

    2016-01-01

    . DESIGN: Prospective observational study. SETTING: Elective primary unilateral total hip and knee arthroplasty with prospectively collected preoperative patient characteristics; similar standardised fast-track protocols; evaluation of complications through discharge and medical records; and complete 90...... days follow-up through nationwide databases. PARTICIPANTS: 8373 consecutive unselected total hip arthroplasty (THA) and knee arthroplasty from January 2010 to November 2012. RESULTS: There were 557 procedures (6.4%) followed by potentially preventable complications resulting in hospitalisation >4 days...

  2. A Fast and High-precision Orientation Algorithm for BeiDou Based on Dimensionality Reduction

    Directory of Open Access Journals (Sweden)

    ZHAO Jiaojiao

    2015-05-01

    Full Text Available A fast and high-precision orientation algorithm for BeiDou is proposed by deeply analyzing the constellation characteristics of BeiDou and GEO satellites features.With the advantage of good east-west geometry, the baseline vector candidate values were solved by the GEO satellites observations combined with the dimensionality reduction theory at first.Then, we use the ambiguity function to judge the values in order to obtain the optical baseline vector and get the wide lane integer ambiguities. On this basis, the B1 ambiguities were solved. Finally, the high-precision orientation was estimated by the determinating B1 ambiguities. This new algorithm not only can improve the ill-condition of traditional algorithm, but also can reduce the ambiguity search region to a great extent, thus calculating the integer ambiguities in a single-epoch.The algorithm is simulated by the actual BeiDou ephemeris and the result shows that the method is efficient and fast for orientation. It is capable of very high single-epoch success rate(99.31% and accurate attitude angle (the standard deviation of pitch and heading is respectively 0.07°and 0.13°in a real time and dynamic environment.

  3. Neuere Untersuchungen zur Prädiktion von EEG-Signalen bei Epilepsie

    Directory of Open Access Journals (Sweden)

    C. Niederhöfer

    2007-06-01

    Full Text Available Seit einigen Jahren ist die Analyse von EEG-Signalen bei Epilepsie Gegenstand zahlreicher wissenschaftlicher Arbeiten; Zielvorstellung ist dabei die Entwicklung von Verfahren zur Erkennung eines möglichen Voranfallszustandes. Im Vordergrund steht beispielsweise die Approximation einer so genannten effektiven Korrelationsdimension, die Bestimmung der maximalen Lyapunov-Exponenten, Detektionsverfahren für Muster bei Zellularen Nichtlinearen Netzwerken, die Bestimmung der mittleren Phasenkohärenz und Verfahren zur nichtlinearen Prädiktion von EEG-Signalen. Trotz umfangreicher Bemühungen kann bis heute eine Erkennung von Anfallsvorboten mit einer Sensitivität und Spezifität, die eine automatisierte Anfallsvorhersage ermöglichen würde, noch nicht durchgeführt werden. In diesem Beitrag werden neue Ergebnisse zur Prädiktion von EEG-Signalen bei Epilepsie vorgestellt. Dabei werden Signale, welche mittels intrakranieller electrocorticographischer (ECoG und stereoelectroencephalographischer (SEEG Ableitungen registriert wurden, segmentweise analysiert. Unter der Annahme, dass sich Änderungen des Systems ,,Gehirn" als Änderungen im Prädiktor, d.h. in seinen Systemparametern widerspiegeln, könnte eine nähere Betrachtung der Prädiktoreigenschaften zu einer Erkennung von Anfallsvorboten führen.

  4. PENGARUH CORPORATE GOVERNANCE TERHADAP TAX AVOIDANCE (Perusahaan Pertambangan yang terdaftar di BEI

    Directory of Open Access Journals (Sweden)

    Sri Mulyani

    2018-05-01

    Full Text Available he purpose of this research is to know the influence of institutional ownership, independent commissioner, audit committee and audit quality to tax avoidance at mining company listed on BEI year 2014-2016. The population of this study is mining companies listed on the BEI 2014-2016 as many as 46 companies. Sampling used in this research purposive sampling method. Data source is secondary data obtained from company website and BEI website (www.idx.co.id. This study uses multiple regression analysis to analyze data with the help of SPSS 21 edition program. The results of this study indicate that the variables of institutional ownership, audit committee and audit quality have significant influence on tax avoidance, while independent commissioner variable has no significant effect on tax avoidance. The results of this study are expected to be an additional consideration of the management in conducting tax avoidance is correct and efficient without violating applicable tax laws, and can provide additional information for users of financial statements in investment decision making.

  5. Experimental study on the precise orbit determination of the BeiDou navigation satellite system.

    Science.gov (United States)

    He, Lina; Ge, Maorong; Wang, Jiexian; Wickert, Jens; Schuh, Harald

    2013-03-01

    The regional service of the Chinese BeiDou satellite navigation system is now in operation with a constellation including five Geostationary Earth Orbit satellites (GEO), five Inclined Geosynchronous Orbit (IGSO) satellites and four Medium Earth Orbit (MEO) satellites. Besides the standard positioning service with positioning accuracy of about 10 m, both precise relative positioning and precise point positioning are already demonstrated. As is well known, precise orbit and clock determination is essential in enhancing precise positioning services. To improve the satellite orbits of the BeiDou regional system, we concentrate on the impact of the tracking geometry and the involvement of MEOs, and on the effect of integer ambiguity resolution as well. About seven weeks of data collected at the BeiDou Experimental Test Service (BETS) network is employed in this experimental study. Several tracking scenarios are defined, various processing schemata are designed and carried out; and then, the estimates are compared and analyzed in detail. The results show that GEO orbits, especially the along-track component, can be significantly improved by extending the tracking network in China along longitude direction, whereas IGSOs gain more improvement if the tracking network extends in latitude. The involvement of MEOs and ambiguity-fixing also make the orbits better.

  6. An accurate Kriging-based regional ionospheric model using combined GPS/BeiDou observations

    Science.gov (United States)

    Abdelazeem, Mohamed; Çelik, Rahmi N.; El-Rabbany, Ahmed

    2018-01-01

    In this study, we propose a regional ionospheric model (RIM) based on both of the GPS-only and the combined GPS/BeiDou observations for single-frequency precise point positioning (SF-PPP) users in Europe. GPS/BeiDou observations from 16 reference stations are processed in the zero-difference mode. A least-squares algorithm is developed to determine the vertical total electron content (VTEC) bi-linear function parameters for a 15-minute time interval. The Kriging interpolation method is used to estimate the VTEC values at a 1 ° × 1 ° grid. The resulting RIMs are validated for PPP applications using GNSS observations from another set of stations. The SF-PPP accuracy and convergence time obtained through the proposed RIMs are computed and compared with those obtained through the international GNSS service global ionospheric maps (IGS-GIM). The results show that the RIMs speed up the convergence time and enhance the overall positioning accuracy in comparison with the IGS-GIM model, particularly the combined GPS/BeiDou-based model.

  7. White matter alterations in neurodegenerative and vascular dementia; Marklagerveraenderungen bei neurodegenerativen und vaskulaeren Demenzerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Supprian, T. [Arbeitsgruppe Gerontopsychiatrie, Universitaets-Nervenklinik Homburg (Germany); Arbeitsgruppe Gerontopsychiatrie, Universitaets-Nervenklinik, Psychiatrie und Psychotherapie, 66421, Homburg (Germany); Kessler, H.; Falkai, P. [Arbeitsgruppe Gerontopsychiatrie, Universitaets-Nervenklinik Homburg (Germany); Retz, W.; Roesler, M. [Arbeitsgruppe Gerontopsychiatrie, Universitaets-Nervenklinik Homburg (Germany); Institut fuer gerichtliche Psychologie und Psychiatrie, Universitaet des Saarlandes, Homburg (Germany); Grunwald, I.; Reith, W. [Abteilung fuer Neuroradiologie, Universitaetskliniken des Saarlandes, Homburg (Germany)

    2003-07-01

    Due to a significant overlap of the two syndromes, differentiation of degenerative dementia of the Alzheimer-type from vascular dementia may be difficult even when imaging studies are available. White matter changes occur in many patients suffering from Alzheimer's disease. Little is known about the impact of white matter changes on the course and clinical presentation of Alzheimer's disease. High sensitivity of MRI in the detection of white matter alterations may account for over-diagnosing vascular dementia. The clinical significance of white matter alterations in dementia is still a matter of debate. The article reviews current concepts about the role of white matter alterations in dementia. (orig.) [German] Die Zuordnung einer Demenzerkrankung zu einem neurodegenerativen Pathomechanismus, wie der Demenz vom Alzheimer-Typ (DAT) oder einem vaskulaeren Pathomechanismus, kann trotz der Verfuegbarkeit bildgebender Verfahren Probleme bereiten. Ueberlappungen neurodegenerativer und vaskulaerer Mechanismen sind haeufig. Mikroangiopathische Veraenderungen des Marklagers finden sich bei einem hohen Anteil von Patienten mit der klinischen Verlaufsform einer Demenz vom Alzheimer-Typ. Es ist unklar, ob es sich um eine Koinzidenz zweier Pathomechanismen handelt oder ob eine wechselseitige Beeinflussung stattfindet. Die hohe Sensitivitaet der Magnetresonanztomographie bei der Erfassung mikroangiopathischer Veraenderungen des Marklagers koennte dazu fuehren, dass zu vaskulaere Demenzerkrankungen haeufig diagnostiziert werden. Der Einfluss mikroangiopathischer Veraenderungen des Marklagers auf den Demenzverlauf wird kontrovers diskutiert. Die vorgelegte Arbeit gibt eine Uebersicht ueber die aktuellen Konzepte zum Stellenwert von Marklagerveraenderungen bei Demenzerkrankungen. (orig.)

  8. Results of infected total knee arthroplasty treated with arthroscopic debridement and continuous antibiotic irrigation system

    Directory of Open Access Journals (Sweden)

    Che-Wei Liu

    2013-01-01

    Conclusion: Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.

  9. Closed Incision Negative Pressure Therapy Versus Standard of Care Surgical Dressing in Revision Total Knee Arthroplasty

    Science.gov (United States)

    2018-06-07

    Surgical Wound; Revision Total Knee Arthroplasty; Wounds and Injuries; Joint Disease; Musculoskeletal Disease; Prosthesis-Related Infections; Infection; Postoperative Complications; Pathologic Processes

  10. Magnetic resonance imaging of the sacroiliac joints in patients with suspected spondyloarthritis. Comparison of turbo spin-echo and gradient-echo sequences for the detection of structural alterations; MRT-Bildgebung der Sakroiliakalgelenke bei Verdacht auf Spondyloarthritis. Vergleich von Turbospinecho- und Gradientenechosequenzen zum Nachweis struktureller Veraenderungen

    Energy Technology Data Exchange (ETDEWEB)

    Dornia, C.; Hoffstetter, P. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik; Asklepios Klinikum, Bad Abbach (Germany). Inst. fuer Roentgendiagnostik; Fleck, M. [Universitaetsklinikum Regensburg (Germany). Klinik fuer Innere Medizin I; Asklepios Klinikum, Bad Abbach (Germany). Klinik fuer Rheumatologie und Klinische Immunologie; Hartung, W. [Asklepios Klinikum, Bad Abbach (Germany). Klinik fuer Rheumatologie und Klinische Immunologie; Niessen, C.; Stroszczynski, C. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik

    2015-02-15

    Magnetic resonance imaging (MRI) is the method of choice for the evaluation of spondyloarthritis (SpA). According to the guidelines of the Assessment of Spondyloarthritis International Society (ASAS) and Outcome Measures in Rheumatology (OMERACT), MRI findings in SpA of the spine and the sacroiliac joints (SIJ) are classified as inflammatory and structural alterations. Modern gradient-echo sequences (GRE) are recommended for optimized detection of structural alterations of the SIJ. We assess the benefit of GRE in the detection of structural alterations of the SIJ in comparison to conventional turbo spin-echo sequences (TSE). Retrospective study of 114 patients who received MRI of the SIJ for the evaluation of SpA. Structural alterations of the SIJ were assessed by two blinded readers separately for T1 TSE and T2{sup *} GRE. The findings were classified according to a previously published chronicity score separately for both sides and sequences. Interobserver reliability was calculated with Cohen's Kappa, and the significance of findings was assessed with the Wilcoxon test. P-values < 0.05 were required for statistical significance. 68 of 114 (60%) patients showed SpA-typical findings of the SIJ. The average chronicity score for GRE (score 3.3) was significantly higher than for TSE (score 2.6), p=0.001. The Kappa-values for the interobserver reliability were 0.86-0.90 without any statistically significant differences between both sides and sequences. Both T1 TSE and T2{sup *} GRE showed a high interobserver reliability in the detection of structural alterations in patients with SpA. However, T2{sup *} GRE detected significantly more structural alterations than T1 TSE and should be an integral part of a modern MRI protocol for the diagnostic workup of patients with suspected SpA.

  11. BIOLOGIC JOINT RECONSTRUCTION: ALTERNATIVES TO ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Brian J. Cole

    2009-06-01

    limited prosthetic resurfacing. Section VI is "Operative treatment-elbow" including chapters arthroscopy, nonprosthetic elbow arthroplasty, biological resurfacing. The Section VII is "Operative treatment-foot and ankle" including chapters about ankle arthroscopy and cartilage repair in the ankle.The text is one of the most comprehensive and up-to-date references in the treatment of cartilage pathologies and biological joint reconstruction. Some other minimal invasive surgical techniques such as prosthetic partial resurfacing or some osteotomies are also subjected as other alternative treatments for joint restoration. Basic sciences, diagnostic imaging, pharmacological treatment and neutraceuticals, and rehabilitation are making the text. The chapter about future developments in cartilage repair is not only describing the recent technology, different types of tissue engineering and related centers in the world but also gives an idea for the possibilities of future in cartilage repair. Chapters about surgical techniques and procedures are uniformly composed of parts including introduction, preoperative evaluation, surgical technique, postoperative issues, results and references in which the techniques and management described in detail. Numerous high quality images, rich illustrations and figures, page design and also colored tables about key points, protocols, or helpful hints makes the reading and understanding easier

  12. Endotoxins in surgical instruments of hip arthroplasty.

    Science.gov (United States)

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

  13. Femoral component loosening after hip resurfacing arthroplasty

    International Nuclear Information System (INIS)

    Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

    2010-01-01

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  14. Effects of spin-orbit coupling on laser cooling of BeI and MgI

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Mingjie, E-mail: wanmingjie1983@sina.com; Huang, Duohui; Shao, Juxiang; Li, Yuanyuan [Computational Physics Key Laboratory of Sichuan Province, Yibin University, Yibin 644007 (China); Yu, You [College of Optoelectronic Technology, Chengdu University of Information Technology, Chengdu 610225 (China); Li, Song [College of Physical Science and Technology, Yangtze University, Jingzhou 434023 (China)

    2015-10-28

    We present the ab initio study of spin-orbit coupling effects on laser cooling of BeI and MgI molecules. Potential energy curves for the X{sup 2}Σ{sup +}{sub 1/2}, A{sup 2}Π{sub 1/2,3/2}, and 2{sup 2}Π{sub 3/2,1/2} states are calculated using multi-reference configuration interaction method plus Davidson corrections. Spectroscopic parameters of BeI and MgI are in excellent agreement with available experimental and theoretical values. The A{sup 2}Π{sub 3/2} state of MgI is a repulsive state. It is an unsuitable scheme for the A{sup 2}Π{sub 3/2}(υ′)← X{sup 2}Σ{sup +}{sub 1/2} (υ″) transition for laser cooling of MgI. Highly diagonally distributed Franck-Condon factors f{sub 00} for the A{sup 2}Π{sub 1/2,3/2} (υ′ = 0) ← X{sup 2}Σ{sup +}{sub 1/2} (υ″ = 0) transitions and suitable radiative lifetimes τ for the A{sup 2}Π{sub 1/2,3/2} (υ′ = 0) of BeI and MgI are obtained. Three laser wavelength drives are required for the A{sup 2}Π{sub 1/2,3/2}(υ′)←X{sup 2}Σ{sup +}{sub 1/2} (υ″) transitions of BeI and MgI. The proposed cooling wavelengths of BeI and MgI are both in the violet region. The results imply the feasibility of laser cooling of BeI and MgI, and that laser cooling of BeI is more possible.

  15. Postoperative Morbidity and Discharge Destinations After Fast-Track Hip and Knee Arthroplasty in Patients Older Than 85 Years

    DEFF Research Database (Denmark)

    Pitter, Frederik T; Jørgensen, Christoffer C; Lindberg-Larsen, Martin

    2016-01-01

    BACKGROUND: Elderly patients are at risk of increased length of hospital stay (LOS), postoperative complications, readmission, and discharge to destinations other than home after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recent studies have found that enhanced...

  16. Clinical Evaluation of Fused/Ankylosed Hip with Severe Flexion Deformity after Conversion to Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Saroj Kumar Suwal

    2016-06-01

    Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties. Keywords: ankylosed hip; fused hip; severe flexion deformity; total hip arthroplasty. | PubMed

  17. Pre-operative ambulatory measurement of asymmetric leg loading during sit to stand in hip arthroplasty patients

    NARCIS (Netherlands)

    Martínez-Ramírez, Alicia; Weenk, D.; Lecumberri, Pablo; Verdonschot, Nicolaas Jacobus Joseph; Pakvis, Dean; Veltink, Petrus H.

