A rare case of primary actinomycosis of the anterior abdominal wall: diagnosis and treatment

We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.

Precursor State to Unconventional Superconductivity in CeIrIn5

We present Hall effect and magnetoresistance measurements in the heavy fermion superconductor CeIrIn(5). At low temperature, a Kondo coherent state is established. Deviations from Kohler's rule and a quadratic temperature dependence of the cotangent of the Hall angle are reminiscent of properties observed in the high-temperature superconducting cuprates. A striking observation pertains to the presence of a precursor state--characterized by a change in the Hall mobility--that precedes the superconductivity in this material, in similarity to the pseudogap in the cuprate superconductors.

Patterns of care in the radiotherapy of prostate cancer in Northern Bavaria 1998-2000

PURPOSE

A patterns-of-care study of radiotherapy (RT) in prostate cancer was performed in Northern Bavaria, Germany, to characterize patient selection, treatment strategies and outcome for the time period 1998-2000.

MATERIAL AND METHODS

Patients who received curative-intent radical or postoperative RT were identified from the databases of six centers (one university, five teaching/regional hospitals). Two centers treated < 20 patients and were excluded from further analysis. At the remaining four centers, 148 patients receiving radical RT and 134 undergoing postoperative RT were analyzed for pretreatment and RT characteristics and actuarial biochemical control (BC; ASTRO definition).

RESULTS

All patients were treated with three-dimensional conformal external-beam techniques. In radical RT patients, cT- and cN-stages as well as the frequency of (neo)adjuvant hormonal therapy (53-91%) and RT to pelvic nodes (2-97%) and the mean total RT dose (64.8-71.0 Gy) varied significantly between centers. In postoperative RT, centers differed significantly in R-status, initial prostate-specific antigen (PSA) and nodal RT frequency (2-89%), whereas total RT doses were similar (62.3-64.8 Gy). After radical RT, 5-year BC was 68.6% and differed significantly between centers on univariate analysis. In a multivariate model, only total RT dose showed a trend toward an effect on BC. In postoperative RT patients, overall 5-year BC was 82.1%, and age and initial PSA were associated with BC on multivariate analysis.

CONCLUSION

From 1998 to 2000, radical RT for prostate cancer at the Northern Bavarian centers now studied was performed with three-dimensional conformal technique to conservative total doses and selection criteria for postoperative RT were highly variable.

Visualization of bronchial lesions using multidetector CT and endobronchial ultrasound (EBUS)

OBJECTIVE

Staging of bronchial carcinoma presents a diagnostic challenge. In addition to CT scans, endobronchial ultrasound is used. The aim of this study was to compare the diagnostic accuracy of high-resolution multidetector CT (MSCT) with that of endobronchial ultrasound with respect of detection and extension of the bronchial lesions.

METHODS

24 patients with lesions in the central bronchial area were examined using both EBUS and MSCT. Multiplanar reconstructions (MPR) as well as virtual endoscopy (VE) were used as adjuncts in this investigation of the comparative diagnostic accuracy of MSCT and EBUS in the imaging of bronchial lesions.

RESULTS

No significant difference could be established between EBUS and MSCT in detecting and extension of bronchial lesions. With both procedures, the use of supplementary techniques may be advantageous and helpful in individual cases.

CONCLUSIONS

When compared with EBUS, MSCT with post-processing has equally high sensitivity with regard to the visualization of malign endobronchial lesions.

Probing the quantum critical behavior of CeCoIn5 via Hall effect measurements

We present highly sensitive Hall effect measurements of the heavy fermion compound CeCoIn5 down to temperatures of 55 mK. A pronounced dip in the differential Hall coefficient | partial differential rho(xy)/ partial differential H| at low temperature and above the upper critical field of superconductivity, H(c2), is attributed to critical spin fluctuations associated with the departure from Landau Fermi liquid behavior. This identification is strongly supported by a systematic suppression of this feature at elevated pressures. The resulting crossover line in the field-temperature phase diagram favors a field induced quantum critical point at mu(0)H(qc) approximately 4.1 T below H(c2)(T=0) suggesting related, yet separate, critical fields.

Ein Vergleich von C-Bogen-CT und Standardbildgebung an Osteosynthesen frakturierter Präparate des distalen Radius

BACKGROUND

The purpose of this study was to evaluate the value of C-arm CT imaging of the distal radius with standard patient positioning in intraoperative assessment of plate osteosynthesis.

MATERIALS AND METHODS

Four complete distal radius specimens from human cadavers were fractured (type C), and internal fixation with palmar plates (stainless steel) was then carried out in each. On the basis of C-arm fluoroscopy, radiography and C-arm CT (Siremobil Iso-C3D, scans with forearm bones positioned parallel to the z-axis), 19 observers subsequently evaluated the positions of screws near the joint and any steps within the joint, after which the bones were surgically exposed and the imaging results checked against direct visual observations.

RESULTS

No statistically significant differences were detected either between the modalities or between the evaluator groups.

