Does gadolinium improve magnetic resonance arthrography of the hip beyond fluid distension alone?

AIM: To determine if there is a difference in the detection of labral tears and cartilage lesions using the T2-weighted sequences of magnetic resonance arthrography (MRA) only, which simulate MRA with saline alone, compared with the full examination including T1-weighted sequences. MATERIALS AND METHODS: One hundred hip MRA examinations performed at 3 T were identified retrospectively. Each study was reviewed by a musculoskeletal radiologist using either the T2-weighted sequences only (without gadolinium-based contrast agent [GBCA] effect) or the entire examination, including T1-weighted sequences (with GBCA effect). Receiver operating characteristic (ROC) curves were calculated for both groups and compared within a non-inferiority framework, using - 0.10 as the limit of non-inferiority. RESULTS: For labral tears, the difference area under the curve (AUC) was -0.004 (95% confidence interval [CI]: -0.064-0.056, p=0.90). For acetabular cartilage lesions, the difference AUC was 0.011 (95% CI: -0.073-0.096, p=0.79). For femoral cartilage lesions, the difference AUC was -0.059 (95% CI: -0.206-0.087, p=0.43). CONCLUSION: T2-weighted sequences alone were not inferior in diagnostic accuracy compared with the full examination (including T1-weighted sequences with intra-articular GBCA) in detecting acetabular cartilage lesions and labral tears. Further study with prospective comparison of saline injectate to GBCA-containing injectate may help clarify the necessity of continued GBCA use in MRA of the hip.

New vertebral fractures after vertebroplasty: 2-year results from a randomised controlled trial.

UNLABELLED: A randomised controlled trial of vertebroplasty (VP) versus placebo assessed the effect of VP on the risk of further vertebral fractures. While no statistically significant between-group differences for new or progressed fracture risk at 12 and 24 months were observed, we observed a consistent trend towards higher risk of any type of fracture in the group undergoing VP. Our analysis was underpowered, and further adequately powered studies are needed to be able to draw firm conclusions about further vertebral risk with vertebroplasty. PURPOSE: This study seeks to assess the effect of VP on the risk of further radiologically apparent vertebral fracture within two years of the procedure. METHODS: We conducted a randomised placebo-controlled trial of VP in people with acute osteoporotic vertebral fracture. Eligible participants were randomly assigned to VP (n = 38) or placebo (n = 40). Cement volume and leakage were recorded for the VP group. Plain thoracolumbar radiographs were taken at baseline, 12 and 24 months. Two independent radiologists assessed these for new and progressed fractures at the same, adjacent and non-adjacent levels. RESULTS: At 12 and 24 months, radiographs were available for 45 (58 %) and 47 (60 %) participants, respectively. There were no between-group differences for new or progressed fractures: 32 and 40 in the VP group after 12 and 24 months compared with 21 and 33 in the placebo group (hazard ratio (HR) 1.80, 95 % confidence interval (CI) 0.82 to 3.94). Similar results were seen when considering only adjacent (HR (95 % CI) 2.30 (0.57 to 9.29)) and non-adjacent (HR (95 % CI) 1.45 (0.55 to 3.81) levels. In all comparisons, there was a consistent trend towards higher risk of any type of fracture in the group undergoing VP. Within the VP group, fracture risk was unrelated to total (HR (95 % CI) 0.91 (0.71 to 1.17)) or relative (HR (95 % CI) 1.31 (0.15 to 11.48)) cement volume or cement leakage (HR (95 % CI) 1.20 (0.63 to 2.31)). CONCLUSION: For patients undergoing VP, our study did not demonstrate significant increases in subsequent fracture risk beyond that experienced by those with vertebral fractures who did not undergo the procedure. However, because of the non-significant numerical increases observed, studies with adequate power are needed to draw definite conclusions about fracture risk.

Plain radiography is effective for the detection of calcinosis cutis occurring in association with autoimmune connective tissue disease.