    Total hip arthroplasty is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after total hip arthroplasty. This clinical evaluation

  18. Adjuvant chemo- and radiotherapy in gastrointestinal tumors; Adjuvante Chemo- und Strahlentherapie bei gastrointestinalen Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Sendler, A. [Technische Univ. Muenchen (Germany). Chirurgische Klinik und Poliklinik; Feldmann, H.J. [Technische Univ. Muenchen (Germany). Inst. und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Fink, U. [Technische Univ. Muenchen (Germany). Chirurgische Klinik und Poliklinik; Molls, M. [Technische Univ. Muenchen (Germany). Inst. und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Siewert, J.R. [Technische Univ. Muenchen (Germany). Chirurgische Klinik und Poliklinik

    1995-04-21

    In modern surgical oncology, adjuvant therapies are important complementary strategies. In local advanced carcinomas of the gastrointestinal tract, 5-year survival data are still disappointing despite standardized surgery. In this context, it has to be differentiated between adjuvant therapy following complete tumor exstirpation (so-called UICC R{sub 0} resection) and additive therapies following incomplete tumor resections (UICC R{sub 1} or R{sub 2} resection). Modalities in the adjuvant setting are chemotherapy, radiotherapy or the combined radio-/chemotherapy. In esophageal and gastric cancer there is up to now no benefit of postoperative adjuvant therapy. In pancreatic cancer, there are studies indicating a benefit of combined radio-/chemotherapy after complete tumor resection. A standard adjuvant chemotherapeutic treatment is proven in colon cancer stage III (Dukes C) with levamisole and 5-FU. Completely resected rectal carcinoma should be treated postoperatively with combined radio-/chemotherapy. In the common clinical or practical setting, adjuvant therapy is indicated only in locally advanced gastrointestinal tumors following R{sub 0} resection. Postoperative therapy following incomplete tumor resection has its reason only in a palliative intention. (orig.) [Deutsch] Adjuvante Therapiestrategien sind wichtige flankierende Massnahmen der modernen onkologischen Chirurgie, da u.a. die 5-Jahres-Ueberlebensquoten bei lokal fortgeschrittenen Tumoren des Gastrointestinaltraktes nach wie vor unbefriedingend sind. Dabei muss grundsaetzlich zwischen adjuvanten Behandlungen nach kompletter Tumorexstirpation (UICC-R{sub 0}-Resektion) und der additiven Therapie nach palliativer Resektion (UICC-R{sub 1}- oder -R{sub 2}-Resektion) unterschieden werden. Als Modalitaeten kommen Chemotherapie, Strahlentherapie und ihre Kombination in Frage. Bei Oesophagus- und Magenkarzinomen kann derzeit keine gueltige Empfehlung zur adjuvanten Therapie gegeben werden. Die Radio

  19. Furosemide urogram in patients with neobladder; Das Diureseurogramm bei Patienten mit Harnblasenersatz

    Energy Technology Data Exchange (ETDEWEB)

    Merkle, E.M. [Univ. Ulm (Germany). Abt. Radiologie; Aschoff, A.J. [Univ. Ulm (Germany). Abt. Radiologie; Bachor, R. [Univ. Ulm (Germany). Abt. fuer Urologie; Vogel, J. [Univ. Ulm (Germany). Abt. Radiologie; Merk, J. [Univ. Ulm (Germany). Abt. Radiologie; Brambs, H.J. [Univ. Ulm (Germany). Abt. Radiologie

    1996-11-01

    Purpose: To differentiate between urodynamically relevant obstruction and functionally unimportant dilation of the upper urinary tract in patients with neobladder using a modified furosemide urogram. Method: An excretory urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation of the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and late radiographs were obtained at 15 min and 30 min, respectively. An obstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contrast medium. Results: In 32 cases, the renoureteral unit (RUU) was dilated on ultrasound. Of these, 25 RUU`s showed good emptyness of contrast medium upon stimulation of diuresis, six RUU`s returned a borderline findings, while one RUU was found to exhibit a decompensated anastomotic stenosis, which was dilated. Two further patients with bordeline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagnostic procedures. Conclusions: The modified furosemide urogram represents a cost-effective diagnostic orientation strategy in patients with neobladder and dilated renal pelves and calyses and is both well-tolerated by patients and meets with broad acceptance from the urologic staff. (orig.) [Deutsch] Ziel: Differenzierung zwischen urodynamisch relevanter Obstruktion und funktionell bedeutungsloser Dilatation des oberen Harntraktes bei Patienten mit Harnblasenersatz durch ein modifiziertes Diureseurogramm. Methodik: Bei 19 Patienten mit Harnableitung und sonographisch sowie urographisch nachgewiesener Erweiterung des oberen Harntraktes wurde ein Ausscheidungsurogramm mit Furosemidbelastung durchgefuehrt. Bei kraeftiger Kontrastierung des erweiterten Nierenbeckenkelchsystems (NBKS) wurden 20 mg Furosemid appliziert und

  20. Registro de artroplastias do ombro Shoulder arthroplasty records

    Directory of Open Access Journals (Sweden)

    Geraldo Motta Filho

    2009-04-01

    Full Text Available OBJETIVO: Determinar as características clínico-cirúrgicas referentes a 145 artroplastias do ombro realizadas no período entre julho de 2004 a dezembro de 2006. MÉTODOS: No período de estudo foram realizadas 145 artroplastias de ombro. Através de protocolo prospectivo, informações demográficas, da anamnese, exame físico e exame radiográfico foram armazenadas em um banco de dados. Os dados coletados foram organizados em três grandes grupos: doenças articulares degenerativas, fraturas e seqüelas traumáticas. Esses dados foram correlacionados a fim de definir o perfil epidemiológico dos pacientes, das lesões e artroplastias. RESULTADOS: Das 145 artroplastias de ombro realizadas 37% foram por seqüelas traumáticas, 30% por doença articular degenerativa e 33% com diagnóstico de fratura. Foram 12% artroplastias totais e 88% parciais. Ocorreram cinco complicações no pós-operatório recente. CONCLUSÃO: As artroplastias de ombro tornaram-se um procedimento frequente na prática ortopédica. Registros cirúrgicos são importantes a fim de demonstrar essa evolução progressiva e permitir avaliações de resultados clínicos no futuro.OBJECTIVE: The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. METHODOLOGY: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. RESULTS: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus

  1. [Modern tribology in total hip arthroplasty: pros and cons].

    Science.gov (United States)

    Gómez-García, F

    2014-01-01

    The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.

  2. Quality of life after total knee arthroplasty: systematic review.

    Science.gov (United States)

    da Silva, Robson Rocha; Santos, Ayrton André Melo; de Sampaio Carvalho Júnior, José; Matos, Marcos Almeida

    2014-01-01

    To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients' quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

  3. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

    2011-01-01

    Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...... bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...

  4. The association between metal allergy, total hip arthroplasty, and revision

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Jakobsen, Stig Storgaard; Engkilde, Kåre

    2009-01-01

    BACKGROUND AND PURPOSE: It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients...... in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA. MATERIALS AND METHODS: The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results...... was similar in cases (12%) and in patients from the DHAR (13%). The prevalence of metal allergy was similar in cases and controls. However, the prevalence of metal allergy was lower in cases who were patch-tested after operation (6%) than in those who were patch-tested before operation (16%) (OR = 2.9; 95% CI...

  5. [Eleven-Year Experience with Total Ankle Arthroplasty].

    Science.gov (United States)

    Popelka, S; Sosna, A; Vavřík, P; Jahoda, D; Barták, V; Landor, I

    2016-01-01

    PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a

  6. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore......AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from...... gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks. CONCLUSION: Nursing care...

  7. Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty: Current Concepts.

    Science.gov (United States)

    Bosco, Joseph A; Bookman, Jared; Slover, James; Edusei, Emmanuel; Levine, Brett

    2015-08-01

    Infection is a rare, serious complication following total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  8. Knitted outer gloves in primary hip and knee arthroplasty.

    Science.gov (United States)

    Tanner, J; Wraighte, P; Howard, P

    2006-01-01

    A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).

  9. Wear particles and osteolysis in patients with total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula

    2014-01-01

    PURPOSE: To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic...... tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS: Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow......-up. Serial annual radiographs were performed prospectively for the evaluation of PPO. We collected blood samples for white blood cell count, C-reactive protein, and metallic ion level. RESULTS: A radiolucent zone of greater than 2 mm was observed juxta-articular to the radial component in 4 patients...

  10. Patient Satisfaction Reporting After Total Hip Arthroplasty: A Systematic Review.

    Science.gov (United States)

    Kahlenberg, Cynthia A; Nwachukwu, Benedict U; Schairer, William W; Steinhaus, Michael E; Cross, Michael B

    2017-05-01

    This review evaluated the quality of patient satisfaction reporting after total hip arthroplasty. The initial search of the MEDLINE database yielded 755 studies. Twenty-four met the inclusion criteria. Most studies provided level III or IV evidence (n=15, 62.5%). The most common method used to assess satisfaction was the 10-point visual analog scale (7 studies, 29.2%), followed by an ordinal satisfaction scale (6 studies, 25.0%). The quality of evidence was poor, and the methods used to assess satisfaction were not standardized. Further research is needed to define the factors that affect patient satisfaction after total hip arthroplasty and how satisfaction is best measured. [Orthopedics. 2017; 40(3):e400-e404.]. Copyright 2017, SLACK Incorporated.

  11. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Eresian Chenok, Kate; Bohm, Eric

    2016-01-01

    survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario...... of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions...... all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health...

  12. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty

    OpenAIRE

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-01-01

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of th...

  13. Vibroacoustography for the assessment of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Hermes A.S. Kamimura

    2013-04-01

    Full Text Available OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications.

  14. Short-term clinical experience with hip resurfacing arthroplasty.

    Science.gov (United States)

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  15. Use of antibiotic-loaded cement in total knee arthroplasty.

    OpenAIRE

    Hinarejos Gómez, Pedro Angel; Guirro Castellnou, Pau; Puig Verdié, Luís; Torres Claramunt, Raúl; Leal Blanquet, Joan; Sánchez Soler, JF.; Monllau García, Juan Carlos

    2015-01-01

    Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement (ALBC) is helpful when treating an infection in total knee arthroplasty (TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in t...

  16. Efficacy and safety of topical tranexamic acid in knee arthroplasty.

    Science.gov (United States)

    López-Hualda, Álvaro; Dauder-Gallego, Cristina; Ferreño-Márquez, David; Martínez-Martín, Javier

    2018-02-26

    Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups. The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups. According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  17. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty.

    Science.gov (United States)

    Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J

    2017-09-01

    Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (Pnew implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.]. Copyright 2017, SLACK Incorporated.

  18. Clinical and Economic Burden of Revision Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mohit Bhandari

    2012-01-01

    Full Text Available Surgery is indicated for symptomatic knee osteoarthritis (OA when conservative measures are unsuccessful. High tibial osteotomy (HTO, unicompartmental knee arthroplasty (UKA, and total knee arthroplasty (TKA are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.

  19. Increasing risk of prosthetic joint infection after total hip arthroplasty

    DEFF Research Database (Denmark)

    Dale, Håvard; Fenstad, Anne M; Hallan, Geir

    2012-01-01

    Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The...... explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.......Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods...... The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection...

  20. Outcome of total knee arthroplasty with insall burstein-11 prosthesis

    International Nuclear Information System (INIS)

    Siddiq, M.Z.; Qayum, H.

    2006-01-01

    Patients with severe degenerative knee joint disease often require knee arthroplasty to reduce pain, improve stability and restore function. Insall Burstein II prosthesis is posteriorly stabilized condylar prosthesis, which provide posterior cruciate ligament substitution. It was designed to improve range of motion, stair climbing ability and to prevent posterior subluxation. Evaluate the functional outcome of total knee arthroplasty with IB II prosthesis and Evaluate the alignment of prosthetic components by radiological parameters and its correlation with functional outcome. Sixty knees of sixty patients were replaced by using Insall Burstein II prosthesis. Postoperative radiographs were evaluated for alignment of knee and prosthetic components by criteria selected from knee society roentogenographic evaluation system. Functional outcome was evaluated by rationale of knee society knee rating system. Prosthetic component was aligned in 93% and mal-alignment in 7% of the cases. There was significant improvement in functions core from mean score 33.83 +-15.5 to 59.5+-17.7 and knee score from 37 +- 12.5 to 76.4 +-2.2. Postoperative functional score was found correlated with alignment significantly. Conclusion: Total knee arthroplasty with I-B-II prosthesis is a safe durable and predictable procedure with proper surgical technique and expertise good alignment and satisfactory functional out come can be achieved. (author)

  1. Padrões Contábeis internacionais do IASB: Um estudo comparativo com as normas contábeis brasileiras e sua aplicação

    Directory of Open Access Journals (Sweden)

    L. Nelson Carvalho

    2009-10-01

    Full Text Available Atribui-se a Jonh Kennteh Galbraith a afirmativa de que os economistas deveriam se preocupar em medir "Felicidade Nacional Bruta" do que "Produto Nacional Bruto" e que "Felicidade", objetivamente considerada , é o pai da família ou jovem em idade de trabalho a encontratem emprego e oportunidades. Isso se dá, em grande parte, por um setor empresarial empreendedor, e este mostra sua vitalidade por meio de mecanismos de comunicação que espelhem suas virtudes. O melhor, o mais clássico e universal - conquanto não é o único- mecanismo de comunicação de desempenho empresarial com credores , investidores, governo, fornecedores é o conjunto das demonstrações contábeis.

  2. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...

  3. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Deleuran, Thomas; Vilstrup, Hendrik; Overgaard, Søren

    2015-01-01

    Background and purpose: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients and methods: Using Danish healthcare registries, we identified all Danish residents who...

  4. Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Madsen, Rune V; Nielsen, Christian S.; Kallemose, Thomas

    2017-01-01

    BACKGROUND: The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated...

  5. SPECT/CT in patients with painful knee arthroplasty - what is the evidence?

    International Nuclear Information System (INIS)

    Hirschmann, Michael T.; Henckel, Johann; Rasch, Helmut

    2013-01-01

    SPECT/CT is increasingly recognized as a promising imaging modality for the investigation of patients with a painful knee after knee arthroplasty. In this review article, we give an overview of the clinical value and current and future applications of SPECT/CT for patients with knee pain following joint arthroplasty. A detailed evidence-based literature review is performed and presented. (orig.)

  6. Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty

    NARCIS (Netherlands)

    Kievit, Arthur J.; Breugem, Stefan J. M.; Sierevelt, Inger N.; Heesterbeek, Petra J. C.; van de Groes, Sebastiaan A. W.; Kremers, Keetie C. A. L. C.; Koëter, Sander; Haverkamp, Daniel

    2013-01-01

    To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect. After standard forward and backward

  7. Care principles at four fast-track arthroplasty departments in Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Solgaard, Søren; Hansen, Torben B

    2010-01-01

    The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery.......The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery....

  8. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2010-01-01

    Pharmacological prophylaxis can reduce the risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and death, and it is recommended 10–35 days after total hip arthroplasty (THA) and at least 10 days after total knee arthroplasty (TKA). However, early mobilization might also reduce the risk...

  9. Revision total knee arthroplasty with the use of trabecular metal cones

    DEFF Research Database (Denmark)

    Jensen, Claus L; Petersen, Michael Mygind; Schrøder, Henrik

    2012-01-01

    "Trabecular Metal Cone" (TM Cone) (Zimmer, Inc, Warsaw, Ind) for reconstruction of bone loss in the proximal tibia during revision total knee arthroplasty is now optional. Forty patients were randomized to receive revision total knee arthroplasty with or without TM Cone (No TM Cone). The Anderson...

  10. SPECT/CT in patients with painful knee arthroplasty - what is the evidence?

    Energy Technology Data Exchange (ETDEWEB)

    Hirschmann, Michael T. [Kantonsspital Baselland-Bruderholz, Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Henckel, Johann [Imperial College London, London (United Kingdom); Rasch, Helmut [Kantonsspital Baselland-Bruderholz, Institute for Radiology and Nuclear Medicine, Bruderholz (Switzerland)

    2013-09-15

    SPECT/CT is increasingly recognized as a promising imaging modality for the investigation of patients with a painful knee after knee arthroplasty. In this review article, we give an overview of the clinical value and current and future applications of SPECT/CT for patients with knee pain following joint arthroplasty. A detailed evidence-based literature review is performed and presented. (orig.)

  11. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte

    2006-01-01

    This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the tra...

  12. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  13. Role of patient characteristics for fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C.; Jacobsen, M; Søballe, Kjeld

    2013-01-01

    BACKGROUND: /st>Patient age and comorbidity have been found to increase the length of hospital stay (LOS), readmissions, and mortality after surgery, including in elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Whether the same applies in fast-track THA and TKA...

  14. The role of pain for early rehabilitation in fast track total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis

    2010-01-01

    To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA).......To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA)....

  15. One-year incidence of prosthetic joint infection in total hip arthroplasty

    DEFF Research Database (Denmark)

    Gundtoft, P H; Pedersen, A B; Schønheyder, H C

    2017-01-01

    OBJECTIVE: To examine the trend of Prosthetic Joint Infections (PJI) following primary total hip arthroplasty (THA) and the antimicrobial resistance of the bacteria causing these infections. MATERIALS AND METHODS: We identified a population-based cohort of patients in the Danish Hip Arthroplasty...

  16. Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees

    Directory of Open Access Journals (Sweden)

    L. Sabatini

    2016-01-01

    Full Text Available Introduction Isolated patellofemoral (PF arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR. The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. Materials and Methods From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients, and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs after surgery in our patients. Results We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. Discussion and Conclusion We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients.

  17. Magnetic resonance angiography and tomography of vertebrobasilar dissections; Magnetresonanzangiographie und Magnetresonanztomographie bei Dissektionen der A. vertebralis

    Energy Technology Data Exchange (ETDEWEB)

    Felber, S. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria)]|[Universitaetsklinik fuer Radiologie, Klinische Abt. 2, Universitaetskliniken Innsbruck (Austria); Auer, A. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria); Schmidauer, C. [Universitaetsklinik fuer Neurologie, Universitaetskliniken Innsbruck (Austria); Waldenberger, P. [Universitaetsklinik fuer Radiologie, Klinische Abt. 1, Universitaetskliniken Innsbruck (Austria); Aichner, F. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria)

    1996-11-01

    wichtige Ursache von Schlaganfaellen bei juengeren Erwachsenen. Wir untersuchten die diagnostischen Moeglichkeiten der Magnetresonanzangiographie (MRA) in Kombination mit der Magnetresonanztomographie (MRT) bei vertebrobasilaeren Dissektionen anhand einer retrospektiven Analyse von 24 Patienten mit einer Vertebralisdissektion und einem Patienten mit einer Basilarisdissektion. Bei 24 von 25 Patienten (95,5%) wurden mit der Magnetresonanzangiographie abnorme Flussverhaeltnisse im disseziierten Gefaess erkannt. Die Sensitivitaet der konventionellen Angiographie war 100% und die des Ultraschalls 77%. In 7 Faellen (30,4%) ergab die Magnetresonanz spezifische Hinweise auf eine Dissektion (Doppellumen n=1, murales Haematom n=4, Pseudoaneurysma n=2). Demgegenueber standen 36,4% spezifische Befunde in der Angiographie. Dabei waren die spezifischen Resultate von MRT/MRA und Angiographie z.T. komplementaer, beide Methoden zusammen erzielten 43,5% Spezifitaet. Die kombinierte MRT und MRA kann bei etwa 1/3 der Patienten bereits die Diagnose einer Vertebralisdissektion stellen. Bei den anderen Patienten kann die Indikation zur konventionellen Angiographie verbessert werden. Dies gilt besonders fuer jene Patienten mit unspezifischen Prodromalsymptomen. Eine negative Magnetresonanzuntersuchung erzetzt bei Patienten mit hinweisenden Symptomen die konventionelle Angiographie allerdings nicht. Die Angiographie wird aufgrund der hoeheren Ortsaufloesung und der sicheren Beurteilbarkeit auch des proximalen V Abschnittes 1 vorerst diagnostischer Standard bleiben. (orig.)

