Postoperative imaging of the internal auditory canal : Visualization of active auditory implants

BACKGROUND

Assessment of the internal auditory canal (IAC) and cochlea is of central importance in neurotology. The artefacts and visibility of active auditory implants on magnetic resonance imaging (MRI) vary because of their specific magnetic components. Knowledge of the size of MRI artefacts and the options for handling them is important for the auditory rehabilitation of specific diseases (e. g., vestibular schwannoma).

METHODS

The current article is a literature review.

RESULTS

MRI assessment of the IAC and cochlea after surgical placement of an active auditory implant is feasible only with a percutaneous bone-anchored hearing aid (BAHA, Ponto). When specific factors (implant position and MRI sequence) are taken into consideration, these structures can be visualized even after cochlear implantation. Complications such as magnet dislocation and pain may occur.

CONCLUSION

The possibility of assessing the IAC and cochlea by MRI is an important aspect that needs to be taken into consideration when planning the auditory rehabilitation of patients after acoustic neuroma surgery.

Validierung anamnestischer Angaben und ausgewählter klinischer Befunde im Hinblick auf Endokarditis beim Rind

Gegenstand und Ziel: Ziel dieser retrospektiven Arbeit war die Prüfung der diagnostischen Validität verschiedener anamnestischer Angaben und klinischer Befunde im Hinblick auf Endokarditis (EK). Material und Methoden: Zur Auswertung gelangten 958 Klinikkarten der Patienten der Klinik für Wiederkäuer aus den Jahren 1997–2004. Die Tiere wurden aufgrund ihres Herzbefundes, der sich aus der klinischen Untersuchung ergab (Herzgeräusch oder kein Herzgeräusch) und aufgrund des Sektionsbefundes (EK oder keine EK) in vier Gruppen eingeteilt. Ergebnisse: Zwischen den an EK erkrankten und nicht erkrankten Tieren bestanden signifikante Unterschiede hinsichtlich Ernährungszustand, Verhalten, Jugularvenen- und Herzbefunden. Außerdem litten EK-Patienten häufiger an Gliedmaßenproblemen. Schlussfolgerung und klinische Relevanz: Aus dem Vorbericht, den Ergebnissen der klinischen Untersuchung sowie den hämatologischen und klinisch-chemischen Befunden lässt sich der Verdacht auf eine Endokarditis zwar erhärten, aber die Sicherung der Diagnose ist nach wie vor in vielen Fällen der pathologischen Untersuchung vorbehalten.

Existence of bovine neonatal pancytopenia before the year 2005? Retrospective evaluation of 215 cases of haemorrhagic diathesis in cattle

Haemorrhagic diathesis (HD) in cattle is a relatively rare syndrome that can have many different causes. With the occurrence of bovine neonatal pancytopenia (BNP) in 2007, the number of cases of HD in cattle has increased. This led to an enhanced interest in diseases presenting with bleeding disorders. The possible causes of HD in cattle, the clinical findings, and the course of various diseases are described and evaluated. Furthermore, we determined whether cases of BNP occurred before the introduction of the vaccine Pregsure BVD since its widespread use was associated with the syndrome. Records of 215 cases of HD in cattle that had been referred to the Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig Maximilian University, Munich, between 1982 and 2014 were evaluated. The two most commonly diagnosed diseases were BNP (n = 95) and septicaemia (n = 35), with fatality rates of 82% and 66%, respectively. In 27 (13%) cases, no clear cause for the HD could be designated. Statistically significant differences were found with regard to the course of the various disorders and the clinical findings. A receiver operating characteristic analysis of thrombocyte counts of affected animals at the time of arrival at the clinic did not provide any predictive information on disease outcome. Two cases of HD occurred before the introduction of Pregsure BVD (1989, 1991). In both cases, clinical, haematological, and pathological findings were identical to BNP. The cause of HD in these two cases could not be determined retrospectively.

[High incidence of jaundice in young calves in Southern Germany]

OBJECTIVE

Between September, 2010, and August, 2011, a series of cases of jaundice of unknown origin in young calves was detected in a number of farms in Southern Germany. This paper describes the syndrome on the basis of 57 cases, and the approach taken to discover the cause.

