[Radiological management in emergency and trauma medicine].
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Austria↗
Biomedical subjects
F Kainberger
Publications and source records attributed to F Kainberger.
[Tendon overuse syndrome: imaging diagnosis].
Injuries of muscles and tendons occur commonly during various sporting activities and in most cases the athletes feel such an accident to be sudden and unavoidable. The rupture of a tendon, however, has to be considered in many cases as the final stage of a long-standing progressive degeneration of collagen fibers. This process can be described as "tendon overuse syndrome (TOS)". Diagnostic imaging modalities, especially sonography and MRI, are suitable to detect and analyse the different stages of this syndrome and the degree of morphological abnormalities. The first stage is painful functional derangement, followed by tendovaginitis, peritendinitis, or bursitis. The third stage is tendinosis resulting from biomechanical or ischaemic injury of tendon fibers which may eventually be followed by partial or complete rupture. Regional or individual specifications of these four stages may occur at anatomically predisposing sites, so-called critical zones, or during periods of specific proneness, the vulnerable phases.
Athletic Injuries↗
["Women's imaging": an integral diagnostic concept].
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Austria↗
[Radiologic imaging of degenerative and inflammatory joint diseases in women].
Pain in joints and other structures of the musculoskeletal system is a common complaint in women. It may occur as functional pain, in many cases as inflammatory episode of arthrosis or of metabolic joint disease, sometimes as early manifestation of rheumatoid disease. With conventional radiography, high-resolution sonography, and MR imaging it is possible to classify many of these clinical syndromes. A semiquantitative assessment of inflammatory activity can be made by analysing the degree of joint effusion, the thickness of the synovium and the extent of hypervascularisation.
Arthralgia↗
[Temporomandibular joint pain: radiological diagnosis].
Pain in the temporomandibular joint is often the result of internal derangement, other causes are traumatic, functional or inflammatory processes. Conventional radiography is indicated in case of suspected trauma or for specialised preoperative measurements to plan the treatment of various facial dysplasias. MRI and CT should be used in the context with the results of clinical investigation and of axiography to differentiate the various functional and morphological abnormalities of this joint.
Diagnosis, Differential↗
[The Internet as a communications medium in radiology].
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Communication↗
[The pharynx. The imaging of its normal anatomy].
BACKGROUND: The pharynx, being part of the digestive as well as the respiratory system, is embedded in the complex spatial anatomy of the neck and, due to its function and location, represents a very sophisticated region. DIAGNOSIS: Cross-sectional imaging with CT and MR imaging plays an indispensable complementary role to clinical work-up, as far as submucosal and deep cervical spaces are concerned. However, as dysphagia is a common symptom in clinical practice, interpretation of double contrast studies and videofluoroscopic investigations are also on frequent demand in the daily routine. CONCLUSION: Close interdisciplinary co-operation and the radiologist's familiarity with the anatomy of the region are required in order to use the diagnostic tools in an optimal fashion.
Cineradiography↗
[Radiologic quantification of joint changes. A methodological overview].
Osteoarthritis as well as rheumatoid arthritis lead to chronical progressive destruction of diseased joints. As aggressive new treatments need to be evaluated, plenty of (semi-) quantitative methods for the radiological joint evaluation had been developed. They lack sufficient reproducibility due to their low objectivity. Modern approaches of computer-assisted radiological quantification should increase the reproducibility and efficiency of radiological scoring. Automatically calculated, computer-assisted measurements of joint space, cartilage- and synovial volume, periarticular assessment of bone mineral density and quantitative analysis of the subchondral plate will have major impact on the radiological routine of the future.
Arthritis, Rheumatoid↗
Long-term home exercise program: effect in women at high risk of fracture.
OBJECTIVE: To determine whether a better outcome in terms of physical frailty could be achieved with a regular home exercise program in women at high risk of fracture. DESIGN: Prospective long-term observational study. SETTING: Outpatient clinic of physical medicine and rehabilitation. PARTICIPANTS: Women with a history of postmenopausal fractures and an age-adjusted low bone mass, as determined 7 to 12 years earlier. INTERVENTION: Home exercise program. OUTCOME MEASURES: Thirty-three women were followed. The exercise group and control group were compared with regard to fracture rates, episodes of falling, neuromuscular performance (one-leg stance, chair rise, body sway, tandem walk, tapping test), and bone mineral density (BMD). RESULTS: Twenty-five women with a mean age of 73.8+/-5.7 yrs appeared for the investigation. An exercise program had been prescribed in 19 women, and six served as controls. Seven women of the exercise group (36.8%) regularly performed the exercises. No differences between participants of the groups in terms of fracture rates, falling episodes, neuromuscular performance, and BMD were observed. CONCLUSION: It appears that a home exercise program does not affect the outcome of postmenopausal women at high risk of fracture.
