Marked Subchondral Bandlike Osteopenia on Radiography after Trauma and Inactivity: A Report of four Cases.

We report about four cases of marked subchondral osteopenia on followup radiography after trauma and prolonged disuse. This localized form of disuse osteopenia has not been reported in details beside the followup imaging of talar neck fractures, where it is known as the "Hawkins sign." Due to its unique morphology, it can be easily recognized as a benign finding in posttraumatic followup imaging and can be morphologically distinguished from severe complications like complex regional pain syndrome type 1 (Sudeck's disease) or periarticular osteopenia in infectious arthritis. It is important for the radiologist and orthopaedic surgeon to be aware of this form of disuse osteopenia in the proper clinical context.

[Mesh shrinkage in hernia surgery: data from a prospective randomized double-blinded clinical study]. / Netzschrumpfung in der Hernienchirurgie : Ergebnisse einer klinischen, prospektiv-randomisierten Doppelblindstudie.

OBJECTIVES: According to an estimated mesh shrinkage following hernia repair of up to 40% a current dogma in hernia surgery requires a mesh overlap of 5 cm around the hernia. However, no valid data addressing this problem of mesh shrinkage are available at present. PATIENTS AND METHODS: Within the framework of a prospective randomized double-blinded clinical trial, 50 patients were operated on for a ventral abdominal hernia with the open sublay technique using specially prepared radio-opaque polypropylene (PP) meshes. Of the patients 27 received a conventional heavyweight mesh (P group) and 23 a new lightweight mesh construction (NK group). Follow-up for at least 2 years after mesh repair included conventional abdominal x-rays after 7 days, 3 weeks and 4, 12 and 24 months, as well as computed tomography after 7 days and 4 and 12 months. Main criteria were mesh shrinkage, recurrence and complication rates and quality of life comparing groups P and NK. RESULTS: In 46 cases (92%) no mesh shrinkage could be detected and only 4 meshes (8%) showed a moderate shrinkage (1 of 22.2%, 2 of 8% and 1 of 3%) all from the P group. While no hernia recurrences were found, 2 surgical complications occurred with 1 seroma in the P group and 1 hematoma in the NK group. Quality of life showed a linear improvement over time up to the 2 year time point following mesh repair with advantages for the NK group. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the two groups. CONCLUSIONS: In principle PP meshes following an uncomplicated ventral hernia repair do not shrink at all. A moderate shrinkage in isolated cases might occur following heavyweight mesh implantation. Under controlled conditions recurrence as well as complication rates are equal for heavyweight and lightweight PP meshes. Quality of life improves up to 2 years following mesh repair with a trend to a better outcome for lightweight meshes. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the lightweight and heavyweight meshes.

Axial rotation in the lumbar spine following axial force wrench.

The report presents measurements of axial rotation of lumbar motion segments (L1/L2, L3/L4, L4/L5), particularly with small angles of rotation (in the range of +/-1 degrees) following axial force wrenches. The investigation focussed on determining the influence of geometrically varying configurations in axial wrench (consisting of axial torque and axial force) applied on the kinematics (as defined by the migrating instantaneous helical axis, IHA) of lumbar motion segments under constant resulting axial force, and relating IHA-migration to anatomical structures. In all segments, IHA migrated over several centimetres (up to 6 cm). The main portion of IHA-migration was linked to the angle of rotation interval of +/-1 degrees. 3. The shape of the IHA-migration was greatly dependent upon the position of the force line F(z). The-force-wrench-dependent wide IHA-migration found for the rotational angle interval of +/-1 degrees suggests that joint guidance predominates in segment kinematics. The segment kinematics can be adjusted by means of the geometrical configuration of the force wrenches. The design of non-fusion spine implants and FE calculations have to take into consideration joint guidance and muscular force distributions with small intervals of axial rotation.

virtX - evaluation of a computer-based training system for mobile C-arm systems in trauma and orthopedic surgery.