BACKGROUND: Studies on the radiological findings of calcinosis cutis in patients with autoimmune connective tissue disease (ACTD) are limited. OBJECTIVES: To describe imaging findings and radiological patterns of calcinosis cutis occurring with ACTD. METHODS: We retrospectively reviewed the cases of 37 patients with imaging studies assessing for calcinosis cutis associated with ACTD at our institution between 1996 and 2009. A formal blinded review of available images (i.e. radiographs, computed tomography scans) for all 37 patients was performed by radiologists. RESULTS: Of 37 patients, 30 (81%) were female. The mean age at diagnosis of calcinosis cutis was 43·4 years. Patients had the following ACTDs: dermatomyositis (n = 17) with classic (n = 9), juvenile (n = 7) and amyopathic (n = 1) subtypes; systemic sclerosis with limited cutaneous scleroderma (n = 8); undifferentiated connective tissue disease (n = 4); mixed connective tissue disease (n = 3); systemic lupus erythematosus (n = 2); lupus panniculitis (n = 1); overlap connective tissue disease (n = 1); and polymyositis (n = 1). Plain radiographs detected calcinosis in all 37 patients; a nodular pattern of calcification was most commonly observed (31/37; 84%). Two or more morphological patterns of calcification were present in 19 patients (51%). In general, individual patterns were not specific to a particular ACTD subtype. CONCLUSIONS: Radiography detected calcinosis in all patients and is recommended for initial imaging of calcinosis. Multiple morphological patterns of calcification were observed across ACTD subtypes. Further studies should correlate radiological studies with treatment of calcinosis and underlying ACTD.

Streptavidin reduces oxygen quenching of biotinylated ruthenium(II) and palladium(II) complexes.

Transition metal complexes such as biotinylated ruthenium(II) tris(bipyridyl) and palladium(II) porphyrin show an increase in luminescence intensity and lifetime upon binding to streptavidin in aqueous solution. Here we show that this increase of luminescence lifetime and intensity are caused by the shielding of the transition metal complexes from dissolved oxygen through streptavidin rather than by hydrophobicity effects as recently claimed.

Shaping emission spectra of fluorescent molecules with single plasmonic nanoresonators.

We show that plasmonic nanoresonators composed of two gold nanoparticles change not only the intensity but also the spectral shape of the emission of fluorescent molecules. The plasmonic resonance frequency can be tuned by varying the distance between the nanoparticles, which allows us to selectively favor transitions of a fluorescent molecule to a specific vibrational ground state. Experimental data from correlated scattering and fluorescence microscopy agree well with calculations in the framework of generalized Mie theory. Our results show that the widely used description of a dye molecule near a metal surface as a mere two-level system is inadequate.

Moving nanoparticles with Raman scattering.

We show how to change optically the distance between two protein-linked gold nanoparticles by Raman-induced motion of the linker protein. Rayleigh scattering spectroscopy of the coupled-particle plasmon allows us to compare the inter-nanoparticle distance of individual protein-linked gold nanoparticle dimers before and after surface-enhanced Raman scattering (SERS). We find that low-intensity (50 microW/microm2) laser light in resonance with the nanoparticle-dimer plasmon provokes a change of the inter-nanoparticle distance on the order of 0.5 nm whenever SERS from the proteins connecting the nanoparticles can be observed.

Gold nanoparticles quench fluorescence by phase induced radiative rate suppression.

The fluorescence quantum yield of Cy5 molecules attached to gold nanoparticles via ssDNA spacers is measured for Cy5-nanoparticle distances between 2 and 16 nm. Different numbers of ssDNA per nanoparticle allow to fine-tune the distance. The change of the radiative and nonradiative molecular decay rates with distance is determined using time-resolved photoluminescence spectroscopy. Remarkably, the distance dependent quantum efficiency is almost exclusively governed by the radiative rate.

[Psychotherapeutic resources in the General Hospital of Vienna. A representative empirical study of psychotherapeutic practices]. / Psychotherapeutische Ressourcen im AKH Wien. Eine repräsentative empirische Untersuchung aller psychotherapeutisch Tätigen.

