[Rotational abnormalities of the hip joint]. / Rotationsfehler des Hüftgelenks.

Changes or limitations of the rotational range of motion of the hip are a non-specific clinical sign. There is a big variety of underlying morphological pathologies resulting in a symptomatic alteration of hip rotation. They need to be assessed by imaging techniques: based on plain radiographs (including specialized projections), often CT or MRI are necessary to visualize the underlying changes of shape, rotation and offset of the articulating surfaces, which might result in a painful "femoroacetabular impingement" as a trigger of secondary osteoarthritis. Highly sophisticated MR-arthrography-protocols are able to visualize conventionally "obscure" but biomechanically relevant morphological changes, that might be individually normalized by joint-preserving corrective surgery.

[Configuration of ethmoid roof in children 0-14 years of age]. / Siebbeindachkonfiguration bei Kindern im Alter von 0 bis 14 Jahren.

BACKGROUND: Knowledge of the unique anatomy of the nose, paranasal sinuses and skull base, particular concerning dangerously low positioned or deep lying cribriform plates is most important, as functional endoscopic sinus surgery has become an increasingly popular procedure for the management of pediatric sinus disease. OBJECTIVES AND METHODS: In addition to Keros who studied the ethmoidal roof and cribriform plate in 450 adult specimen and divided them into 3 groups, retrospective analysis in 272 patients between 0 and 14 years was performed by means of coronal CT scans of the paranasal sinuses with a slice thickness of 2 mm. Measurements were carried out in the frontal, middle and dorsal section of the ethmoid. RESULTS: The depth and width of the fossa olfactoria were significantly less in patients aged 0 - 12 months than in other age groups (p < 0.001). Among the other age groups, beginning at 2 years no differences were found: 14.2 % presented with type I according to Keros, 70.6 % with Keros II and 15.2 % with Keros III. The prevalence of asymmetric position of the ethmoidal roof was 15 % (41 patients). The height of the ethmoidal sinuses consistently increased over the years from 5 - 7 mm to 15 - 20 mm. CONCLUSION: The current data may serve as a reference for evaluation of normal and abnormal development of the roof of the ethmoid and may be of great value in diagnostic and therapeutic management of pediatric sinus disease. Our data obviously show that the classification into the 3 types of positions of the ethmoid roof and cribriform plate according to Keros is possible in children from the second year of life.

Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes.

OBJECTIVE: The goal of this study was to compare the capabilities of conventional radiography, CT, and MR imaging in revealing ligamentous and bony changes in patients after hyperflexion injuries. SUBJECTS AND METHODS: Forty-nine patients with hyperflexion injuries of the foot were included in our study. Conventional radiography, weight-bearing radiography, CT, and MR imaging were performed. All images were reviewed with respect to ligamentous and bony abnormalities and alignment alterations. Eleven patients with joint malalignment underwent surgery, which is considered the gold standard in these patients. Five patients with joint malalignment refused surgery. RESULTS: For all 49 patients, conventional radiographs revealed 33 metatarsal and 20 tarsal fractures. Eight patients presented with tarsometatarsal joint (Lisfranc's joint) malalignment. Weight-bearing radiographs showed joint malalignment in the same eight patients only. CT showed 41 tarsal fractures and 53 metatarsal fractures. Joint malalignment was evident in 16 patients. MR imaging revealed 41 metatarsal fractures and 18 metatarsal bone bruises. Tarsal bones were fractured at 39 sites and there were nine tarsal bone bruises. Metatarsal fractures were mostly localized in the second metatarsal bone; tarsal fractures, in the cuboid. Joint malalignment was evident in 16 patients; in 11 of these 16 patients, Lisfranc's ligament was disrupted. Surgery confirmed bony and ligamentous changes and joint malalignment in 11 patients. CONCLUSION: Conventional radiographs including weight-bearing images are not sufficient for routine diagnostic workup of patients with acute hyperflexion injuries of the foot. CT should serve as the primary imaging technique for such patients.

Emergence of multidrug resistance in ubiquitous and dominant Pseudomonas aeruginosa serogroup O:11. The Greek Pseudomonas Aeruginosa Study Group.

The serotypes of 88 nonreplicate nosocomial Pseudomonas aeruginosa isolates from 11 Greek hospitals were studied in relation to their antibiotic susceptibilities. Rates of resistance to beta-lactams, aminoglycosides, and quinolones ranged from 31 to 65%, except for those to ceftazidime (15%) and imipenem (21%). Four serotypes were dominant: O:12 (25% of isolates), O:1 (17%), O:11 (16%), and O:6 (10%). Multidrug resistance rates in the major serogroups O:12 (91%) and O:11 (79%) were higher than those in serogroups O:1 (40%) and O:6 (43%). Further typing with respect to pulsed-field gel electrophoresis patterns following XbaI digestion of genomic DNA discriminated the isolates into 74 types. Pulsed-field gel electrophoresis revealed that the ubiquitous O:12 group was genetically homogeneous, since 95% of strains belonged to two clusters of genotypic similarity, while the O:11 strains, present in 8 of the 11 hospitals, were distributed among five such clusters. Therefore, apart from the already reported O:12 multidrug-resistant European clone, an O:11 population, characterized by a serotype known to be dominant in the environment and the hospital in several parts of the world, but previously not associated with multidrug resistance to antibiotics, has progressed to a multidrug-resistant state.

Sex steroids do not alter melatonin secretion in the human.

It is unclear whether sex steroids influence melatonin secretion in the human. In an attempt to find an answer to this important question 36 women within an age range of 19 to 40 years were studied within a 3-month period under the following conditions: natural menstrual cycle, ovulation induction with gonadotrophins, early pregnancy, and intake of monophasic or triphasic oral contraceptives. Except in the case of pregnancy, repeated measurements in the same individual were done because of the well-known large inter-individual variations in melatonin secretion. Melatonin concentration was measured in plasma samples obtained at 4-hourly intervals in a 24 h period and < 200 lux for all subjects studied. No consistent change in melatonin blood concentrations was demonstrated in response to the varying endogenous or exogenous concentrations of sex steroids. These observations suggest that circadian melatonin secretion is not significantly modulated by sex steroids.

PIP: The pineal gland hormone, melatonin, has been increasingly thought to play a significant role in the ovarian cycle. Though the evidence is unclear, some research suggests a pineal gland-ovary connection based on melatonin production during different phases in the ovarian cycle. This article reports the findings of a study on the effects of endogenous and exogenous sex steroids on melatonin secretion. 36 German women were studied over a 3-month summer period. This timing was intended to minimize the effects of seasonal influences on the women. Blood was taken every 4 hours (a total of 7 blood samples per day). Four groups were studied: women with natural menstrual cycles; 10-week pregnant women; women being treated with human menopausal/human chorionic gonadotropin; and women using phasic oral contraceptives. Melatonin was extracted from blood by using Bond Elut reverse-phase C18 columns. Statistical analysis included normal distribution, non-parametric analysis, and standard statistical analysis methods. No consistent change in melatonin blood levels was found in response to the varying endogenous and exogenous sex steroid levels. These findings suggest that circadian melatonin secretion is not modulated by sex steroids in a significant way.

Ultrasound and MRI findings in a case of childhood amyloid goiter.

Goiter secondary to amyloidosis is rare in clinical practice and only a few descriptions of its radiologic features have been reported. We present the ultrasound and MRI findings of thyroid amyloidosis in a 7-year-old Turkish boy with familial Mediterranean fever.