OBJECTIVES: Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. METHODS: Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. RESULTS: CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. CONCLUSIONS: Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.

[Residual particle free surfaces after shot peening in modular hip arthroplasty are feasible]. / Restpartikelfreie Oberflächen nach Stahlkugelstrahlen modularer Hüftendoprothesen sind erreichbar.

INTRODUCTION: Shot peening with steel balls is used for introduction of compressive stress in the production of morse taper junctions of modular hip endoprostheses. After this procedure, significant contamination with residual particles can be detected, which may lead to increased corrosion and third body wear. Additionally, the European norm EN 12010 requires surfaces free of residual particles. The aim of this study is to evaluate the effects of several cleaning procedures with regard to complying with EN 12010. MATERIAL AND METHOD: The surfaces of 12 Ti6Al7Nb rods with a diameter of 15 mm was shot peened with steel balls (GS VERA, Fa. Würth, Bad Friedrichshall, Germany). A field emission scanning electron microscopy (SEM, LEO 1525) was used for the detection of residual particles on the surface of the rods with a backscattered electron detector. After SEM examination, one sample each was cleaned using shot peening with sugar or dry ice and 10 rods using a pH dependent cleaning procedure. After these cleaning procedures, the samples were again analysed with the SEM for residual particle contamination. RESULTS: The surface of all rods showed a considerable contamination with steel particles after shot-peening with steel balls. After the cleaning procedure with dry ice or sugar steel contamination was lower, however, only the pH dependent cleaning procedure was able to achieve surfaces free of residual particles. DISCUSSION: For smooth shot-peened surfaces in modular hip arthroplasty Euro Norm EN 12010 can be fulfilled using shot peening with steel balls followed by a pH dependent cleaning procedure.

[Residual particle free rough surfaces after rough blasting with steel grit in total hip arthroplasty]. / Restpartikelfreie raue Oberflächen nach Stahldrahtkornstrahlen in der Hüftendoprothetik.

INTRODUCTION: Several shot peening and grit blasting techniques are used to modify the surface in the production of hip endoprostheses. A number of publications in maxillo- facial- surgery and orthopedic surgery demonstrated significant contamination on alumina blasted surfaces. Latest research studies suspected an association between surface contamination and early failure of endoprostheses associated with third body wear. Additionally, the European standard EN 12010 requires surfaces free of residual particles. The aim of this study is to evaluate the effects of rough blasting using steel grit followed by a pH dependent cleaning procedures with regard to complying with EN 12010. MATERIAL AND METHOD: Ti6Al7Nb rods were rough blasted 1 time using steel grit ("Stahldrahtkorn", hardness: 56 HRC; R+K Draht GmbH, Leisnig). All blasting procedures were carried out with a special grit blasting device with direct pressure. One Ti6Al7Nb rod each was grit blasted with 3 and 4 bar pressure and 10 rods with 5 bar pressure. Surface roughness was measured by means of Mitutoyo- Surftest 301 three times before and after grit blasting. The mean value was calculated. A field emission scanning electron microscopy (SEM, LEO 1525) was used for the detection of residual particles on the surface of the rods with a backscattered electron detector. RESULTS: By rough blasting using steel grit a mean roughness of 54,9 microm and a maximum roughness of 61,4 microm could be achieved. The surface of all rods showed a considerable contamination with steel particles after grit blasting. After the a pH- dependent cleaning procedure a residual particle free surface was detected in all samples. DISCUSSION: The European standard EN 12010 can be fulfilled using rough blasting with steel grit followed by a pH dependent cleaning procedure.

Impact of chemoradiotherapy-induced anemia on survival in uniformly staged patients with locally advanced squamous cell carcinoma of the esophagus.