Since 1993 the Austrian Federal-Hospital-Law demands the guarantee of adequate psychotherapeutic and clinical psychological care in Austrian hospitals. The target of the present survey was to explore the extent of realisation of this demand concerning the psychotherapeutic care in the General Hospital of Vienna (AKH). 125 of the 128 employees with psychotherapeutic qualifications were interviewed. The considerable number of psychotherapeutically qualified employees cannot obscure the fact that inadequate structural preconditions impede a satisfying care. These are: most of the interviewed persons have been employed because of other vocational qualifications (medical doctors, psychologists etc.). Therefore they can only use a very limited part of their worktime on psychotherapeutic interventions. Deficits of spatial and temporal resources could be detected as well as unclear vocational characteristics and qualification requirements. These deficits point out the necessity of developing professionally founded organisation structures, which enable well aimed networking and an optimal usage of resources.

[Periportal hyperechogenicity of the liver. Clinical aspects and pathology of the so-called fixed star heaven phenomenon of the liver]. / Periportale Hyperechogenität der Leber. Klinik und Pathologie des sogenannten Fixsternhimmelphänomens der Leber.

INTRODUCTION: The clinical significance of the sonographic finding "periportal hyperechogenicity", which is characterized by hard periportal echoes, is largely undetermined. This phenomenon has been reported in a large number of disorders, as well as in healthy persons. METHODS: A prospective study of 1853 patients revealed this finding in 12 cases. These 12 patients were followed up after two to four months. RESULTS: Only four cases were seen to still have diffuse periportal accentuation in the follow-up, while five patients showed a partially and three a completely normal liver. The laboratory values of these 12 patients were largely normal at the time of diagnosis and follow-up. Periportal accentuation was not correlated with any hepatological disorders. Examination using two different ultrasound devices revealed no major differences. DISCUSSION: Overall, these findings confirm the earlier assumption that this sonographic picture designated as periportal hyperechogenicity or accentuation is not diagnostic of any hepatological disorder, nor is it even a sign of disease, because most patients with this phenomenon can be termed hepatologically "healthy".

Mother-father relationship, object relations and premature contractions.

Mother-father relationship during pregnancy and its influence on obstetric complications, such as premature contractions, has been little investigated, but seems to be far more important than has been acknowledged so far. From a psychoanalytic and psychodynamic perspective three case studies are used to illustrate the ongoing dynamics. First the fetus is identified with an object of the past and/or the present. To ward off threatening object representations the pregnant woman needs a third person, the father. If he is unavailable for her she is in danger of rejecting the child. Results are discussed also in relation to the medical support system.

[Psychosocial prognostic factors for refertilization or IvF after tubal sterilization]. / Psychosoziale Prognosefaktoren für Refertilisierung oder IvF nach Tubensterilisation.

In a psychosomatic study we interviewed 33 women who had undergone tubal anastomosis or IvF after tubal ligation. As a control group we chose a randomised sample of 45 women after elective tubal ligation. We used a semi-structured interview and the Giessen-test as psychometric instruments. According to the leading indication for reanastomosis, we allocated women to one of 2 groups: 21 patients had found a new partner (R-partner), 12 mentioned experiences of loss (R-loss). The groups were well comparable in respect of sociodemographic items, but showed relevant differences in psychological variables, like motivation for and time for deliberation to sterilisation or age difference between partners. Women of the R-partner group were highly satisfied with tubal reanastomosis as compared to R-loss subjects. Satisfaction with the procedure was basically independent of an actual pregnancy. Women experienced the two methods in different, rather specific ways. Cluster analysis of the Giessen-test result confirmed group allocation. We conclude that experiences of loss as a leading reason for tubal reanastomosis are unfavourable prognostic factors. IvF has an unfavourable prognosis in women with the intention to restore the mutilated body image. Preoperative counselling by a psychotherapeutically trained counsellor seems mandatory.

