Radiological evaluation before and after treatment with an osseointegrated bone-anchor following major limb amputation-a guide for radiologists

Osseointegrated implants have been developed to allow direct skeletal fixation of a prosthesis as an alternative to traditional socket-fitted prostheses for patients who have suffered from a major limb amputation. The implants contribute to improvements in functional outcome and quality of life and radiological evaluation plays a crucial role in pre- and post-operative assessment. This article acts as a guide for radiologists who may be tasked with providing the radiological information required by surgeons and prosthetists. We also look at the radiological appearances of complications that may arise in patients treated with an osseointegrated implant. Plain X-rays are used to screen patients who wish to undergo treatment. Limb-length X-rays are then used to measure the length of any residual bone, and comparisons can be made with the normal side (if present). From this, decisions about the likely size of the implant and the need for further amputation can be made. CT scans enable accurate assessment of the medullary cavity and cortical thickness. Post-operatively, plain X-rays form the mainstay of the routine monitoring of the bone-implant interface. Potential complications include infection, aseptic loosening, mechanical fracture of the implant and periprosthetic fracture. Infection and aseptic loosening can be seen as a lucency at the bone-implant interface which (if left untreated) can lead to loss of the implant. Implant and periprosthetic fractures are radiographically obvious. Radiologists involved in the care of patients undergoing treatment with an osseointegrated implant should become familiar with the imaging requirements so they can contribute to optimal patient outcomes.

[Communicable disease control measures in group A streptococcal diseases at community facilities]

Considering the fact that various epidemiological situations in Public Health departments arise everyday life, many different proposals are made for Public Health and sanitary measures, e.g. throat culture, antibiotic treatment and, in particular, readmission to community institutions.

[Amebic liver abscess--diagnostic and therapeutic advances]

Liver abscess is the most frequent complication of intestinal disease caused by entamoeba histolytica. Noninvasive procedures are nowaday most important in establishing the diagnosis: sonography, scintigraphy and computer tomography (CT). Sonography is rather precise and should be used in the first place. Recently it became possible to demonstrate specific antigens to amoeba in the pus of the abscess or in liver biopsy material; this procedure has been proven to be dependable and fast in establishing a diagnosis. Serological methods like indirect hemagglutination tests usually show positive results in high titers. The clinical picture, serological and immunological diagnostic procedures as well as demonstration of intrahepatic defects by sonography and/or scintigraphy usually help to establish a diagnosis fastly; only in a few cases will it be necessary to do computer tomography additionally. Metronidazole, tinidazole and other nitroimidazoles have led to a considerable decrease of lethality, which used to be rather high before. Treatment of the intestinal disease caused by amoebae should not be forgotten. Cortisone is contraindicated.

[Chronic recurrent intestinal amebiasis in Israel (author's transl)]

Abdominal pain, nausea, flatulence and diarrhea are the main clinical symptoms in chronic amebiasis; diarrhea and constipation may alternate in many cases, whereas constipation alone does occur only rarely. These symptoms may persist over years, with long asymptomatic intervals. In most cases cysts of entameba histolytica can be demonstrated in the feces, accompanied rather often by dientameba fragilis in Israel. 835 carriers of entameba histolytica were found among our patients between 1968 and 1974. Patients exhibiting 3 of the above mentioned clinical symptoms and having entameba histolytica in the stools are defined to be suffering from chronic recurrent amebiasis; 371 (= 44%) of our patients could be classified in this group. In spite of the fact, that the number of cases of acute amebiasis and its complications in Israel has been reduced considerably in the past, chronic amebiasis continues to be a clinical and epidemiological problem, its incidence being scarcely diminished.

[Liver cirrhosis in Israel (author's transl)]

The incidence of death caused by cirrhosis of the liver has increased in Israel during the last 20 years as it has in other parts of the world; still the incidence is much lower than in most countries. Increasing alcoholism and higher rates of hepatitis probably play a role, however in many cases the cause of cirrhosis remains in the dark.

[Poliomyelitis epidemic in a district of Freiburg i. Br. in autumn 1975 (author's transl)]

In the autumn of 1975 five cases of poliomyelitis occurred within 6 weeks in German children of families of low socioeconomic class. They lived in two districts of Freiburg with close familial and occupational contacts. One child had been immunised against polio once orally several years ago and none of the others were immunised. The clinical course and results of investigations of the environment are reported. Included is the state of immunisation of 472 school beginners in Freiburg schools and the antibody levels of 284 children aged 1 to 10 years from Freiburg and the adjoining areas.