Webbasiertes Lernen in der Sonographie des Bewegungsapparates

Zusammenfassung: Die Ausbildung in der Sonographie des Bewegungsapparates erfolgt durch das Besuchen von Kursen, durch praktisches Üben und durch Selbststudium. In den letzten Jahren wurde webbasiertes Lernen auch in der Sonographie untersucht. Die vorliegende Arbeit setzte sich zum Ziel, Normalbefunde und pathologische Befunde nach den Richtlinien international anerkannter Fachgesellschaften in einem webbasierten Tool zu erfassen. In einer Zeitspanne von 3Jahren wurden im Rahmen einer prospektiven Arbeit Normalbefunde und häufige pathologische Befunde des Bewegungsapparates dokumentiert und katalogisiert. 1240 Aufnahmen, aus 1057 Ultraschallbildern und 183 Videos bestehend, wurden erfasst. Insgesamt waren 14,4% Normalbefunde und 85,6% der Bilder oder Videos pathologische Befunde. 61% der Aufnahmen betrafen die obere Extremität, 39% die untere Extremität und andere Gelenke. Die hauptsächlich dokumentierten Pathologien beschreiben eine Arthritis (33,3%), gefolgt von mechanischen oder entzündlichen Pathologien der Sehnen (19,6%). Mit 20% ist die rheumatoide Arthritis die Krankheit, die am meisten vertreten ist. Weitere häufig vorkommende Krankheiten sind die Kalziumpyrophosphatarthropathie (CPPD) mit 8,2%, die Gicht mit 7,1% und die Arthrose mit 6,9%. Zudem werden ultraschallgesteuerte Infiltrationen dargestellt. Die Aufnahmen wurden beschriftet und in ein einfach zu bedienendes webbasiertes Lernwerkzeug zusammengefass

Cost Analysis on Imaging Diagnostic Techniques in Cerebral and Abdominal Neonatal Pathology

Background: Improvement of health care quality and cost control are the main aims of the health care reform in Romania. Objective: The aims of the research are to analyse the trend of costs for imaging techniques used as diagnostic tools for cerebral and abdominal neonatal pathology and to study the relationship between cost and diagnostic benefits. Design: This is a retrospective observational study design without a control group, conducted in the Radio-Imaging Department, Cluj District University Hospital, Romania, from October 2000 to February 2006. Patients: The study population was represented by neonates investigated in the Radio-Imaging Department, Cluj District University Hospital. Intervention: Five imaging diagnostic techniques used in the diagnosis of cerebral and abdominal neonatal pathology were investigated. Measurements: The costs of the investigated techniques were calculated. The concordance between clinical and imaging diagnostic was recorded. Results: Magnetic resonance proved to be the most expensive investigation. The rate between the raising of costs on investigation type on year was constant. The average cost of imaging investigations for patients with identified pathological aspects (€ 42.72) was not statistically significant (p > 0.05) compared with the average cost for patients with no pathologic imaging aspects (€ 37.62). The concordance between the clinical suspicion and the radio-imaging diagnosis was of 52.35%. Conclusions: The raise of radio-imaging investigation costs had a decreasing tendency over the years studied, decrease explained by the stabilization of the Romanian monetary market. The results on concordance analysis lead to the necessity of training of both clinicians and radiologists