[Coping with illness and body image following different surgical techniques in breast cancer]. / Krankheitsbewältigung und Körperbild nach unterschiedlichen Operationstechniken bei Brustkrebs.

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.

Psychosomatic aspects of galactorrhea.

We interviewed 33 women with non-puerperal galactorrhea, 5 (15%) of whom had HPRL levels greater than 18 ng/ml and 24 controls, namely women with benign breast lesions. We used a semi-structured interview covering the duration of symptoms, preceding life events and the effect on the relationship of the couple. We also used the Beck depression inventory, the Strauss and Appelt body image questionnaire and an 8 item Visual Analogue Scale (VAS). Galactorrheic women were more depressive (P less than 0.1), had more prior life events (P less than 0.001), longer duration of symptoms (P less than 0.01), and less fear of their disease (P less than 0.05) than did controls. Both groups had similar results with the body image questionnaire. Within the study group, results were independent of prolactin (HPRL) levels or amenorrhea.

[Integration of psychological management strategies in the treatment course of breast carcinoma]. / Integration psychologischer Betreuungsstrategien in den Behandlungsablauf beim Mammakarzinom.

The integration of psychological counselling programmes into the treatment procedures of breast cancer has to overcome specific methodological and contextual difficulties. We present a counselling strategy for breast cancer patients which aims at a reduction of short-term sequelae of the crisis of cancer diagnosis and stress of therapy. Its main features, summarized as follows are based on the relevant literature and the results of a pilot study in our department. Counselling is offered and made available to all patients, since both self- and professional referral lead to a selection bias. Psychological counselling is considered as integral part of the entire diagnostic and therapeutic process. The psychologist acts as a continuous supportive partner at all relevant treatment stages, and is introduced to the patient at the outset of the therapy and is always available as familiar contact person for discussion of all problems. Intensity and structure of counselling closely follow the different stages of somatic treatment. Technically, elements of crisis intervention and Progressive Muscular Relaxation (PME, according to Jacobson) are applied. Aspects of patient/doctor relationship and interdisciplinary cooperation between physicians and psychologists are discussed.

Couple relationship, birth preparation and pregnancy outcome: a prospective controlled study.

In a prospective, controlled trial we assessed correlations between couple structure, birth preparation and fetal outcome in 158 couples (316 individuals). 88 couples (study group, SG) attended 8 hours of birth preparation classes (BPC). 70 couples served as controls. For couple diagnostic, we used OLSON's two dimensional circumplex model with the FACES III questionnaire, which evaluates the dimensions cohesion and adaptability. In the SG "structured-connected" couples prevailed as compared to the CG, which showed more variability (p less than 0.01). Within the SG, the before-after BPC comparison revealed a tendency toward more functional couple structures. Fetal outcome and complication rate did not differ between groups. In the SG Cesarean section rate correlated positively, premature birth negatively with age and socio-economic status; complication rate in general correlated positively with couple satisfaction. Couple structure should be recognized in routine pregnancy care, BPC ought to be organized in a way that all different types of couples feel invited. Methodologically, the circumplex model proved to be applicable in obstetrics.

Vaginal agenesis and congenital adrenal hyperplasia. Psychosocial sequelae of diagnosis and neovagina formation.

Eleven patients with Mayer-Rokitansky-Küster syndrome (MRK) and 7 patients with adrenogenital syndrome (CVAH) were interviewed and tested pre- and postoperatively. MRK subjects were operated on with a modified Vecchietti procedure, CVAH subjects underwent genitoplastic and clitoroplastic operation. Psychosocial sequelae of and coping with malformation and treatment were assessed with semistructured interviews and the Giessen test. Anatomical and functional results of the vaginoplastic operation were excellent, and sexual satisfaction correlated with coping. 7/11 MRK patients were capable of good to fair adaptation to the malformation, whereas CVAH patients suffered severe distortions of body image. The malformation caused narcissistic damage in all cases. Circumstances of diagnosis, prevailing defense mechanism and consequences for counselling are discussed.