  18. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders

    2014-01-01

    neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset......OBJECTIVE: To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. METHODS: In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA......). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured...

  19. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty.

    Science.gov (United States)

    Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H

    2011-07-22

    In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  20. MRI in cardiac sarcoidosis and amyloidosis; MRT bei kardialer Sarkoidose und Amyloidose

    Energy Technology Data Exchange (ETDEWEB)

    Bauner, K.U. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Wintersperger, B. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada)

    2013-01-15

    Sarcoidosis and amyloidosis are both multisystem disorders, which may involve the heart; however, isolated cardiac disease is rare. Diagnosis of cardiac sarcoidosis and amyloidosis is crucial because the patient prognosis is dependent on cardiac involvement and early treatment. Echocardiography is the first line imaging modality in the diagnostic work-up of both diseases, possibly giving hints towards the correct diagnosis. Besides myocardial biopsy and radionuclide studies cardiac magnetic resonance imaging (MRI) is routinely performed in patients suspect of having infiltrative cardiomyopathy. The T1 mapping procedure is currently being evaluated as a new technique for detection and quantification of global myocardial enhancement, as seen in cardiac amyloidosis. Sensitivities and specificities for detection of cardiac sarcoidosis and amyloidosis can be significantly improved by MRI, especially with late gadolinium enhancement (LGE) imaging. In cardiac sarcoidosis the use of LGE is outcome-related while in amyloidosis analysis of T1-mapping may be of prognostic value. If cardiac involvement in sarcoidosis or amyloidosis is suspected cardiac MRI including LGE should be performed for establishing the diagnosis. (orig.) [German] Die Sarkoidose und Amyloidose sind Multisystemerkrankungen, in deren Verlauf es zu einer kardialen Beteiligung kommen kann. Bildgebend wird als primaeres Verfahren die Echokardiographie eingesetzt. Zur weiteren Diagnostik wird neben der Biopsie und nuklearmedizinischen Verfahren v. a. die MRT herangezogen. Als neuere Technik zur Darstellung globaler diffuser Kontrastmittelanreicherungen, wie sie im Rahmen der Amyloidose vorkommen, wird z. Z. das T1-Mapping evaluiert. Durch den Einsatz der MRT, insbesondere des Late-Gadolinium-Enhancements (LGE), koennen die Sensitivitaet und Spezifitaet in der Diagnostik der kardialen Sarkoidose und Amyloidose entscheidend verbessert werden. Bei der Sarkoidose stellt das Vorhandensein eines LGE einen

  1. Aspects of radiation protection during chest X-radiography; Strahlenhygienische Aspekte bei der Roentgenuntersuchung des Thorax

    Energy Technology Data Exchange (ETDEWEB)

    Seidenbusch, M.C.; Schneider, K. [Dr. von Haunersches Kinderspital, Klinikum der Universitaet Muenchen, Institut fuer Klinische Radiologie - Kinderradiologie, Muenchen (Germany)

    2015-07-15

    Radiation safety in conventional X-ray diagnostics is based on the concepts of justification, optimization of an X-ray examination and limitation of the radiation exposure achieved during the examination. Optimization of an X-ray examination has to be considered as a multimodal process in which all technical components of the X-ray equipment have to be adapted to each other and also have to be adapted to the anthropometric characteristics of patients and the clinical indications. In this article the technical components of a conventional pediatric chest X-radiograph are presented, and recommendations for optimizing chest X-rays in children are provided. The following measures are of prime importance: correct x-ray beam limitation, using the posteroanterior projection when possible and not using anti-scatter grids in children under approximately 8 years old. In pediatric radiology chest x-rays that are taken not at the peak of inspiration can also be of some diagnostic significance. Optimization of an X-ray examination inevitably results in the limitation of radiation exposure. (orig.) [German] Die Strahlenhygiene in der konventionellen radiologischen Diagnostik basiert auf der Trias Rechtfertigung, Optimierung bzw. Limitierung der Roentgenuntersuchung bzw. Strahlenexposition. Die Optimierung einer Roentgenuntersuchung ist als multimodaler Prozess aufzufassen, in welchem saemtliche technische Komponenten der Roentgeneinrichtung sowohl miteinander als auch mit den anthropometrischen Eigenschaften des Patienten und der klinischen Fragestellung abzustimmen sind. Im vorliegenden Beitrag werden die technischen Komponenten bei der konventionellen Roentgenuntersuchung des paediatrischen Thorax in ihrer Beziehung zueinander dargestellt und Empfehlungen fuer eine Optimierung der konventionellen Thoraxaufnahme bei Kindern ausgesprochen. Die wichtigsten Massnahmen bestehen in einer korrekten Einblendung, in der Anfertigung der Aufnahmen im posteroanterioren Strahlengang und im

  2. Retrospektive Analyse von Zufallsbefunden, die bei Patienten mit kutanem malignen Malignom durch (18) F-Fluordeoxyglucose-PET/CT erhoben wurden.

    Science.gov (United States)

    Conrad, Franziska; Winkens, Thomas; Kaatz, Martin; Goetze, Steven; Freesmeyer, Martin

    2016-08-01

    Bei der (18) F-Fluordeoxyglucose-Positronenemissionstomographie/Computertomographie (FDG-PET/CT) ergeben sich häufig Zufallsbefunde. In der vorliegenden Studie konzentrierten wir uns auf mittels FDG-PET/CT erhaltene Zufallsbefunde bei Patienten mit kutanem Melanom und überprüften deren Relevanz hinsichtlich weiterer diagnostischer Maßnahmen und Interventionen. Die Krankenakten von 181 konsekutiven Melanom-Patienten wurden retrospektiv ausgewertet, um das Management von Zufallsbefunden zu dokumentieren. Der Schwerpunkt lag dabei auf den histologischen Befunden. Bei 33 von 181 (18 %) Patienten lagen 39 relevante Zufallsbefunde vor, und zwar im Kolorektalbereich (n = 15 Patienten), in der Schilddrüse (n = 8), der Prostata (n = 2), dem Bewegungsapparat (n = 2), in Lymphknoten (n = 2), der Parotis (n = 1), den Mandeln (n = 1), den Nieren (n = 1) und der Gallenblase (n = 1). Bei 25 Patienten schlossen sich weitere diagnostische Verfahren an, wobei in 21 Fällen ein klinisches Korrelat nachgewiesen wurde. Bei 16 von 21 Patienten ergab sich eine Neoplasie, darunter fünf maligne Läsionen (vier Kolonkarzinome und ein Prostatakarzinom). Die Malignome wurden frühzeitig diagnostiziert und in der Mehrzahl der Fälle erfolgreich entfernt. Der Einsatz der FDG-PET/CT als Routine-Diagnostik wird in den Leitlinien empfohlen und ist indiziert bei malignem Melanom ab Stadium IIC. In dieser Studie wurden auf effektive Weise ansonsten nicht erkannte Krebserkrankungen, insbesondere Kolonkarzinome, detektiert. In den meisten Fällen war eine frühe Intervention möglich. Zufallsbefunde durch FDG-PET/CT sollten, unter Berücksichtigung des Zustands und der Wünsche des Patienten, mit den geeigneten diagnostischen Maßnahmen abgeklärt werden. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  3. Der Einfluss von Alitretinoin auf die Lebensqualität bei Patienten mit schwerem chronischen Handekzem: FUGETTA - Beobachtungsstudie unter Praxisbedingungen.

    Science.gov (United States)

    Augustin, Matthias; Thaçi, Diamant; Kamps, Anja

    2016-12-01

    Alitretinoin ist die einzige zugelassene Behandlung für schweres chronisches Handekzem (CHE), das refraktär gegenüber potenten topischen Corticosteroiden ist. Bei dieser Studie (FUGETTA) wurde die Wirksamkeit von leitliniengerecht angewendetem oralem Alitretinoin sowie dessen Einfluss auf die Lebensqualität (LQ) bei Patienten mit schwerem refraktärem CHE beurteilt. Multizentrische, offene, nichtinterventionelle Beobachtungsstudie, durchgeführt in Deutschland. Die Patienten wurden nach Ermessen ihres behandelnden Arztes mit Alitretinoin 10 mg oder 30 mg einmal täglich über maximal 24 Wochen behandelt. Die Wirksamkeit wurde anhand des Physician Global Assessment (PGA) und des Dermatology Life Quality Index (DLQI) bewertet. Zudem wurden unerwünschte Ereignisse (UE) erfasst. Die Studienpopulation bestand aus 658 Patienten (30 mg: n = 581; 10 mg: n = 77). Bei Beobachtungsbeginn litten die meisten Patienten (83 %) gemäß PGA an einem schweren CHE. Bei Beobachtungsende war das Handekzem bei 48 % der Patienten gemäß PGA vollständig oder fast vollständig abgeheilt (30 mg: 49 %; 10 mg: 43 %). Die mittlere Verbesserung des DLQI-Scores in Woche 24 betrug 58 % (30 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,4 [8,04]) und 70 % (10 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,8 [7,29]). Die Gesamtinzidenz von NW war niedrig und in den beiden Gruppen ähnlich. Alitretinoin führte zu einer schnellen, deutlichen Verbesserung der LQ bei Patienten mit schwerem CHE. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  4. Magnetic resonance spectroscopy for inflammatory brain diseases; Magnetresonanzspektroskopie bei entzuendlichen Hirnerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Grunwald, I.Q.; Hartmann, K.M.; Politi, M.; Roth, C.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Farmakis, G. [Universitaetsklinikum des Saarlandes, Klinik fuer Nuklearmedizin, Homburg/Saar (Germany)

    2008-06-15

    Magnetic resonance spectroscopy (MRS) is a non-invasive method for investigation of cerebral metabolite concentrations in various pathologic conditions. The clinical use of MRS for intracranial disorders is well established. In this review the characteristic MRS findings for the most important inflammatory brain diseases will be discussed. (orig.) [German] Die Magnetresonanzspektroskopie (MRS) ist eine nichtinvasive Methode, die die Messung der Konzentration zerebraler Metaboliten erlaubt. Die Verwendung der MRS bei verschiedenen intrakraniellen Erkrankungen ist gut etabliert. In diesem Review werden die MRS-Charakteristiken der wichtigsten entzuendlichen Hirnerkrankungen diskutiert. (orig.)

  5. Os controles internos e contábeis na gestão de tesouraria

    OpenAIRE

    Pereira, Marcos Augusto Assi

    2010-01-01

    As atividades de Controles Internos e Contábeis fazem parte da gestão do negócio, mas ainda existe muita dificuldade no entendimento da aplicabilidade da matéria seja por ignorância dos benefícios, seja pela ausência de cultura de controle. Essas atividades exigem multiplicidade de conhecimentos de gestão, controle e governança corporativa, além da permanente atualização profissional. O controle contábil é derivado do controle interno, que determina as políticas e procedi...

  6. Spontaneous aliquorrhea syndrome due to cervicothoracic liquor leak; Spontanes Liquorunterdrucksyndrom bei zervikothorakalem Liquorleck

    Energy Technology Data Exchange (ETDEWEB)

    Kuhl, V.; Thoemke, F.; Hopf, H.C. [Klinik und Poliklinik fuer Neurologie, Johannes-Gutenberg-Univ. Mainz (Germany); Andreas, J. [Klinik und Poliklinik fuer Nuklearmedizin, Johannes-Gutenberg-Univ. Mainz (Germany); Mueller-Forell, W. [Institut fuer Neuroradiologie, Johannes-Gutenberg-Univ. Mainz (Germany)

    2000-07-01

    The radiological and nuclear medicine methods applied for diagnostic evaluation in the case reported (MRI, myelography, liquor myeloscintigraphy) were the key modalities for diagnosis, explanation of causes, and follow-up and are described in this report. In case of recurrent headaches during therapy, a CCT examination should be performed in order to exclude the presence of subdural hematoma.(orig./CB) [German] Die radiologischen und nuklearmedizinischen Untersuchungsmethoden (MRT, Myelographie, Liquormyeloszintigraphie) nehmen zur Diagnosestellung, Ursachenabklaerung und Verlaufsbeurteilung eine zentrale Schluesselposition ein und wurden anhand unseres Fallbeispieles demonstriert und beschrieben. Bei Wiederauftreten von Kopfschmerzen im Verlauf der Erkrankung sollte zum Ausschluss subduraler Haematome eine CCT-Untersuchung erfolgen. (orig.)

  7. Betriebseigenschaften der CEDARs für Likelihood-Teilchenidentifikation bei COMPASS

    CERN Document Server

    Gensler, Armin

    Die CEDAR Detektoren bei COMPASS können genutzt werden um Teilchen zu identifizieren. In dieser Arbeit wird eine Unregelmäßigkeit untersucht, die in den Daten der Photomultiplier der CEDARs auftritt. Insbesondere wird ermittelt, welche Daten davon betroffen sind und wie diese identifiziert und herausgefiltert werden können. Dabei zeigt sich, dass etwa 10% aller Events betroffen sind. Anschließend werden die Auswirkungen auf das in [4] beschriebene Likelihod-Identifikationsverfahren für Pionen und Kaonen analysiert, wobei sich heraus stellt, dass sich die Effizienz der Verfahrens dadurch deutlich verbessern lässt.

  8. Konzepte und Methoden zur Qualitätssicherung bei der Produktion von hypertextuellen Online-Lernumgebungen

    Directory of Open Access Journals (Sweden)

    Christian Swertz

    2002-04-01

    Full Text Available Die didaktische Ontologie der Webdidaktik ermöglicht die Qualitätssicherung von Prozessen und Ergebnissen bei der Produktion von Online- Lernumgebungen. Die Qualität wird durch die am pädagogischen Prozess beteiligten Menschen bestimmt. Der Qualitätssicherungsprozess kann durch Software unterstützt werden. Für diese Prozesse der Qualitätssicherung bringt der Autor Beispiele aus dem Lerndorf (www.lerndorf.de und der Lernumgebung des von der Deutschen Bundesstiftung Umwelt geförderten Forschungs- und Entwicklungsprojekt «Zentrum für Umweltwissen und Bildung» (ZUB.

  9. Prospektive Entwicklung des postoperativen Sprachverstehens nach Tympanoplastik bei chronischer Otitis media

    OpenAIRE

    Knof, B; Plotz, K; Krack, A; Stumper, J; Schönfeld, R

    2013-01-01

    Einleitung: Tympanoplastiken I/III bei chron. Otitis media COM (mesotympanalis CMOM und epitympanalis CEOM). In der Literatur werden erfolgreiche operative Behandlungen mit Verringerung der Schallleitungskomponente (air-bone gap) belegt (Gierke et al. 2011). Aus Sicht des Patienten steht die Verbesserung des Hörvermögens und des Sprachverstehens im Alltag im Vordergrund. Das Ziel war die Untersuchung der Entwicklung des Hörvermögens in Ruhe sowie im Störgeräusch.Methoden: An den Hör- und Sp...

  10. Planungsunterstützung für Pankreasoperationen bei Hyperinsulinismus von Kindern

    Science.gov (United States)

    Dornheim, J.; Preim, B.; Preim, U.; Mohnike, K.; Blankenstein, O.; Füchtner, F.; Mohnike, W.; Empting, S.; Mohnike, K.

    Auf Basis von sechs PET/CT-Datensätzen des Pankreas wird eine Computerunterstützung für die Teilresektion der Bauchspeicheldr üse (Pankreas) bei fokalem Hyperinsulinismus von Kindern entwickelt. Ziel ist es, die Lokalisation des krankhaften Fokus im Pankreasgewebe präoperativ dreidimensional zu visualisieren, um so die Sicherheit des Eingriffs zu erhöhen. Die relevanten anatomischen Strukturen werden im CT segmentiert und anschließend dreidimensional visualisiert. Der im PET erkennbare Fokus wird in diese anatomische 3D-Visualisierung eingeblendet. Es zeigt sich eine klare Erkennbarkeit des Fokus in allen sechs Fällen.

  11. EXCESS CASH HOLDINGS DAN KEPEMILIKAN INSTITUSIONAL PADA PERUSAHAAN MANUFAKTUR YANG TERDAFTAR DI BEI

    Directory of Open Access Journals (Sweden)

    Yessica Tria Christina

    2014-02-01

    Full Text Available This research provides an empirical evidence about the effect of institutional ownerships as a proxy of information transparancy on excess cash holdings. Manufacture companies listed on BEI from years 2002 to 2011 are employed. The results show that the higher the proportion of institutional ownership, the lower the excess cash holdings. Informational transparancy, as one of the requirements of good corporate governance, can in fact lower the chance of aggrevating the manager’s behavior to practice excess cash holdings that can lower the company’s efficiency.

  12. Valuasi Harga Wajar Saham Sektor Perbankan Yang Go Public Di BEI

    OpenAIRE

    Khairi, Sherly Emita

    2011-01-01

    Investment on stock needs analyisis about valuation of stocks to calculate the intrinsic value of each stocks based on the its fundamental data. The aim of this research is to calculate the intrinsic stock prices of the two company which included in financial sectors and to see whether the stocks of the companies is in the undervalued or overvalued conditions. This research takes samples of financial sectors which are got IPO in BEI from 2005 to 2010. As the samples, it is chosen two banks...

  13. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

    Science.gov (United States)

    Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J; Anderson, Deverick J; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Weber, David J; Lewis, Sarah S

    2015-12-01

    To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. Retrospective cohort study A total of 43 community hospitals located in the southeastern United States. Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; Poperative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; Poperative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.

  14. Evaluation of a regional real-time precise positioning system based on GPS/BeiDou observations in Australia

    Science.gov (United States)

    Ding, Wenwu; Tan, Bingfeng; Chen, Yongchang; Teferle, Felix Norman; Yuan, Yunbin

    2018-02-01

    The performance of real-time (RT) precise positioning can be improved by utilizing observations from multiple Global Navigation Satellite Systems (GNSS) instead of one particular system. Since the end of 2012, BeiDou, independently established by China, began to provide operational services for users in the Asia-Pacific regions. In this study, a regional RT precise positioning system is developed to evaluate the performance of GPS/BeiDou observations in Australia in providing high precision positioning services for users. Fixing three hourly updated satellite orbits, RT correction messages are generated and broadcasted by processing RT observation/navigation data streams from the national network of GNSS Continuously Operating Reference Stations in Australia (AUSCORS) at the server side. At the user side, RT PPP is realized by processing RT data streams and the RT correction messages received. RT clock offsets, for which the accuracy reached 0.07 and 0.28 ns for GPS and BeiDou, respectively, can be determined. Based on these corrections, an accuracy of 12.2, 30.0 and 45.6 cm in the North, East and Up directions was achieved for the BeiDou-only solution after 30 min while the GPS-only solution reached 5.1, 15.3 and 15.5 cm for the same components at the same time. A further improvement of 43.7, 36.9 and 45.0 percent in the three directions, respectively, was achieved for the combined GPS/BeiDou solution. After the initialization process, the North, East and Up positioning accuracies were 5.2, 8.1 and 17.8 cm, respectively, for the BeiDou-only solution, while 1.5, 3.0, and 4.7 cm for the GPS-only solution. However, we only noticed a 20.9% improvement in the East direction was obtained for the GPS/BeiDou solution, while no improvements in the other directions were detected. It is expected that such improvements may become bigger with the increasing accuracy of the BeiDou-only solution.

