Magnetic Resonance Imaging of the Axial Skeleton in Patients With Spondyloarthritis: Distribution Pattern of Inflammatory and Structural Lesions

Purpose: Spondyloarthritis is a chronic inflammatory disorder of the musculoskeletal system driven by systemic enthesitis and typically involving the axial skeleton, ie, the spine and the sacroiliac joints. The purpose of this study was to assess the distribution pattern of inflammatory and structural magnetic resonance imaging (MRI) findings in spondyloarthritis. Methods: Retrospective study of 193 patients with axial spondyloarthritis who received MRI of the spine and the sacroiliac joints. We quantitatively assessed inflammatory and structural lesions using established MRI-based scoring methods. The significance of the differences between gender, HLA-B27 status, and spine and sacroiliac involvement was determined. Results: In total, 174 patients (90.2%) showed a sacroiliac involvement and 120 patients (62.2%) a combined involvement of the sacroiliac joints and the spine. An isolated sacroiliac involvement was found in 54 patients (28.0%) and an isolated spine involvement in 19 patients (9.8%). The sacroiliac joint was significantly more involved in men than in women (P < .01), and men had significantly higher scores for structural lesions (P < .001). The subgroup of HLA-B27–positive patients showed a significantly higher percentage of sacroiliac involvement compared with HLA-B27–negative patients (P < .05). Conclusions: Spondyloarthritis is a systemic disorder predominantly involving the sacroiliac joints. However, the entire axial skeleton may be affected. In particular, HLA-B27–negative women show atypical manifestations without sacroiliac involvement. Magnetic resonance imaging in spondyloarthritis should cover the entire axial skeleton, ie, sacroiliac joints and the spine to meet the pathophysiology of this disorder and capture the true extent of inflammatory and structural lesions

Bedside diagnosis of pleural effusion with a latest generation hand-carried ultrasound device in intensive care patients

Background: Further development established hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several advantages such as fast bedside availability and prompt diagnosis. Purpose: To evaluate the diagnostic yield of a latest generation HCU imager compared to chest radiography (CR) for the detection of pleural effusion (PE) in intensive care patients. Material and Methods: Forty-eight hemithoraces of 24 patients on surgical intensive care units were enrolled in this study. All hemithoraces were evaluated using both HCU and CR. Definite diagnosis of PE was achieved using a high-end ultrasound system as standard of reference. Statistical analysis was performed using 2 × 2 tables and a McNemar test. A P value of <0.05 was considered statistically significant. Results: PE was present in 35 of 48 hemithoraces (73%). The HCU examination was carried out technically successfully in all hemithoraces. Sensitivity and specificity of HCU for the diagnosis of PE was 91% and 100%, respectively, whereas sensitivity and specificity of CR was 74% and 31%, respectively. The difference between HCU and CR was statistically significant with respect to specificity but not sensitivity (P = 0.008 and P = 0.11, respectively). Conclusion: Due to its ease of use and its high diagnostic yield HCU systems of the latest generation constitute a helpful technique for the primary assessment of PE

Diagnosis of pericardial effusion with a new generation hand-carried ultrasound device in cardiothoracic intensive care unit patients

Background: Technological advances introduced hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several benefits such as fast bedside availability and prompt diagnosis. Purpose: To evaluate the diagnostic yield of a latest generation HCU imager compared to contrast-enhanced multidetector computed tomography (MDCT) for the detection of pericardial effusion (PE) in cardiothoracic intensive care unit (ICU) patients. Material and Methods: Thirty-six patients from a cardiothoracic ICU were enrolled to this study irrespective of their underlying disease. All patients were examined with a new generation HCU for the presence of PE. Definite diagnosis of PE was based on findings of MDCT as standard of reference. Statistical analysis was performed using PASW 18. Results: PE was identified in 20 patients by MDCT (prevalence 56%). The HCU examination was carried out technically successfully in all patients. Sensitivity, specificity, positive and negative predictive value of HCU for the diagnosis of PE were 75%, 88%, 88%, and 74%, respectively. Conclusion: HCU provides rapid, practical, reliable, and cost-effective diagnosis of PE in patients on cardiothoracic ICU

Detektion von Sequenzvarianten mittels DHPLC : Etablierung als automatisiertes Verfahren zur direkten Mutationsanalyse bei autosomal-rezessiver polyzystischer Nierenerkrankung

