[Low level laser therapy : A narrative literature review on the efficacy in the treatment of rheumatic orthopaedic conditions]. / Low-Level-Lasertherapie : Eine narrative Literaturübersicht zur Wirksamkeit bei der Behandlung rheumatologisch-orthopädischer Krankheitsbilder.

BACKGROUND: In low level laser therapy (LLLT) low wattage lasers are used to irradiate the affected skin areas, joints, nerves, muscles and tendons without any sensation or thermal damage. Although the exact mechanism of its effect is still unknown, it seems beyond dispute that LLLT induces a variety of stimulating processes at the cellular level affecting cell repair mechanisms, the vascular system and lymphatic system. LLLT has been popular among orthopaedic practitioners for many years, whereas university medicine has remained rather sceptical about it. OBJECTIVES: Overview of studies on the efficacy of LLLT in the treatment of rheumatic orthopaedic conditions, i. e. muscle, tendon lesions and arthropathies. MATERIALS AND METHODS: Narrative literature review (PubMed, Web of Science). RESULTS: While earlier studies often failed to demonstrate the efficacy of LLLT, several recent studies of increasing quality proved the efficacy of LLLT in the treatment of multiple musculoskeletal pain syndromes like neck or lower back pain, tendinopathies (especially of the Achilles tendon) and epicondylolpathies, chronic inflammatory joint disorders like rheumatoid arthritis or chronic degenerative osteoarthritis of the large and small joints. In addition, there is recent evidence that LLLT can have a preventive capacity and can enhance muscle strength and accelerate muscle regeneration. CONCLUSION: LLLT shows potential as an effective, noninvasive, safe and cost-efficient means to treat and prevent a variety of acute and chronic musculoskeletal conditions. Further randomized controlled studies, however, are required to confirm this positive assessment.

An atypical presentation of necrotising fasciitis.

Necrotising fasciitis is a rare infection with a high mortality rate. Clinical manifestation may be influenced by an underlying disease state. We report a case of a 70-year-old man with an anaplastic large-cell lymphoma who presented with inconclusive signs of necrotising fasciitis following a neutropenic phase after chemotherapy. Surgical exploration did not reveal the typical macroscopic features of necrotising fasciitis. Microbiological investigations revealed Escherichia coli. The lack of massive tissue inflammation, probably due to the neutropenia in our patient, has not been described by other authors. Diagnostic uncertainties owing to masked or uncharacteristic signs in immune compromised patients may lead to a delayed surgical debridement, of which clinicians should be aware.

Use of a mechanical thrombectomy catheter for percutaneous extraction of renal fungal bezoars in a premature infant.

Fungal urinary tract infections are commonly encountered in the hospitalized neonate. Although these infections most commonly take the form of cystitis, the infection may be complicated by the formation of fungal bezoars, with subsequent urinary tract obstruction. In certain cases, endosurgical debulking or extraction of the fungal bezoar may be necessary. This is particularly challenging in neonates due to their often-compromised physiologic state and small size. We report a case of a premature infant with bilateral obstructing renal fungal bezoars in whom a percutaneous catheter-based thrombectomy system was used successfully to debulk the fungal burden.

Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction. Results from a sub-study of the randomised Antibiotic Therapy in Acute Myocardial Infarction (ANTIBIO) trial.

BACKGROUND: Results of studies concerning prevention of cardiovascular disease by treatment with macrolide antibiotics targeting C. pneumoniae infection are still controversial. This study describes the results of different tests for infection with C. pneumoniae as well as the effect of treatment with roxithromycin in patients with acute myocardial infarction (AMI) in relation to their serostatus against C. pneumoniae. METHODS: We analysed blood of 160 patients who came from the ANTIBIOtic therapy after an AMI ( ANTIBIO-) study, a prospective, randomised, placebo-controlled, double-blind study to investigate the effect of roxithromycin 300 mg/OD for 6 weeks in patients with an AMI. Anti- Chlamydia IgG-, IgA-, and IgM-antibodies of these patients were analysed by means of different test systems. RESULTS: There was a good correlation between the two IgG and IgA methods (r = 0.900, p < 0.001 and r = 0.878, p < 0.001, respectively), but marked differences in the prevalence of positive tests. This resulted in only moderate concordance values, as expressed by the Kappa coefficients, for IgG kappa = 0.611 (95% CI = 0.498-0.724, p < 0.001) and for IgA kappa = 0.431 (95% CI: 0.322-0.540, p < 0.001). No significant association between positive C. pneumonia titers and the combined clinical endpoint during the 12 month follow-up could be found. In all test systems used, patients with positive anti- C. pneumoniae titers did not benefit from roxithromycin therapy (p = ns). CONCLUSION: Depending on the test system used, there are large differences in the prevalence of anti- C. pneumoniae seropositive patients. Clinical events during the 12 month follow-up after AMI did not depend on serostatus against C. pneumoniae and treatment with roxithromycin did not influence these events, independently of the serostatus against C. pneumoniae. However, the power of this subgroup analysis was low to detect small but significant differences.

Allograft epiphysiodesis for slipped capital femoral epiphysis.

