Computed tomography in the determination of leg geometry

In 286 adults with misalignment of the lower limb the length and torsional angles of the femur and tibia were determined using a method based on computed tomography. Depending on the location of the axial scan values for femoral antetorsion changed substantially. Normal values obtained in non injured extremities by this technique were an internal torsion of 23.5 +/- 8.6 degrees (mean +/- SD) in the femur and an external torsion of 34.9 +/- 8.6 degrees in the tibia. Mean intraindividual side differences in the femur and tibia were 4 degrees, the 95% confidence interval was 11.0 degrees in the femur and 12.3 degrees in the tibia. CT-methods can only be used for the determination of torsional angles in the femur and tibia if reproducible and standardized locations for the acquisition of axial scans are defined.

[The measurement of the femoral torsion angle in children by NMR tomography compared to CT and ultrasound]

PURPOSE

Anteversion of the femoral neck was measured by MRI in 19 children (37 hips) preoperatively before femoral rotation osteotomies.

MATERIAL AND METHODS

The results of this new technique were compared with values for anteversion obtained by CT and ultrasound. The measurements were performed independently by two observers to determine the correlation between the three different methods and to assess their reliability.

RESULTS

It was possible to show a high correlation coefficient (Pearson) between MRI and CT (r = 0.77) as well as MRI and sonography (r = 0.81). The mean angles obtained by CT (34 degrees, range +5 to +82 degrees) and ultrasound (25.6 degrees, range +10 to +40 degrees) appeared larger than the MRI values (mean angle 23.2 degrees, range 0 to +65 degrees), which can be explained by the different measurement techniques. Mean inter- and intra-variability was low for MRI (r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly higher for sonography (r = 0.88 and r = 0.88). MRI is a new reliable and precise method to evaluate femoral anteversion that does not require ionising radiation.

CONCLUSION

MRI is recommended for preoperative planning of paediatric femoral rotation osteotomy patients.

[The value of various ultrasound criteria in objective assessment of acute reactive cholecystitis. A prospective follow-up study of ventilated intensive care patients]

Ultrasound of the abdomen was performed in 30 artificially respirated patients under intensive care conditions for 7 days per patient over a time period of 6 months to elucidate the therapeutic value of different ultrasonographic findings with respect to the diagnosis "reactive acute cholecystitis". Our results show, that neither the detection of concrements or sludge within the gallbladder, nor the transient dilatation of the bile duct, nor a transient wall-thickening or the occurrence of a three-layered wall of the gallbladder can be interpreted as reliable sonographic criteria for the occurrence of an acute reactive cholecystitis. From this we conclude, that reactive acute cholecystitis leading to the indication for cholecystectomy can only be diagnosed from the combination of clinical and sonographic findings. However, reactive acute cholecystitis can almost certainly be excluded, even in obscure upper abdominal symptoms, when the sonogram of the gallbladder is normal.

[The early recognition of infected fluid collections in acute pancreatitis in computed tomography]

Infected accumulations of abdominal fluid are a severe complication and the major cause of death (mortality rate between 20 and 60%) in patients suffering from acute pancreatitis. In 93 patients with confirmed acute pancreatitis including 28 with surgically confirmed pancreatic abscess CT findings (volume of pancreatic and extrapancreatic necrosis, capsular enhancement, gas bubble formation and contact between fluid collection and intestinum) were retrospectively correlated with clinical and operative data to assess abscess formation. This revealed a sensitivity of 0.57 in respect of pancreatic necrosis; for extrapancreatic necrosis the sensitivity was 0.39, for capsular enhancement 0.5, for gas bubble formation 0.46 and for intestinal contact 0.93. The specificity was high for gas bubbles (1.0) and intestinal contact (0.91) and low for the other criteria.

IN CONCLUSION

There is a strong relationship between fluid accumulations in direct contact with intestinal structures and the occurrence of abscess. This parameter enhances the reliability of CT in the early detection of extrapancreatic infection.

[Percutaneous aspiration thromboembolectomy in the treatment of acute occlusion of the lower leg arteries]

Percutaneous aspiration thrombembolectomy (PAT) is a very suitable method for the recanalization of the popliteal and lower limb arteries after embolic occlusion. In thrombotic occlusion in patients with arteriosclerotic disease, PAT can easily be combined with other interventional procedures, yielding good results. With the use of PAT the dose of regionally effective fibrinolytic drugs, which may be additionally administered, can be significantly reduced.