  15. MRI of the musculature in patients with myalgia - indications and imaging results; MRT der Muskulatur bei Myalgien - Indikationen und Bildbefunde

    Energy Technology Data Exchange (ETDEWEB)

    Beese, M.S. [Universitaetsklinik Hamburg-Eppendorf (Germany). Radiologische Klinik; Winkler, G. [Universitaetsklinik Hamburg-Eppendorf (Germany). Neurologische Klinik; Maas, R. [Universitaetsklinik Hamburg-Eppendorf (Germany). Radiologische Klinik; Buechler, E. [Universitaetsklinik Hamburg-Eppendorf (Germany). Radiologische Klinik

    1996-05-01

    241 patients suffering from myalgic symptoms were examined by axial scans of the muscular system with T1w and STIR-sequences. All patients underwent a complete neuromuscular examination, which included an MRI guided muscle-biopsy of 203 patients. The images were retrospectively analysed as to the typical characteristics of differential diagnosis. In cases of idiopathic or bacterial/viral induced myositis, primary vasculitis, and rhabdomyolysis, edematous changes of the muscles could always be found. Abscesses were only found in bacterial myositis. In cases of poly- and dermatomyositis as well as inclusion-body-myositis, MRI showed a uniform distribution pattern with emphasis on the quadriceps muscles. In contrast to other neuromuscular diseases in bacterial induced myositis, focal myositis, and rhabdomyolysis a strong contrast agent enhancement was seen. All patients with myalgic syndromes without any other additional neuropathological findings and 86% of the patients suffering from polymyalgia rheumatica had normal MR-findings. MRI allows a correct exclusion of an inflammatory, tumorous, or rhabdomyolitic cause of a myalgia and leads to pathognomonic findings for these diseases. Diseases belonging to the group of endocrine, toxic, or metabolic myopathies might be normal in MRI. (orig./MG) [Deutsch] Bei 241 Patienten mit myalgischen Beschwerden wurden axiale Aufnahmen der Muskulatur mit T1w- und STIR-Sequenzen angefertigt. Bei allen Patienten wurde eine vollstaendige neuromuskulaere Untersuchung durchgefuehrt, die bei 203 Patienten eine MRT-gezielte Muskelbiopsie beinhaltete. Das Bildmaterial wurde retrospektiv hinsichtlich differentialdiagnostischer Charakteristika analysiert. Bei idiopathischen und erregerbedingten Myositiden, primaeren Vaskulitiden und bei Rhabdomyolysen bestanden ohne Ausnahme oedematoese Veraenderungen der Muskulatur. Abszessformationen wurden nur bei erregerbedingten Myositiden vorgefunden. Bei Poly- und Dermatomyositiden sowie

  16. Treatment side effects and follow-up of malignant melanoma; Therapienebenwirkungen und Nachsorge bei malignem Melanom

    Energy Technology Data Exchange (ETDEWEB)

    Stahl, T. [Klinikum der Stadt Ludwigshafen gGmbH, Zentralinstitut fuer diagnostische und interventionelle Radiologie, Ludwigshafen (Germany); Loquai, C. [Universitaetsmedizin der Johannes-Gutenberg Universitaet Mainz, Hautklinik und Poliklinik, Mainz (Germany)

    2015-01-30

    gravierenden Wandel unterzogen und unterscheiden sich explizit von der klassischen Zytostatikatherapie. Die Immuntherapeutika, insbesondere Ipilimumab, nehmen aufgrund ihrer spezifischen immunvermittelten Wirkmechanismen und den damit verbundenen Nebenwirkungen (irAE, ''immune related'' Adverse Events) eine Sonderstellung ein. Der ueberwiegende Anteil der Behandlungsfolgen manifestiert sich an der Haut (> 50 %) und entgeht im Allgemeinen der radiologischen Diagnostik. Nur ein vergleichsweise geringer Anteil der Nebenwirkungen ist mit bildgebender Diagnostik fassbar (15-20 %), dann aber, am Beispiel der therapieinduzierten Kolitis unter Ipilimumab, u. U. rasch toedlich. Neben der Kolitis (10-20 %) sind Hypophysitis (1,8-17 %), Thyreoidits (0,8 %), Myositis (1,7 %), Fasziitis und sarkoidoseartige Lymphknotenveraenderungen (6,8 %) weitere in der Bildgebung apparente Therapiefolgen. Um radiologisch nachweisbare Therapienebenwirkungen fruehzeitig zu erkennen und sie insbesondere auch gegen Tumorprogress oder (opportunistische) Infektionen abzugrenzen, ist eine detaillierte Kenntnis der therapeutischen Verfahren in der Melanombehandlung, ihrer Wirkmechanismen und ihrer z. T. sehr spezifischen Nebenwirkungen fuer den Diagnostiker zwingend notwendig. (orig.)

  17. The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas; CT und MRT des erworbenen Cholesteatoms: Prae- und postoperative Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, C.; Czerny, C. [Abteilung fuer Osteologie, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria); Gstoettner, W. [Univ.-Klinik fuer Hals-Nasen-Ohren-Heilkunde, Frankfurt (Germany); Franz, P. [Univ.-Klinik fuer Hals-Nasen-Ohren-Heilkunde, Wien (Austria)

    2003-03-01

    The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI. HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma, bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination. (orig.) [German] In dieser Arbeit wird die Rolle der hochaufloesenden Computertomographie (HRCT) und der Magnetresonanztomographie (MRT) zur Abklaerung prae- und postoperativ bedingter Komplikationen erworbener Cholesteatome beschrieben. Die Bildgebung wurde sowohl mit der HRCT als auch mit der MRT durchgefuehrt. Die HRCT und die MRT wurden in axialer und koronaler Ebene (auch

  18. Scintigraphic examinations after stent implantation in central airways; Szintigraphische Untersuchungen bei Stents in den zentralen Atemwegen

    Energy Technology Data Exchange (ETDEWEB)

    Richter, W.S.; Kettner, B.I.; Munz, D.L. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Charite, Medizinische Fakulteat der Humboldt-Univ. zu Berlin (Germany)

    1998-03-01

    Endotracheal and endobronchial stent implantation has been developed as an effective treatment of benign and malignant airway stenosis and of tracheo- or bronchoesophageal fistulas. The selection of the stent type depends on the kind and site of disease. Chest X-ray and bronchoscopy are the procedures of choice for monitoring of stent position, structure, and function. However, with scintigraphic methods the effects of stent implantation on pulmonary ventilation and perfusion can be assessed non-invasively. The validation of the effect of a stent implantation on mucociliary and tussive clearance remains to be elucidated. (orig.) [Deutsch] Die endotracheale und -bronchiale Stentimplantation wurde in den letzten Jahren als effektive Massnahme bei benignen und malignen Stenosen der Atemwege, drohendem Atemwegsverschluss und bei tracheo- bzw. bronchooesophagealen Fisteln eingefuehrt. Der gewaehlte Stenttyp richtet sich nach dem Implantationsort und den krankheitsbedingten Veraenderungen. Zum Monitoring von Lage, Struktur und Funktion eines Stents dienen Thoraxroentgenaufnahmen und die Bronchoskopie. Nuklearmedizinische Verfahren koennen nicht-invasiv den Effekt der Stenteinlage auf Lungenventilation und -perfusion belegen. Die Validierung des Effekts einer Stentimplantation auf die mukoziliaere und tussive Clearance steht noch aus. (orig.)

  19. Global Ionospheric Modelling using Multi-GNSS: BeiDou, Galileo, GLONASS and GPS.

    Science.gov (United States)

    Ren, Xiaodong; Zhang, Xiaohong; Xie, Weiliang; Zhang, Keke; Yuan, Yongqiang; Li, Xingxing

    2016-09-15

    The emergence of China's Beidou, Europe's Galileo and Russia's GLONASS satellites has multiplied the number of ionospheric piercing points (IPP) offered by GPS alone. This provides great opportunities for deriving precise global ionospheric maps (GIMs) with high resolution to improve positioning accuracy and ionospheric monitoring capabilities. In this paper, the GIM is developed based on multi-GNSS (GPS, GLONASS, BeiDou and Galileo) observations in the current multi-constellation condition. The performance and contribution of multi-GNSS for ionospheric modelling are carefully analysed and evaluated. Multi-GNSS observations of over 300 stations from the Multi-GNSS Experiment (MGEX) and International GNSS Service (IGS) networks for two months are processed. The results show that the multi-GNSS GIM products are better than those of GIM products based on GPS-only. Differential code biases (DCB) are by-products of the multi-GNSS ionosphere modelling, the corresponding standard deviations (STDs) are 0.06 ns, 0.10 ns, 0.18 ns and 0.15 ns for GPS, GLONASS, BeiDou and Galileo, respectively in satellite, and the STDs for the receiver are approximately 0.2~0.4 ns. The single-frequency precise point positioning (SF-PPP) results indicate that the ionospheric modelling accuracy of the proposed method based on multi-GNSS observations is better than that of the current dual-system GIM in specific areas.

  20. High-precision GNSS ocean positioning with BeiDou short-message communication

    Science.gov (United States)

    Li, Bofeng; Zhang, Zhiteng; Zang, Nan; Wang, Siyao

    2018-04-01

    The current popular GNSS RTK technique would be not applicable on ocean due to the limited communication access for transmitting differential corrections. A new technique is proposed for high-precision ocean RTK, referred to as ORTK, where the corrections are transmitted by employing the function of BeiDou satellite short-message communication (SMC). To overcome the limitation of narrow bandwidth of BeiDou SMC, a new strategy of simplifying and encoding corrections is proposed instead of standard differential corrections, which reduces the single-epoch corrections from more than 1000 to less than 300 bytes. To solve the problems of correction delays, cycle slips, blunders and abnormal epochs over ultra-long baseline ORTK, a series of powerful algorithms were designed at the user-end software for achieving the stable and precise kinematic solutions on far ocean applications. The results from two long baselines of 240 and 420 km and real ocean experiments reveal that the kinematic solutions with horizontal accuracy of 5 cm and vertical accuracy of better than 15 cm are achievable by convergence time of 3-10 min. Compared to commercial ocean PPP with satellite telecommunication, ORTK is of much cheaper expense, higher accuracy and shorter convergence. It will be very prospective in many location-based ocean services.

  1. Kyphoplasty and vertebroplasty for spinal trauma; Kyphoplastie und Vertebroplastie bei Wirbelsaeulentraumata

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F. [Kantonsspital Baden AG, Abteilung fuer Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland); Omidi, R. [Kantonsspital Baden AG, Interventionelle Radiologie, Institut fuer Radiologie, Baden (Switzerland)

    2016-08-15

    Minimally invasive treatment of spinal fractures. Conservative treatment versus spinal surgery. Minimally invasive stabilization techniques, such as percutaneous (assisted) cementoplasty have been introduced as new procedures. Magnetic resonance imaging (MRI), X-rays and computed tomography (CT) are the imaging techniques of first choice. The most important questions concern recent fractures, instability and indications for minimally invasive treatment. Vertebroplasty and kyphoplasty are established methods for the treatment of patients with osteoporosis. Cementoplasty techniques are promising treatment options for traumatic spinal injuries. The application of the techniques should best be carried out in individual cases within the framework of prospective controlled studies. (orig.) [German] Minimal-invasive Behandlung von Wirbelsaeulentraumata. Konservative Behandlung vs. Wirbelsaeulenchirurgie. Als neue Verfahren wurden minimal-invasive Stabilisationstechniken, z. B. perkutane (assistierte) Zementoplastien eingefuehrt. Roentgen, MRT und CT sind die bildgebenden Verfahren der ersten Wahl. Die wichtigsten Fragestellungen sind: Frische Fraktur? Instabilitaet? Indikation fuer minimal-invasive Behandlung ?Vertebroplastie und Kyphoplastie sind bei Osteoporosepatienten etabliert. Bei Wirbelsaeulentraumata sind Zementoplastietechniken vielversprechende Therapieoptionen. Die Anwendung der Techniken sollte im individuellen Fall am besten im Rahmen prospektiver kontrollierter Studien erfolgen. (orig.)

  2. Clinically relevant incidental cardiovascular findings in CT examinations; Klinisch relevante kardiovaskulaere Zufallsbefunde bei CT-Untersuchungen

    Energy Technology Data Exchange (ETDEWEB)

    Voigt, P.; Fahnert, J.; Kahn, T.; Surov, A. [Universitaetsklinikum Leipzig, Klinik fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Schramm, D.; Bach, A.G. [Universitaetsklinikum Halle (Saale), Klinik fuer Radiologie, Halle (Germany)

    2017-04-15

    Incidental cardiovascular findings are a frequent phenomenon in computed tomography (CT) examinations. As the result of a dedicated PubMed search this article gives a systemic overview of the current literature on the most important incidental cardiovascular findings, their prevalence and clinical relevance. The majority of incidental cardiovascular findings are of only low clinical relevance; however, highly relevant incidental findings, such as aortic aneurysms, thromboses and thromboembolic events can also occasionally be found, especially in oncology patients. The scans from every CT examination should also be investigated for incidental findings as they can be of decisive importance for the further clinical management of patients, depending on their clinical relevance. (orig.) [German] Inzidentelle kardiovaskulaere Befunde sind ein haeufiges Phaenomen bei CT-Untersuchungen. Mit dieser Arbeit soll nach gezielter PubMed-Recherche ein systematischer Literaturueberblick ueber die wichtigsten kardiovaskulaeren Zufallsbefunde sowie deren Haeufigkeit und klinische Relevanz gegeben werden. Die Mehrzahl der inzidentellen kardiovaskulaeren Befunde sind klinisch nur von untergeordneter Bedeutung, allerdings werden immer wieder auch hochgradig relevante Zufallsbefunde wie beispielsweise Aortenaneurysmata oder - gerade bei onkologischen Patienten - Thrombosen und thrombembolische Ereignisse detektiert. Jede CT-Untersuchung sollte gezielt nach inzidentellen Befunden durchsucht werden, da diese je nach klinischer Relevanz von entscheidender Bedeutung fuer das weitere klinische Management des Patienten sein koennen. (orig.)

  3. Radiotherapy for solitary plasmacytoma and multiple myeloma; Strahlentherapie bei solitaerem Plasmozytom und multiplem Myelom

    Energy Technology Data Exchange (ETDEWEB)

    Schmaus, M.C. [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Neuhof, D. [MVZ Strahlentherapie und Nuklearmedizin Weinheim, Weinheim (Germany)

    2014-06-15

    Solitary plasmacytoma and multiple myeloma require a differentiated radiotherapy. The irradiation for plasmacytoma with an adequate total dose (medullary 40-50 Gy or extramedullary 50-60 Gy) leads to a high degree of local control with a low rate of side effects. In cases of multiple myeloma radiotherapy will achieve effective palliation, both in terms of recalcification as well as reduction of neurological symptoms and analgesia. In terms of analgesia the rule is the higher the single dose fraction the faster the reduction of pain. As part of a conditioning treatment prior to stem cell transplantation radiotherapy contributes to the establishment of a graft versus myeloma effect (GVM). (orig.) [German] Das solitaere Plasmozytom und das multiple Myelom fordern eine differenzierte Strahlenbehandlung. Bei Plasmozytomen fuehrt eine Bestrahlung mit ausreichender Gesamtdosis (medullaer 40-50 Gy oder extramedullaer 50-60 Gy) zu einer hohen Lokalkontrolle mit einer geringen Rate an Nebenwirkungen. Beim multiplen Myelom kann die Strahlentherapie eine effektive Palliation sowohl hinsichtlich Rekalzifikation als auch Reduktion neurologischer Symptomatik und Analgesie erzielen. Hinsichtlich der Analgesie gilt: Je hoeher die Einzeldosis, desto schneller der Wirkeintritt. Im Rahmen einer Konditionierungstherapie vor Stammzelltransplantation traegt die Strahlentherapie zur Etablierung eines Graft-versus-Myelom-Effekts (GvM) bei. (orig.)

  4. Comparison of Ultra-Rapid Orbit Prediction Strategies for GPS, GLONASS, Galileo and BeiDou.

    Science.gov (United States)

    Geng, Tao; Zhang, Peng; Wang, Wei; Xie, Xin

    2018-02-06

    Currently, ultra-rapid orbits play an important role in the high-speed development of global navigation satellite system (GNSS) real-time applications. This contribution focuses on the impact of the fitting arc length of observed orbits and solar radiation pressure (SRP) on the orbit prediction performance for GPS, GLONASS, Galileo and BeiDou. One full year's precise ephemerides during 2015 were used as fitted observed orbits and then as references to be compared with predicted orbits, together with known earth rotation parameters. The full nine-parameter Empirical Center for Orbit Determination in Europe (CODE) Orbit Model (ECOM) and its reduced version were chosen in our study. The arc lengths of observed fitted orbits that showed the smallest weighted root mean squares (WRMSs) and medians of the orbit differences after a Helmert transformation fell between 40 and 45 h for GPS and GLONASS and between 42 and 48 h for Galileo, while the WRMS values and medians become flat after a 42 h arc length for BeiDou. The stability of the Helmert transformation and SRP parameters also confirmed the similar optimal arc lengths. The range around 42-45 h is suggested to be the optimal arc length interval of the fitted observed orbits for the multi-GNSS joint solution of ultra-rapid orbits.