CONCLUSION

With standard patient positioning, the performance of C-arm CT was equivalent to and not better than that of current standard procedures, i.e. intraoperative fluoroscopy and postoperative radiography. Further studies should examine whether this holds true in clinical practice with representative patient collectives when titanium implants are used and/or optimized patient positioning is practised.

Skin cholesterol: test performance, evaluation of potential determinants and correlation analysis with cardiovascular risk factors and circulating markers of inflammation

BACKGROUND

Skin cholesterol (SkC) has been suggested to be an additional risk predictor, so we evaluated the test performance, potential determinants of this marker as well as a potential correlation of SkC with markers of inflammation and the history of cardiovascular events.

PATIENTS AND METHODS

SkC, determined by the non-invasive PREVU POC Skin Sterol test, as well as serum lipids, the body fat status, high-sensitive CRP (hs-CRP) and serum amyloid A (SAA) were evaluated in consecutive patients with and without documented atherosclerotic disease.

RESULTS

SkC was assessed in 201 patients. The within-day precision (CV) was 3.8%, the day-to-day CV of the right hand was 8.6% and 4.3% for the left hand, respectively. Neither univariate analysis nor multiple regressions identified a significant influence of age, sex, serum lipids, body fat status, smoking or diabetes mellitus on SkC, corresponding results were observed in a further analysis including 174 of these patients concerning hs-CRP and SAA (all p > 0.05). T-test analyses detected no significant differences between patients with and without a history of coronary, peripheral vascular and cerebrovascular events (all p > 0.05).

CONCLUSIONS

The PREVU POC Skin Sterol test for the assessment of SkC proved an acceptable test performance. SkC is independent from serum lipids, traditional cardiovascular risk factors, two sensitive markers of systemic inflammation as well as the history of cardiovascular events indicating that the perception of this parameter as an established marker of vascular disease is premature.

Frühmanifestationen rheumatischer Gelenkerkrankungen an den Weichgewebestrukturen der Hand

PURPOSE

The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis.

MATERIAL AND METHODS

A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis.

RESULTS

The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p <0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%).

CONCLUSION

Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).

Influence of HMG-CoA-reductase inhibitors on the body fat status

BACKGROUND

While the literature has conclusively shown a significant decrease of plasma lipids after intake of HMG-CoA reductase inhibitors, there is no detailed information provided about their effects on the body fat status.

PATIENTS AND METHODS

We performed a retrospective analysis of a prospective randomized controlled trial including consecutive patients with suspected arterial occlusive disease. Normolipidemic patients served as the control group and hyperlipidemic patients were randomized to either 20 mg atorvastatin or to 40 mg simvastatin. At baseline, after 6 weeks and after 6 months we assessed the relative body fat, the waist circumference and the body mass index (BMI) as well as plasma total cholesterol (chol), low-densitiy lipoprotein cholesterol (LDL) and triglycerides (TG).

RESULTS

In total we included 129 patients in our analysis. The body fat status remained unchanged in the control group as well as in the atorvastatin group (all p > 0.05) for the whole study period, while simvastatin treatment led to a slight, but significant increase of the relative body fat (+ 4.2%) between the 6 weeks and 6 months assessment (p = 0.013).

CONCLUSIONS

Long-term intake of statins seems to have no positive influence on parameters of the body fat status and therefore misses one important goal in the cardiovascular risk prevention.

Vergleich unterschiedlicher Bildwiedergabegeräte bei der Erkennung von Niedrigkontrastdetails in digitalen Radiographien

PURPOSE

Assessment of low-contrast details in digital radiographs on different review displays (RD).

MATERIALS AND METHODS

20" flat screen panels (RD1: standard color LCD-TFT, RD2: monochrome LCD-TFT for radiological reading, RD1*: RD1 with optional image inversion; 205 cd/m (2) luminance, respectively) were evaluated. At 30 lx ambient lighting, 10 radiologists gradually increased the contrast (constant steps) for both a homogeneous picture and a cutout of a thorax radiography of n = 480 simulated nodules until they became recognizable.

RESULTS

In the case of bright nodules on an anthropomorphic background, the use of image inversion produced significantly better results. No other significant differences were detected.

CONCLUSION

Provided that the working environment is not bright, the results suggest that low-cost RD can be used for the recognition of low-contrast details in radiographies of the chest. Further studies including more display models are necessary. Among different ambient lighting and luminance settings, these studies should include a closer analysis of the special features of digital systems such as brightness/contrast adaptation, picture enlargement (zoom shot), and image inversion.

[The undetected brain lesion in sports. Minor traumatic brain injury and its sequelae]

The minor traumatic brain injury (mTBI) in sports is often looked at as a bagatelle. The treating physician underestimates the severity of the injury suspecting that a mTBI is a nonstructural lesion with an overall excellent prognosis in the majority of the cases. This paper shows that the minor traumatic brain injury may be a structural brain lesion with potentially life-threatening dangers. The therapy should follow exactly defined guidelines, e.g., stepwise protocol of the Concussion in Sports (CIS-) Group. Return to sports activities should happen only when all physical but also cognitive symptoms have subsided. All mTBIs that have been sustained prior to the actual injury have to be recorded properly because repeated mTBIs may cause chronic degenerative brain damage. Neuropsychological testing will aid in the correct diagnosis of a mTBI and is a useful parameter in the course of the injury. In the future biochemical markers may serve as indicators of the severity of the brain injury and may also aid in predicting the outcome after TBI. Today biochemical markers do not serve as a substitute for neuroimaging.