Evidenzbasierte Therapie des Raynaud-Syndroms

Zusammenfassung: Das Raynaud-Syndrom ist mit einer Prävalenz von 3-5% ein häufiges klinisches Problem. Dennoch ist die Wirkung der meisten Therapiemöglichkeiten nur unzureichend durch kontrollierte Studien belegt. Zu den Therapien mit höherem Evidenzgrad gehört der Kalziumantagonist Nifedipin, für den in Metaanalysen sowohl bei primärem als auch bei sekundärem Raynaud-Syndrom eine verbesserte periphere Durchblutung sowie eine Abnahme der Frequenz und des Schweregrades der Raynaud-Attacken nachgewiesen werden konnte. Ähnliches gilt für intravenös appliziertes Iloprost in der Therapie des sekundären Raynaud-Syndroms bei systemischer Sklerose. Intravenös verabreichtes Iloprost verbessert darüber hinaus das Abheilen von Fingerkuppenulzera bei Patienten mit systemischer Sklerose. Vielversprechende Therapieansätze stellen Angiotensin-II-Rezeptor-1-Antagonisten (Losartan), die Kalziumantagonisten Felodipin und Amlodipin, Serotonin-Reuptake-Hemmer (Fluoxetin) und Phosphodiesterase-V-Hemmer (Sildenafil, Vardenafil) dar, die sich in kontrollierten Einzelstudien als wirksam erwiesen haben. Jedoch fehlen Erfahrungen mit größeren Patientenzahlen und längeren Anwendungszeiten, um diese Therapiemöglichkeiten abschließend zu beurteile

Retrosigmoid approach for a ruptured pontine cavernous malformation, in a 10 years old pacient: Case report

Brainstem cavernous malformations have a high risk of hemorrhage, ranging from 4 to 60%, this risk being even higher in children where larger lesions are encountered. Even small hemorrhages can cause ,severe neurological symptoms because of the high density of cranial nerve nuclei and fiber tracts within the brainstem. The goal of surgical treatment is not only the improvement of neurological symptoms, but also preservation of the patient’s quality of life. We present a case of a 10 years old female pacient who presented after a 5 weeks conservative treatment with right sided weakness and loss of coordination, right hemihipoesthesia, She was diagnosed with a large left pontine cavernous malformation on MRI. The cavernoma was resected using a retrosigmoidian approach , but a small remnant was left, when the surgery had to be stopped due to severe bradicardia. The neurological deficit improved at follow up.The choice of the surgical approach that allows the best exposure of the lesion is mandatory. In this case the lesion was evident on the surface of the brainstem and this facilitated its resection. Traction on the tumor and coagulation near the cranial nerves nuclei should be avoided, but if bradicardia appears the surgery must be stopped.Surgery is the best choice for the patients with symptomatic brainstem cavernomas that present with hemorrhage and neurological deficit, and its objectives should be complete removal and improvement of neurological deficit.&nbsp

Public, private and non-specific antibodies induced by non-cytopathic viral infections

Lymphocytic choriomeningitis virus (LCMV) represents a useful experimental model of murine infection with a non-cytopathic virus, bearing resemblance to HIV and hepatitis C virus (HCV) infections in humans. Recent data from the LCMV model indicate that the humoral immune response that is induced by non-cytopathic viruses is far more complex than previously appreciated. LCMV-induced IgG production is largely polyclonal, with more than 90% of the antibody repertoire constituting non-relevant specificities. A delayed virus-neutralizing antibody response is induced, including specificities directed not only against the parental LCMV-strain present in the host but also cross-specifically against LCMV-variants isolated from other hosts. These findings provide novel insights to aid our understanding of clinically relevant observations that are recorded following human infection with HIV, HCV and dengue viruses

Multiple cerebral aneurysms of middle cerebral artery: Case report

Multiple cerebral aneurysms present a wide variation in incidence with averages of 13% at angiographic studies and 22.7% at autopsy. High blood pressue, cigarette smoking, stress and possible also age and female sex seem to be risk factors for multiple intracranial aneurysms (MIAn) in patients of working age who have suffered a subarachnoid hemorrhage (SAH). Aneurysms were situated on the same side in one-third of the patients with two aneurysms and the most common site was the middle cerebral artery (MCA). To manage these challenging lesions neurosurgeons must use all available innovations and advances, including diagnostic, technical and perioperative adjuncts. The author presents a case of middle age female, with two saccular aneurysms situated on the same side (right MCA), who was operated in our clinic, 20 days after first SAH episode, I grade on Hunt/Hess scale. The angio MRI was performed before, and control DS angiography after operation. After pterional approach, the author used the magnification, microsurgical technics, temporal clip, and two permanent Yasargil curved clips. A postoperative good recovery enable the patient go to work and drive one month later