  5. Pediatric radiological diagnostics in suspected child abuse; Kinderradiologische Diagnostik bei Verdacht auf Kindesmisshandlung

    Energy Technology Data Exchange (ETDEWEB)

    Erfurt, C.; Schmidt, U. [Technische Universitaet Dresden, Institut fuer Rechtsmedizin, Medizinische Fakultaet, Dresden (Germany); Hahn, G. [Universitaetsklinikum Carl Gustav Carus, Dresden, Abteilung Kinderradiologie, Institut und Poliklinik fuer Radiologische Diagnostik, Dresden (Germany); Roesner, D. [Universitaetsklinikum Carl Gustav Carus, Dresden, Klinik und Poliklinik fuer Kinderchirurgie, Dresden (Germany)

    2009-10-15

    Advanced and specialized radiological diagnostics are essential in the case of clinical suspicion of pediatric injuries to the head, thorax, abdomen, and extremities when there is no case history or when ''battered child syndrome'' is assumed on the basis of inadequate trauma. In particular, the aim of this sophisticated diagnostic procedure is the detection of lesions of the central nervous system (CNS) in order to initiate prompt medical treatment. If diagnostic imaging shows typical findings of child abuse, accurate documented evidence of the diagnostic results is required to prevent further endangerment of the child's welfare. (orig.) [German] Klinisch diagnostizierte Verletzungen an Kopf, Thorax, Abdomen oder Extremitaeten eines Kindes bei scheinbar leerer Anamnese oder Angabe eines inadaequaten Traumas erfordern beim Verdacht auf ein Battered-Child-Syndrom eine erweiterte und spezialisierte radiologische Diagnostik. Diese soll insbesondere im Bereich des ZNS Verletzungsfolgen erfassen, um therapeutische Massnahmen einleiten zu koennen. Bei typischen, auf eine Misshandlung hinweisenden radiologischen Befunden ist eine praezise beweissichere Befunddokumentation erforderlich, um eine weitere Kindeswohlgefaehrdung zu vermeiden. (orig.)

  6. Comparison of Ultra-Rapid Orbit Prediction Strategies for GPS, GLONASS, Galileo and BeiDou

    Directory of Open Access Journals (Sweden)

    Tao Geng

    2018-02-01

    Full Text Available Currently, ultra-rapid orbits play an important role in the high-speed development of global navigation satellite system (GNSS real-time applications. This contribution focuses on the impact of the fitting arc length of observed orbits and solar radiation pressure (SRP on the orbit prediction performance for GPS, GLONASS, Galileo and BeiDou. One full year’s precise ephemerides during 2015 were used as fitted observed orbits and then as references to be compared with predicted orbits, together with known earth rotation parameters. The full nine-parameter Empirical Center for Orbit Determination in Europe (CODE Orbit Model (ECOM and its reduced version were chosen in our study. The arc lengths of observed fitted orbits that showed the smallest weighted root mean squares (WRMSs and medians of the orbit differences after a Helmert transformation fell between 40 and 45 h for GPS and GLONASS and between 42 and 48 h for Galileo, while the WRMS values and medians become flat after a 42 h arc length for BeiDou. The stability of the Helmert transformation and SRP parameters also confirmed the similar optimal arc lengths. The range around 42–45 h is suggested to be the optimal arc length interval of the fitted observed orbits for the multi-GNSS joint solution of ultra-rapid orbits.

  7. Magnetic resonance maging of epidural and subdural spinal hematomas; Magnetresonanztomographie bei epiduralen und subduralen spinalen Haematomen

    Energy Technology Data Exchange (ETDEWEB)

    Felber, S. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Langmaier, J. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Judmaier, W. [Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Dessl, A. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Ortler, M. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Birbamer, G. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz; Piepgras, U. [Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie

    1994-11-01

    wurde. Wir berichten ueber 9 Patienten, die primaer magnetresonanztomographisch diagnostiziert wurden. Bei allen Patienten wurden T1, Spindichte und T2-gewichtete Bilder erzeugt. Zusaetzlich wurden T2*-gewichtete Gradientenechosequenzen angewendet. Die Magnetresonanztomographien wurden mit dem intraoperativen Situs korreliert. Computertomographische Befunde waren bei 4 und myelographische Befunde waren bei 2 Patienten vorhanden. Die Haematome komprimierten in 2 Faellen das Zervikalmark, bei 6 Patienten das Thorakalmark und bei 2 Patienten Konus und Cauda. Die Magnetresonanztomographie ergab 6 epidurale und 3 subdurale Haematome, operativ handelte es sich um 5 epidural und 4 subdurale Blutungen. In einem Fall konnte die Kernspintomographie nicht zwischen epi- und subduraler Lokalisation unterscheiden. Perakute Haematome (<24 h) waren isointens auf T1-gewichteten Bildern und hatten gemischte Signalintensitaet auf T2- und T*-gewichteten Bildern (n=3). Akute Blutungen (24 h bis 3 Tage) waren ebenfalls isointens auf T1 aber hypointens auf T- und T2*-gewichteten Bildern (n=4). Erst nach 7 Tagen fand sich die methaemoglobintypische Hyperintensitaet auf T1- und T2-gewichteten Bildern (n=2). Diese Ergebnisse unterstreichen, dass die Magnetresonanztomographie perakute und akute spinale Blutungen adaequat diagnostizieren kann. Die exakte Beurteilung der kraniokaudalen Ausdehnung verbessert die Operationsplanung. (orig.)

  8. Prognostic value of cardiovascular MRI in diabetics; Prognostischer Wert der kardiovaskulaeren MRT bei Diabetikern

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, C.L.; Bertheau, R.C.; Kauczor, H.U.; Weckbach, S. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany)

    2015-04-01

    Risikostratifizierung von Noeten ist. Die klinische Untersuchung und die Bestimmung von Blutwerten dienen bei Diabetikern typischerweise zur Risikostratifizierung bzgl. kardio(zerebro)vaskulaerer Ereignisse in der Zukunft. Sowohl die Kardio- als auch die Ganzkoerper-MRT stellen standardisierte Verfahren in der klinischen Diagnostik dar. Deren Stellenwert bei der Vorhersage von Ereignissen mit entsprechender Risikostratifizierung bei Diabetikern gewinnt basierend auf aktuellen Studienergebnissen zunehmend an Bedeutung. Late Gadolinium Enhancement (LGE) im Kardio-MRT detektiert bei bis zu 30 % der Diabetiker stumme Myokardischaemien, die mit einer Hazard Ratio von 3-6 mit kardiovaskulaeren Ereignissen assoziiert sind. Ebenfalls zeigen linksventrikulaere Wandbewegungsstoerungen sowie eine erniedrigte Ejektionsfraktion einen prognostischen Wert. Im Ganzkoerper-MRT sind der Vessel-Score und Karotisstenosen zusaetzliche Praediktoren fuer kardio(zerebro)vaskulaere Ereignisse. Die MRT-basierte Vorhersage kardio(zerebro)vaskulaerer Ereignisse bietet einen signifikanten Mehrwert zur klassischen Risikostratifizierung bei Diabetikern. Jedoch erlaubt nur die umfassende Ganzkoerper-MRT-Untersuchung Patienten zu identifizieren, die ueber einen Zeitraum von 6 Jahren komplett frei von kardio(zerebro)vaskulaeren Ereignissen bleiben. Die Kardio-MRT, insbesondere die Erfassung von LGE, empfiehlt sich fuer die Vorhersage von Ereignissen. Die Ganzkoerper-MRT stellt einen prognostischen Mehrwert dar, deren klinische Relevanz in weiteren Studien geklaert werden muss. (orig.)

  9. The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty.

    Science.gov (United States)

    Deutsch, Harel

    2010-06-01

    The goal of the study was to determine patient factors predictive of good outcome after lumbar disc arthroplasty. Specifically, the paper examines the relationship of the preoperative Oswestry Disability Index (ODI) to patient outcome at 1 year. The study is a retrospective review of 20 patients undergoing a 1-level lumbar disc arthroplasty at the author's institution between 2004 and 2008. All data were collected prospectively. Data included the ODI, visual analog scale scores, and patient demographics. All patients underwent a 1-level disc arthroplasty at L4-5 or L5-S1. The patients were divided into 2 groups based on their baseline ODI. Patients with an ODI between 38 and 59 demonstrated better outcomes with lumbar disc arthroplasty. Only 1 (20%) of 5 patients with a baseline ODI higher than 60 reported a good outcome. In contrast, 13 (87%) of 15 patients with an ODI between 38 and 59 showed a good outcome (p = 0.03). The negative predictive value of using ODI > 60 is 60% in patients who are determined to be candidates for lumbar arthroplasty. Lumbar arthroplasty is very effective in some patients. Other patients do not improve after surgery. The baseline ODI results are predictive of outcome in patients selected for lumbar disc arthroplasty. A baseline ODI > 60 is predictive of poor outcome. A high ODI may be indicative of psychosocial overlay.

  10. Assessment of patient functional performance in different knee arthroplasty designs during unconstrained squat.

    Science.gov (United States)

    Verdini, Federica; Zara, Claudio; Leo, Tommaso; Mengarelli, Alessandro; Cardarelli, Stefano; Innocenti, Bernardo

    2017-01-01

    In this paper, squat named by Authors unconstrained because performed without constrains related to feet position, speed, knee maximum angle to be reached, was tested as motor task revealing differences in functional performance after knee arthroplasty. It involves large joints ranges of motion, does not compromise joint safety and requires accurate control strategies to maintain balance. Motion capture techniques were used to study squat on a healthy control group (CTR) and on three groups, each characterised by a specific knee arthroplasty design: a Total Knee Arthroplasty (TKA), a Mobile Bearing and a Fixed Bearing Unicompartmental Knee Arthroplasty (respectively MBUA and FBUA). Squat was analysed during descent, maintenance and ascent phase and described by speed, angular kinematics of lower and upper body, the Center of Pressure (CoP) trajectory and muscle activation timing of quadriceps and biceps femoris. Compared to CTR, for TKA and MBUA knee maximum flexion was lower, vertical speed during descent and ascent reduced and the duration of whole movement was longer. CoP mean distance was higher for all arthroplasty groups during descent as higher was, CoP mean velocity for MBUA and TKA during ascent and descent. Unconstrained squat is able to reveal differences in the functional performance among control and arthroplasty groups and between different arthroplasty designs. Considering the similarity index calculated for the variables showing statistically significance, FBUA performance appears to be closest to that of the CTR group. III a.

  11. Assessment of patient functional performance in different knee arthroplasty designs during unconstrained squat

    Science.gov (United States)

    Verdini, Federica; Zara, Claudio; Leo, Tommaso; Mengarelli, Alessandro; Cardarelli, Stefano; Innocenti, Bernardo

    2017-01-01

    Summary Background In this paper, squat named by Authors unconstrained because performed without constrains related to feet position, speed, knee maximum angle to be reached, was tested as motor task revealing differences in functional performance after knee arthroplasty. It involves large joints ranges of motion, does not compromise joint safety and requires accurate control strategies to maintain balance. Methods Motion capture techniques were used to study squat on a healthy control group (CTR) and on three groups, each characterised by a specific knee arthroplasty design: a Total Knee Arthroplasty (TKA), a Mobile Bearing and a Fixed Bearing Unicompartmental Knee Arthroplasty (respectively MBUA and FBUA). Squat was analysed during descent, maintenance and ascent phase and described by speed, angular kinematics of lower and upper body, the Center of Pressure (CoP) trajectory and muscle activation timing of quadriceps and biceps femoris. Results Compared to CTR, for TKA and MBUA knee maximum flexion was lower, vertical speed during descent and ascent reduced and the duration of whole movement was longer. CoP mean distance was higher for all arthroplasty groups during descent as higher was, CoP mean velocity for MBUA and TKA during ascent and descent. Conclusions Unconstrained squat is able to reveal differences in the functional performance among control and arthroplasty groups and between different arthroplasty designs. Considering the similarity index calculated for the variables showing statistically significance, FBUA performance appears to be closest to that of the CTR group. Level of evidence III a. PMID:29387646

  12. Two-stage exchange knee arthroplasty: does resistance of the infecting organism influence the outcome?

    Science.gov (United States)

    Kurd, Mark F; Ghanem, Elie; Steinbrecher, Jill; Parvizi, Javad

    2010-08-01

    Periprosthetic joint infection after TKA is a challenging complication. Two-stage exchange arthroplasty is the accepted standard of care, but reported failure rates are increasing. It has been suggested this is due to the increased prevalence of methicillin-resistant infections. We asked the following questions: (1) What is the reinfection rate after two-stage exchange arthroplasty? (2) Which risk factors predict failure? (3) Which variables are associated with acquiring a resistant organism periprosthetic joint infection? This was a case-control study of 102 patients with infected TKA who underwent a two-stage exchange arthroplasty. Ninety-six patients were followed for a minimum of 2 years (mean, 34.5 months; range, 24-90.1 months). Cases were defined as failures of two-stage exchange arthroplasty. Two-stage exchange arthroplasty was successful in controlling the infection in 70 patients (73%). Patients who failed two-stage exchange arthroplasty were 3.37 times more likely to have been originally infected with a methicillin-resistant organism. Older age, higher body mass index, and history of thyroid disease were predisposing factors to infection with a methicillin-resistant organism. Innovative interventions are needed to improve the effectiveness of two-stage exchange arthroplasty for TKA infection with a methicillin-resistant organism as current treatment protocols may not be adequate for control of these virulent pathogens. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  13. ACL status in arthroplasty patients, why not to preserve?

    Directory of Open Access Journals (Sweden)

    Abdelbadie Ahmed

    2018-01-01

    Full Text Available Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient

  14. Patterns of functional improvement after revision knee arthroplasty.

    Science.gov (United States)

    Ghomrawi, Hassan M K; Kane, Robert L; Eberly, Lynn E; Bershadsky, Boris; Saleh, Khaled J

    2009-12-01

    Despite the increase in the number of total knee arthroplasty revisions, outcomes of such surgery and their correlates are poorly understood. The aim of this study was to characterize patterns of functional improvement after revision total knee arthroplasty over a two-year period and to investigate factors that affect such improvement patterns. Three hundred and eight patients in need of revision surgery were enrolled into the study, conducted at seventeen centers, and 221 (71.8%) were followed for two years. Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lower-Extremity Activity Scale (LEAS) scores were collected at baseline and every six months for two years postoperatively. A piecewise general linear mixed model, which models correlation between repeated measures and estimates separate slopes for different follow-up time periods, was employed to examine functional improvement patterns. Separate regression slopes were estimated for the zero to twelve-month and the twelve to twenty-four-month periods. The slopes for zero to twelve months showed significant improvement in all measures in the first year. The slopes for twelve to twenty-four months showed deterioration in the scores of the WOMAC pain subscale (slope = 0.67 +/- 0.21, p coefficient = -5.46 +/- 1.91, p coefficient = 5.41 +/- 2.35, p coefficient = 1.42 +/- 0.69, p < 0.05]). Factors related to the surgical technique did not predict outcomes. The onset of worsening pain and knee-specific function in the second year following revision total knee arthroplasty indicates the need to closely monitor patients, irrespective of the mode of failure of the primary procedure or the surgical technique for the revision. This information may be especially important for patients with multiple comorbidities.

  15. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ Implant Arthroplasty

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2014-09-01

    Full Text Available Background:  Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna.  The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months. Also, patients were contacted prospectively by phone in order to  minister the disabilities of the armshoulder and hand (DASH, patient rated wrist evaluation (PRWE, and visual analogue scale (VAS, and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months.  Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.

  16. Compartment syndrome after total knee arthroplasty: regarding a clinical case

    Directory of Open Access Journals (Sweden)

    Ana Alexandra da Costa Pinheiro

    2015-08-01

    Full Text Available ABSTRACT Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  17. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

    Directory of Open Access Journals (Sweden)

    Rex Chadrabose

    2011-12-01

    Full Text Available Abstract Background Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Materials Our case series includes 9 patients (seven males and two females with the mean age of 34 years (13-56 years. Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. Results The average duration of follow up is 65 months (45 months-80 months. The mean Mayo's elbow performance score (MEPS preoperatively was 48 (35-70. The MEPS at final follow up was 80 (60-95. With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°. The mean post operative range of motion at final follow up was 27°of extension (20-500, 116°of flexion (1100-1300, and the arc of motion was 88°(800-1000. One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. Conclusion We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  18. Staged lengthening arthroplasty for pediatric osteosarcoma around the knee.

    Science.gov (United States)

    Kong, Chang-Bae; Lee, Soo-Yong; Jeon, Dae-Geun

    2010-06-01

    Orthopaedic oncologists often must address leg-length discrepancy after resection of tumors in growing patients with osteosarcoma. There are various alternatives to address this problem. We describe a three-stage procedure: (1) temporary arthrodesis, (2) lengthening by Ilizarov apparatus, and (3) tumor prosthesis. We asked (1) to what extent are affected limbs actually lengthened; (2) how many of the patients who undergo a lengthening procedure eventually achieve joint arthroplasty; and (3) can the three-stage procedure give patients a functioning joint with equalization of limb length? We reviewed 56 patients (younger than 14 years) with osteosarcoma who had staged lengthening arthroplasty between 1991 and 2004. Thirty-five of the 56 patients (63%) underwent soft tissue lengthening, and of these 35, 28 (50% of the original group of 56) had implantation of a mobile joint. Three of the 28 prostheses were later removed owing to infection after arthroplasty. The overall average length gained was 7.8 cm (range, 4-14 cm), and 25 (71%) of the 35 patients had a mobile joint at final followup. The average Musculoskeletal Tumor Society functional score was 23.2 (range, 15-28) and limb-length discrepancy at final followup was 2.6 cm (range, 0-6.5 cm). Although most mobile joints had an acceptable ROM (average, 74.2 degrees ; range, 35 degrees -110 degrees ), extension lag was frequent. Our approach is one option for skeletally immature patients, especially in situations where an expandable prosthesis is not available. However, this technique requires multiple stages and would be inappropriate for patients who cannot accept prolonged functional deficit owing to a limited lifespan or other reasons. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  19. USER'S GUIDE TO THE PERSONAL COMPUTER VERSION OF THE BIOGENIC EMISSIONS INVENTORY SYSTEM (PC-BEIS2)

    Science.gov (United States)

    The document is a user's guide for an updated Personal Computer version of the Biogenic Emissions Inventory System (PC-BEIS2), allowing users to estimate hourly emissions of biogenic volatile organic compounds (BVOCs) and soil nitrogen oxide emissions for any county in the contig...