[MRT and dynamic CT in the diagnosis of a recurrence of rectal carcinoma]

A prospective study on 29 patients with presacral lesions after operation of rectal cancer was performed to define the accuracy of CT using a dynamic contrast study and MRI for detection of tumour recurrence (sensitivity) and differentiation from scar formation (specificity). In dynamic CT sensitivity was 88% and specificity was 100%. In MRI the respective data were 94% (sensitivity) and 92% (specificity). Additionally 14 patients with primary rectal cancer were included to define standards for dynamic CT; no differences between primary tumour and relapse were found. In MRI the assessment of signal intensities in T2w images permits differentiation between tumour relapse and scar tissue. In dynamic CT automatically calculated time-density graphs enable differentiation of presacral lesions and the initial increase of density after standardised bolus application was shown to be the most reliable parameter.

Rapid increase in lumbar spine bone density in osteopenic women by high-dose intramuscular estrogen-progestogen injections. A preliminary report

This prospective pilot study has been carried out to assess the effect of high parenteral doses of estrogens and progestogens on lumbar spine bone density in osteopenic women. Thirteen osteopenic women received 40 mg estradiol valerate and 250 mg hydroxyprogesterone caproate by intramuscular injections once a week for 6 months (so called "pseudopregnancy"). One g oral calcium was added. Six out of the 13 patients (49.5 +/- 4.8 y were peri- and postmenopausal = group A. Seven patients (21.5 +/- 2.2 y) suffered from primary and secondary amenorrhea, in 4 out of them due to gonadal dysgenesis = group B. Estradiol was measured by commercial radioimmunoassay. Bone density was determined by dual-energy X-ray absorptiometry (DEXA) of the upper 4 lumbar vertebrae. Lumbar spine bone density as well as estradiol serum levels were measured before and 3 and 6 months after therapy, respectively. Estradiol increased from 34.8 +/- 7.5 pg/ml to 3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months, respectively, in group A. Bone density increased by 15.3 +/- 3.6% within the first 3 months to a total of 18.8 +/- 3.9% after 6 months, respectively. Two patients we have controlled for two years, maintained this increase. In group B estradiol increased from 27.8 +/- 6.5 pg/ml to 3028 +/- 728 after 3 and to 2491 +/- 684 pg/ml after 6 months. Bone density in this group increased by 11.8 +/- 1.9% within 3 and to a total of 18.2 +/- 2.8% after 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Neem oil inhibits two-cell embryo development and trophectoderm attachment and proliferation in vitro

PURPOSE

The in vitro effect of neem oil was studied on the development of mouse two-cell embryos and trophectodermal cell attachment and proliferation.

METHOD

Female mice were primed with gonadotropins for superovulation and caged with male mice. Early embryos, at the two-cell and the blastocyst stages, were recovered at 40 and 88 hr post-hCG from the oviducts and the uteri, respectively. In the first experiment, two-cell embryos were exposed to culture medium containing different concentrations of neem oil for 1, 12, and 24 hr and then grown in neem oil-free culture medium and assessed for the formation of total and hatching blastocysts at 96 hr. In the second experiment, partially hatching blastocysts were cocultured with human endometrial stromal cell monolayers in culture medium containing different concentrations of neem oil and assessed for the attachment and proliferation of trophectodermal cells at 96 hr.

RESULTS

Exposure of two-cell embryos to neem oil concentrations of 0.050-0.500% for 1 hr, 0.010-0.250% for 12 hr, and 0.005-0.100% for 24 hr caused significant inhibition of the formation of total and hatching blastocysts, in a dose-dependent manner. Neem oil at 0.050-0.100% concentrations inhibited, in a dose-dependent manner, the in vitro attachment and proliferation of trophectodermal cells of partially hatching blastocysts cocultured with human endometrial stromal cells monolayers.

CONCLUSION

Neem oil inhibits the development of two-cell embryos and attachment and proliferation of the trophectodermal cells of partially hatching blastocysts in vitro. The study encourages the use of this herbal product as a postcoital contraceptive that warrants further research.

