[Importance of SPECT/CT for knee and hip joint prostheses]. / Stellenwert der SPECT/CT bei Knie- und Hüftgelenkprothesen.

CLINICAL/METHODICAL ISSUE: Complications, such as loosening or infections are common problems after hip or knee arthroplasty. STANDARD RADIOLOGICAL METHODS: If conventional X-rays are equivocal bone scintigraphy is the classical second-line imaging modality. METHODICAL INNOVATIONS: 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. PERFORMANCE: 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. ACHIEVEMENTS: In our hospital SPECT/CT regularly gives important additional information regarding prosthetic joint complications. PRACTICAL RECOMMENDATIONS: SPECT/CT is increasingly being used as the second step imaging standard modality if conventional X-rays are equivocal.

MR/CT image fusion of the spine after spondylodesis: a feasibility study.

The objective of this study is to evaluate feasibility, accuracy and time requirements of MR/CT image fusion of the lumbar spine after spondylodesis. Sagittal MR and CT images derived from standard imaging protocols (sagittal T2-weighted MR/sagittal reformatted multi-planar-reformation of the CT) of the lumbar spine with correct (n = 5) and incorrect (n = 5) implant position were fused by two readers (R1, R2) using OsiriX in two sessions placing one (session 1) or two (session 2) reference point(s) on the dorsal tip(s) of the cranial and caudal endplates from the second lumbar to the first sacral vertebra. R1 was an experienced musculoskeletal radiologist; R2 a spine surgeon, both had received a short training on the software tool. Fusion times and fusion accuracy, defined as the largest deviation between MR and CT in the median sagittal plane on the ventral tip of the cranial end plate of the most cranial vertebra visible on the CT, were measured in both sessions. Correct or incorrect implant position was evaluated upon the fused images for all patients by an experienced senior staff musculoskeletal radiologist. Mean fusion time (session 1/session 2; in seconds) was 100.4/95 (R1) and 104.2/119.8 (R2). Mean fusion deviation (session 1/session 2; in mm) was 1.24/2.20 (R1) and 0.79/1.62 (R2). The correct/incorrect implant position was identified correctly in all cases. In conclusion, MR/CT image fusion of the spine with metallic implants is feasible, fast, accurate and easy to implement in daily routine work.

[Periorbital ecchymosis--trauma or tumor?]. / Säugling mit Brillenhämatom - Trauma oder Tumor?

We report about an 11 month old patient, who presented with progressive supraorbital swelling, periorbital ecchymosis, hepatosplenomegalia and B-symptoms. Neuroblastoma was subsequently diagnosed based on the clinical history, physical examination, laboratory tests and imaging findings. Neuroblastoma is the second most frequent solid tumor in infancy. Clinical symptoms are not specific. The so called "raccoon eyes", as seen in our patient, result from osseous metastasis to the orbits and skull. Periorbital swelling may initially be misinterpreted as child abuse. Prognosis of neuroblastoma depends on various factors including initial tumor staging, tumor biology and the child's age.

Changes in birth weight, birth length and head circumference of Hungarian children in the county Baranya between 1968 and 1979-1981.

Possible secular changes of newborn's body measurements were investigated in a cross-sectional growth study in the County Baranya (South Hungary) in 1979-1981. The total sample includes 2,130 children. The results were compared with those obtained by Fekete et al. (1968, 1974) in the same region on 3,567 neonates. During the 12-years interval the birth weight increased slightly. The head circumference did not change in girls, but decreased slightly in boys. The birth length values could not be evaluated because of technical reasons. According to the present results secular changes in the body measurements of the newborns could not be seen during the investigated period. The fetal growth standard values ascertained by Fekete et al. (1968, 1974) are still suitable. A repeated anthropometric investigation of newborns is necessary in the near future.

Pubertal development in south-Hungarian boys and girls.

Data on pubertal development in 1392 boys and 1494 girls from the cross-sectional Pécs Growth Study are reported. Genital, breast and pubic-hair development were rated according to Tanner (1962). The initiation of pubic-hair development in boys was 11.8 years and that of genital development was 12.0 years. Stage 2 of pubic-hair development (PH2) in boys occurred 1.7 years later than in girls. The mean time of different stages of pubertal development in boys was in the same range as in Eveleth and Tanner's study (1991). Stages 2, 3 and 4 for pubic-hair and breast development in Pécs girls occurred earlier than in Eveleth and Tanner's subjects (1991), while the mean time of stage 5 for both sexual characteristics occurred at a later age than reported in Eveleth and Tanner (1991). The age of menarche was 12.9 years in Pécs girls, which seems later by 0.1-0.6 years than in Western-European countries and earlier by 0.1-0.3 years than in South-European countries.

Medical treatment of vesicoureteral reflux detected in infancy.

Between 1970 and 1982, 41 neonates and infants with grades II and III vesicoureteral reflux (international classification) but with no medical or urological complications were treated medically and followed for an average of 7.5 years. In 33 of the 41 patients the vesicoureteral reflux resolved (group 1) and in 8 it persisted (group 2). The severity and frequency of urinary infection decreased to a greater degree in group 1 (p less than 0.0005) than in group 2 (p less than 0.05). There was no difference in endogenous creatinine clearance between the 2 groups. Comparison of kidney length and bipolar parenchymal thickness revealed that bipolar parenchymal thickness was significantly less in group 2 patients (p less than 0.01). Body weight tended to increase in both groups but it was greater in group 1. In both groups height was lower at the time of detection of reflux and it approached nearly normal values during followup. It is tempting to conclude that early recognition of mild forms of vesicoureteral reflux (grades II and III) and systematic medical treatment can preserve renal function and promote renal and somatic growth. However, this tendency is less pronounced in patients with persistent reflux.

The effect of unprocessed wheat bran on blood glucose and plasma immunoreactive insulin levels during oral glucose tolerance test in obese children.

Blood glucose and plasma immunoreactive insulin concentrations were measured during oral glucose tolerance test in 10 obese children. Oral glucose was given by itself or combined with 15 g unprocessed wheat bran. Bran significantly reduced the blood glucose and plasma immunoreactive insulin concentrations at 30 min of the tolerance test. It is concluded that supplementation of obese children's diet with unprocessed bran is advantageous.

Metabolic effects of septicaemia in newborn and young infants with particular reference to the plasma free amino acids.

Blood samples were obtained from 13 infants with clinically and microbiologically confirmed septicaemia. Two subgroups of the septic infants were formed according to postnatal age, an early onset group consisting of 6 infants younger than 7 days, and a late onset group comprising 7 infants of 20 infants. The blood samples were analysed for 18 plasma amino acids and glucose, lactate and FFA. Except the significantly lowered blood glucose in the early onset group of infants, no appreciable change occurred in the glucose, lactate and FFA levels. The plasma aminogram was different in the two groups, as hypoaminoacidaemia was more pronounced in the early onset group. The branched chain amino acids decreased significantly in both groups. The three important glucogenic amino acids alanine, glycine and proline showed a decrease only in the early onset group. Among the calculated plasma amino acid ratios the phenylalanine: tyrosine quotient was markedly increased. This, in addition to the response of the branched chain amino acids, has been found characteristic of a variety of clinical and experimental infections.