AIM: Objective of this study was to evaluate the hemoglobin level (Hb) as potential prognostic factor in uniformly staged patients (pts) undergoing primary chemoradiotherapy (ChRT) for locally advanced squamous cell carcinoma (SCC) of the esophagus. PATIENTS AND METHODS: Pts with histologically proven SCC of the esophagus (uT3/4 Nx or uTx N+) were included in the analysis. Staging procedures comprised endoscopic ultrasound, barium swallow and computed tomography. All pts received radiotherapy (> or =40 Gy) and > or =2 courses of fluorouracil/folinic acid, and cisplatin (5 days/month). In selected pts surgical resection after neoadjuvant ChRT was carried out. Clinical parameters, especially Hb were retrospectively evaluated for their impact on survival. RESULTS: 46 pts were treated between 1996 and 2001. Median survival was 16 months. Survival for pts treated with definitive ChRT (n = 28) was 14 months, whereas pts treated surgically after neoadjuvant ChRT (n = 18) survived 19 months (p = 0.79). Pts with low Hb levels at baseline did not show a worse outcome in comparison with pts with normal Hb levels (16 months), whereas a significant decrease in Hb level within the time period of ChRT was associated with a significantly inferior outcome (11 vs. 31 months; p = 0.046). Pts requiring blood transfusion tended to have inferior survival (11 vs. 24 months; p = 0.07). CONCLUSION: In this retrospective analysis a significant decrease of Hb level during ChRT was identified as prognostic factor for pts undergoing ChRT of SCC of the esophagus.

Bilateral thoracic extraadrenal myelolipoma.

Myelolipoma commonly occurs in the adrenal gland and is composed of both adipose tissue and normal hematopoietic elements. Extraadrenal myelolipoma may occur in the retroperitoneum, stomach, liver, lung, and in 3% of cases even in the mediastinum. We present a 65-year-old female patient with unspecific clinical symptoms. Routine chest roentgenograms revealed bilateral widening of the posterior mediastinum. Computed tomography showed bilateral, paravertebral lesions of 4.5 and 6.5 cm in diameter, respectively. After surgical removal, bilateral thoracic myelolipoma was pathomorphologically diagnosed. The imaging differential diagnosis of bilateral solid lesions in the posterior mediastinum including lymph node metastases, lymphomas, neurogenic tumors and extramedullary hematopoietic tumors is discussed.

[Fractures of the cervical vertebrae: diagnosis with multi-slice spiral CT]. / Halswirbelsäulenfrakturen: Diagnostik mit der Mehrschicht-Spiral-CT.

PURPOSE: It is the aim of this study to investigate the efficiency of multislice helical CT for the diagnosis of cervical spine fractures. The advantages of this technique are demonstrated by case reports. MATERIAL AND METHODS: The entire cervical spine or selected vertebral bodies of 66 patients with cervical spine fractures known from preceding plain films were scanned with a multislice helical CT. The CT-scans were obtained with a slice thickness of 1.25 mm and with two different pitches (0.75 or 1.5) and table speeds (3.75 or 7.5 mm/rot.). Additionally, sagittal and coronal reformations were performed. RESULTS: The mean scan-time for the cervical spine was 13 seconds. High quality sagittal and coronal reformations were obtained from axial images within a few minutes. Fractures of the dens (n = 17) and of the vertebral body of C3-C7 (n = 12) occurred predominantly. CONCLUSION: Multislice helical CT is an effective tool to diagnose fractures of the cervical spine rapidly and exactly.

[Intramural hematomas of the aorta]. / Intramurale Hämatome der Aorta.

Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can de differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membrane are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection.

Flavonols and flavones of parsley cell suspension culture change the antioxidative capacity of plasma in rats.

The flavonoid aglycones from an illuminated parsley (Petroselinum crispum (Mill.) Nym.) cell suspension culture were identified and quantified as the flavones apigenin, luteolin and chrysoeriol and the flavonols kaempferol, quercetin and isorhamnetin. Flavonoid extracts from these cultures were purified by solid phase extraction from RP C-18 phase and given by gavage to rats. Only extract from illuminated culture increased the antioxidative capacity (AOC) of blood plasma temporarily with maximum values after 1 h. It is concluded that the course of AOC reflects changes in the plasma content of flavonoids.