Aged↗
Subchondral bone and cartilage disease: a rediscovered functional unit.
The role of subchondral bone in the pathogenesis of cartilage damage has likely been underestimated. Subchondral bone is not only an important shock absorber, but it may also be important for cartilage metabolism. Contrary to many drawings and published reports, the subchondral region is highly vascularized and vulnerable. Its terminal vessels have, in part, direct contact with the deepest hyaline cartilage layer. The perfusion of these vessels accounts for more than 50% of the glucose, oxygen, and water requirements of cartilage. Bony structure, local metabolism, hemodynamics, and vascularization of the subchondral region differ within a single joint and from one joint to another. Owing to these differences, repetitive, chronic overloading or perfusion abnormalities may result in no pathological reaction at all in one joint, while in another joint, these same conditions may lead to osteonecrosis, osteochondritis dissecans, or degenerative changes. According to this common etiological root, similar pathological reactions beginning with marrow edema and necrosis and followed by bone and cartilage fractures, joint deformity, and insufficient healing processes are found in osteonecrosis, osteochondritis dissecans, and degenerative disease as well.
Biomechanical Phenomena↗
Bone mineral density and biochemical parameters of bone metabolism in female patients with systemic lupus erythematosus.
OBJECTIVE: To evaluate bone mineral density and biochemical parameters of bone metabolism in ambulatory premenopausal female patients with systemic lupus erythematosus (SLE). METHODS: 30 women who fulfilled the ARA criteria for the classification of SLE were studied. Lumbar and femoral bone mineral density was determined by dual energy x ray absorptiometry. Various laboratory parameters including serum calcium, serum phosphorus, alkaline phosphatase, bone specific isoform of alkaline phophatase, propeptide of type 1 procollagen, deoxypyridinoline excretion, telopeptide of type 1 collagen, serum creatinine, osteocalcin, parathyroid hormone, 25-OH vitamin D, testosterone, progesterone, estradiol, follicle stimulating hormone and luteinotropic hormone were measured. RESULTS: According to the WHO criteria 39% of all patients with SLE studied had normal bone mineral density, 46% had osteopenia and 15% had osteoporosis at the lumbar spine; at the femoral neck 38.5% had normal bone mineral density, 38.5% had osteopenia and 23% suffered from osteoporosis. Significantly lower osteocalcin levels were found in SLE patients. All other bone resorption and formation markers measured were not statistically different, but higher serum albumin corrected calcium and lower phosphorus values were found in the SLE group. Of all sex hormones tested lower testosterone and higher follicle stimulating hormone concentrations were seen in patients with SLE. CONCLUSION: A high incidence was found of osteopenia and osteoporosis in premenopausal patients with SLE. Bone diminution in SLE seems to be attributable, at least in part, to decreased bone formation in SLE patients.
Adolescent↗
Ultrasound therapy for calcific tendinitis of the shoulder.
BACKGROUND AND METHODS: Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies. RESULTS: We enrolled 63 consecutive patients (70 shoulders). Fifty-four patients (61 shoulders) completed the study. There were 32 shoulders in the ultrasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in nine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent) in the ultrasound-treatment group and improved in 7 shoulders (23 percent), as compared with respective values of 2 (8 percent) and 3 (12 percent) in the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greater improvements in the quality of life than those who had received sham treatment; at nine months, the differences between the groups were no longer significant. CONCLUSIONS: In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement.
Calcinosis↗
Is there a diagnostic role for bone scanning of patients with a high pretest probability for metastatic renal cell carcinoma?
BACKGROUND: The utility of performing whole-body bone scintigraphy (BS) as part of a routine staging workup for patients with renal cell carcinoma (RCC) is currently being debated. This study investigated the diagnostic performance of BS in 36 patients with a high pretest probability for bone metastases due to abnormal laboratory tests, pain, or confirmed nonosseous metastases. METHODS: Planar whole-body BS was performed in all patients 3 hours after the intravenous injection of 555 MBq (15 mCi) of technetium-99m-3,3-diphosphono-1,2-propane dicarboxylic acid tetrasodium salt). RESULTS: In 14 of 36 patients, bone metastases could be confirmed either due to computed tomography or magnetic resonance imaging (n=11) or open site directed biopsy (n=3), respectively. The sensitivity ranged from 10% to 60%, depending on the applied visual threshold. The extent of the metastatic involvement was underestimated in all cases. No diagnostic pattern of tracer accumulation, clinical features, or laboratory tests was identified as enhancing the sensitivity for the detection of bone metastases in this population. CONCLUSIONS: The authors concluded that, even among preselected patients, BS has no diagnostic role in RCC and should therefore be omitted from the clinical workup.