MATERIAL AND METHODS

The clinical course of the disease is described in 19 patients. Using a case definition (calves aged 1-3 weeks, total serum bilirubin > 20 µmol/l and/or serum glutamate dehydrogenase [GLDH] activity >50U/l and/or autopsy findings with striking liver pathology [jaundice, liver dystrophy, cirrhosis]), 36 farms were included in an epidemiological survey. In a feeding trial, two batches of a dietary supplement feed, previously used in diseased calves on farms, were fed at the dosage recommendations of the manufacturer to four clinically healthy calves over 5days. Four other calves served as controls. The calves were clinically monitored daily, and blood samples were investigated using clinical chemistry and haematology.

RESULTS

Clinical examination revealed behavioural alterations (weakness, tonic-clonic seizures and bawling just before death), recumbency, jaundice and discolouration of faeces. In less severe cases without clinical signs, there was an increase in serum bilirubin concentration and/or GLDH activity. In the epidemiological survey of affected farms, the feeding of a diet supplement feed was registered in 54 of 57 cases. The feeding of two batches of that diet supplement feed to four clinically healthy calves resulted in a significant (p<0.05) increase in bilirubin and lactate concentrations, as well as the GLDH activity in serum, but without serious impairment of the general condition, whereas in control calves, no comparable changes were observed.

CONCLUSION

The results of the epidemiological survey and the feeding trial suggest a causal involvement of a dietary supplement feed. The toxic principle is unknown.

CLINICAL RELEVANCE

Knowledge of the clinical picture and the probable feed-related context is important to detect this disease early. The suspected dietary supplement feed has been taken off the market, but with other products similar problems may arise.

Häufung von Ikterus bei jungen Kälbern in Süddeutschland

Gegenstand: Zwischen September 2010 und August 2011 traten in süddeutschen Rinderbetrieben mehrere Fälle unklarer Hepatopathien bei jungen Kälbern auf. Beschrieben werden die Kasuistik von 57 Fällen und der beschrittene Weg zur Ursachenklärung. Material und Methoden: Der klinische Verlauf der Erkrankung wird anhand von 19 Patienten dargestellt. Eine epidemiologische Erhebung nach Falldefinition (Alter der Tiere 1–3 Wochen, Gesamtbilirubinkonzentration > 20 μmol/l und/oder Glutamatdehydrogenase-[GLDH-]Aktivität > 50 U/l und/oder auffälliger Leberbefund [Ikterus, Leberdystrophie, Leberzirrhose] in der Sektion) umfasste 36 Betriebe. In einem Fütterungsversuch wurden zwei Chargen eines zuvor in betroffenen Betrieben eingesetzten Diätergänzungsfuttermittels nach Herstellerangabe an vier klinisch gesunde Kälber über 5 Tage verfüttert. Vier weitere Kälber dienten als Kontrollen. Täglich erfolgte eine klinische, klinisch-chemische und hämatologische Untersuchung. Ergebnisse: Bei klinisch manifester Erkrankung treten Verhaltensauffälligkeiten (Mattigkeit, tonisch-klonische Krämpfe, Klagen kurz vor dem Verenden), Festliegen, Ikterus und auffällig heller Kot auf. In weniger stark ausgeprägten Fällen ohne klinische Symptomatik bestehen eine erhöhte Serum-Bilirubinkonzentration und/oder GLDH-Aktivität. Die Befragung in betroffenen Betrieben ergab in 54 von 57 Fällen als Gemeinsamkeit den Einsatz eines Diätergänzungsfuttermittels. Im Fütterungsversuch zeigten Versuchskälber eine signifikante (p < 0,05) Erhöhung von Bilirubin- und L-Laktat-Konzentration sowie GLDH-Aktivität im Serum ohne schwerwiegende Beeinträchtigung des Allgemeinbefindens. Bei den Kontrolltieren fehlten vergleichbare Veränderungen. Schlussfolgerung: Epidemiologische Erhebung und Fütterungsversuch deuten auf eine ursächliche Beteiligung eines Diätergänzungsfuttermittels hin. Das toxische Prinzip ist bisher unbekannt. Klinische Relevanz: Die Kenntnis des klinischen Bildes und der vermutlich fütterungsbedingten Zusammenhänge ist wichtig, um die Krankheit rechtzeitig zu erkennen. Das Diätergänzungsfuttermittel wurde vom Markt genommen, doch könnte die Verfütterung vergleichbar zusammen gesetzter Produkte ähnliche Krankheitserscheinungen hervorrufen.