[Flavonols, flavone and anthocyanins as natural antioxidants of food and their possible role in the prevention of chronic diseases]. / Flavonole, Flavone und Anthocyane als natürliche Antioxidantien der Nahrung und ihre mögliche Rolle bei der Prävention chronischer Erkrankungen.

Flavonoids are non-nutritive compounds of plants that have been intensively investigated during the past years due to their possible protective effects against chronic diseases. In vitro studies were able to demonstrate for flavonols, flavones, and most recently also for anthocyanins a considerable antioxidative activity, mainly based on scavenging of oxygen radicals. Flavonols and anthocyanins are commonly found in European fruits and vegetables. In addition, black tea and red wine may have a high content of these compounds. Those food items are the main sources of flavonol consumption each contributing to a different degree to the overall intake. The absorption of aglycones has been established before. However, only recently could the absorption of flavonolglycosides be demonstrated. The mean intake of flavonols of the German population was calculated using data from the National German Food Consumption Survey. According to this analysis, the daily per capita intake was about 11.5 mg flavonols, mainly derived from fruits and vegetables, but also from black tea and red wine. Epidemiological studies have been directed to investigate the association between flavonol consumption and diseae risk. An inverse association between flavonol intake and mortality from myocardial infarction was observed. According to one of three studies, the flavonoid intake can be inversely correlated with cancer risk. This review summarizes the current knowledge on the occurrence, intake, bioavailability, and antioxidative properties of flavonols, flavones, and anthocyanins as well as the associations between flavonol intake and disease risks. Possible health related effects especially of flavonols are critically reflected, and the necessity of further research in outlined.

Conventional cell culture media do not adequately supply cells with antioxidants and thus facilitate peroxide-induced genotoxicity.

Commercially available calf serum did not supply the cultured murine fibroblast cell line L929 with amounts of selenium and alpha-tocopherol sufficient to protect against peroxide damage. Supplementation of the culture medium with 30 microM alpha-tocopherol or 50 nM sodium selenite led to a substantial increase of cellular alpha-tocopherol concentrations from 18 +/- 3.0 to 3179 +/- 93.0 pmol/10(6) cells or cellular selenium concentrations from 0.17 +/- 0.02 to 1.75 +/- 0.16 ng/10(6) cells, respectively. L929 fibroblasts grown in selenite-containing medium also had markedly raised activities of both cytosolic glutathione peroxidase (from 11 +/- 0.9 to 67.2 +/- 4.2 mU/10(7) cells) and phospholipid hydroperoxide glutathione peroxidase (from 0.2 to 9.5 +/- 0.9 mU/10(7)cells). Supplementation with alpha-tocopherol inhibited single-strand breaks induced by low concentrations of H2O2 only, whereas an adequate selenium supply almost completely inhibited single-strand breaks induced by up to 30 microM H2O2 and also significantly reduced H2O2-induced cell death. An inadequate selenium supply and corresponding increase of GPx activity upon selenite supplementation was also observed with other cell lines, for instance, D10N, ECV-304, HepG2, and THP-1. Our data strengthen the relevance of standardized and adequate supplementation of tissue culture media with antioxidants to improve viability and genetic stability of cultured cells in general and in particular, if they are oxidatively challenged.

MR-guided localization of suspected breast lesions detected exclusively by postcontrast MRI.

OBJECTIVE: We describe and evaluate a preoperative MRI localization procedure for suspected breast lesions. MATERIALS AND METHODS: Fourteen consecutive patients underwent MR localization of suspected breast lesions discovered with contrast-enhanced MRI but not detected by conventional mammography or ultrasound. In each case diagnostic MRI was repeated after the application of special skin markers. A non-magnetic wire was subsequently inserted into the breast and a second MRI performed to document the position of the wire tip relative to the lesion. RESULTS: The procedure was successful in all 14 patients, enabling excision of the lesion and allowing histological diagnoses. CONCLUSION: We found the described procedure to be quite useful.

