The first metatarsal bone under loading conditions: a finite element analysis.

An individual-based, three-dimensional finite element model of the first metatarsal (MT I) bone was created with fine CT. The three-dimensional model of the bone was fixed proximally at the metatarsocuneiform joint and load was applied on the metatarsal head. Loading conditions were simulated, including muscular forces as described for a normal metatarsophalangeal (MTP) joint during three typical phases of gait as the combination of the load in the contact areas of the sesamoid bones and the base of the proximal phalanx. The resultant strain and stress distributions within the loaded MT I were calculated and visualized with the MTP in different positions.

[Sonography of the lungs and pleura]. / Die Sonographie der Lunge und Pleura.

Diagnoses were made by ultrasound in 73 out of 80 cases with unclear thorax x-ray. One case was misinterpreted, no diagnoses were possible in 6 cases. Pleural effusion or opacities reaching the pleura are necessary to perform ultrasound examination. Sonographic findings in pleural or pulmonary changes are discussed and correlated with pathological anatomical findings. Additional information can be obtained by sonography in pleural lesions and in pulmonary lesions masked by pleural effusion. Atelectases can be differentiated from pneumonia, and tumours can be identified in peritumorous pneumonia or atelectases.

[Radiofrequency-thermoablation in malignant liver disease]. / Radiofrequenz-Thermoablation maligner Raumforderungen der Leber.

The clinical application of radiofrequency tumor ablation in primary liver tumors and metastatic liver disease is rapidly growing because this technique has proven to be simple, safe, and effective in first clinical studies. Most of the patients with malignant liver disease are not candidates for surgical resection due to localisation or comorbidity, so radiofrequency therapy offers a good alternative for inoperable patients. With this method, high frequency alternating current is delivered to tissue via a needle electrode, the produced heat leads to coagulation necrosis. The largest focus of necrosis that can be induced with the currently available systems is approximately 4 - 5 cm with a single application. The radiofrequency needle is usually placed with US or CT guidance. For follow up examinations CT and MRI can be used, they proved to be equally accurate in the assessment of treatment response.

[The value of barium double-contrast study in the aftercare of gastrectomy patients (Roux-Y)]. / Stellenwert der Barium-Doppelkontrast-Untersuchung in der Nachsorge von Gastrektomierten (Roux-Y).

We evaluated 32 patients who had undergone jejuno-oesophagostomy for gastric carcinoma. Double contrast radiography was performed 3 to 36 months after gastrectomy, 3 to 14 days prior to routine endoscopy. Endoscopy is superior to double contrast radiography in detecting tumour recurrence, particularly in small tumours, due to the possibility of biopsy. Double contrast radiography is excellent in demonstrating the afferent loop. We found a high number of jejuno-oesophageal reflux and very different small intestine transit times without correlation to clinical signs and symptoms.

[Hereditary onycho-osteo-arthrodysplasia (nail-patella syndrome) with progressive renal failure]. / Die hereditäre Onycho-Osteo-Arthrodysplasie (Nagel-Patella-Syndrom) mit progredientem Nierenversagen.

A case of a fully developed hereditary onycho-osteo-arthrodysplasia (nail-patella syndrome) is presented. The typical signs, such as the iliac horns or variations of the knees, cubitals and nails should be familiar to every radiologist. The associated nephropathy seems to be caused by typical changes in the glomerular basement membrane seen in electron microscopy. Asymptomatic proteinuria is found in about 60% of the cases, in 5.5-8% the disease leads to the necessity of haemodialysis because of renal insufficiency. Hence, early diagnosis is very important.

[Multiple cerebrovascular lesions as fatal late sequelae of syphilis]. / Multiple zerebrovaskuläre Läsionen als letale leutische Spätfolgen.

A previously healthy man, aged 33 years, suddenly developed a hemiparesis and right facial paresis, as well as anisocoria and motor aphasia, preceded by recurrent attacks of dizziness. On admission he was somnolent. A flow murmur was heard over both carotid arteries; the blood pressure was 160/80 mm Hg. Cerebral computed tomography demonstrated multiple hypodense areas in the area supplied by several cerebral arteries, and marked cerebral oedema. Angiography of the aortic arch and the supra-aortic branches showed an occlusion of the left common carotid artery and a stenosis of the brachiocephalic trunk. The cerebral oedema, caused by ischaemia, did not respond to treatment. The patient died on the fourth hospital day from brainstem "strangulation". At autopsy syphilitic mesaortitis with characteristic lymphoplasmacellular endangiitis of the vasa vasorum of the aortic arch was demonstrated as the cause of the "aortic arch syndrome". Serology confirmed the diagnosis of an untreated tertiary syphilis. (VDRL titre 1:256; TPHA reactive; IgM-SPHA titre 1:64). Although a very rare cause, a late stage of syphilis should be considered in the differential diagnosis of cerebrovascular lesions in youngish patients.

Magnetic resonance imaging of perianal fistulas: predictive value for Parks classification and identification of the internal opening.

OBJECTIVE: MRI has been reported to be valuable in the investigation of patients with fistula in ano. The aim of this study was to evaluate the results of preoperative magnetic resonance imaging (MRI) in such patients using a surface coil and to compare it with surgical findings. PATIENTS AND METHODS: In a prospective study, 28 patients (19 males, nine females, median age 39 years) with perianal fistula underwent preoperative MRI. Parks classification as well as the identification of an internal opening into the anal canal and/or rectum were compared with the surgical findings. RESULTS: Classification during surgery revealed five extrasphincteric, eight transsphincteric, seven suprasphincteric and eight intersphincteric fistulas. All patients with intersphincteric, suprasphincteric and transsphincteric fistulas were correctly classified by MRI. The comparison of MRI and surgical results revealed a concordance in 27 of 28 (96%) patients in terms of classification (κ 0.95, P < 0.01) and in 21 (75%) patients regarding the identification of the internal opening (sensitivity 63%, specificity 92%). CONCLUSION: Our results indicate that MRI of perianal fistulas with the use of extra-anal surface coils can accurately assess the surgical anatomy. It is a rapid, well-tolerated technique which might play an important role in the management of perianal fistula.

Arterial occlusion after total knee arthroplasty: successful management of an uncommon complication by percutaneous thrombus aspiration.

Management of arterial occlusion after total knee arthroplasty is controversial in the literature, in part because of the relatively small number of reported cases. We report a case of perioperative popliteal artery thrombosis after total knee arthroplasty that was treated successfully with percutaneous thrombus aspiration and balloon dilation. Immediate intervention prevented ischemic muscular necrosis, resulting in full recovery of the limb.

Special compression sutures: a new surgical technique to achieve a quick decrease in shunt volume caused by diffuse hemangiomatosis of the liver.

A new surgical technique for the management of shunting liver hemangiomas that otherwise would rapidly lead to intractable cardiac failure is presented. Rapid, significant reduction of shunt volume was achieved surgically by transhepatic compression sutures using PTFE pledgets and selective ligation of a large feeding vessel from the right hepatic artery.