[Cochlear implants in isolated temporal bones: evaluation of electrode position with 64-slice computed tomography]

BACKGROUND

For the functional outcome after cochlear implant surgery, the electrode position is of essential importance. Therefore, radiological techniques to localize the electrode within the cochlea are becoming increasingly important. In our study, we used multi-slice computed tomography (CT) to find radiological criteria to allocate the electrode within the cochlea.

METHODS

Ten Nucleus 24 RCA electrodes were implanted into isolated human temporal bones using an extended cochleostomy and the Advance Off-Stylet technique. Five electrodes were implanted into the scala tympani and five into the scala vestibuli. After implantation, the temporal bones were blinded to the radiologist, and 64-slice CT scans were performed and analysed.

RESULTS AND CONCLUSIONS

In all 10 cases, the surgical positioning of the electrode was equal to the radiological analysis of the CT scans. Radiological criteria were found that permit correct identification of the electrode within the cochlea. We think that this technique is sufficient for most questions concerning quality control and is widely available.

Application of the glutaraldehyde test in cattle

In a cohort study involving 62 cows from an experimental farm, the kinetics of the glutaraldehyde test (GAT) according to Sandholm (1974) was examined by testing samples of EDTA blood, lithium heparinate blood, serum, and plasma taken at various intervals. Total protein was measured in serum, and fibrinogen was determined in plasma. Gamma globulin was measured by electrophoresis. All glutaraldehyde tests were performed in duplicates, and the relation of the two results was used as measurement of precision. Optimal cut-off of the GAT time was determined as the zenith of the sum of sensitivity and specificity of various intervals for detecting combinations of gamma globulin and fibrinogen levels above 32 g/l. Precision was the best in EDTA blood. The relation between coagulation time and gamma globulin plus fibrinogen is best described by an exponential curve. The maximum value for the sum of sensitivity and specificity was found at 7 and 8 min. Seven days was the shortest interval observed between a negative test result (>15 min) and a strongly positive test result (<3 min). Twenty-one days was the shortest interval observed between a strongly positive test result and a negative test result. EDTA blood should be used for the GAT. A cut-off of 8 min yields the highest efficiency. Test results must be viewed in light of clinical findings.

[Idiopathic normal-pressure hydrocephalus. Flow measurement of cerebrospinal fluid using phase contrast MRI and its diagnostics importance]

AIM

The measurement of CSF flow in the aqueduct has been a focus of interest since the development of MR imaging (MRI) techniques for this purpose in diagnosing idiopathic normal-pressure hydrocephalus (iNPH).The purpose of this prospective study was to determine the ability of this diagnostic tool to replace invasive methods in establishing the diagnosis of iNPH.

PATIENTS AND METHODS

Between January 2003 and April 2005, 61 patients with the Hakim triad of clinical symptoms and dilated ventricular systems underwent the intrathecal infusion test, cerebrospinal tap test, and phase-contrast MRI to measure CSF flow rate in the aqueduct. Shunted patients were controlled 12 months postoperatively. Pre- and postoperative clinical symptoms were evaluated with the Kiefer score. Outcome was calculated according to the NPH recovery rate.

RESULTS

According to these criteria the patients were classified into groups of 41 with iNPH and 20 with brain atrophy. Of the iNPH patients, 39 were shunted and two did not agree to surgery. The mean Kiefer score of the shunted patients was statistically significantly lower after surgery. The aqueductal CSF flow rate of these patients was statistically analyzed and showed that a flow rate of more than 24.5 ml/min is 95% specific to iNPH.

CONCLUSIONS

Measurement of the CSF flow rate in the aqueduct using phase-contrast MRI is a highly specific preselective method for diagnosing iNPH.

