Keine gewöhnliche perianale Fistel

Zusammenfassung: Wir präsentieren den Fall eines 63-jährigen Schweizer Staatsbürgers mit chronischer Diarrhö, Schleimabgang ab ano, analer Fistel und chronischem Analulkus bei anamnestisch bekannter Lungentuberkulose vor 56Jahren. Nach Bildgebung wurde klinisch und endoskopisch initial der Verdacht auf eine chronisch entzündliche Darmerkrankung geäußert. Erst eine gezielte Probenentnahme und Untersuchung mittels PCR konnte die Diagnose einer abdominalen Tuberkulose mit perianaler Manifestation sichern. Die differenzialdiagnostische Berücksichtigung der extrapulmonalen Tuberkulose ist wichtig bei der Abklärung chronisch abdomineller Symptome. Eine immunsuppressive Therapie bei ursprünglich vermuteter chronisch entzündlicher Darmerkrankung hätte zu einer Progression mit Gefahr der miliaren Tuberkulose führen könne

Total-body contrast-enhanced MRA on a short, wide-bore 1.5-T system: intra-individual comparison of Gd-BOPTA and Gd-DOTA

Total-body contrast-enhanced MRA (CE-MRA) provides information of the entire vascular system according to a one-stop-shop approach. Short, wide-bore scanners have not yet been used for total-body CE-MRA, probably due to their restricted field of view in the z-direction. The purpose of this feasibility study is to introduce an image protocol for total-body MRA on a short, wide-bore system. The protocol includes five to six table-moving steps and two injection runs. Two pharmacologically different contrast materials (CM) were applied in ten healthy volunteers in view of possible CM-dependent influences on the protocol outcome (Gd-Bopta, Gd-Dota). Differences consisted of significantly higher CNR with Gd-Bopta with a mean of 73.8 ± 38.7 versus 69.1 ± 34.3 (p = 0.008), significantly better arterial visualization values with Gd-Dota with a mean of 1.26 ± 0.44 versus 1.53 ± 0.73 (p = 0.003) and a tendency to less venous overlay with Gd-Dota, mean 1.19 ± 0.44 and 1.34 ± 0.72, respectively (p = 0.065) (two-tailed Wilcoxon matched-pairs test). Overall 94% of the steps were valued as qualitatively excellent or good. The good results with both CM suggest a transfer to further patient evaluatio

Optimization of imaging before pulmonary vein isolation by radiofrequency ablation: breath-held ungated versus ECG/breath-gated MRA

Isolation of the pulmonary veins has emerged as a new therapy for atrial fibrillation. Pre-procedural magnetic resonance (MR) imaging enhances safety and efficacy; moreover, it reduces radiation exposure of the patients and interventional team. The purpose of this study was to optimize the MR protocol with respect to image quality and acquisition time. In 31 patients (23-73years), the anatomy of the pulmonary veins, left atrium and oesophagus was assessed on a 1.5-Tesla scanner with four different sequences: (1) ungated two-dimensional true fast imaging with steady precession (2D-TrueFISP), (2) ECG/breath-gated 3D-TrueFISP, (3) ungated breath-held contrast-enhanced three-dimensional turbo fast low-angle shot (CE-3D-tFLASH), and (4) ECG/breath-gated CE-3D-TrueFISP. Image quality was scored from 1 (structure not visible) to 5 (excellent visibility), and the acquisition time was monitored. The pulmonary veins and left atrium were best visualized with CE-3D-tFLASH (scores 4.50 ± 0.52 and 4.59 ± 0.43) and ECG/breath-gated CE-3D-TrueFISP (4.47 ± 0.49 and 4.63 ± 0.39). Conspicuity of the oesophagus was optimal with CE-3D-TrueFISP and 2D-TrueFISP (4.59 ± 0.35 and 4.19 ± 0.46) but poor with CE-3D-tFLASH (1.03 ± 0.13) (p < 0.05). Acquisition times were shorter for 2D-TrueFISP (44 ± 1s) and CE-3D-tFLASH (345 ± 113s) compared with ECG/breath-gated 3D-TrueFISP (634 ± 197s) and ECG/breath-gated CE-3D-TrueFISP (636 ± 230s) (p < 0.05). In conclusion, an MR imaging protocol comprising CE-3D-tFLASH and 2D-TrueFISP allows assessment of the pulmonary veins, left atrium and oesophagus in less than 7 min and can be recommended for pre-procedural imaging before electric isolation of pulmonary vein

Oases in the Sahara Desert–Linking biological and cultural diversity

The diversity of life sensu lato comprises both biological and cultural diversity, described as “biocultural diversity.” Similar to plant and animal species, cultures and languages are threatened by extinction. Since drylands are pivotal systems for nature and people alike, we use oases in the Sahara Desert as model systems for examining spatial patterns and trends of biocultural diversity. We identify both the underlying drivers of biodiversity and the potential proxies that are fundamental for understanding reciprocal linkages between biological and cultural diversity in oases. Using oases in Algeria as an example we test current indices describing and quantifying biocultural diversity and identify their limitations. Finally, we discuss follow-up research questions to better understand the underlying mechanisms that control the coupling and decoupling of biological and cultural diversity in oases

Thermography and thermoregulation of the face

BACKGROUND: Although clinical diagnosis of thermoregulation is gaining in importance there is no consistent evidence on the value of thermography of the facial region. In particular there are no reference values established with standardised methods. METHODS: Skin temperatures were measured in the facial area at 32 fixed measuring sites in 26 health subjects (7–72 years) with the aid of a contact thermograph (Eidatherm). A total of 6 measurements were performed separately for the two sides of the face at intervals of equal lengths (4 hours) over a period of 24 hours. Thermoregulation was triggered by application of a cold stimulus in the region of the ipsilateral ear lobe. RESULTS: Comparison of the sides revealed significant asymmetry of face temperature. The left side of the face showed a temperature that was on the average 0.1°C lower than on the right. No increase in temperature was found following application of the cold stimulus. However, a significant circadian rhythm with mean temperature differences of 0.7°C was observed. CONCLUSION: The results obtained should be seen as an initial basis for compiling an exact thermoprofile of the surface temperature of the facial region that takes into account the circadian rhythm, thus closing gaps in studies on physiological changes in the temperature of the skin of the face

Correction to: CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting—a consensus document by the European Society of Cardiovascular Radiology (ESCR)

The original version of this article, published on 05 September 2019, unfortunately contained a mistake. The image of “Jena Valve” in Table 3 was incorrect

Human metapneumovirus infection after allogeneic hematopoietic stem cell transplantation

Background: The clinical characteristics of human metapneumovirus (hMPV)-associated lower respiratory tract infection (LRTI) after allogeneic hematopoietic stem cell transplantation (HSCT) is not well described. We describe the clinical course in eight HSCT recipients suffering from hMPV infection. Methods: We prospectively included all patients with hMPV-associated LRTI after allogeneic HSCT during a period of 1year. hMPV was diagnosed by multiplex polymerase chain reaction (PCR) from bronchoalveolar lavage (BAL). Results: Eight patients with hMPV-associated LRTI were identified from 93 BAL samples. Three of the eight patients had co-infections with other pathogens. The median age of the patients was 45years [interquartile range (IQR) 36.8-53.5], the median time posttransplant was 473days (IQR 251-1,165), 5/8 patients had chronic graft-versus-host disease (cGvHD), and 6/8 patients received immunosuppression. Chest computed tomography (CT) scanning showed a ground-glass pattern in 7/8 patients. Seven of eight patients required hospitalization due to severe symptoms and hypoxemia. All were treated with intravenous immunoglobulin (IVIG), which was combined with oral ribavirin in six patients. The mortality rate was 12.5% (1/8). Conclusions: hMPV-associated LRTI in allogeneic HSCT recipients are not uncommon and present with unspecific respiratory symptoms, ground-glass pattern in CT scanning, and co-infectio

^(10)Be/^9Be ratio up to 1.0 GeV/nucleon measured in the ISOMAX 98 balloon flight

The Isotope Magnet Experiment, ISOMAX, a balloon-borne superconducting magnet spectrometer was built with the capability to measure the isotopic composition of the light isotopes (3 ≤ Z ≤ 8) of the cosmic radiation up to 4 GeV/nucleon by using the β vs. rigidity technique with a mass resolution better than 0.25 amu, employing a combination of time-of-flight (TOF) system and silica-aerogel Cherenkov counters for the velocity determination. One of the primary scientific goals of ISOMAX was the accurate measurement of radioactive 10 Be with respect to its stable neighbor isotope 9 Be conveying information on the age of the cosmic rays in the galaxy. ISOMAX had its first flight on August 4-5, 1998, from Lynn Lake, Manitoba, Canada. It provided 13 h of data with a residual atmosphere of less than 5 g/cm^2 . This paper reports the results of the beryllium ratio 10 Be/9 Be = 0.195 ± 0.036 at the top of atmosphere in the energy range from 0.261 - 1.030 GeV/nucleon using the TOF in the 1998 flight. The high energy results of the beryllium ratio up to 2 GeV/nucleon in the Cherenkov regime as well as the lithium results in the TOF energy range are also reported in these proceedings

Measurement of the Abundance of Radioactive ^(10)Be and Other Light Isotopes in Cosmic Radiation up to 2 GeV Nucleon^(-1) with the Balloon-Borne Instrument Isomax

The Isotope Magnet Experiment (ISOMAX), a balloon-borne superconducting magnet spectrometer, was designed to measure the isotopic composition of the light isotopes (3 ≤ Z ≤ 8) of cosmic radiation up to 4 GeV nucleon^(-1) with a mass resolution of better than 0.25 amu by using the velocity versus rigidity technique. To achieve this stringent mass resolution, ISOMAX was composed of three major detector systems: a magnetic rigidity spectrometer with a precision drift chamber tracker in conjunction with a three-layer time-of-flight system, and two silica-aerogel Cerenkov counters for velocity determination. A special emphasis of the ISOMAX program was the accurate measurement of radioactive ^(10)Be with respect to its stable neighbor isotope ^9Be, which provides important constraints on the age of cosmic rays in the Galaxy. ISOMAX had its first balloon flight on 1998 August 4–5 from Lynn Lake, Manitoba, Canada. Thirteen hours of data were recorded during this flight at a residual atmosphere of less than 5 g cm^(-2). The isotopic ratio at the top of the atmosphere for 10Be/9Be was measured to be 0:195 ± 0:036 (statistical) ± 0:039 (systematic) between 0.26 and 1.03 GeV nucleon^(-1) and 0:317 ± 0:109 (statistical) ± 0:042 (systematic) between 1.13 and 2.03 GeV nucleon^(-1). This is the first measurement of its kind above 1 GeV nucleon^(-1). ISOMAX results tend to be higher than predictions from current propagation models. In addition to the beryllium results, we report the isotopic ratios of neighboring lithium and boron in the energy range of the time-of-flight system (up to ~1 GeV nucleon^(-1)). The lithium and boron ratios agree well with existing data and model predictions at similar energies

In-flight Performance of the ISOMAX TOF

A state-of-the-art time-of-flight (TOF) system has been developed for the ISOMAX balloon-borne cosmic ray instrument. ISOMAX was built to measure the isotopic composition of the light elements in the cosmic rays, (3<Z<8), in particular beryllium. In-flight performance of the TOF, during the first flight in August of 1998, and some isotopic results are presented. The uncorrected timing resolution for a single paddle was determined to be ~47 ps for helium and ~23 ps for carbon