[PACS: storage and retrieval of digital radiological image data]

BACKGROUND

Efficient handling of both picture archiving and retrieval is a crucial factor when new PACS installations as well as technical upgrades are planned.

MATERIALS AND METHODS

For a large PACS installation for 200 actual studies, the number, modality,and body region of available priors were evaluated. In addition, image access time of 100 CT studies from hard disk (RAID), magneto-optic disk (MOD), and tape archives (TAPE) were accessed.

RESULTS

For current examinations priors existed in 61.1% with an averaged quantity of 7.7 studies. Thereof 56.3% were within 0-3 months, 84.9% within 12 months, 91.7% within 24 months, and 96.2% within 36 months. On average, access to images from the hard disk cache was more than 100 times faster then from MOD or TAPE.

CONCLUSION

Since only PACS RAID provides online image access, at least current imaging of the past 12 months should be available from cache. An accurate prefetching mechanism facilitates effective use of the expensive online cache area. For that, however, close interaction of PACS, RIS, and KIS is an indispensable prerequisite.

[Digital teaching archive. Concept, implementation, and experiences in a university setting]

Film-based teaching files require a substantial investment in human, logistic, and financial resources. The combination of computer and network technology facilitates the workflow integration of distributing radiologic teaching cases within an institution (intranet) or via the World Wide Web (Internet). A digital teaching file (DTF) should include the following basic functions: image import from different sources and of different formats, editing of imported images, uniform case classification, quality control (peer review), a controlled access of different user groups (in-house and external), and an efficient retrieval strategy. The portable network graphics image format (PNG) is especially suitable for DTFs because of several features: pixel support, 2D-interlacing, gamma correction, and lossless compression. The American College of Radiology (ACR) "Index for Radiological Diagnoses" is hierarchically organized and thus an ideal classification system for a DTF. Computer-based training (CBT) in radiology is described in numerous publications, from supplementing traditional learning methods to certified education via the Internet. Attractiveness of a CBT application can be increased by integration of graphical and interactive elements but makes workflow integration of daily case input more difficult. Our DTF was built with established Internet instruments and integrated into a heterogeneous PACS/RIS environment. It facilitates a quick transfer (DICOM_Send) of selected images at the time of interpretation to the DTF and access to the DTF application at any time anywhere within the university hospital intranet employing a standard web browser. A DTF is a small but important building block in an institutional strategy of knowledge management.

Initial Clinical Results with a New Needle Screen Storage Phosphor System in Chest Radiograms

PURPOSE

To evaluate image quality and anatomical detail depiction in dose-reduced digital plain chest radiograms using a new needle screen storage phosphor (NIP) in comparison to full dose conventional powder screen storage phosphor (PIP) images.

MATERIALS AND METHODS

24 supine chest radiograms were obtained with PIP at standard dose and compared to follow-up studies of the same patients obtained with NIP with dose reduced to 50 % of the PIP dose (all imaging systems: AGFA-Gevaert, Mortsel, Belgium). In both systems identical versions of post-processing software supplied by the manufacturer were used with matched parameters. Six independent readers blinded to both modality and dose evaluated the images for depiction and differentiation of defined anatomical regions (peripheral lung parenchyma, central lung parenchyma, hilum, heart, diaphragm, upper mediastinum, and bone). All NIP images were compared to the corresponding PIP images using a five-point scale (- 2, clearly inferior to + 2, clearly superior). Overall image quality was rated for each PIP and NIP image separately (1, not usable to 5, excellent).

RESULTS

PIP and dose reduced NIP images were rated equivalent. Mean image noise impression was only slightly higher on NIP images. Mean image quality for NIP showed no significant differences (p > 0.05, Mann-Whitney U test).

CONCLUSION

With the use of the new needle structured storage phosphors in chest radiography, dose reduction of up to 50 % is possible without detracting from image quality or detail depiction. Especially in patients with multiple follow-up studies the overall dose can be decreased significantly.

[Possibilities for workflow optimization in radiology departments beyond RIS and PACS]

Technological progress and the rising cost pressure on the healthcare system have led to a drastic change in the work environment of radiologists today. The pervasive demand for workflow optimization and increased efficiency of its activities raises the question of whether by employment of electronic systems, such as RIS and PACS, the potentials of digital technology are sufficiently used to fulfil this demand. This report describes the tasks and structures in radiology departments, which so far are only insufficiently supported by commercially available electronic systems but are nevertheless substantial. We developed and employed a web-based, integrated workplace system, which simplifies many daily tasks of departmental organization and administration apart from well-established tasks of documentation. Furthermore, we analyzed the effects exerted on departmental workflow by employment of this system for 3 years.