[The aetiology of generalized alopecia in young calves]

The objective of this study was to test for correlations between alopecia and ruminal drinking in young calves. 331 calves up to an age of 31 days were tested for evidence of generalized hair loss daily during their stay in the clinic. Incidence of diarrhoea and the results of ruminal fluid and blood analysis were compared between the groups with and without alopecia. Calves with alopecia showed a significantly higher incidence of diarrhoea and of ruminal acidosis persisting for at least 24 hours. Blood analysis revealed significant differences in degree of acidosis, in concentrations of D-lactate, urea, and creatinine in serum as well as in the activities of glutathione peroxidase, aspartate amino transferase, and creatine kinase. Alopecia in calves is correlated to longer periods of diseases, which are known to be accompanied by the production of D-lactate in the gastrointestinal tract, such as diarrhoea and ruminal drinking. The question, whether alopecia is due to formation of toxic substances or to deficiency of essential substances can not be answered.

Der angeborene Sehnenstelzfuß beim Kalb

Gegenstand und Ziel: Einleitend werden die sehr unterschiedlichen Überlegungen in der Literatur zur Ätiologie des angeborenen Sehnenstelzfußes (NMDC) des Kalbes beschrieben und diskutiert. In einer Feldstudie sollten die Inzidenz in landwirtschaftlichen Betrieben, Zusammenhänge mit dem Geburtsverlauf und die weitere Entwicklung betroffener Kälber untersucht werden. Material und Methoden: Innerhalb von 12 Monaten wurden ca. 70% aller neugeborenen Kälber aus 65 Betrieben (n = 1238) zwischen erstem und drittem Lebenstag hinsichtlich des Vorliegens einer NMDC untersucht. Kälber mit NMDC wurden wöchentlich kontrolliert, bis die Symptomatik verschwunden oder der Proband einer weiteren Untersuchung nicht mehr zugänglich war. Angaben über den Geburtsverlauf wurden erfragt. Ergebnisse: Bei 13,6% (n = 168) der untersuchten Kälber ließ sich eine NMDC feststellen (Grad I: 88,7%; Grad II: 11,3%; Grad III: 0%). In 90,5% der Fälle bestand die NMDC nur an den Vordergliedmaßen, bei 7,7% an Vorder- und Hintergliedmaßen und bei 1,8% nur an den Hintergliedmaßen. Männliche Tiere waren signifikant häufiger betroffen als weibliche und Kälber aus Zwillingsträchtigkeiten signifikant häufiger als Einlinge. In Hinterendlage geborene Kälber hatten signifikant häufiger eine NMDC als in Vorderendlage geborene. Schlussfolgerungen: Die Resultate sind mit der Vorstellung vereinbar, dass die Raumverhältnisse im Uterus bei der Entstehung der NMDC eine Rolle spielen. Bei knapp 90% der Tiere verschwand die Beugesehnenverkürzung ohne tierärztliche Behandlung. Klinische Relevanz: Die notwendigen Therapiemaßnahmen orientieren sich am Grad der NMDC. Geringgradige Verkrümmungen bedürfen keiner speziellen Behandlung. Die Therapieoptionen bei mittelgradig ausgeprägter NMDC (Aufkleben vorne überstehender Holzbrettchen auf die Klauensohlen, Stützverbände mit/ohne Tenotomie der Beugesehnen) werden detailliert beschrieben. Durch die Gabe von Oxytetracyclin (60 mg/kg KM, n = 10) ließ sich der Verlauf der NMDC nicht nachweislich beeinflussen.