Bone Neoplasms↗
[Rheumatic diseases of the ankle joint and tarsus].
Diseases of the hindfoot are associated with considerable functional impairment and therefore may hamper patients' movements during gait considerably. Because of biomechanical overload, articular structures, tendons and ligaments are prone to early degenerative changes during the course of rheumatic diseases as visible with plain film radiography, sonography (US), or magnetic resonance imaging (MRI). Findings may occur as arthritis of major joints or in the form of fibroostitis and bursitis of the os calcis. Despite the progressive course of rheumatic diseases and characteristic imaging findings, high variability of X-ray signs may occur. Plain film radiograms and high-resolution ultrasonography play a key role in imaging rheumatic diseases of the hindfoot. MRI supports imaging diagnosis in selected cases. The principal goals of diagnostic imaging are precise and reproducible documentation of morphologic abnormalities and differentiated analysis for planning proper conservative or surgical treatment.
Ankle↗
[Teleradiology in dentistry].
Teleradiology is a means of electronically transmitting radiographic patient images and consultative text. This offers a new way to communicate with other radiologists and transferring clinicians. Different applications of teleradiology, such as on-call services for emergency departments or rural regions, as well as expert consultation (second opinion) already have been realized. Especially in concern of dental radiography, analog (film-based) imaging gets progressively replaced by digital imaging. The combination with ultrafast data transfer offers an increasing efficacy in diagnosis and therapy, acceleration of communication and new means of quality assessment in patient care. Various applications of teleradiology concerning dental medicine are discussed.
Humans↗
The role of magnetic resonance imaging in routine decision making for meniscal surgery.
This clinical study evaluated factors affecting the decision for meniscal surgery in a patient population seen routinely at a trauma clinic. The study hypothesis was that patients who sustain a traumatic injury to the knee or have a long history of clinical symptoms are likelier to be operated on. We investigated 149 patients clinically and by magnetic resonance imaging (MRI). Group A (n = 62) underwent arthroscopic surgery and group B (n = 87) were treated conservatively. Multiple logistic regression analysis was used to examine correlations with regard to age, gender, injury pattern, period between the injury and first clinical examination, and MRI results. We found no significant difference between the two groups with regard to gender (P = 0.1), injury pattern (P = 0.44), or period between injury and first clinical examination (P = 0.5). Patients in group A were significantly older than those in group B (P = 0.044), and, as expected, MRI signal alterations were significantly higher in group A than in group B (P = 0.001). In acutely injured patients MRI helps to establish an accurate diagnosis, and in cases of positive MRI findings in a symptomatic patient, the surgeon should not wait 4-6 weeks but should immediately recommend surgery.
Acute Disease↗
Internet use in radiology: results of a nationwide survey.
PURPOSE: To determine the number of radiologists who currently have Internet access, their use patterns on the Internet for Radiology purposes, the web sites they would recommend, and the potential site access to the Internet that they would like to see in the future. In addition, this study analyzed the best way to find nationwide radiological sites and their content. MATERIALS AND METHODS: In a nationwide survey, 854 Austrian radiologist were asked to fill out and return a questionnaire about Internet access, current problems, current and future use, which web site they recommend, and about the use of e-mail. Next, the available nationwide radiological sites were searched with seven major search engines using 37 different keywords, as well as by category search, and by searching for links on the homepages of the radiological departments of all Universities of Austria. Then, the offered information of the founded pages was classified in categories. RESULTS: Of the 210 (24.6%) radiologists who returned the questionnaire, 154 (73%) had Internet access. Time expenditure was considered the main problem using the Internet. The Internet was used for literature research by 69% of the radiologists with Internet access, for e-mail by 60%, and for congress information by 57%. In future, 43% would like to read electronic journals more often and 39% would like to use the web more intensively for scientific congresses. At the present time, we found 17 radiological web sites in Austria. The most promising way to find these sites was to use the search engines Alta Vista and Hotbot. Fifteen (88%) sites offered information for patients, seven (41%) for radiologists, five (29%) for students, and four (24%) for researchers. SUMMARY: Many radiologists in Austria already have Internet access, although time expenditure was considered the main problem with Internet use. Survey responses showed a need for electronic journals. To our point of view, Universities and radiological societies are urged to publish journals electronically on the Web. Alta Vista and Hotbot were the best search engines for radiological sites in our setting, and a careful reading of the specific search engine's instructions is recommended. In our experience, Web pages with clear structure, small file size, precise HTML keyword editing, and page titles, facilitate more accurate discovery of specific sites. In addition, there seems to be a need for regular publication of reviewed radiological link collections and the establishment of standards for teleconsulting.
Austria↗