  20. Radiotherapy of heterotopic bone formation in patients with paraplegia. Preliminary results; Strahlentherapie heterotoper Ossifikationen bei Querschnittsgelaehmten. Praeliminaere Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Liebermeister, E. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Heinze, H.G. [Klinik fuer Strahlentherapie, Staedtisches Klinikum Karlsruhe (Germany); Nanassy, A. [Klinik fuer Orthopaedie, Rehabilitationskrankenhaus Langensteinbach (Germany); Stoltze, D. [Klinik fuer Orthopaedie, Rehabilitationskrankenhaus Langensteinbach (Germany)

    1995-08-01

    In 20 patients with paralysis, 25 regions were irradiated with (mostly) 10 Gy in single fractions of 2 to 2.5 Gy using 8 MW photons. In 15 patients radiotherapy was performed as a primary treatment in the status of myositis; 7 patients were treated after (subtotal) resection of already manifest ossifications (2 patients were treated twice, primarily and postoperatively). In a minimum follow-up 12 weeks, none of the 20 irradiated patients showed any progression of the developing or already manifest ossification; thus mobilisation and rehabilitation could be carried out as desired. No side effects occurred. The preliminary results of the present study suggest that radiotherapy is an effective local treatment with minimal side effects for the prevention of heterotopic bone formation in patients with paraplegia. (orig.) [Deutsch] Bei 20 Patienten (18 Maenner, zwei Frauen, Alter 19 bis 62 Jahre) mit Querschnittssyndrom wurden 25 Regionen mit ueberwiegend 10 Gy a 2 bis 2,5 Gy Einzeldosis mit 8-MW-Photonen bestrahlt. Die Radiatio erfolgte bei 15 Patienten als Primaerprophylaxe im entzuendlichen Stadium, bei sieben Patienten sekundaer nach (subtotaler) Resektion von Ossifikationen (zwei Patienten wurden sowohl primaer als auch sekundaer bestrahlt). Bei einer Mindestnachbeobachtungszeit von zwoelf Wochen trat in keinem Fall eine Progression der sich entwickelnden bzw. bereits bestehenden heterotopen Ossifikationen auf: saemtliche Patienten konnten wunschgemaess mobilisiert und im Rahmen ihrer neurologischen Ausfaelle rehabilitiert werden. Nebenwirkungen traten nicht auf. Die vorliegende praeliminaeren Ergebnisse deuten hin, dass die Strahlentherapie eine effektive und nebenwirkungsarme lokale Therapie zur Verhinderung heterotoper Ossifikationen beim Querschnittssyndrom darstellt. (orig.)

  1. Europe CERN recherche - Pret de 300 millions d'euros de la BEI pour l'accelerateur de particules

    CERN Multimedia

    2002-01-01

    "La Banque europeenne d'investissement (BEI) va preter 300 millions d'euros pour financer la phase finale de la construction du grand accelerateur de particules LHC (Large Hadron Collider) du CERN, a indique jeudi l'organisation europeenne pour la recherche nucleaire" (1/2 page).

  2. A Modified Differential Coherent Bit Synchronization Algorithm for BeiDou Weak Signals with Large Frequency Deviation.

    Science.gov (United States)

    Han, Zhifeng; Liu, Jianye; Li, Rongbing; Zeng, Qinghua; Wang, Yi

    2017-07-04

    BeiDou system navigation messages are modulated with a secondary NH (Neumann-Hoffman) code of 1 kbps, where frequent bit transitions limit the coherent integration time to 1 millisecond. Therefore, a bit synchronization algorithm is necessary to obtain bit edges and NH code phases. In order to realize bit synchronization for BeiDou weak signals with large frequency deviation, a bit synchronization algorithm based on differential coherent and maximum likelihood is proposed. Firstly, a differential coherent approach is used to remove the effect of frequency deviation, and the differential delay time is set to be a multiple of bit cycle to remove the influence of NH code. Secondly, the maximum likelihood function detection is used to improve the detection probability of weak signals. Finally, Monte Carlo simulations are conducted to analyze the detection performance of the proposed algorithm compared with a traditional algorithm under the CN0s of 20~40 dB-Hz and different frequency deviations. The results show that the proposed algorithm outperforms the traditional method with a frequency deviation of 50 Hz. This algorithm can remove the effect of BeiDou NH code effectively and weaken the influence of frequency deviation. To confirm the feasibility of the proposed algorithm, real data tests are conducted. The proposed algorithm is suitable for BeiDou weak signal bit synchronization with large frequency deviation.

  3. F-18-FDG PET of the thyroid in Graves` disease; F-18-FDG-PET der Schilddruese bei Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Boerner, A.R.; Voth, E.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin, Koeln Univ. (Germany); Wienhard, K.; Wagner, R. [Max-Planck-Institut fuer Neurologische Forschung, Koeln (Germany)

    1998-12-31

    This study evaluates F-18-FDG PET of the thyroid in Graves` disease. Methods: Thirty patients were investigated the day before radioiodine therapy, 15 patients 3-10 days after radioiodine therapy. Twenty patients with cancer of the head or neck and normal thyroid function served as controls. Results: F-18-FDG uptake was higher in Graves` disease patients than in controls. Negative correlations of F-18-FDG uptake with half-life of radioiodine and absorbed radiation dose due to radioiodine therapy were found along with a positive correlation to autoantibody levels. Conclusion: Thus F-18-FDG PET is likely to give information on the biological activity of Graves` disease as well as on early radiation effects. (orig.) [Deutsch] Ziel: Diese Studie evaluiert F-18-Fluoro-Deoxy-Glukose (F-18-FDG) PET der Schilddruese bei Patienten mit M. Basedow. Methoden: 30 Patienten wurden am Tag vor Radioiod-Therapie, 15 Patienten am 3.-10. Tag nach Radioiodtherapie untersucht. 20 Patienten mit Kopf/Halstumoren und normaler Schilddruesenfunktion dienten als Kontrollgruppe. Ergebnisse: Die F-18-FDG-Aufnahme in der Schilddruese war signifikant hoeher bei Patienten mit M-Basedow im Vergleich zu den Kontrollen. Sie stieg mit hoeheren, antithyreoidalen Antikoerpern und sank bei laengerer I-131-Halbwertzeit. Es bestand eine Korrelation einer reduzierten Glukose-Utilisation bei hoeherer absorbierter Schilddruesendosis nach Radioiod-Therapie. Schlussfolgerung: Damit erscheint die F-18-FDG-PET-Untersuchung zur biologischen Aktivitaetsbeurteilung des M. Basedow und Darstellung von fruehen Strahleneffekten geeignet. (orig.)

  4. Solution Method and Precision Analysis of Double-difference Dynamic Precise Orbit Determination of BeiDou Navigation Satellite System

    Directory of Open Access Journals (Sweden)

    LIU Weiping

    2016-02-01

    Full Text Available To resolve the high relativity between the transverse element of GEO orbit and double-difference ambiguity, the classical double-difference dynamic method is improved and the method, which is to determine precise BeiDou satellite orbit using carrier phase and pseudo-range smoothed by phase, is proposed. The feasibility of the method is discussed and the influence of the method about ambiguity fixing is analyzed. Considering the characteristic of BeiDou, the method, which is to fix double-difference ambiguity of BeiDou satellites by QIF, is derived. The real data analysis shows that the new method, which can reduce the relativity and assure the precision, is better than the classical double-difference dynamic method. The result of ambiguity fixing is well by QIF, but the ambiguity fixing success rate is not high on the whole. So the precision of BeiDou orbit can't be improved clearly after ambiguity fixing.

  5. In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty.

    Science.gov (United States)

    Watanabe, Toshifumi; Abbasi, Ali Z; Conditt, Michael A; Christopher, Jennifer; Kreuzer, Stefan; Otto, Jason K; Banks, Scott A

    2014-07-01

    There is great interest in providing reliable and durable treatments for one- and two-compartment arthritic degeneration of the cruciate-ligament intact knee. One approach is to resurface only the diseased compartments with discrete unicompartmental components, retaining the undamaged compartment(s). However, placing multiple small implants into the knee presents a greater surgical challenge than total knee arthroplasty, so it is not certain that the natural knee mechanics can be maintained or restored. The goal of this study was to determine whether near-normal knee kinematics can be obtained with a robot-assisted multi-compartmental knee arthroplasty. Thirteen patients with 15 multi-compartmental knee arthroplasties using haptic robotic-assisted bone preparation were involved in this study. Nine subjects received a medial unicompartmental knee arthroplasty (UKA), three subjects received a medial UKA and patellofemoral (PF) arthroplasty, and three subjects received medial and lateral bi-unicondylar arthroplasty. Knee motions were recorded using video-fluoroscopy an average of 13 months (6-29 months) after surgery during stair and kneeling activities. The three-dimensional position and orientation of the implant components were determined using model-image registration techniques. Knee kinematics during maximum flexion kneeling showed femoral external rotation and posterior lateral condylar translation. All knees showed femoral external rotation and posterior condylar translation with flexion during the step activity. Knees with medial UKA and PF arthroplasty showed the most femoral external rotation and posterior translation, and knees with bicondylar UKA showed the least. Knees with accurately placed uni- or bi-compartmental arthroplasty exhibited stable knee kinematics consistent with intact and functioning cruciate ligaments. The patterns of tibiofemoral motion were more similar to natural knees than commonly has been observed in knees with total knee

  6. Primary cemented total hip arthroplasty: 10 years follow-up

    Directory of Open Access Journals (Sweden)

    Nath Rajendra

    2010-01-01

    Full Text Available Background: Primary cemented total hip arthroplasty is a procedure for non-traumatic and traumatic affections of the hip. Long term follow-up is required to assess the longevity of the implant and establish the procedure. Indo-Asian literature on long term result of total hip arthroplasty is sparse. We present a 10-year follow-up of our patients of primary cemented total hip arthroplasty. Materials and Methods: We operated 31 hips in 30 patients with primary cemented total hip arthroplasty. We followed the cases for a minimum period of 10 years with a mean follow-up period of 12.7 years. The mean age of the patients was 60.7 years (range 37-82 yrs male to female ratio was 2:1. The clinical diagnoses included - avascular necrosis of femoral head (n=15, sero positive rheumatoid arthritis (n=5, seronegative spondylo-arthropathy (n=4, neglected femoral neck fractures (n=3, healed tubercular arthritis (n=2 and post traumatic osteoarthritis of hip (n=2. The prostheses used were cemented Charnley′s total hip (n=12 and cemented modular prosthesis (n=19. The results were assessed according to Harris hip score and radiographs taken at yearly intervals. Results: The mean follow-up is 12.7 yrs (range 11-16 yrs Results in all operated patients showed marked improvement in Harris hip score from preoperative mean 29.2 to 79.9 at 10 years or more followup. However, the non-inflammatory group showed more sustained long term improvement as compared to the inflammatory group, as revealed by the Harris hip score. Mean blood loss was 450ml (±3.7 ml, mean transfusion rate was 1.2 units (±.3. The complications were hypotension (n=7, shortening> 1.5 cm (n=9, superficial infection (n=2 and malposition of prosthesis (n=1. Conclusion: The needs of Indian Asian patients, vary from what is discussed in literature. The pain tolerance is greater than western population and financial constraints are high. Thus revision surgery among Indian-Asian patients is less compared

  7. Criteria used when deciding on eligibility for total knee arthroplasty

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Ross, Ewa M.; Laursen, Mogens Berg

    2016-01-01

    BACKGROUND: Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA....... CONCLUSION: Radiographic severity and functional limitations were confirmed as drivers for TKA eligibility, while pain was not. Not responding to non-surgical treatment was not included in the decision-making, suggesting low uptake of clinical guidelines in clinical practice. This study highlights...

  8. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf

    2006-01-01

    BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  9. Resection arthroplasty of the hip in paralytic dislocations.

    Science.gov (United States)

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  10. Does knee awareness differ between different knee arthroplasty prostheses?

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas

    2016-01-01

    BACKGROUND: Low knee awareness after Total Knee Arthroplasty (TKA) has become the ultimate goal in trying to achieve a natural feeling knee that meet patient expectations. To accommodate this manufacturers of TKAs have developed new prosthetic designs that potentially could give patients a more...... natural feeling knee during activities. The purpose af this study was to compare the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) of patients treated with a previous generation standard Cruciate Retaining (CR) TKA to the scores obtained by patients treated with a newer generation CR TKA...

  11. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-08-01

    Full Text Available The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program, where improved healing process is particularly useful to comorbid patients.

  12. Reducing Length of Stay in Total Joint Arthroplasty Care.

    Science.gov (United States)

    Walters, Megan; Chambers, Monique C; Sayeed, Zain; Anoushiravani, Afshin A; El-Othmani, Mouhanad M; Saleh, Khaled J

    2016-10-01

    As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty.

    Science.gov (United States)

    Park, Kyung Soon; Diwanji, Sanket R; Kim, Hyung Keun; Song, Eun Kyoo; Yoon, Taek Rim

    2009-08-01

    Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.

  14. Postoperative radiologic imaging of joint arthroplasty; Postoperative radiologische Beurteilung von Gelenkendoprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Aldinger, P.R. [Abt. Orthopaedie I, Orthopaedische Universitaetsklinik Heidelberg (Germany); Ludwig, K. [Sektion Diagnostische Radiologie, Orthopaedische Universitaetsklinik Heidelberg (Germany)

    2006-06-15

    With increased life expectancy in industrialised countries, improvement of implant design and operative technique, arthroplasty has become a routine procedure. The hip and knee joints are treated by arthroplasty most frequently. Nowadays joint replacement can be performed in many other joints. Radiologic imaging is an important tool for evaluation of the operative results and for detection of early and late complications. In the following article we describe the relevance of different imaging modalities as well as their systematic application in patients with joint arthroplasty. (orig.)

  15. Wie schneiden Sie ab?: Studie über Kontroll- und Prüfungsaktivitäten bei mittelgrossen Unternehmen, Spitälern und Hochschulen in der Schweiz

    OpenAIRE

    Ruud, T F; Isufi, S; Friebe, P; Stebler, W; Seheri, F; Emmenegger, M

    2008-01-01

    Kontroll- und Prüfungsaktivitäten unterstützen den Verwaltungsrat und die Geschäftsleitung bei der Steuerung und Kontrolle des Unternehmens. Bei mittelgrossen Unternehmen ist aufgrund der begrenzten personellen und finanziellen Ressourcen ein effektiver und effizienter Einsatz dieser Aktivitäten unerlässlich. Auch bei Spitälern und Hochschulen gewinnen Kontroll- und Prüfungsaktivitäten infolge erhöhter Wettbewerbsintensität und steigenden Kostendrucks sowie zunehmender Unabhängigkeit diese...

  16. Bewältigungsstrategien der Oberwalliser Primarlehrpersonen und Massnahmen der Gesundheitsförderung an Oberwalliser Primarschulen bei Stress und Burnout

    OpenAIRE

    Imhof, Barbara; Mattig, Astrid

    2009-01-01

    Die vorliegende Studie befasst sich mit der Gesundheitsförderung bei Stress und Burnout an den Oberwalliser Primarschulen und der Bewältigungsstrategien der Oberwalliser Primarlehrpersonen bei Stress und Burnout. Der theoretische Teil befasst sich mit Stress und Burnout und der Bewältigung von Stress und Burnout. Verschiedene Aspekte des Lehrerberufs werden näher angeschaut und es werden mögliche Massnahmen der Gesundheitsförderung bei Stress und Burnout aufgeführt. Die Untersuchung zeigt, da...

  17. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint.

    Science.gov (United States)

    Achten, Juul; Parsons, Nick R; Edlin, Richard P; Griffin, Damian R; Costa, Matthew L

    2010-01-14

    Hip replacement (arthroplasty) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint. For older patients, several designs of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money. However, in younger more active patients, there is approximately a 50% failure rate at 25 years for traditional implants. Hip resurfacing is a relatively new arthroplasty technique. In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified, including the risk of femoral neck fracture and collapse of the head of the femur. The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty. Secondary aims include assessment of complication rates for both procedures as well cost effectiveness. All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study. A randomisation sequence will be produced and administered independently. After consenting, all patients will be clinically reviewed and hip function, quality of life and physical activity level will be assessed through questionnaires. The allocated surgery will then be performed with the preferred technique of the surgeon. Six weeks post-operation hip function will be assessed and complications recorded. Three, six and 12 months post-operation hip function, quality of life and physical activity level will be assessed. Additional information about patients' out-of-pocket expenses will also be collected. Current Controlled Trials ISRCTN33354155. UKCLRN portfolio ID 4093.

  18. Intra- und postoperative Komplikationen bei Patienten mit roboterassistierter laparoskopischer radikaler Prostatektomie (RALP. Eine Analyse von 3000 konsekutiven Fällen

    Directory of Open Access Journals (Sweden)

    Zugor V

    2012-01-01

    Full Text Available Einleitung: Das Ziel dieser Studie ist es, die intra- und postoperativen Komplikationen bei Patienten mit roboterassistierter laparoskopischer radikaler Prostatektomie anhand von 3000 konsekutiven Fällen aufzuzeigen. Material und Methoden:3000 Männer, welche sich einer RALP unterzogen, wurden retrospektiv untersucht. Alle Patienten wurden sowohl hinsichtlich ihrer intra- als auch postoperativen Komplikationen beobachtet. Postoperative Komplikationen und Re-Interventionen wurden bis 30 Tage nach OP erfasst und anhand der Clavien-Klassifikation in „Minor“- (Clavien-Klassifikation I–IIIa und „Major“- Komplikationen (Clavien-Klassifikation IIIb–IVa eingeteilt. Ergebnisse: Die intraoperativen Komplikationen sind ebenso wie die „minor“ und „major“ postoperativen Komplikationen in Tabellen 3 und 4 aufgeführt. Das mediane Alter der Patienten betrug 64,1 Jahre, der mediane BMI 26,7 kg/m2 , das mediane Prostatagewicht 40,1 g und der mediane PSA-Wert 10,1 ng/ml. Der Gleason-Score bei Biopsie war in 65 % kleiner als 7, in 34,4 % gleich 7 und größer als 7 in 9,6 % der Fälle. Die Lymphknotendissektion wurde in 75,9 % durchgeführt. Ein organbeschränktes Stadium zeigte sich in 75 % und eine extraprostatische Ausbreitung in 25 %. Die gesamte intraoperative Komplikationsrate lag bei 5,1 %, die „minor“ postoperative Komplikationsrate bei 16,1 % und die „major“ bei 1,8 %. Zusammenfassung: Die RALP ist nicht komplikationslos. In erfahrenen Händen ist sie jedoch ein sicheres chirurgisches Verfahren mit einer niedrigen Morbidität und Mortalität.