Neurotological and neuroanatomical changes in the connexin-26-related HID/KID syndrome

The phenotype of the HID (hystrix-like ichthyosis, deafness)/KID (keratitis, ichthyosis, deafness) syndrome is primarily characterized by skin changes. However, the connexin 26 (Cx 26) autosomal dominant mutation underlying this syndrome is of special neurotological interest. In the present paper, the clinical pattern, audiovestibular and neuroimaging findings and the detailed genetic analysis of 4 patients with identical HID/KID-associated mutation D50N of Cx 26 are reported. The audiological test results demonstrated profound sensorineural hearing loss in all of the patients. Neurotological testing revealed inconsistent abnormalities in dynamic posturography (sensory organization test), but the vestibular ocular reflex upon caloric irrigation was normal in all patients. Vestibular-evoked myogenic potential testing for otolith function (saccule) showed a regular response in 1 patient and pathologic responses in 3 patients, while subjective haptic vertical (utricular function) testing was normal in all of the patients. CCT showed an extended (in length), but very thin (in diameter) bony lining between the basal portion of the internal auditory canal and the vestibule in the 3 scanned patients. Our study provides evidence for functionally intact semicircular canals and normal utricular function in subjects with the autosomal dominant D50N mutation of Cx 26, in contrast to saccular function which was generally compromised and hearing loss which was profound.

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

BACKGROUND

Ultrasonography is regarded as the tool of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Although its sensitivity is too low for definite exclusion of abdominal organ injury, proponents of ultrasound argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of computed tomography scans and cut costs.

OBJECTIVES

To assess the efficiency and effectiveness of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, CENTRAL, CCMED, publishers' databases, controlled trials registers and the Internet. Bibliographies of identified articles and congress abstracts were handsearched. Trials were obtained from the Cochrane Injuries Group's trials register. Authors were contacted for further information and individual patient data.

PARTICIPANTS

patients with blunt torso, abdominal or multiple trauma undergoing diagnostic investigations for abdominal organ injury.

INTERVENTIONS

diagnostic algorithms comprising emergency ultrasonography (US).

CONTROLS

diagnostic algorithms without US ultrasound examinations (e.g. primary computed tomography [CT] or diagnostic peritoneal lavage [DPL]).

OUTCOME MEASURES

mortality, use of CT and DPL, cost-effectiveness, laparotomy and negative laparotomy rates, delayed diagnoses, and quality of life.

STUDIES

randomised controlled trials (RCTs) and quasi-randomised trials (qRCTs).

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected trials for inclusion, assessed methodological quality and extracted data. Where possible, data were pooled and relative risks (RRs), risk differences (RDs) and weighted mean differences, each with 95% confidence intervals (CIs), were calculated by fixed- or random-effects modelling, as appropriate.

MAIN RESULTS

We identified two RCTs with US in the experimental arm and another with US in the control group. We also considered two qRCTs. Overall, trials were of moderate methodological quality. Few authors responded to our written inquiries seeking to resolve controversial issues and to obtain individual patient data. We were able to pool data from two trials comprising 1037 patients for primary endpoint analysis (i.e. mortality). The relative risk in favour of the no-US arm was 1.4 (95% CI 0.94 to 2.08). Because of a lack of details, the meaning of this observation remains unclear. There was a marginal benefit with US-based pathways in reducing CT scans (random-effects RD -0.46; 95% CI -1.00 to 0.13), offset by trials of higher methodological rigour. No differences were observed in DPL and laparotomy rates.

AUTHORS' CONCLUSIONS

There is insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

[Emergency ultrasound for blunt abdominal trauma--meta-analysis update 2003]

