Three-Dimensional High-Resolution Black-Blood Magnetic Resonance Imaging for Detection of Arteritic Anterior Ischemic Optic Neuropathy in Patients With Giant Cell Arteritis

Objectives: Arteritic anterior ischemic optic neuropathy (A-AION) caused by inflammatory occlusion of the posterior ciliary arteries is the most common reason for irreversible vision loss in patients with giant cell arteritis. Atypical clinical presentation and negative funduscopy can delay systemic high-dose corticosteroid therapy to prevent impending permanent blindness and involvement of the contralateral eye. The purpose of this study was to assess the diagnostic accuracy of 3-dimensional (3D) high-resolution T1-weighted black-blood magnetic resonance imaging (T1-BB-MRI) for the detection of posterior ciliary artery involvement in patients with giant cell arteritis and funduscopic A-AION. Materials and Methods: After institutional review board approval and informed consent, 27 patients with suspected giant cell arteritis and vision disturbances were included in this monocentric prospective cohort study. Giant cell arteritis was diagnosed in 18 patients according to the diagnostic reference standard (6 men, 73.8 [69.0-78.0] years);14 of those were positive for A-AION. Precontrast and postcontrast 3D T1-BB-MRI was performed in all 27 patients. Two radiologists separately assessed image quality and local fat suppression (4-point scale), visual contrast enhancement (3-point scale), and diagnostic confidence (5-point scale) regarding arteritic posterior ciliary artery involvement. Magnetic resonance imaging findings were assessed in comparison to funduscopy. Statistical analysis included accuracy parameters and interrater agreement. Results: Sensitivity of 3D T1-BB-MRI was 92.9% (95% confidence interval, 66.1%-99.8%) and specificity was 92.3% (95% confidence interval, 64.0%-99.8%) for detection of A-AION-positive patients. Image quality and local fat suppression were assessed with 3.2 +/- 0.8 (median 3) and 3.8 +/- 0.5 (median 4). Visual contrast enhancement with 2.3 +/- 0.8 (median 3) and diagnostic confidence was rated at 4.7 +/- 0.5 (median 5). Interrater agreement was high (kappa = 0.85, P < 0.001). Three-dimensional T1-BB-MRI displayed bilateral findings in 50% of the cases, whereas only unilateral A-AION was detected in funduscopy as a possible indication for the contralateral eye at risk. Conclusions: Three-dimensional T1-BB-MRI allows accurate detection of arteritic posterior ciliary artery involvement in patients with A-AION. Further, 3D T1-BB-MRI seems to display arteritic involvement of the posterior ciliary arteries earlier than funduscopy and might, therefore, display "vision-at-risk" in patients with visual impairment and suspected giant cell arteritis but unremarkable funduscopy

Bohrdrahtosteosynthese versus Plattenosteosynthese nach distaler Radiusfraktur

Die vorliegende Studie befasst sich mit den Behandlungsergebnissen von 110 distalen intra-artikulären Radiusfrakturen, die zu 43% primär mit Platten und zu 57% mit Bohrdrahtosteosynthesen versorgt wurden. Das Heilungsergebnis wurde subjektiv von den Patienten selbst zu 70,91% als sehr gut und gut beurteilt. Nach Kriterien von Sarmientos ausgewertet sind 92% der Frakturen als sehr gut und gut zu werten. Vergleicht man fünf gängige Fraktureinteilungen wie Fernandez, Gartland, Frykman, Melone und die AO-Klassifikation nach ihrer Aussagefähigkeit hinsichtlich der Güte des zu erwartenden Ergebnisses, so zeigt sich bei der Einteilung nach Gartland die beste Korrelation zwischen Fraktureinteilung und Ergebnisqualität. Auf die jeweilige Behandlungsmethode hin untersucht zeigt sich, dass mit Bohrdrähten versorgte Frakturen im Ergebnis besser beurteilt werden, als Plattenostheosynthesen

ORIGINAL ARTICLE Tape functionality: position, change in shape, and outcome after TVT procedure—mid-term results

# The Author(s) 2010. This article is published with open access at Springerlink.com Introduction and hypothesis This study evaluates the relevance of the tape position and change in shape (tape functionality) under in vivo conditions for mid-term outcome. Methods Changes in the sonographic tension-free vagina