  19. A Aderência dos Pronunciamentos Contábeis do CPC às Normas Internacionais de Contabilidade

    Directory of Open Access Journals (Sweden)

    Jorge Andrade Costa

    2012-09-01

    Full Text Available A convergência para os padrões contábeis internacionais tem se tornado um assunto relevante, com agenda definida para sua adesão em muitos países ao redor do mundo. No Brasil, coube ao CPC a responsabilidade de emitir pronunciamentos contábeis de acordo com as normas IFRS. Cada documento emitido pelo CPC corresponde a uma norma internacional de contabilidade emitida pelo IASB. Este trabalho tem como objetivo comparar os pronunciamentos do CPC com as normas do IASB e verificar a existência de diferenças entre os mesmos. Para tanto, realizou-se uma pesquisa documental aos pronunciamentos do CPC e às normas do IASB. Utilizou-se a técnica da análise de conteúdo, tendo o tema como unidade de significação. O universo de análise compreendeu os 65 pronunciamentos técnicos que estão sendo utilizados nas demonstrações contábeis das companhias brasileiras, emitidos pelo CPC entre os anos de 2007 a 2011. Os resultados apontaram para a existência de diferenças entre os pronunciamentos emitidos pelo CPC e as normas emitidas pelo IASB, as quais foram agrupadas em quatro categorias de análise. Após análise, concluiu-se que as diferenças apontadas não prejudicam a declaração de que as demonstrações contábeis consolidadas brasileiras, preparadas de acordo com os CPCs estão de acordo com as normas do IASB. Palavras-chave: CPC, IFRS, IASB, demonstrações contábeis

  20. Potenzielle Arzneimittelwechsel-wirkungen und unerwünschte Arzneimittelwirkungen bei stationären dermatologischen Patienten.

    Science.gov (United States)

    Koch, Lukas; Kränke, Birger; Aberer, Werner

    2016-11-01

    Informationen zur Häufigkeit von Arzneimittelwechselwirkungen und unerwünschten Arzneimittelwirkungen zu präsentieren und Hilfestellung zu leisten, wie diese wichtigen Probleme in der pharmakologischen Behandlung stationärer dermatologischer Patienten minimiert werden können. Die Medikation von 1 099 stationären dermatologischen Patienten wurde retrospektiv mittels einer Internet-basierten Software für Medikamenteninteraktionen (Diagnosia ® Check) auf Arzneimittelwechselwirkungen und unerwünschte Arzneimittelwirkungen analysiert. Wir beschreiben eine Gesamthäufigkeit relevanter Arzneimittelwechselwirkungen von 51,7 % mit durchschnittlich 3,2 Interaktionen pro betroffenem stationären Patienten. Arzneimittelkombinationen, die gemieden werden sollten, wurden bei 5,7 % der Studienpopulation festgestellt. Der wichtigste Risikofaktor war die Gesamtzahl der verabreichten Medikamente. Die Arzneimittelgruppen, die bei der Mehrzahl der Wechselwirkungen beteiligt waren, waren Analgetika, Herz-Kreislauf-Medikamente und gerinnungshemmende Medikamente sowie Antidepressiva. Das Risiko unerwünschte Arzneimittelwirkungen auszubilden wurde bei 53,1 % der stationären Patienten als "hoch" eingestuft. Die fünf wichtigsten unerwünschten Nebenwirkungen in dieser Patientengruppe waren Blutungen, Obstipation, anticholinerge Effekte, Sedierung und orthostatische Effekte. Potenzielle Arzneimittelwechselwirkungen sowie unerwünschte Arzneimittelwirkungen sind bei stationären dermatologischen Patienten alarmierend häufig. Bei jedem zweiten Patienten besteht die Gefahr, derartige Wechselwirkungen oder unerwünschte Nebenwirkungen zu erleiden und jeder zwanzigste Patient erhält eine Arzneimittelkombination, die nicht verabreicht werden sollte. Erhöhte Wachsamkeit ist erforderlich, um die gefährdeten Patienten zu erkennen. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  1. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    Science.gov (United States)

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a

  2. PET/CT in lymphoma patients; PET-CT bei Lymphompatienten

    Energy Technology Data Exchange (ETDEWEB)

    Steinert, H.C. [Universitaetsspital Zuerich, Klinik und Poliklinik fuer Nuklearmedizin (Switzerland)

    2004-11-01

    First results of PET/CT in Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) are reported. From March 2001 to August 2004 822 PET/CT were performed at our clinic in lymphoma patients for primary staging, restaging after therapy, and diagnosis of recurrence. For coregistration non contrast-enhanced low-dose CT were used. Due to the exact anatomic localization of {sup 18}F-FDG accumulating lesions equivocal or false positive PET findings are avoided. In comparison to contrast enhanced CT, PET/CT has a higher sensitivity and specificity in patients with HD and aggressive NHL. Integration of PET/CT in treatment planning of radiation therapy optimizes the field volume. Even in the initial phase of clinical evaluation, PET/CT has proven useful in staging and restaging of lymphoma. The exact anatomic localization of the PET findings is essential for a precise report, for treatment planning of radiation therapy, and for planning surgical biopsy. (orig.) [German] Erste Ergebnisse der PET-CT bei Morbus Hodgkin (HD) und den aggressiven Non-Hodgkin-Lymphomen (NHL) werden beschrieben. Von Maerz 2001 bis August 2004 wurden 822 PET-CT bei Lymphompatienten zum primaeren Staging, zum Restaging nach Therapie und zur Rezidivdiagnostik an unserer Klinik durchgefuehrt. Fuer die Koregistration wurde ein Low-dose-CT ohne i.v.-Kontrastmittel verwendet. Durch die exakte anatomische Zuordnung der {sup 18}F-FDG aufnehmenden Laesionen wurden unklare oder falsch-positive PET-Befunde vermieden. Die PET-CT erzielte im Vergleich zur KM-verstaerkten CT eine hoehere Sensitivitaet und Spezifitaet bei Patienten mit HD und aggressiven NHL. Die Integration der PET-CT in die Planung der Strahlentherapie fuehrte zu einer Optimierung der Feldgrenzen. Die PET-CT hat sich bereits in der Phase der initialen klinischen Evaluation als wertvoll beim Staging und Restaging von Lymphomen erwiesen. Die exakte anatomische Zuordnung der PET-Informationen ist fuer eine sichere Befundung

  3. Imaging diagnostics of breast metastases from extramammary tumors; Bildgebende Diagnostik bei Brustmetastasen extramammaerer Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Wienbeck, S.; Lotz, J. [Georg-August-Universitaet Goettingen, Institut fuer Diagnostische und Interventionelle Radiologie, Goettingen (Germany); Nemat, S. [Universitaet Homburg/Saar, Institut fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Surov, A. [Universitaet Leipzig, Institut fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany)

    2017-06-15

    klinischen Merkmale und die unterschiedlichen Bildgebungsbefunde intramammaerer Metastasen solider extramammaerer Tumoren aufgezeigt. Brustmetastasen werden haeufig zufaellig in Zusammenhang mit einer Computertomographie (CT) oder Positronenemissionstomographie-Computertomographie (PET-CT) entdeckt. Mammographisch weisen Brustmetastasen 2 unterschiedliche bildgebende Erscheinungsmuster im Sinne von Herdbefunden oder aber einer Architekturstoerung mit Kutisverdickung auf. Diese kommen in der Regel als solitaere, seltener als multiple runde Herdbefunde mit glatter Randbegrenzung zur Darstellung. Assoziierter Mikrokalk tritt selten auf. Eine diffuse Architekturstoerung mit Kutisverdickung kommt gehaeuft bei Brustmetastasen der meisten Magenkarzinome, Ovarialkarzinome und Rhabdomyosarkome vor. Sonographisch stellen sich die Befunde hypoechogen, oval oder rund mit glatter Randbegrenzung und dorsaler Schallverstaerkung dar. Die MR-Kriterien bei Brustmetastasen sind dagegen inkonstant und koennen nicht sicher als benigne oder maligne klassifiziert werden. Die erhobenen radiologischen Befunde imponieren hierbei eher benigne, sodass bei bekannter Malignomerkrankung stets an das Vorliegen von Brustmetastasen gedacht werden sollte. (orig.)

  4. Somatostatin receptor scintigraphy in endocrine ophthalmopathy; Somatostatin-Rezeptor-Szintigraphie bei endokriner Orbitopathie

    Energy Technology Data Exchange (ETDEWEB)

    Diaz, M. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Mainz (Germany); Kahaly, G. [3. Medizinische Klinik und Poliklinik, Innere Medizin - Endokrinologie, Univ. Mainz (Germany); Muehlbach, A. [3. Medizinische Klinik und Poliklinik, Innere Medizin - Endokrinologie, Univ. Mainz (Germany); Bockisch, A. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Mainz (Germany); Beyer, J. [3. Medizinische Klinik und Poliklinik, Innere Medizin - Endokrinologie, Univ. Mainz (Germany); Hahn, K. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Mainz (Germany)

    1994-12-01

    Somatostatin receptor scintigraphy with {sup 111}In-labeled octreotide proves to be a very sensitive diagnostic tool for evaluation of inflammative activity in endocrine ophthalmopathy (EO). The results of somatostatin receptor scintigraphy (SRS) in 40 patients with EO show a high orbital accumulation of {sup 111}In-octreotide in clinically active EO (4h-median/orbit-brain-ratio: 12.6; controls 4h-median: 5.8) Patients with clinically inactive EO (4h-median: 7.1) show a similar orbital accumulation of radioactivity compared to controls. 5 patients with active orbital myositis also revealed an even higher orbital accumulation of radioactivity (4h-median: 42.3). The diagnostic value of SRS lies in its ability to act as a measure of inflammation and an be useful as an activity parameter when planning therapeutic procedure as well as for EO follow-up. The results in patients with orbital myositis nevertheless do not permit a differential diagnosis with this method. The therapeutic value of {sup 111}In-octreotide in Graves` disease has yet to be established. (orig.) [Deutsch] Die Somatostatin-Rezeptor-Szintigraphie (SRS) mit dem {sup 111}Indium-markierten Somatostatinanalogon Octreotid stellt ein sensitives Verfahren zur Einschaetzung der entzuendlichen Aktivitaet bei endokriner Orbitopathie (EO) dar. Die Untersuchungen an 40 Patienten mit EO ergaben eine im Vergleich zur Kontrollgruppe signifikant hoehere orbitale Octreotidanreicherung bei klinisch aktiver Erkrankung (4h-Median/Orbita-Hirn-Quotient: 12,6; Kontrollgruppe 4h-Median: 5,8; p=0,0032). Patienten mit klinisch nicht aktiver Erkrankung (4h-Median: 7,1) unterschieden sich bezueglich der orbitalen Octreotidanreicherung nicht wesentlich von der Kontrollgruppe. Auch 5 Patienten mit florider orbitaler Myositis zeigten eine deutlich gesteigerte orbitale Aktivitaetsanreicherung (4h-Median: 42,3). Der diagnostische Nutzen der SRS liegt somit in ihrer Eigenschaft als Aktivitaets- und Entzuendungsparameter und kann mit

  5. A FORMAÇÃO COMPORTAMENTAL DE AUDITORES CONTÁBEIS INDEPENDENTES: UM ESTUDO MULTICASO

    Directory of Open Access Journals (Sweden)

    Luiz Alberton

    2002-11-01

    Full Text Available RESUMO
    O presente artigo tem como objetivo apresentar uma proposta de um modelo de formação comportamental para auditores contábeis independentes. Deste modo, inicialmente, discorre-se sobre os aspectos que devem ser considerados pelo profissional responsável pela gestão das pessoas nas organizações que prestam serviços de auditoria contábil independente, e do perfil destas pessoas requerido pelas empresas. Em seguida são identificadas as teorias que tratam da gestão de pessoas nas organizações, especificamente nos processos de recrutamento e seleção, capacitação e avaliação de desempenho. As empresas buscam profissionais com talentos e, principalmente, que saibam manter o equilíbrio entre a razão e a emoção no ambiente de trabalho. Na literatura que versa sobre a profissão do auditor contábil, é dada muita ênfase aos aspectos técnicos, tratando superficialmente ou renegando os aspectos comportamentais considerados importantes ao desempenho destes profissionais. Para confirmar essas afirmações e dar suporte ao delineamento do modelo, é realizada uma pesquisa de campo com os responsáveis pela gestão de pessoas em quatro empresas internacionais de auditoria contábil independente, que fazem parte das big five, e em uma empresa nacional. Assim, para o delineamento do modelo de formação, a ênfase desta pesquisa recai sobre os aspectos de liderança, comunicação, motivação, negociação, coaching, mentoring, administração de conflitos, trabalho em equipe, técnica de entrevista, análise transacional e de programação neurolingüística, que podem ser utilizados para o desenvolvimento de auditores contábeis independentes, de forma que possam melhorar suas condições de competitividade e empregabilidade. Portanto, são incorporados esses conceitos como ponto de partida para o delineamento de um modelo de formação comportamental

  6. MR of the liver in Wilson`s disease; MRT der Leber bei Morbus Wilson

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Steiner, S. [Klinikum Grosshadern, Radiologische Klinik und Poliklinik, Univ. Muenchen (Germany); Hammerstingl, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Schwarz, S. [Klinikum Grosshadern, Neurologische Klinik, Univ. Muenchen (Germany); Kraft, E. [Klinikum Grosshadern, Neurologische Klinik, Univ. Muenchen (Germany); Weinzierl, M. [Klinikum Grosshadern, 2. Medizinische Klinik, Univ. Muenchen (Germany); Felix, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

    1994-01-01

    To show that Wilson`s disease is one likely cause of multiple low-intensity nodules of the liver we obtained MR images in 16 patients with clinically and histopathologically confirmed Wilson`s disease. Corresponding to morphological changes MRI enabled the subdivision of the patients into two groups. Using a T{sub 2}-weighted spin-echo sequence (TR/TE=2000/45-90) liver parenchyma showed multiple tiny low-intensity-nodules surrounded by high-intensity septa in 10 out of 16 patients. 5 patients had also low-intensity nodules in T{sub 1}-weighted images (TR/TE=600/20). In patients of this group histopathology revealed liver cirrhosis (n=7) and fibrosis (n=2). Common feature of this patient group was marked inflammatory cell infiltration into fibrous septa, increase of copper concentration in liver parenchyma and distinct pathological changes of laboratory data. In the remaining 6 patients no pathological change of liver morphology was demonstrated by MRI corresponding to slight histopathological changes of parenchyma and normal laboratory data. As low-intensity nodules surrounded by high intensity septa can be demonstrated in patients with marked inflammatory infiltration of liver parenchyma MRI may help to define Wilson patients with poorer prognosis. In patients with low-intensity nodules of the liver and unknown cause of liver cirrhosis laboratory data and histopathology should be checked when searching for disorders of copper metabolism. (orig.) [Deutsch] Im Rahmen einer prospektiven Studie wurde die Leber bei 16 Patienten mit klinisch gesichertem Morbus Wilson magnetresonanztomographisch untersucht. Zum Einsatz kamen T{sub 1}- und T{sub 2}-gewichtete Spin-Echo-Sequenzen vor und nach Applikation von Gd-DTPA (0,1 mmol/kg KG). Anhand der MRT-Befunde konnten zwei unterschiedliche Patientenkollektive definiert werden. 10 Patienten wiesen in der T{sub 2}-gewichteten Sequenz hypointense Regeneratknoten auf und zeigten histopathologisch ausgepraegte Befunde einer

  7. Functional MRI procedures in the diagnosis of brain tumors. Perfusion- and diffusion-weighted imaging; Funktionelle MR-Verfahren in der Diagnostik intraaxialer Hirntumoren. Perfusions- und Diffusions-Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, M. [Universitaetsklinikum Heidelberg (Germany). Neurologische Klinik, Abteilung Neuroradiologie; Heiland, S.; Sartor, K.

    2002-08-01

    die Haemodynamik bis zur Kapillarebene. Mit Hilfe dieser neuen Methoden werden die Diagnose, die Differenzialdiagnose und postoperativ auch die Verlaufskontrolle verbessert. Eine Unterscheidung zwischen Tumor und Nicht-Tumor ist ebenso moeglich wie eine zwischen niedergradigem und anaplastischem Gliom. Zudem wird die Moeglichkeit einer nicht-invasiven Tumorklassifikation eroeffnet, und hoehergradige intraaxiale Tumoren koennen verlaesslicher von tumorsimulierenden Herdlaesionen unterschieden werden. Auch bei der Therapieplanung liefern Diffusions- und Perfusions-MRT entscheidende Zusatzinformationen, da diejenigen Tumorareale dargestellt werden koennen, die bei Biopsie, Operation und Bestrahlung angegangen werden muessen. In der Nachsorge erlauben die neuen Verfahren eine zuverlaessige Differenzierung zwischen Therapieerfolg, Tumorrezidiv und Therapiekomplikationen, etwa der Strahlennekrose. (orig.)

  8. Cardiac transplant due to metal toxicity associated with hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Sheldon Moniz, MBBS (UWA

    2017-09-01

    Full Text Available Concerns regarding metal-on-metal (MoM bearing couples in total hip arthroplasty are well documented in the literature with cobalt (Co and chromium (Cr toxicity causing a range of both local and systemic adverse reactions. We describe the case of a patient undergoing cardiac transplantation as a direct result of Co and Cr toxicity following a MoM hip replacement. Poor implant positioning led to catastrophic wear generating abundant wear particles leading to Co and Cr toxicity, metallosis, bony destruction, elevated metal ion levels, and adverse biological responses. Systemic symptoms continued for 3 years following cardiac transplantation with resolution only after revision hip arthroplasty. There was no realization in the initial cardiac assessment and subsequent transplant workup that the hip replacement was the likely cause of the cardiac failure, and the hip replacement was not recognized as the cause until years after the heart transplant. This case highlights the need for clinicians to be aware of systemic MoM complications as well as the importance of positioning when using these prostheses.

  9. Iatrogenic popliteal artery injury in non arthroplasty knee surgery.

    Science.gov (United States)

    Bernhoff, K; Björck, M

    2015-02-01

    We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support. ©2015 The British Editorial Society of Bone & Joint Surgery.

  10. The role of total elbow arthroplasty in traumatology.

    Science.gov (United States)

    Mansat, P; Bonnevialle, N; Rongières, M; Bonnevialle, P

    2014-10-01

    Fractures of the distal humerus account for 5% of osteoporotic fractures in subjects older than 60 years. A history of osteoporosis, co-morbidities, and joint comminution make their management difficult. The therapeutic options are limited to functional treatments, osteosynthesis, or either partial or total arthroplasty. Functional treatment of distal humerus fractures in the elderly subject provide inconsistent results, often with persistence of pain with a stiff or unstable elbow. Osteosynthesis remains the reference treatment for these fractures, following the principle of stable and rigid osteosynthesis allowing early mobilization. However, joint comminution and a history of osteoporosis occasionally make it impossible to meet this objective, with a considerable rate of complications and surgical revisions. Total elbow arthroplasty remains an alternative to osteosynthesis with very satisfactory immediate results restoring a painless, stable, and functional elbow. These results seem reproducible and sustainable over time. The complication rate is not uncommon with an approximately 10% surgical revision rate. Elbow hemiarthroplasty remains to be validated in this indication. V. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Innovations in design and technology. The story of hip arthroplasty.