Emergency ultrasound has established itself as a key procedure of primary diagnostic work-up for blunt abdominal and multiple trauma. However, in a systematic review published in 2001 ultrasonography turned out to provide an unexpectedly low sensitivity. We conducted an update of this analysis to investigate if test characteristics will be maintained including recent studies. Prospective trials published between January 1957 and January 2003 were identified using the Medline/Oldmedline, Embase and Cochrane Controlled Trials Register databases. The searching strategy comprised a manual search as well as a search along the world-wide web. Qualitative rating was carried out by two investigators using criteria proposed by the Centre for Evidence-Based Medicine, Oxford. We investigated a composite endpoint (i. e., free fluid and/or organ laceration) as well as the single criteria organ injury and free intraabdominal fluid collections. After calculation of two-by-two-tables, Summary Receiver Operating Characteristics (SROC) and Q* values were determined together with their 95% confidence intervals. The Q* value was proposed as the point of intersection where sensitivity equals specificity. In addition, a random effects model was employed to compute common positive and negative likelihood ratios (LR). By assessing the title and/or abstract, 349 of 957 papers contained potentially valid information for the purpose of this review. A total of 67 studies were deemed eligible, nine of which had to be excluded from meta-analysis because of dual publication. This left 58 trials allocating 16,361 subjects for statistical analysis. Despite a trend towards improved study designs observed during the past decade, the included trials were of average methodological quality. Two-thirds of all investigations fulfilled two or less of the six possible quality criteria. The diagnostic reference standard was applied independently in only 40% of all protocols. With regard to the composite endpoint and the sonographic depiction of free fluid, the Q* value was estimated at 0.91, whereas Q* equaled 0.90 for the detection of organ injury. Q* values subsequently decreased with improving study quality and fell clearly below 0.80 in methodologically proper studies. Accounting for a negative LR of 0.23 (composite endpoint) and an assumed prevalence of 35% of intraabdominal injury, a post-test probability of 11% will remain in case of a negative sonogram. In pediatric trauma, ultrasound showed even worse test characteristics (negative LR = 0.43). Thus, in case of a 35% prevalence, the post-test probability has to estimated at 19%. Emergency ultrasound provides high specificity but insufficient sensitivity to reliably rule out intraabdominal injury.

d-Lactic Acidosis in Calves as a Consequence of Experimentally Induced Ruminal Acidosis

In order to test the hypothesis that ruminal drinking in calves can lead to D-lactic metabolic acidosis, ruminal acidosis was induced in nine calves by intraruminal application of untreated whole milk via a stomach tube. The amount of the daily force-fed liquid was 3 x 1 l. The experimental design called for an end of intraruminal applications if two or more of the following signs were observed: severe depression, estimated degree of dehydration >10%, absence of sucking reflex, lack of appetite for two consecutive feedings, severe metabolic acidosis with calculated Actual Base Excess (ABE) <-15 mmol/l. The procedure was scheduled to be discontinued on the 17th day of experiment. The onset of ruminal acidification occurred rapidly, and mean pH value fell from 6.70 (+/-0.48) to 4.90 (+/-0.38) after the first application. The following days the pH values varied between 4 and 5. Rumen acidity was characterized biochemically by a significant increase in both isomers of lactic acid. The effects of the intraruminal administration on the calves were detrimental; eight of nine calves showed an acute disease process. According to the pre-established clinical standard, seven of nine calves were removed from the intraruminal feeding schedule. All but one of the calves developed severe systemic acidosis. The increase in anion gap demonstrated the net acid load. In all the calves D-lactate levels were found to show a significant and rapid increase. On the contrary, L-lactate never deviated from physiological levels. These observations confirm that, in young calves as in adult cattle, ruminal acidosis may lead to a clinically manifested D-lactic metabolic acidosis.

[Diagnostic efficacy of gadodiamide-enhanced dynamic examination technique in comparison to conventional magnet resonance tomography in exacerbated chronic osteomyelitis]

PURPOSE

To evaluate the diagnostic effectiveness of dynamic gadodiamide-enhanced MRI in discriminating reparative tissue formation from florid inflammation in patients with chronic osteomyelitis.

MATERIALS AND METHODS

Subjects with chronic osteomyelitis and clinically suspected exacerbation were consecutively enrolled into a prospective trial. Following conventional contrast-enhanced MRI scanning, a dynamic contrast-enhanced SE sequence was carried out in all patients (acquisition interval 58 s, 11 repetitions with a total acquisition time of 11 minutes). The relative increase of the time-dependent signal intensity was assessed in representative circular regions of interest placed over bone marrow and surrounding soft tissues. As diagnostic reference standard, histologic and intraoperative findings were obtained independently from the result of the index test. The MRI studies were evaluated by two radiologists who were blinded to the findings of the reference test.

RESULTS

30 of 51 patients were subsequently scheduled for surgery (mean age 42.6 +/- 12.7 years, 27 males). 19 cases had a florid granulocytic infection, with 6 cases showing histologic signs of putrid liquefaction. Another 11 patients had chronic-granulating, fibrosing osteomyelitis. The course of the signal-time curves differed significantly between the different pathologic processes (multiple measures ANOVA, p < 0,001) in both bone marrow and soft tissue. The areas under the receiver operating characteristics (ROC) curves of the dynamic sequence as a performance measure to distinguish between acute and chronic infection were 0.73 (95 % confidence interval 0.41 - 1.00) and 0.82 (95 % confidence interval 0.59 - 1.00), respectively. Although no overall difference was found in diagnostic efficacy between conventional and dynamic MRI, the dynamic technique provided important additional information for equivocal conventional results.

CONCLUSION

Dynamic contrast-enhanced MRI scanning is a safe and potentially valuable tool to discriminate between florid and chronic inflammation in documented osteomyelitis.

Evaluation of the Merlin, Micronaut system for automated antimicrobial susceptibility testing of Pseudomonas aeruginosa and Burkholderia species isolated from cystic fibrosis patients

Since accurate antimicrobial susceptibility testing of bacterial cystic fibrosis isolates is known to be problematic and an optimal in vitro testing method has not yet been evaluated, the study presented here was conducted to compare the performance of the reference agar dilution method and broth microdilution with a commercially available automated susceptibility test system (Merlin; Micronaut, Germany). In this pilot study, the susceptibility of 70 clinical strains of Pseudomonas aeruginosa and Burkholderia cepacia-like organisms to nine antimicrobial agents was tested using these methods. Susceptibility results generated by broth microdilution (both automated and according to the National Committee for Clinical Laboratory Standards recommendations) were demonstrated to be of good reproducibility, and they compared favourably to the time- and material-consuming standard agar dilution reference method, especially after a prolonged incubation time (48 h).

Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma

BACKGROUND

How precise and reliable is ultrasonography as a primary tool for injury assessment in blunt abdominal trauma?

METHODS

A systematic review and meta-analysis were conducted of prospective clinical trials of ultrasonography for blunt abdominal trauma. Publications were retrieved by structured searching among databases, review articles and major text books. Authors and experts in the field were contacted for original and unpublished data. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using weighted and robust regression models, with Q* denoting the shoulder of the curve. Post-test probabilities were calculated as a function of pooled likelihood ratios (LRs).

RESULTS

Thirty of 123 trials enrolling 9047 patients were eligible for final analysis. With respect to targeting organ lesions, ultrasonography showed a summary Q* value of 0.91 (inverse variance weights, 95 per cent confidence interval (c.i.) 0.76-1.07); negative predictive values ranged from 0.72 to 0.99. A similar SROC slope was calculated for screening for free fluid (Q* = 0.89 (95 per cent c.i. 0.73-1.05)). Ultrasonography detects the presence of organ lesions, but fails to exclude abdominal injuries (random effects negative LR 0.23 (95 per cent c.i. 0.18-0.28)). Given a pretest probability of 50 per cent for blunt abdominal injury, a post-test probability of nearly 25 per cent remains in the case of a negative sonogram.

CONCLUSION

Despite its high specificity, ultrasonography has an unexpectedly low sensitivity for the detection of both free fluid and organ lesions. In clinically suspected abdominal trauma, another assessment (e.g. helical computed tomography) must be performed regardless of the initial ultrasonographic findings.

[Systemic effects of ruminal acidosis following ruminal drinking in dairy calves. A retrospective analysis of 293 cases]

In a retrospective study the data of 293 young calves (age upon admission less than four weeks) with evidence of ruminal drinking (rumen pH < 6.0) were analyzed for possible associations between ruminal acidosis and various parameters of systemic acid-base metabolism (blood pH, blood levels of HCO3- and L-lactate, as well as anion gap). On the basis of the degree of ruminal acidosis (pH < 5.0/ > or = 5.0) and evidence of diarrhea, the animals were assigned to one of four groups. The results indicate that severe ruminal acidosis leads to disturbances of systemic acid-base metabolism in young calves, too. With additional diarrhea, those disturbances can be complex.

[Investigations on the development of hyponatremia in older calves with diarrhea]

The study involved 50 hospitalized calves (four weeks to five months old) suffering from diarrhoea and hyponatraemia (blood sodium concentration below 130 mmol/l). Starting from the day of admission blood, urine, and faecal samples were taken each morning and sodium and potassium concentrations were measured. In addition, blood and urine samples were taken in the evenings, if electrolytes had been given orally during the day. The obtained values from urine samples were compared with the plasma concentrations in order to check for inadequate renal excretion of electrolytes. Consistency of the faeces and visible blood admixture were the main criteria in the evaluation of electrolyte concentration in the 317 samples of faecal water. With one exception no inadequate renal losses of sodium were observed. Sodium and potassium concentrations in faecal water showed a distinct negative correlation. As the consistency of faeces grew increasingly normal, electrolyte contents of faeces approached those reported for adult cattle, i.e. potassium levels rose and sodium levels decreased. Visible blood admixtures had no significant effect on the sodium and potassium concentrations in the faeces. A distinct relationship between electrolyte contents in faecal water and the consistency of the faeces was found. There were highly significant differences in electrolyte concentrations between faeces of watery (Na: 82 +/- 21 mmol/l; K: 23 +/- 12 mmol/l) and soupy (Na: 54 +/- 26 mmol/l; K: 42 +/- 19 mmol/l) consistency (mean +/- standard deviation). By contrast, soupy and pulpy faeces just showed a slight or no difference in electrolyte concentrations. Only faeces of watery consistency contained approximately as much sodium as observed in neonatal calf diarrhoea. These results show that the pronounced hyponatraemia in older calves can hardly be attributed to loss of sodium via faeces and urine. The following possible causes are proposed: (a) older calves usually have access to water (therefore there is more gradual dehydration or no dehydration at all); (b) oral electrolyte solutions are seldom administered.

[Abomasal ulcers in calves: clinical investigations and experiences]

Observations and experiences as well as results of clinical investigations in 364 calves with clinically apparent abomasal ulcers (bleeding 28, deep 37, perforating 299) are communicated. The anamnestic data, evaluated systematically, allow to conclude, that influences of the feeding regime, in particular faults during the early weaning period, play an important role in the multifactorial etiology. Furthermore, symptoms, diagnosis and differential diagnosis as well as treatment and prevention are described. The various localizations (and ways) of perforating abomasal ulcers are demonstrated by schematic representations and by the respective findings at operation or at necropsy.

[Enzootic otitis in a herd of calves]

Following an outbreak of enzootic bronchopneumonia, 15 out of 19 calves of one herd were affected by uni- or bilateral otitis media. The animals (aged four days to nine weeks) were housed in individual boxes. Type and distribution of concurrent diseases as well as the symptoms indicative of otitis are listed in two tables; two other tables give the results of the bacteriological examinations of aural and nasal swabs taken before and during treatment. In order to cure otitis media, systemic as well as simultaneous local treatments are necessary. The application of oily suspensions of antibiotics into the auditory canal cannot be recommended. Twelve of the 15 sick calves recovered.

[Rapid diagnosis of botulism in cattle using heated microcomplement fixation reactions]

Clostridium botulinum toxin, type C, could be demonstrated by means of temperature induced microcomplement fixation in blood serum and in aspirated rumen fluid of cattle suffering from botulism. The results were already available after seven hours. Botulinum toxin likewise could be identified from hair of a suspicious carcass. The investigations confirm the high sensitivity of this method.

Computer simulation of clinical irradiation schemes applied to in vitro tumor spheroids

In this contribution the attempt is made to study the effect of irradiation on in vitro tumor spheroids by computer simulation applying clinical treatment schedules. The starting point is a computer model stimulating the spatial (three-dimensional) growth of a tumor spheroid, developed by our group previously. In the present paper, this model is extended by creating a comfortable data input with a graphical interface. This expansion includes characteristic features of radiotherapy (sensitivity, repair capacity, reoxygenation, repopulation) and therapy schedules. In this way, it is possible to test different clinical irradiation schemes on in vitro tumor spheroids by computer experiments (standard and non-standard fractionations). In the long run the aim of our work is to optimize irradiation schedules by computer simulation prior to clinical therapy.