Autosomal recessive polycystic kidney disease (ARPKD) is one of the most common genetic disorders of the kidney in childhood. Beside cystic alterations of both kidneys, ARPKD is associated with cystic malformation of the bile ducts and congenital fibrosis of the liver. The clinical spectrum ranges from intrauterine manifestation with prenatal demise to survival into adulthood. The very severe course of disease and the statistic risk of 25% for any newborn in affected families points out that reliable prenatal diagnosis is an important element of genetic counseling in this disease. Prenatal ultrasound examination must be considered as uncertain; linkage analysis has its limitations and is sometimes even impossible. In cases with diagnostic doubts prenatal testing is only feasible by direct mutation analysis. ARPKD is caused by mutations in the PKHD1 gene on chromosome 6p12 which extents over about 470 kb and includes at least 66 exons with a large number of alternatively spliced transcripts. The longest continuous open reading frame encodes a 4074 amino acid protein. In addition to the diagnostic advantages, mutation analysis of PKHD1 contributes to the understanding of the molecular causes of ARPKD. Because of its high sensitivity and the high throughput of samples DHPLC is an appropriate method for the analysis of large multi exon genes. In this study DHPLC was tested for detection of sequence variants in PKHD1. The sensitivity of DHPLC varies with several conditions, particularly with the temperature of analysis. As an application to predict DHPLC conditions we employed the Transgenomic Wavemaker software and used 64 samples with known mutations to determine the reachable detection rate. For 72 of a total of 77 PCR fragments mutation analysis could be established by DHPLC, the remaining five fragments should be examined by direct sequencing. Under the defined DHPLC conditions it succeeded to detect all 64 known samples, in order to reach a sensitivity of 100%. DHPLC analysis has proven to be an efficient technique to detect sequence variants in PKHD1

Morphometric characteristics of anencephalic skulls – A comparative study

Anencephaly is the most severe form of a neural tube defect resulting from the incomplete occlusion of the anterior neuropore in the fourth week of development and associated with a severely underdeveloped brain mass. As desmal ossification of the neurocranium is induced by the presence of soft tissues (brain), no bone develops as direct consequence of the missing brain. The cranial base, by contrast, is formed by chondral ossification, which is genetically determined, and thus present also in anencephaly. Morphometric characteristics of anencephalic skulls, however, have not yet been investigated in sufficient detail before. In this study we therefore comparatively assessed macroscopic morphological-anatomical and cephalometric CT data on structures and dimensions of 11 macerated anencephalic and 4 normal neonatal skulls highlighting skeletal morphological differences. The most striking results were the missing skullcap and the greatly changed morphology of the existing skull bones, which were reduced in size. The parameters of the skull base, the transverse orbital diameter and maxillary width were significantly smaller in anencephalic skulls. The morphology of the viscerocranium appeared similar to that of normal neonatal skulls. The results of this study can be used in diagnosis and skeletal classification for anencephaly. This can help identify bones that are incomplete, fragmented and taphonomically altered, which is often the case in historical and forensic studies. (C) 2020 Elsevier GmbH. All rights reserved

Yellow nail syndrome: Dystrophic nails, peripheral lymphedema and chronic cough

Yellow nail syndrome, a challenging entity with a clinical onset varying from birth to late adult life, is often misdiagnosed. Due to its secondary association with malignancies and autoimmune diseases, its initial diagnosis should prompt further investigations. This report documents a case involving a 41-year-old man who presented with the characteristic features of yellow nail syndrome

Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography

Background: Rib series (RS) are a special radiological technique to improve the visualization of the bony parts of the chest. Objectives: The aim of this study was to evaluate the diagnostic accuracy of rib series in minor thorax trauma. Methods: Retrospective study of 56 patients who received RS, 39 patients where additionally evaluated by plain chest film (PCF). All patients underwent a computed tomography (CT) of the chest. RS and PCF were re-read independently by three radiologists, the results were compared with the CT as goldstandard. Sensitivity, specificity, negative and positive predictive value were calculated. Significance in the differences of findings was determined by McNemar test, interobserver variability by Cohens kappa test. Results: 56 patients were evaluated (34 men, 22 women, mean age =61 y.). In 22 patients one or more rib fracture could be identified by CT. In 18 of these cases (82%) the correct diagnosis was made by RS, in 16 cases (73%) the correct number of involved ribs was detected. These differences were significant (p = 0.03). Specificity was 100%, negative and positive predictive value were 85% and 100%. Kappa values for the interobserver agreement was 0.92-0.96. Sensitivity of PCF was 46% and was significantly lower (p = 0.008) compared to CT. Conclusions: Rib series does not seem to be an useful examination in evaluating minor thorax trauma. CT seems to be the method of choice to detect rib fractures, but the clinical value of the radiological proof has to be discussed and investigated in larger follow up studies

Bow section of a steel ship at the St. John's dry dock.

This collection consists of photographs taken from two Job family albums, reflecting their business ventures, family activities and historical events

Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA – An Experimental Study

Purpose Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between +15 degrees anterior and -15 degrees posterior and 0 degrees to 20 degrees rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results The cup anteversion measured on CT was 23.3 degrees; on AP pelvic radiographs, however, variations in pelvic tilt (+/- 15 degrees) resulted in anteversion angles between 11.0 degrees and 36.2 degrees (mean error 8.3 degrees +/- 3.9 degrees). The cup inclination was 34.1 degrees on CT and ranged between 31.0 degrees and 38.7 degrees (m.e. 2.3 degrees +/- 1.5 degrees) on radiographs. Pelvic rotation between 0 degrees and 20 degrees showed high variation in radiographic anteversion (21.2 degrees-31.2 degrees, m.e. 6.0 degrees +/- 3.1 degrees) and inclination (34.1 degrees-27.2 degrees, m.e. 3.4 degrees +/- 2.5 degrees). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6 degrees +/- 0.2 degrees and in inclination measurements to 0.7 degrees (SD +/- 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4 degrees +/- 0.4 degrees for anteversion and to 1.3 degrees +/- 0.8 for inclination. Conclusion Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools