Alpine Skiing With total knee ArthroPlasty (ASWAP): physical activity, knee function, pain, exertion, and well-being.

This study focused on the psychological and quality of life aspects of resuming alpine skiing practice after total knee arthroplasty (TKA) in elderly skilled skiers. Two data pools were used in order to analyze psychological states: (a) at the beginning, at the end, and 8 weeks after a 12-week skiing intervention; and (b) concerning diurnal variations of states (i.e., skiing days compared with everyday life during intervention and retention phase). In particular, effects of skiing on amount of physical activity and perceived exertion, perceived pain and knee function, and subjective well-being were analyzed using a control group design. Results reveal that the skiing intervention substantially increases the amount of physical activity by the intervention group (122.30 ± 32.38 min/day), compared with the control group (75.14 ± 21.27 min/day) [F (2, 32) = 8.22, P < 0.01, η(2) = 0.34)]. Additionally, the analyses of psychological states demonstrated that skiing goes along with enhanced well-being and no significant impact on perceived pain, exertion or knee function. In sum, alpine skiing can be recommended for older persons with TKA with respect to well-being, perceived pain and knee function, and perceived exertion.

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany.

OBJECTIVE: This is a retrospective analysis of interventional embolisation performed with catheter angiography in 29 patients with upper gastrointestinal bleeding in the setting of a secondary care hospital. PATIENTS, MATERIALS, AND METHODS: From April 2007 to February 2013, 29 patients with upper gastrointestinal bleeding underwent endovascular diagnostics and treatment. The diagnosis was established by endoscopy, computed tomography or clinically based on a significant decrease in hemoglobin. Transcatheter arterial embolisation was performed with coils, liquid embolic agents, and particles. The technical and clinical outcomes were assessed by postinterventional endoscopy, hemoglobin concentrations, number of necessary transfusions, or surgical interventions, as well as by post-interventional mortality within 28 days after the procedure. RESULTS: Selective angiographic embolisation in upper gastrointestinal bleeding was primarily successful technically and clinically in 22 of 29 patients. In 4/29 cases an angiographic reintervention was performed, which was successful in 3 cases. In 3 cases of primarily technically unsuccessful procedures reintervention was not attempted. No catheterisation-related complications were recorded. Peri-interventional mortality was 31%, but only 2 of these patients died due to uncontrolled massive bleeding, whereas the lethal outcome in the other 7 patients was due to their underlying diseases. CONCLUSION: Transcatheter arterial embolisation is an effective and rapid method in the management of upper gastrointestinal bleeding. Radiological endovascular interventions may considerably contribute to reduced mortality in GI bleeding by avoiding a potential surgical procedure following unsuccessful endoscopic treatment. The study underlines the importance of the combination of interventional endoscopy with interventional radiology in secondary care hospitals for patient outcome in complex and complicated upper gastrointestinal bleeding situations.

Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study.

BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

Does a skiing intervention influence the psycho-social characteristics of the elderly?

The purpose of this study was to assess whether a guided alpine skiing intervention lasting 12 weeks has an impact on psycho-social dimensions, measured by subjective assessments, of individuals who are 60+ years of age. A number of well-established questionnaires were used to measure well-being, life satisfaction, self-concept, health status, depression and self-efficacy. The physical self-concept in the domain "strength" increased significantly in the intervention group from pre- to post-test and remained stable through the retention test, whereas the control group demonstrated nearly no alteration. A similar effect was obtained in life satisfaction for the dimension "friends and relatives." On the contrary, psycho-social aspects of the elderly were not negatively influenced. The subjects of this study had very high pre-test scores that might reflect a ceiling effect which, in turn, can explain the marginal positive impact of the intervention. The findings of this study argue for recommending a guided alpine skiing intervention for individuals who are 60 years of age and older with high values in psycho-social variables.

Effect of a skiing intervention on the psycho-physiological reactivity and recovery in the elderly.

This study determined the effects of a skiing intervention lasting 12 weeks on the psycho-physiological reactivity to and recovery from mental stressors in individuals who are 60+ years of age. In accordance with the cross-stressor hypothesis, it was assumed that a skiing intervention optimizes psycho-physiological pre-conditions for coping with stress. A cognitive task was used to investigate stress-induced changes (reactivity) in the high-frequency (HF) component of the heart rate variability (HRV) and in the skin conductance level (SCL) as well as recovery from this stressor. The intervention group demonstrated a significant increase in maximal oxygen consumption that was not accompanied by alterations in HRV at rest. In comparison with the control group, there was no difference in the alteration of the reactivity and recovery in the HF component and in the SCL after completing the training. The findings indicate that neither the psycho-physiological reactivity nor the recovery was influenced by the skiing intervention. It may be speculated that the intensity of the skiing intervention was too low to induce such adaptations. Therefore, further studies are encouraged to enhance the duration and intensity of the exercises to achieve adaptations of the autonomous nervous system of elderly individuals.

Physical self-concept and physical fitness in elderly individuals.

This investigation examined the relations between physical self-concept and physical fitness (endurance, balance, muscle strength, muscle power) for gaining knowledge about the interrelationship between subjective ratings and objective fitness scores in the elderly in three steps: (1) detecting correlations and changes in time, (2) clarifying the influence of gender, and (3) of a skiing intervention lasting 12 weeks. Physical self-concept was assessed using a modified version of the Physical Self-Concepts (PSK) scales (Stiller et al., 2004) reflecting three first-order factors (endurance, strength, general sportiness) and one second-order factor (global fitness). Objective fitness scores were obtained by VO(2 max), counter movement jump, concentric muscle strength, and static balance. The results reveal that elderly individuals' global physical self and general sportiness are mainly linked to VO(2 max) and concentric muscle strength. Global physical self is predicted by VO(2 max) in females and by physical strength (concentric muscle strength) in males, indicating gender differences. Over time, correlations between subjective ratings and objective fitness scores become stronger in the sense of convergent validity in the skiing intervention group, whereas convergent and divergent validity cannot be supported by data of the control group. In sum, physical self-concept is an important factor in the context of physical intervention programs in the elderly.

Salzburg Skiing for the Elderly Study: study design and intervention--health benefit of alpine skiing for elderly.

The aim of this study was to monitor the long-term effects of skiing on the health-related parameters of older individuals. This paper describes the overall study design and the intervention phase. The study utilized a randomized control group design consisting of an intervention group (n=27; age: 67.5 ± 2.8 years) and a control group (n=20; age: 67.3 ± 4.4 years). Parameters of interest were measured during pre-, post- and retention-test sessions. The intervention phase lasted for 12 weeks, with an average of 28.5 days of guided skiing. Daily heart rate (HR) profiles and global positioning system data throughout the ski day were recorded. Perceived exertion levels as well as mood status of the subjects were recorded regularly. The intervention group completed an average of 4885 vertical meters of downhill skiing, with a total skiing distance of 40.5 km/day. In the skiing phase, the average physiological load was 72.4 ± 8.9% of HR(max) . The dimension "positive mood" referred to skiing (on scale of 0-10), with an average value of 7.6 ± 1.7 after skiing. The dimension of "negative mood" was much less pronounced, having a mean of 1.1 ± 1.5 after skiing. Two subjects suffered injuries while falling during skiing. The effects of the 12-week skiing intervention on the tested parameters will be reported in the following papers of this supplementum.

[SARS-CoV-2 antibodies in ICU and clinic staff : From Germany's region with the highest infection rate]. / SARS-CoV-2-Antikörper bei Intensiv- und Klinikpersonal : Aus der am höchsten durchseuchten Region Deutschlands.

BACKGROUND: Healthcare workers are a high-risk population for SARS-CoV­2 infection. For capacity planning of healthcare providers and to optimize protection of healthcare workers (HCW) in SARS-CoV­2 pandemics, it is essential to know the risk of infection and potential immunity status of staff dealing with COVID-19 patients. MATERIALS AND METHODS: We examined seropravalence of SARS-CoV­2 IgM/IgG antibodies (AB) in HCW of a region with the highest rate of infection (1570/100,000) during COVID-19 pandemic in Germany, 4 months after its start. Employees of a nonmedical company (MU) served as control group. Demographic data, medical history and working situation were recorded. RESULTS: A total of 1838 HCW and 986 MU volunteered to participate. Seroprevalence for SARS-CoV­2 in HCW was 15.1% and 3.7% in MU. Among HCWs, nurses had a seropositivity of 20.0%, ICU personnel 20.3%, housekeepers 19.3%, physicians 12.0%, medical services (e.g., radiology, physiotherapy) 11.3%, administration 7.1% and technical services 6%. Symptoms typical for COVID-19 were not experienced by 10% of seropositive HCWs. CONCLUSION: Seroprevalence of SARS-CoV­2 antibodies in HCW of a region heavily affected by COVID-19 is with 15.1% significantly higher than in a control group of nonmedical staff with 3.7%. Infection rate in HCW was higher in staff with close contact to infected patients. Seropositivity in ICU personnel is higher than in other clinical professions. The occupational risk for housekeepers seems to be underestimated.

The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry.

BACKGROUND AND PURPOSE: Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location. MATERIALS AND METHODS: Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated. RESULTS: Eighty-four patients (median age, 54 years) with 84 posterior circulation aneurysms were treated with the FRED. A total of 25 aneurysms (29.8%) had previously ruptured, even though most aneurysms were diagnosed incidentally (45.2%). The intradural vertebral artery was the most common location (50%), and saccular, the most common morphology (40.5%). The median size was 7 mm. There were 8 (9.5%) symptomatic thromboembolic and no hemorrhagic complications. Thromboembolic complications occurred mostly (90.9%) in nonsaccular aneurysms. On last follow-up at a median of 24 months, 78.2% of aneurysms were completely occluded. Functional outcome at a median of 27 months was favorable in 94% of patients. All mortalities occurred in patients with acute subarachnoid hemorrhage and its sequelae. CONCLUSIONS: The largest cohort of posterior circulation aneurysms treated with the FRED to date demonstrated favorable safety and efficacy profiles of the device for this indication. Treatment in the setting of acute subarachnoid hemorrhage was strongly related to mortality, regardless of whether procedural complications occurred.

Frontal midline theta in the pre-shot phase of rifle shooting: differences between experts and novices.

In the present study the time course of frontal midline theta (Fmtheta) during the aiming period in rifle shooting was investigated. Experts (n=8) and novices (n=10) had to shoot repeatedly while EEG was recorded, and the time course of Fmtheta during the aiming period was significantly different between the two groups, showing a steady increase of power for the last 3s before the shot only for experts, but not for novices. Source analysis (LORETA) indicated a significantly stronger theta activity for experts strictly located at the anterior cingulate area and medial frontal cortex, locations well known for focused attention. The results suggest that experts and novices use different strategies during the aiming period. While novices keep a relatively constant amount of attention to the target, experts are able to increase attention exactly to the time point of the trigger pull.

Microcirculation and perfusion with contrast enhanced ultrasound (CEUS) in Crohn's disease: first results with linear contrast harmonic imaging (CHI).

AIM: To evaluate a newly introduced high resolution linear transducer for vascularization and mural perfusion assessment using contrast harmonic imaging (CHI) with quantitative time intensity curve analysis (TIC) in patients with active Crohn's disease (CD). MATERIAL AND METHODS: We prospectively evaluated 14 consecutive patients (7 women, 7 males, age range 19-42 years, median 28 years) with histologically proven CD having an acute episode of the disease applying contrast enhanced MRI and high resolution ultrasound. For the ultrasound we used a newly introduced high resolution linear multi-frequency transducer (6-9 MHz, Logiq 9, GE). Ultrasound was performed by an experienced radiologist applying color coded Doppler sonography (CCDS), power Doppler (PD) and contrast enhanced CHI using the 'true agent detection mode'. Additionally, 5 healthy volunteers were examined by ultrasound applying CCDS, PD and CHI. After the injection of 2.4 ml ultrasound contrast agent (SonoVue) the dynamic CHI cine sequences were recorded as digital raw data for 60 seconds. Therefore we were able to perform a quantitative perfusion analysis using TIC retrospectively. CCDS, PD and CHI with TIC were compared and analyzed. RESULTS: In all 14 patients MRI showed inflammatory changes in the terminal or pre-terminal ileum. Using PD and CCDS enlarged vessels surrounding the bowel wall were visualized in all patients. PD as well as CCDS diagnosed just in 9 of 14 patients augmented mural vessels. Having CHI with TIC increased mural contrast enhancement was diagnosed in all 14 patients. Patients with CD showed a maximum enhancement 36 s after injection with 9 dB (range 5.9-13.2 dB), while healthy volunteers reached the maximum level of 2.8 dB (range 2-3.8 dB) after 23 s (p<0.05). CONCLUSION: Using high resolution linear transducer mural perfusion changes in active Crohn's disease can be appreciated applying CHI with TIC. This technique could be an effective dynamic imaging modality for diagnosis and especially follow-up examination to monitor treatment in CD.

European Multicenter Study for the Evaluation of a Dual-Layer Flow-Diverting Stent for Treatment of Wide-Neck Intracranial Aneurysms: The European Flow-Redirection Intraluminal Device Study.

BACKGROUND AND PURPOSE: Endoluminal reconstruction with flow-diverting stents represents a widely accepted technique for the treatment of complex intracranial aneurysms. This European registry study analyzed the initial experience of 15 neurovascular centers with the Flow-Redirection Intraluminal Device (FRED) system. MATERIALS AND METHODS: Consecutive patients with intracranial aneurysms treated with the FRED between February 2012 and March 2015 were retrospectively reviewed. Complications and adverse events, transient and permanent morbidity, mortality, and occlusion rates were evaluated. RESULTS: During the defined study period, 579 aneurysms in 531 patients (median age, 54 years; range, 13-86 years) were treated with the FRED. Seven percent of patients were treated in the acute phase (≤3 days) of aneurysm rupture. The median aneurysm size was 7.6 mm (range, 1-36.6 mm), and the median neck size 4.5 mm (range, 1-30 mm). Angiographic follow-up of >3 months was available for 516 (89.1%) aneurysms. There was progressive occlusion witnessed with time, with complete occlusion in 18 (20%) aneurysms followed for up to 90 ± 14 days, 141 (82.5%) for 180 ± 20 days, 116 (91.3%) for 1 year ± 24 days, and 122 (95.3%) aneurysms followed for >1 year. Transient and permanent morbidity occurred in 3.2% and 0.8% of procedures, respectively. The overall mortality rate was 1.5%. CONCLUSIONS: This retrospective study in real-world patients demonstrated the safety and efficacy of the FRED for the treatment of intracranial aneurysms. In most cases, treatment with a single FRED resulted in complete angiographic occlusion at 1 year.

BLADE sequences in transverse T2-weighted MR imaging of the cervical spine. Cut-off for Artefacts?

PURPOSE: The BLADE (PROPELLER) technique reduces artefacts in imaging of the cervical spine in sagittal orientation, but till now failed to do so in axial orientation, because here it increased through plane CSF-flow artefacts, which spoiled the benefit of BLADE artefact reduction "in plane". The aim of this study was to compare a BLADE sequence with optimised measurement parameters in axial orientation to T2-TSE. MATERIALS AND METHODS: Both sequences were compared in 58 patients with 31 discal, 16 bony and 11 spinal cord lesions. Image sharpness, reliability of spinal cord depiction, CSF flow artefacts and lesion detection were evaluated by 3 independent observers. Additionally the observers were asked which sequence they would prefer for diagnostic workup. Statistical evaluations were performed using sign and χ2 test. RESULTS: BLADE was significantly superior concerning image sharpness, spinal cord depiction and overall lesion detection. BLADE was rated better for most pathologies, for bony lesions the differences compared with TSE were statistically significant. Regarding CSF-flow artefacts both sequences showed no difference. All readers preferred BLADE in side by side reading. CONCLUSION: An optimised axial T2 BLADE sequence decreases the problems of increased through plane CSF-flow artefacts in this orientation. By reducing various other artefacts it yields better image quality and has the potential to reduce the number of non-diagnostic examinations especially in uncooperative patients.

BLADE Sequences in Transverse T2-weighted MR Imaging of the Cervical Spine. Cut-off for Artefacts?

PURPOSE: The BLADE (PROPELLER) technique reduces artefacts in imaging of the cervical spine in sagittal orientation, but till now failed to do so in axial orientation, because here it increased through plane CSF-flow artefacts, which spoiled the benefit of BLADE artefact reduction "in plane". The aim of this study was to compare a BLADE sequence with optimised measurement parameters in axial orientation to T2-TSE. MATERIALS AND METHODS: Both sequences were compared in 58 patients with 31 discal, 16 bony and 11 spinal cord lesions. Image sharpness, reliability of spinal cord depiction, CSF flow artefacts and lesion detection were evaluated by 3 independent observers. Additionally the observers were asked which sequence they would prefer for diagnostic workup. Statistical evaluations were performed using sign and χ2 test. RESULTS: BLADE was significantly superior concerning image sharpness, spinal cord depiction and overall lesion detection. BLADE was rated better for most pathologies, for bony lesions the differences compared with TSE were statistically significant. Regarding CSF-flow artefacts both sequences showed no difference. All readers preferred BLADE in side by side reading. CONCLUSION: An optimised axial T2 BLADE sequence decreases the problems of increased through plane CSF-flow artefacts in this orientation. By reducing various other artefacts it yields better image quality and has the potential to reduce the number of non-diagnostic examinations especially in uncooperative patients. KEY POINTS: T2 BLADE/PROPELLER sequences proofed to reduce artefacts in sagittal spine imaging. BLADE/PROPELLER improve image quality, but can aggravate CSF flow artefacts in axial orientation. Optimised parameter setting for axial T2 BLADE reduces "through-plane" CSF artefacts aggravation. Optimised axial T2 BLADE reduces non-diagnostic examinations especially in uncooperative patients.

Single-Layer WEBs: Intrasaccular Flow Disrupters for Aneurysm Treatment­Feasibility Results from a European Study.

BACKGROUND AND PURPOSE: The safety and efficiency of the dual-layer Woven EndoBridge (WEB) device has already been published. However, this international multicenter study sought to evaluate the safety of single-layer devices, which are the newest generation of the WEB intrasaccular flow-disrupter family. They have been designed to offer smaller-sized devices with a lower profile to optimize navigability and delivery, which may, in turn, broaden their range of use. MATERIALS AND METHODS: Data from all consecutive patients treated with a single-layer WEB device, in 10 European centers from June 2013 to May 2014 were included. Clinical presentations, technical details, intra- and perioperative complications, and outcomes at discharge were recorded. Clinical and angiographic data at last follow-up were also analyzed when available. RESULTS: Ninety patients with 98 WEB-treated aneurysms were included in this study. In 93 cases (95%), WEB placement was possible. Complete occlusion at the end of the procedure was obtained in 26 instances (26%). Additional treatment during the procedure (coiling and/or stent placement) was necessary in 12 cases (12.7%). Procedure-related complications occurred in 13 cases, leading to permanent neurologic deficits in 4 patients (4.4%). Early vascular imaging follow-up data were available for 44 patients (57%), with an average time interval of 3.3 months. Treatment-related morbidity and mortality rates at last follow-up were 2.2% and 1.1%, respectively. CONCLUSIONS: In this study, the feasibility and safety of the single-layer WEB device was comparable with that of the double-layer. However, further studies are needed to evaluate long-term efficacies.

[CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients]. / CT-gesteuerte thorakale Sympathikolyse zur Behandlung der peripheren arteriellen Verschlusskrankheit und thorakaler Schmerzen in 6 Fällen.

UNLABELLED: CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients. PURPOSE: Retrospective evaluation of the safety and effectivity of CT-guided percutaneous thoracal sympathicolysis (CT-TSL) in the treatment of patients with peripheral arterial occlusive disease (PAOD) of the upper limb and chronic thoracal pain syndromes. Comparison of our own experience with literature reports. MATERIAL AND METHODS: Between 6/96 and 12/99, 4 patients with PAOD of the upper limb and two with chronic thoracal pain syndromes caused by herpes zoster were treated by unilateral CT-TSL. RESULTS: 18, 21 and 32 months after the intervention 3 out of 4 patients treated for PAOD reported subjective improvements, and one remained unchanged. Two patients treated for pain syndromes showed no long-term benefit of the procedure. There were no serious complications. CONCLUSION: The CT-TSL is an alternative method in the treatment of PAOD in patients who are unsuitable for treatment by revascularization.

[Volume-artifact reduction technique by spiral CT in the anterior, middle and posterior cranial fossae. Comparison with conventional cranial CT]. / Volumen-Artefakt-Reduktionstechnik mittels Spiral-CT in der vorderen, mittleren und hinteren Schädelgrube. Vergleich mit der konventionellen kranialen CT.

PURPOSE: The object of this study was to determine the extent to which a new volume-artifact reduction (VAR) modality using helical CT was able to reduce artifacts in the anterior, middle and posterior fossae in comparison with conventional CT (sequential mode). METHODS: In a prospective, randomized trial, 50 patients underwent helical CT (VAR) and 50 underwent sequential CT. The results were evaluated by three radiologists; influences on image quality where scaled between 1 (no artifact) and 4 (not assessable). Eight regions of the anterior, middle and posterior fossae were evaluated. RESULTS: On average, artifacts were scaled at 2.5 in helical CT (VAR) and 3.1 in conventional CT. Significant differences were seen at the eyeball, anterior to the petrosal bone, at the internal occipital crest, and at the level of the transverse sinus (p < 0.005). CONCLUSIONS: Helical CT with the VAR modality is superior to conventional, sequential CT in the area of the anterior, middle and posterior fossae.

[Indirect MR-arthrography of the shoulder-value in the detection of SLAP-lesions]. / Indirekte MR-Arthrographie der Schulter-Wertigkeit im Nachweis von SLAP-Läsionen.

PURPOSE: A prospective study to assess the value of indirect magnetic resonance-arthrography (MR-Arthro) in the detection of lesions of the superior labrum (SLAP-lesions). MATERIALS AND METHODS: Unenhanced magnetic resonance imaging (MRI) and indirect MR-Arthro of the shoulder were performed in 35 patients (9 females and 26 males) with a history of acute or chronic shoulder disorder. The images of unenhanced MRI and indirect MR-Arthro were analyzed independently from each other for the occurrence of SLAP-lesions and the findings correlated with the arthroscopic results. For arthroscopy, MRI and MR-Arthro, the SLAP-lesions were categorized based on the classification system of Snyder. RESULTS: SLAP-lesions were diagnosed by arthroscopy in 22 of 35 patients (63 %). 9 of the 22 lesions (41 %) were classified as type 1, 9 (41 %) as type 2, three (13.5 %) as type 3 and one (4.5 %) as type 4. Using unenhanced MRI sensitivity, specificity and accuracy in the detection of SLAP-lesions were calculated to be 73 %, 85 % and 77 %. Indirect MR-Arthro showed a sensitivity of 91 %, a specificity of 85 % and an accuracy of 89 %. Unenhanced MRI revealed correlation to the arthroscopic classification in 9 of 22 cases (41 %) and indirect MR-Arthro in 18 of 22 cases (82 %). CONCLUSION: Indirect MR-Arthro is a non-invasive method which offers excellent sensitivity in the diagnosis of SLAP-lesions. It provides important preoperative informations with regard to the exact location and extent of a tear.

[Treatment of para-ostium renal artery stenoses with a new, solidly premounted balloon expandable stent]. / Behandlung von ostiumnahen Nierenarterienstenosen mit einem neuen, fest vormontierten, ballonexpandierbaren Stent.

PURPOSE: Evaluation of the handling, technical success rate, and six-months patency rate of a new, premounted balloon-expandable stent in ostial renal artery stenoses. MATERIAL AND METHODS: In a prospective study, 27 ostial renal artery stenoses in 20 patients were primarily treated with the new "Renal Bridge Stent" (Medtronic AVE, Düsseldorf). All patients had a history of hypertension and 8 patients had renal dysfunction. The handling and visibility of the stent was scored on a three grade scale by the operators. Follow-up angiography including intra-arterial trans-stenotic pressure measurements was performed in 23 out of 27 stenoses (17 patients). RESULTS: Handling and visibility were scored as good by all operators. 26 of 27 stenoses were treated with technical success by implantation of 28 stents. The mean degree of stenosis was reduced from 74.2% to less than 5%. At 6 months, 8 stents out of 23 (35%) showed a significant in-stent stenosis (stenosis degree > 50% and intra-arterial pressure gradient > 10 mmHg). The stenosis rates were 63% using 5-mm stents, 30% using 6-mm stents, and 0% using 7-mm stents. CONCLUSION: Endovascular treatment of ostial renal artery stenosis with the used stent is safe and effective. The new stent shows a good handling and visibility. The high rate of in-stent stenoses might be explained by the rigid follow-up protocol including angiography, trans-stenotic pressure measurements, and the high number of 5-mm vessels in our study.

[Therapy of iliac artery lesions with a new premounted balloon-expandable stent ("Flexible Iliac Bridge Stent")]. / Therapie von Beckenarterienläsionen mit einem neuen vormontierten ballonexpandierbaren Stent ("Flexible Iliac Bridge Stent").

PURPOSE: Evaluation of the handling, technical success rate and six month patency rate of a new, premounted balloon-expandable stent in iliac artery lesions. MATERIALS AND METHODS: In a prospective study 26 stenoses and 3 occlusions of the iliac arteries were primary treated in 24 patients (Fontaine IIa-III, mean age 60.4 year) with the "Flexible Iliac Bridge Stent" (Medtronic AVE, Düsseldorf). Five patients had bilateral stenoses. The ankle-brachial index (ABI) in rest and after exercise was determined before the intervention as well as 1-3 days, 1 and 6 months after the Intervention. The handling and visibility of the stent was scored on a three grade scale by the operators. Follow-up angiography including intraarterial pressure measurement was performed in 17 out of 24 patients (21 out of 29 lesions) after 6 months. RESULTS: All 29 lesions were treated with technical success by implantation of 36 stents. The mean degree of the stenoses before intervention was 72.7 +/- 13.8% (+/- 1 standard deviation) and less than 5% in all cases postinterventionally. The mean pressure gradient before and after stent placement was 21 +/- 13.1 mm Hg and 0.8 +/- 2.3 mm Hg, respectively. The Fontaine stage improved by at least one in all patients. The mean ABI at rest improved from 0.63 +/- 0.15 to 0.89 +/- 0.16, and after exercise from 0.46 +/- 0.17 to 0.8 +/- 0.2, respectively. At 6 months 2 lesions out of 21 (9.5%) showed a restenosis of 55% and 70% with an intraarterial pressure gradient of 16 mm Hg and 27 mm Hg, respectively. After 6 months the mean ABI at rest decreased to 0.83 +/- 0.13, and to 0.72 +/- 0.14 after exercise. Handling and visibility was scored as good by all operators. CONCLUSION: Endoluminal therapy of iliac artery lesions with the used stent is safe and effective. The six month patency rate is comparable to the published data of other stents.