Selected physico-chemical properties of succinylated legumin from pea (Pisum sativum L.).

Selected physico-chemical properties of pea legumin before and after succinylation have been investigated using isoelectric focusing, PAGE, SDS-PAGE, hydrophobicity measurements, SE-HPLC and RP-HPLC. Exhaustive succinylation shifted the I.P. of legumin from 4.75 to 3.5. The stepwise dissociation of legumin by increasing succinylation has been confirmed both by means of PAGE in a nondenaturing system, and by SE-HPLC. The results of SDS-PAGE provided evidence for the exposure of alpha-polypeptide chains in the native legumin. High succinylation resulted in a decrease of the surface hydrophobicity (S0) measured by both fluorescence probes (cis-parinaric acid and anilino-naphthalene sulfonic acid). RP-HPLC gave a response both to conformational changes and the introduced succinyl residues.

Characterization of endopolygalacturonase (EC 3.2.1.15) from Aspergillus niger as glycoprotein by electrophoretic methods and lectin affino-blotting.

Chromatographically purified endopolygalacturonase (PG) from Aspergillus niger was deglycosylated with N-glycosidase F (PNGase F) and characterized by means of sodium dodecyl sulfate (SDS)-electrophoresis, polyacrylamide gel electrophoresis (PAGE) without denaturing agents, isoelectric focusing (IEF) and lectin affino-blotting. The results show that PG, which is apparently homogeneous in SDS-PAGE but heterogeneous in IEF and PAGE, consists of at least two polypeptide chains with different glycosylation patterns. The component with the higher electrophoretic mobility is deglycosylated with PNGase F and reacts with concanavalin A (Con A) and Galanthus nivalis agglutinin (GNA), indicating a "high mannose" or "hybrid"-type of glycoprotein (GP). The other component may contain O-glycosidically linked mannose, N-acetylglucosamine or glucose.

A new hydrophilic copolymer membrane for dermabrasion.

Omiderm, a hydrophilic copolymer membrane, is a new dressing for the postoperative care of the dermabrasion patient. The unique physical properties of this dressing will be examined. Based on the clinical experiences presented, suggestions will be outlined that facilitate the best results from its use following dermabrasion.

Prolonged continuous versus intermittent oral acyclovir treatment in normal adults with frequently recurring genital herpes simplex virus infection.

In Year 1 of this two-year trial, patients with six or more genital herpes recurrences in the past year received suppressive treatment with either acyclovir, 400 mg, or placebo, orally twice daily for one year, and physician-documented recurrences were treated with open-labeled acyclovir, 200 mg, orally five times per day for five days (acute treatment). In Year 2, patients received open-labeled acyclovir treatment either with daily suppressive therapy or intermittent acute therapy. Among 683 patients who completed two years of treatment, 348 received continuous suppressive treatment for two years, 276 received acute treatment in Year 1 and suppressive treatment in Year 2, 24 received suppressive treatment in Year 1 and acute treatment in Year 2, and 35 received acute treatment for two years. Patient groups receiving intermittent acute acyclovir treatment experienced means of 7.0 to 12.6 recurrences/year during treatment as compared with 1.4 to 1.9 recurrences/year among groups receiving continuous suppressive treatment. No patients who received acute treatment remained recurrence-free for two years as compared with 29 percent of patients receiving continuous acyclovir suppression for two years. There was no evidence of cumulative toxicity detected by clinical, hematologic, or blood chemistry evaluations performed monthly in Year 1 and quarterly in Year 2. Suppressive oral acyclovir therapy remained effective and well-tolerated in this two-year trial.