[Magnetic resonance imaging of the shoulder: impingement and instability related abnormalities--update 2013]. / Magnetresonanztomographie der Schulter: Impingement und instabilitätsassoziierte Veränderungen--Update 2013.

Magnetic resonance imaging (MRI) plays an important role in the diagnosis and differentiation of numerous shoulder abnormalities and chronic shoulder pain. Important indications for MRI are assessment of the rotator cuff and the labrocapsular complex. The assessment of the rotator cuff muscles is crucial. The value of MR arthrography is discussed. The potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities, shoulder instability-related lesions and the assessment of pathological conditions of the long biceps tendon. The following article describes the most common pathological findings of the shoulder joint and gives a description of the relevant findings for the orthopedic shoulder surgeon. The current article represents an update of an article previously published in 2006 with the same title (Zanetti and Saupe, Radiologe 46:79-89, 2006).

Radiological changes and signs of osteoarthritis in the fingers of male performance sport climbers.

AIM: The aim of this study was to investigate the radiological changes and signs of osteoarthritis in the fingers of performance sport climbers that felt to be from acute mechanical stress placed on the fingers and intense training regime over years. METHODS: A total of 31 male sport climbers who were either strong rock climbers or former members of the Swiss climbing team, and 67 non-climbers participated in the study. Fisher's exact test was used to compare the proportions of signs of osteoarthritis between climbers and non-climbers. For the evaluation of radiological changes, antero-posterior and lateral radiographs were taken of both hands. Distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints of the fingers Dig. II-V on the antero-posterior radiographs were scored for signs of osteoarthritis using an atlas (Altman) method. Osteophytes at the DIP and PIP joints were also evaluated on lateral radiographs and compared to the findings on the antero-posterior radiographs. RESULTS: According to the Kellgren-Lawrence method, 6 out of 31 climbers had evidence of clear signs of osteoarthritis in the fingers, whereas none of the non-climbers developed any signs of osteoarthritis (P≤0.001). Twenty-three climbers had definite signs of osteophytosis using antero-posterior radiographs compared to 31 climbers using lateral radiographs. Lateral radiographs have shown to be more accurate in finding, localizing and rating of osteophytes than antero-posterior radiographs. CONCLUSION: Male climbers have more signs of osteoarthritis compared to male non-climbers at similar age. Development of osteophytes seems to be ordinary in every climber. Lateral radiographs are more accurate in diagnosing osteophytes in climbers than using traditional antero-posterior radiographs.

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision.

Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176 mm(2) in asymptomatic patients and 365 mm(2) in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0 mm(2) in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5 mm(2) or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75 mm(2) or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75 mm(2) in early postoperative MRI was found to be the threshold for clinical significance.

[MR imaging of the shoulder. Impingement and instability-related abnormalities]. / Magnetresonanztomographie der Schulter Impingement- und instabilitätsassoziierte Veränderungen.

In addition to the case history and the clinical examination, MR imaging has an important role in the diagnosis and differential diagnosis of numerous shoulder abnormalities and in the investigation of chronic shoulder pain. Important indications for MR imaging are any conditions or symptoms making assessment of the rotator cuff and the labrocapsular complex necessary. Assessment of the rotator cuff muscles, in particular, is crucial. The value of MR arthrography, which is still controversial, is discussed. The greatest potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities and shoulder instability-related lesions, and the assessment of pathologic conditions of the long biceps tendon. This paper describes the most common pathologic findings of the shoulder joint and describes how the relevant findings are reported and quantified for the orthopaedic shoulder surgeon.

Hypoxia and reoxygenation of brain endothelial cells in vitro: a comparison of biochemical and morphological response.

Reactive oxygen species are thought to be important for a variety of pathological processes in the brain. Endothelial cells have been proposed as both a significant source of oxidants and targets of oxidative damage. Therefore, lipid peroxidation (LPO) was investigated and compared to biochemical and morphological alterations in cultured pig brain capillary endothelial cells after hypoxia (120 min. 95% N2/5% CO2) and reoxygenation (30 min. 95% O2/5% CO2). The content of thiobarbituric acid reactive substances (TBARS) representing radical-induced LPO was 2.50 +/- 0.46 after hypoxia and 5.92 +/- 0.54 nmol/mg protein after reoxygenation (p < 0.05 each, vs. normoxic control 1.79 +/- 0.21). During hypoxia, ATP content decreased to 7.9 +/- 1.6 nmol/mg protein; lactate dehydrogenase activity in the incubation solution increased to 0.17 +/- 0.03 U/mg protein; (p < 0.05 vs. control 15.7 +/- 3.1 and 0.09 +/- 0.02, respectively). After hypoxia, morphological changes in lysosomes, multivesicular bodies and vacuoles were observed in contrast to normoxic cells. During reoxygenation, the ATP values were normalized; electron micrographs showed increasing amounts of lysosomes, multivesicular bodies, vacuoles, blebs and lipofuscin granula and lyzed cells. Comparing the biochemical and morphological observations, a sequence of disturbances occurred, in which energy depletion was accompanied and followed, respectively, by membrane destruction, cellular disintegration and an increase in LPO products. These results support the assumption that the damage of brain endothelial cells caused by hypoxia and reoxygenation is accompanied by peroxidation of membrane lipids.