[Optical coherence tomography for differentiation of parathyroid gland tissue]. / Optische Kohärenztomographie als Verfahren zur Differenzierung von Nebenschilddrüsengewebe.

BACKGROUND: Optical coherence tomography (OCT) is a high-resolution imaging technique that allows the identification of microarchitectural features in real-time. OBJECTIVE: Can OCT be used to differentiate parathyroid tissue from other cervical tissue entities? MATERIAL AND METHODS: All investigations were carried out during cervical operations. Initially, ex vivo images were analyzed to define morphological imaging criteria for each tissue entity. These criteria were used to evaluate a first series of ex vivo images. In a second phase the practicability of the technique was investigated in vivo and in the third phase backscattering intensity measurements were analyzed employing linear discriminant analysis (LDA). RESULTS: In the ex vivo series parathyroid tissue could be differentiated from other tissue entities with a sensitivity and specificity of 84  % and 94  %, respectively. Parathyroid tissue was correctly identified in the in vivo series in only 69.2 %. The analysis of backscattering intensity profiles employing LDA reliably distinguished between the different tissue types. CONCLUSION: The OCT images displayed typical characteristics for each tissue entity. Due to technical problems in handling the probe the in vivo OCT images were of much poorer quality. Backscattering intensity measurements illustrated that OCT images provide an individual profile for each tissue entity independent of the defined morphological assessment criteria. The results show that OCT is fundamentally suitable for intraoperative differentiation of tissues.

[Osteological interdisciplinary management : exemplified by a bilateral proximal humeral fracture]. / Osteologisch-interdisziplinäres Management : Am Beispiel einer bilateralen proximalen Humerusfraktur.

Following locking plate osteosynthesis of a proximal humeral fracture, a 62-year-old male patient suffered mild secondary dislocation. Subsequent bone densitometry identified an osteoporosis. Laboratory testing and sonography revealed an underlying primary hyperparathyroidism. In the short term, the patient suffered a similar proximal humeral fracture of the contralateral side. Given the knowledge about the underlying osteoporosis a cement-augmented locking plate osteosynthesis was carried out to treat the fracture. Parathyroidectomy was performed shortly thereafter and laboratory parameters returned to normal. Secondary fractures did not arise. Treatment of this patient in a certified osteoporosis center with a multimodal management led to systematic interdisciplinary diagnostics, a specific surgical therapy and ended in an excellent result.

Magnetic resonance imaging in early stage charcot arthropathy: correlation of imaging findings and clinical symptoms.

OBJECTIVE: To report on qualitative and quantitative MRI findings in early stage of diabetic osteoarthropathy (CA) and correlation with clinical symptoms. MATERIALS AND METHODS: Clinical data of 13 patients (mean age = 61.2 years) with Charcot arthropathy (CA, Eichenholtz 0) were compared with findings in native and contrast-enhanced MRI. 12 patients had diabetes mellitus (7 type 2, 5 type 1), one had idiopathic polyneuropathy. Evaluation was performed at acute stage of CA and at a 4 months follow-up. After baseline assessment, patients were treated with pressure-relieving means. Mean values of signal-intensity in short T1 inversion recovery (STIR) images of bones of the foot and ankle and corresponding contrast-enhancement were evaluated. Additional MRI-findings (soft tissue edema, varicosis, tenovaginitis, joint effusion) were analyzed. A correlation with symptoms (reddening, swelling, hyperthermia, pain) was performed. RESULTS: Bone marrow edema in affected bones significantly decreased (p<0.001). Soft tissue edema and pain showed a significant correlation with intensity of bone marrow edema (p<0.05). The presence of bone marrow edema in the STIR sequence was strongly associated with a corresponding contrast enhancement (p<0.0001, kappa-coefficients 0.976 at baseline and 0.953 at follow-up). CONCLUSION: MRI in early stage of CA provides valuable diagnostic information on the activity of the disease. A significant correlation of intensity of bone marrow edema in MRI and some clinical parameters (soft tissue edema and pain) was found. Paramagnetic contrast-agent did not provide additional information. This is the first report on quantitative assessment of signal alterations in stage 0 CA before and after treatment.

A rare case of primary actinomycosis of the anterior abdominal wall: diagnosis and treatment.

We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.

[Soft tissue infections treatable in the doctor's office]. / Kleine Schnitte in der Praxis.

A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful. All other courses indicate a multifactorial pathology and belong in the hands of an experienced specialist.

[Management of acute wounds]. / Meist ist es mit ein paar Stichen getan.

Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.