    Science.gov (United States)

    Amstutz, H C

    2000-09-01

    The current study reviews the early history of surgeon-initiated trial and error development in hip joint arthroplasty and the subsequent methodological evolution to proper criteria for hypothesis testing using bioengineers and other research scientists. The interplay and relationships to industry, universities, scientific organizations, and the Food and Drug Administration with respect to device development in hip arthroplasty are reviewed. The ethics of and responsibilities to involved parties are outlined, citing the history of many contemporary developments. Examples are provided from the evolution and introduction of unsuccessful innovations, and the problems inherent in the current methodology of the approval process from the Food and Drug Administration using the 5-10K, Investigative Device Exemption, and the Pre-Market Approval protocols. The pros and cons of randomized trials for devices are outlined with the conclusion that they are not appropriate for device introduction. The proper, rational methodology for introduction of new devices is a phased-in clinical trial process after pertinent bench testing. Finally, the ethical dilemmas created by managed care are addressed. Industry involvements of the surgeon-spokesmen are cited.

  12. Blood Conservation Strategies in Total Hip and Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    David Liu

    2015-01-01

    Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  13. Oral Tranexamic Acid Reduces Transfusions in Total Knee Arthroplasty.

    Science.gov (United States)

    Perreault, Roger E; Fournier, Christine A; Mattingly, David A; Junghans, Richard P; Talmo, Carl T

    2017-10-01

    Tranexamic acid (TXA) reduces intraoperative blood loss and transfusions in patients undergoing total knee arthroplasty. Although numerous studies demonstrate the efficacy of intravenous and topical TXA in these patients, few demonstrate the effectiveness and appropriate dosing recommendations of oral formulations. A retrospective cohort study was performed to evaluate differences in transfusion requirements in patients undergoing primary unilateral total knee arthroplasty with either no TXA (n = 866), a single-dose of oral TXA (n = 157), or both preoperative and postoperative oral TXA (n = 1049). Secondary outcomes included postoperative hemoglobin drop, total units transfused, length of stay, drain output, and cell salvage volume. Transfusion rates decreased from 15.4% in the no-oral tranexamic acid (OTA) group to 9.6% in the single-dose OTA group (P < .001) and 7% in the 2-dose group (P < .001), with no difference in transfusion rates between the single- and 2-dose groups (P = .390). In addition, postoperative hemoglobin drop was reduced from 4.2 g/dL in the no-OTA group to 3.5 g/dL in the single-dose group (P < .01) and to 3.4 g/dL in the 2-dose group (P < .01), without a difference between the single- and 2-dose groups (P = .233). OTA reduces transfusions, with greater ease of administration and improved cost-effectiveness relative to other forms of delivery. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Surgical practices in total knee arthroplasty in Turkey.

    Science.gov (United States)

    Erduran, Mehmet; Akseki, Devrim; Araç, Sükrü

    2012-01-01

    The aim of this study was to determine the current practices in the total knee arthroplasty (TKA) and the differences of practice among the orthopedic surgeons in Turkey. Data in this cross-sectional and descriptive study was collected through a questionnaire from 76 orthopaedic surgeons performing TKA. The questionnaire form contained 57 questions under four main headings, covering the professional properties of the surgeon, pre-surgery approach, surgical technique applied for TKA and the surgical details peculiar to the technique with solutions applied for complication scenarios, and finally the postoperative approach. It was determined that 39.7% of the TKA applications were performed in operating theatres without laminar airflow or HEPA filters. Nearly 1/5 of the surgeons used more than one antibiotic for prophylaxis, and more than 85% continued prophylaxis use over 3 days. Low-molecular-weight heparin was the most commonly used method for thromboprophylaxis. 94.67% of the surgeons used only the cemented technique in primary TKA. 44% indicated that they performed simultaneous bilateral arthroplasty, 89% did not use any scoring system and 72.37% preferred fixed-bearing and posterior-cruciate-retaining type prosthesis. Results showed no standardization in TKA surgery among surgeons in Turkey, and important educational deficiencies were noted.

  15. Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

    Science.gov (United States)

    Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

    The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  16. Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

    Directory of Open Access Journals (Sweden)

    Russel Tilney

    2017-01-01

    Full Text Available A forty-year-old man experienced worsening heart failure four years following bilateral complicated total hip replacement. His condition was extensively worked up but no underlying pathology was immediately evident. Given the cobalt-chromium alloy component present in the hip arthroplasties, the raised cobalt blood levels, and a fitting clinical picture coupled with radiological findings, the patient underwent right hip revision. Evidence of biotribocorrosion was present on direct visualisation intraoperatively. The patient subsequently experienced symptomatic improvement (NYHA class III to class I and echocardiography showed recovery of ejection fraction. Cobalt exists as a bivalent and trivalent molecule in circulation and produces a cytotoxicity profile similar to nanoparticles, causing neurological, thyroid, and cardiological pathology. Blood levels are not entirely useful as there is no identifiable conversion factor for levels in whole blood, serum, and erythrocytes which seem to act independently of each other. Interestingly cobalt cardiomyopathy is frequently compounded by other possible causes of cardiomyopathy such as alcohol and a link has been postulated. Definitive treatment is revision of the arthroplasty as other treatments are unproven.

  17. Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

    Science.gov (United States)

    Pisanu, Gabriele; Rosso, Federica; Bertolo, Corrado; Dettoni, Federico; Blonna, Davide; Bonasia, Davide Edoardo; Rossi, Roberto

    2017-01-01

    Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA. PMID:29270562

  18. Help, my rating looks bad! Coding comorbidities in arthroplasty.

    Science.gov (United States)

    Galloway, Joseph D; Voss, Frank R

    2016-09-01

    In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome. Adjusting outcomes to account for risk factors should be a way to prevent this effect, but these methods need to be studied more. The current performance measures being released are based on administrative claims data, and to date, much of that information is not properly risk adjusted. To ensure that the increasing transparency reveals an accurate picture, it is critical that the complexity of care provided by surgeons be carefully documented. Therefore, we propose accurate coding of patients' comorbidities during hospitalization for total knee arthroplasty and total hip arthroplasty, and we have included a chart detailing our recommendations of the specific diagnostic codes that are most important.

  19. Help, my rating looks bad! Coding comorbidities in arthroplasty

    Directory of Open Access Journals (Sweden)

    Joseph D. Galloway, MD

    2016-09-01

    Full Text Available In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome. Adjusting outcomes to account for risk factors should be a way to prevent this effect, but these methods need to be studied more. The current performance measures being released are based on administrative claims data, and to date, much of that information is not properly risk adjusted. To ensure that the increasing transparency reveals an accurate picture, it is critical that the complexity of care provided by surgeons be carefully documented. Therefore, we propose accurate coding of patients' comorbidities during hospitalization for total knee arthroplasty and total hip arthroplasty, and we have included a chart detailing our recommendations of the specific diagnostic codes that are most important.

  20. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Raaij Jos JAM

    2008-10-01

    Full Text Available Abstract Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA, serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score, physician reported functional status and range of motion (Harris hip score, number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years. Discussion

  1. Safety of retransfusing shed blood after local infiltration analgesia in total knee arthroplasty

    NARCIS (Netherlands)

    Thomassen, B.J.; Pool, L.; Van Der Flier, R.; Stienstra, R.; in 't Veld, B.A.

    2012-01-01

    We investigated the safety of LIA (local infiltration analgesia) combined with retransfusion of drained blood. Total knee arthroplasty patients received two peri-articular injections during surgery followed by continuous infusion, both with ropivacaine (567 mg). Ropivacaine plasma concentrations

  2. Medium term results of total knee arthroplasty as a primary treatment for knee fractures

    Directory of Open Access Journals (Sweden)

    Ebied Ayman

    2018-01-01

    Conclusion: Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent.

  3. Saving Blood and Reducing Costs: Updating Blood Transfusion Practice in Lower Limb Arthroplasty

    LENUS (Irish Health Repository)

    Fenelon, C

    2018-04-01

    Our aim was to quantify blood transfusion rates in lower limb arthroplasty following the introduction of a multimodal enhanced recovery programme (ERP). We then sought to update the maximum surgical blood ordering schedule (MSBOS) and calculate cost savings achieved.

  4. Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

    NARCIS (Netherlands)

    Brunnekreef, J.J.; Hoogervorst, P.; Ploegmakers, M.J.M.; Rijnen, W.H.C.; Schreurs, B.W.

    2013-01-01

    PURPOSE: Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether

  5. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jaeger, Pia; Zaric, Dusanka; Fomsgaard, Jonna Storm

    2013-01-01

    Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps...

  6. Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads

    NARCIS (Netherlands)

    de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W.; van der Scheer, Jan W.; Alta, Tjarco D.; Willems, W. Jaap; Veeger, DirkJan (H. E. J)

    2012-01-01

    Background: Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe

  7. A Facile Technique to Make Articulating Spacers for Infected Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Yu-Ping Su

    2009-03-01

    Conclusion: Treating infected total knee arthroplasty with these self-made articulating spacers eradicates infection effectively, improves the life quality before reimplantation and provides good final results without significant complications.

  8. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  9. Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders

    2017-01-01

    BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA...

  10. Comparison of total hip arthroplasty in osteoarthritis of mechanical and rheumatologic causes

    Science.gov (United States)

    Ejnisman, Leandro; Leonhardt, Nathalia Zalc; Fernandes, Laura Fillipini Lorimier; Leonhardt, Marcos de Camargo; Vicente, José Ricardo Negreiros; Croci, Alberto Tesconi

    2014-01-01

    Objective: To compare the use of uncemented implants in total hip arthroplasty in patients with rheumathologic diseases and mechanical osteoarthrosis. Methods: We retrospectively evaluated 196 patients who were operated by the Hip and Arthroplasty Surgery Group of the IOT-HCFMUSP between 2005 and 2009. Patients were divided into two groups: mechanical causes (165 patients) and rheumathologic causes (31 patients). Groups were compared between each other in age, gender and follow-up time. Osseointegration rate and percentage of failure in arthroplasty were evaluated. Results: No statistically significant difference was found in osseointegration rates (in both femoral and acetabular components) in both groups. The rates of revision surgery and implant survival also did not show statistically significant differences. Conclusion: The use of uncemented total hip arthroplasty did not show worse results in rheumathologic patients. Level of Evidence III, Retrospective Case Control Study. PMID:24644419

  11. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  12. Preoperative ambulatory measurement of asymmetric leg loading during sit-to-stand in hip arthroplasty patients

    NARCIS (Netherlands)

    Martinez-Ramirez, A.; Weenk, D.; Lecumberri, P.; Verdonschot, N.J.; Pakvis, D.; Veltink, P.H.

    2014-01-01

    Total hip arthroplasty (TGA) is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after TGA . This clinical evaluation does,

  13. Low-dose dexamethasone during arthroplasty: What do we know about the risks?

    NARCIS (Netherlands)

    Wegener, Jessica T.; Kraal, Tim; Stevens, Markus F.; Hollmann, Markus W.; Kerkhoffs, Gino M. M. J.; Haverkamp, Daniël

    2016-01-01

    Dexamethasone is commonly applied during arthroplasty to control post-operative nausea and vomiting (PONV). However, conflicting views of orthopaedic surgeons and anaesthesiologists regarding the use of dexamethasone raise questions about risks of impaired wound healing and surgical site infections

  14. Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty

    Directory of Open Access Journals (Sweden)

    Ashok S Gavaskar

    2013-01-01

    Full Text Available CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software.

  15. Automatic assessment of volume asymmetries applied to hip abductor muscles in patients with hip arthroplasty

    Science.gov (United States)

    Klemt, Christian; Modat, Marc; Pichat, Jonas; Cardoso, M. J.; Henckel, Joahnn; Hart, Alister; Ourselin, Sebastien

    2015-03-01

    Metal-on-metal (MoM) hip arthroplasties have been utilised over the last 15 years to restore hip function for 1.5 million patients worldwide. Althoug widely used, this hip arthroplasty releases metal wear debris which lead to muscle atrophy. The degree of muscle wastage differs across patients ranging from mild to severe. The longterm outcomes for patients with MoM hip arthroplasty are reduced for increasing degrees of muscle atrophy, highlighting the need to automatically segment pathological muscles. The automated segmentation of pathological soft tissues is challenging as these lack distinct boundaries and morphologically differ across subjects. As a result, there is no method reported in the literature which has been successfully applied to automatically segment pathological muscles. We propose the first automated framework to delineate severely atrophied muscles by applying a novel automated segmentation propagation framework to patients with MoM hip arthroplasty. The proposed algorithm was used to automatically quantify muscle wastage in these patients.

  16. Contribution of BeiDou satellite system for long baseline GNSS measurement in Indonesia

    Science.gov (United States)

    Gumilar, I.; Bramanto, B.; Kuntjoro, W.; Abidin, H. Z.; Trihantoro, N. F.

    2018-05-01

    The demand for more precise positioning method using GNSS (Global Navigation Satellite System) in Indonesia continue to rise. The accuracy of GNSS positioning depends on the length of baseline and the distribution of observed satellites. BeiDou Navigation Satellite System (BDS) is a positioning system owned by China that operating in Asia-Pacific region, including Indonesia. This research aims to find out the contribution of BDS in increasing the accuracy of long baseline static positioning in Indonesia. The contributions are assessed by comparing the accuracy of measurement using only GPS (Global Positioning System) and measurement using the combination of GPS and BDS. The data used is 5 days of GPS and BDS measurement data for baseline with 120 km in length. The software used is open-source RTKLIB and commercial software Compass Solution. This research will explain in detail the contribution of BDS to the accuracy of position in long baseline static GNSS measurement.

  17. Analysis on coverage ability of BeiDou navigation satellite system for manned spacecraft

    Science.gov (United States)

    Zhao, Sihao; Yao, Zheng; Zhuang, Xuebin; Lu, Mingquan

    2014-12-01

    To investigate the service ability of the BeiDou Navigation Satellite System (BDS) for manned spacecraft, both the current regional and the future-planned global constellations of BDS are introduced and simulated. The orbital parameters of the International Space Station and China's Tiangong-1 spacelab are used to create the simulation scenario and evaluate the performance of the BDS constellations. The number of visible satellites and the position dilution (PDOP) of precision at the spacecraft-based receiver are evaluated. Simulation and analysis show quantitative results on the coverage ability and time percentages of both the current BDS regional and future global constellations for manned-space orbits which can be a guideline to the applications and mission design of BDS receivers on manned spacecraft.

  18. Emission reduction in thermal processes for sewage sludge disposal; Emissionsreduzierung bei thermischen Verfahren zur Klaerschlammentsorgung

    Energy Technology Data Exchange (ETDEWEB)

    Nethe, L.P. [Maerker Umwelttechnik GmbH, Hamburg (Germany)

    1998-09-01

    Owing to the intensification of treatment processes and the construction of new sewage plants sewage arisings are due to rise considerably. The thermal treatment of sewage sludge which it has not been possible to avoid or utilise is an important and indispensable part of any sewage sludge disposal concept. If equipped with a state-of-the-art flue gas purification process that uses carbonaceous adsorbents (Sorbalit trademark), thermal treatment of sewage sludge can be regarded as an environmentally safe process technique. [Deutsch] Die anfallenden Klaerschlammengen werden durch die Intensivierung der Klaerprozesse und der Bau neuer Klaeranlagen deutlich zunehmen. Die thermische Behandlung nicht vermiedener oder verwerteter Klaerschlaemme stellt einen bedeutenden und unverzichtbaren Teil der Klaerschlamm-Entsorgungskonzepte dar. Bei Installation einer - dem Stand der Technik - entsprechenden Rauchgasreinigung mit dem Einsatz kohlenstoffhaltiger Adsorbentien (Sorbalit {sup trademark}) ist die thermische Behandlung von Klaerschlamm eine umweltsichere Verfahrenstechnik. (orig.)

  19. Magnetic resonance imaging in acute intractional tuberculosis; Magnetresonanztomographie bei akuter intrakranieller Tuberkulose

    Energy Technology Data Exchange (ETDEWEB)

    Venz, S. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Sander, B. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Benndorf, G. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Terstegge, K. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Podrabsky, P. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Cordes, M. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

    1994-12-31

    We reported three cases of acute intracranial tuberculosis including miliary tuberculosis, basal meningitis, tuberculomas and neuritis of cranial nerves. All patients had native and contrast enhanced CT and MRI scans. MRI revealed more granulomas and a better imaging contrast in the detection of basal meningitis. Neuritis was diagnosed only with the MRI. MRI scans should be prefered as the imaging procedure in clinically presumed intracranial tuberculosis. (orig.) [Deutsch] Die Befunde von drei Patienten mit intrakranieller Tuberkulose (intrakranielle Miliartuberkulose, Meningitis tuberculosa, Neuritis und Tuberkulome) in der Magnetresonanztomographie (MRT) wurden mit der Computertomographie (CT) verglichen. Sowohl die MRT als auch die CT wurden nativ und nach Kontrastmittelgabe durchgefuehrt. Die MRT zeigte sich im Nachweis von Granulomen insbesondere im Bereich des Hirnstamms ueberlegen. Ebenso wurde ein hoeherer Bildkontrast bei der Darstellung der Meningitis beobachtet. Eine Neuritis der Hirnnerven war nur mit der MRT nachweisbar. Die kontrastmittelunterstuetzte MRT sollte in der bildgebenden Diagnostik einer intrakraniellen Turberkulose primaer zum Einsatz gelangen. (orig.)

  20. Anzeichen einer linearen dosis-effekt beziehung bei sehr kleinen bestrahlungsdosen

    CERN Document Server

    Diehl, I.

    1980-01-01

    Zur Aufstellung einer Strahlungsdosis - Effekt - Kurve bei kleinen Dosen wurde der Mikrokerntest verwendet, da er relativ einfach und gleich- zeitig sehr empfindlich ist. Die Bohne Vicia Faba (Fillbasket) wurde mit 60Co Gammastrahlen und mit hochenergetischen Neutronen bestrahlt. Die Neutronen wurden von 600 MeV Protonen, die auf ein Be—Target auftrafen produziert und unter einem Winkel von 0 Grad extrahiert. Informationen fiber Dosimetrie und Eigenschaften der verwandeten Strahlung wurder bereits an anderer Stelle beschriebenl) des gleichen auch Einzelheiten fiber die Aufzucht der BORE Vicia Fabaz). Nach der Bestrahlung wurden jeweils 5 Bohnen zu bestimmten Zeitpunkten fixiert und danach die Prfiparate herge— stellt. Pro Préparat wurden 1000 Zellen ausgewertet.