[Sonographic aspects of clinically suspected acute appendicitis]

Revealing a sensitivity of 97.5% and a specificity of 95.12% this study emphasizes the excellent diagnostic value of sonography in the elucidation of patients with clinical signs of "acute appendicitis". Evaluation of morphology on the one hand and maximal diameter of the organ and the organ wall on the other, in conjunction with the clinical presentation, allows a restrictive management of the surgical treatment and thus decreases the rate of negative laparotomy.

Comparison of single- and dual-energy quantitative computed tomography for therapy control under antiosteoporotic treatment

Lumbar spine bone mineral density was determined in 50 female patients (mean age: 55.4 +/- 12.3 years), who were treated because of osteoporosis or osteopenia. Bone mineral density was assessed using single-energy QCT with 80 and 120 kV tube voltage and with dual-energy QCT. Compared to single-energy QCT, dual-energy QCT showed much higher variability of the bone density values obtained. Therefore we conclude that single energy QCT is a method that allows precise and reproducible determination of spinal bone mineral content under clinical conditions which cannot be further improved by the use of dual-energy QCT.

[Traumatic occlusion of the internal carotid artery as an injury sequela of soccer]

The largest number of people engaged in sports in Germany play football. There were about 1.5 million sports injuries annually in the previous Federal Republic of Germany. Steinbrück (5) reported that the highest number was found in football players, in whom the injuries of the legs are most frequent. Head and vascular injuries are unusual and seldom in football players. We report on the case of a patient who received an elbow blow from his opponent. He developed a stroke with hemiparesis because of a traumatic dissection of the A. carotis interna.

Belief network for grading prostate lesions

A Bayesian belief network for grading prostatic lesions into eight primary Gleason grades was developed and tested. The network employs 13 diagnostic clues, 8 based on tissue architectural features and 5 based on nuclear features. For every diagnostic clue, three to five different outcomes are specified by membership functions. The network works in a robust fashion and attained agreement with consensus visual grading in 241 of 256 microscopic fields.

[3D-CT and angiography of cast preparations of pelvic vessels: demonstration of arterial blood supply of the acetabulum]

Anatomical studies of the arterial blood supply of the acetabulum were performed utilizing conventional angiography and 3D-CT on 27 hip specimens. In 16 cases the arterial arborization was filled with undiluted barium-sulfate via the internal artery and in 11 cases with a solution of resin and lead power. 3 specimens out of 30 were excluded because of extravasation using barium-sulfate in one case and incomplete filling with resin in 3 cases. Conventional angiograms were performed in all specimens and in preparations with resin/lead power additional three-dimensional reconstructions of the surface of the acetabulum and arterial cast were done with 3D-CT. 3D-CT shows precise relationship of the arteries to the acetabulum in any spatial plane and definition of vascular supply without elaborate preparation. 3D-CT is superior to non-selective conventional angiography because of better definition of arterial arborization. Filling with resin and lead powder is optimal for anatomical studies because of its reliability and stability. It permits comparative 3D-CT and conventional x-ray examination and subsequent preparation of the vessels in corrosion technique. The advantages of 3D-CT in vessels of cadaver specimens should encourage research on its viability in patients.

[The place of portangiography in the follow-up control of locoregional chemotherapy]

101 portangiographies in patients with liver metastases from colorectal primaries who underwent hepatic intraarterial or intraperitoneal chemotherapy were performed and studied between January 1991 and February 1992. 81% of the examinations did not involve complications. In 19% of the angiographies abnormalities of the arterial perfusion of the liver, like occlusion, dissection or narrowing of hepatic arteries, were found. We conclude that portangiography is a very important investigation before regional chemotherapy.

[The value of tumor volumetry as opposed to bidimensional determination of tumor size during follow-up of hepatic metastases from colorectal carcinoma]

36 patients with liver metastases due to colorectal carcinoma under treatment with arterial perfusion chemotherapy of the liver with 5-fluoro-2-desoxyuridine (FUDR) via a subcutaneous pump were investigated by axial liver CT at 6-monthly intervals. In all examinations a dynamic CT scan with intravenous bolus injection of contrast medium was carried out following a native scan. Changes in tumour size were documented by means of 1. volumetry and 2. bidimensional measurement according to WHO criteria. Since we were not able to assess small newly developing lesions within the liver using the volumetric classification, the WHO-classification showed much higher sensitivity in cases of progressive disease. In addition, volumetric determination of tumour size by means of region-of-interest technique proved to be rather impracticable in clinical routine compared to bidimensional measurement.