During this retrospective investigation, use of freeze-dried irradiated allograft for achieving epiphysiodesis in patients with Grade I or Grade II slipped capital femoral epiphyses was evaluated. The study reviewed 40 grafting procedures in 33 patients: 20 patients were boys and 13 were girls, whose average age was 13 years old. The group included 31 Grade I slips and 9 Grade II slips. Six were unstable and 34 were stable. Procedure time averaged 1 hour 57 minutes and blood loss averaged 360 ml. The average time to complete physeal closure was 28 weeks. An incomplete bony physeal bridge, apparent at an average 11 weeks, may impart earlier stability. Thirty-eight cases had followup averaging 3 years 6 months. At most recent evaluation, according to the Harris hip rating system, 35 hips had excellent ratings, 1 had a good rating, and 2 had fair ratings. Six patients were identified with major postoperative complications, including 1 case each of segmental avascular necrosis, chondrolysis, femoral neck fracture, subtrochanteric hip fracture, bilateral progressive coxa vara deformities requiring corrective osteotomies, and a unilateral progressive coxa vara deformity. The senior author (TLS) currently uses a fluoroscopically guided percutaneous lateral approach, a cannulated reaming system, and freeze-dried irradiated cortical allograft. The procedure promotes premature physeal closure. Allograft epiphysiodesis is an alternative operating technique for treating patients with a slipped capital femoral epiphysis.

John Caffey Award paper. Avascular necrosis: early MR imaging and histologic findings in a canine model.

To examine the early MR and histologic changes of avascular necrosis, we surgically devascularized the distal femur of adult beagle dogs and performed short TR/short TE MR imaging and histologic examinations. MR showed increasing areas of low signal, and histologic examination showed changes of fat necrosis, inflammatory infiltrate, and fibrocytic and bony repair. These processes were divided into four stages. Stage 1 is seen in the first days after surgery and consists of homogeneous high signal on MR and only subtle histologic changes of early fat necrosis. Stage 2, seen by 7 days after surgery, shows linear low-signal areas within the high-signal marrow on MR and fat necrosis and an inflammatory infiltrate on histologic sections. Stage 3, seen by 16 days after surgery, shows patchy low signal occupying more of the marrow on MR with a fibrocytic infiltrate on histologic sections. Stage 4, seen by 23 days after surgery, shows a more homogeneous low and intermediate signal on MR and histologic findings of more organized fibrocytes and the onset of new bone formation. Using this model, we have proved that MR imaging can show marrow changes as soon as 1 week after the onset of avascular necrosis. Whereas MR imaging showed a progression of increasing areas of low signal, the histologic findings seen during this time were diverse, including inflammatory infiltration (a previously unreported finding), fat necrosis, and fibrocytic and osseous repair.

Airway evaluation in children with use of ultrafast CT: pitfalls and recommendations.

Ultrafast computed tomographic (CT) evaluation of the airway can be performed with either 50-msec low-resolution images (cine CT) or 100-msec high-resolution images (high-resolution CT). To determine the best imaging strategy for ultrafast CT of the pediatric airway, the authors prospectively compared ultrafast CT and endoscopy in 20 children. Both studies were performed in 11 patients; cine CT alone was performed in six and high-resolution CT alone in three. Six patients had normal anatomy. Six patients had focal tracheal stenoses, four had tracheomalacia or laryngomalacia, one had a laryngoesophageal cleft, one had irregularity and narrowing in the subglottic area, one had laryngeal papillomas, and one had focal stenosis with stoma granuloma. Cine CT results agreed with those of endoscopy in 10 of 17 cases. In five cases focal stenosis was misinterpreted with cine CT as tracheomalacia. High-resolution CT results agreed with those of endoscopy in 10 of 14 cases. The results of a technique that combined high-resolution CT for the entire airway and cine CT at selected areas agreed with those of endoscopy in 10 of 11 cases; only a tracheoesophageal cleft was missed with the combined technique. For the greatest diagnostic accuracy with ultrafast CT in evaluation of the pediatric airway, both cine and high-resolution modes should be used.

Neonatal nasopharyngeal hairy polyp: CT and MR appearance.

We report a rare tumor of the nasopharynx in the neonate: the teratoid or hairy polyp. In addition to the traditional modes of evaluation (barium swallow, plain radiography, and indirect laryngoscopy), CT and magnetic resonance were used to assess this unusual cause of respiratory distress and vomiting in a newborn.

Glomerulocystic kidney disease: case report.

A newborn infant with abdominal masses was found to have Glomerulocystic Kidney Disease. Imaging showed markedly enlarged kidneys with multiple macroscopic cysts. Radiographic and clinical findings are discussed.

Diagnosis and management of the hydronephrotic type of multicystic dysplastic kidney. Use of antegrade pyelography.

The distinction between the hydronephrotic type of multicystic kidney disease and ureteropelvic junction obstruction can be difficult using conventional imaging techniques. Antegrade pyelography with or without percutaneous nephrostomy may be performed to confirm the diagnosis of complete ureteral obstruction and to guide management decisions. One may elect either immediate nephrectomy or observation after performance of this diagnostic procedure. Reconstruction of nonsalvageable kidneys is avoided.

The significance of MRI abnormalities in children with neurofibromatosis.

We prospectively evaluated 47 children with neurofibromatosis to determine whether the previously reported high signals on magnetic resonance imaging (MRI) (prolonged T2) correlated with CT, brainstem auditory evoked responses (BAER), EEG, clinical examinations, cognitive abilities, or seizure disorder. Thirty percent of children had a history of seizures and 70% had either learning disabilities or mental retardation. Overall, 74% had an abnormal MRI examination. Sixty-two percent had high signals (prolonged T2) on T2-weighted images. Abnormal signals were located primarily in the basal ganglia, brainstem, and cerebellum. Twenty-five percent of patients had abnormal EEGs, 28% had abnormal CTs, and 27% had abnormal BAER examinations. The abnormal signals on MRI did not consistently relate to findings on CT, BAER, EEG, school placement, or clinical examination. The abnormal signals presumably reflect areas of abnormal brain parenchyma, either hamartomas, heterotopias, or local areas of brain dysplasia.

Metastatic Wilms' tumor to the liver with MR findings simulating cysts: case report emphasizing need for integrated imaging.

A case of Wilms' tumor metastatic to the liver with previously undescribed MR findings is presented. Although there is no evidence that there were hepatic metastases at presentation in this case, small lesions with this appearance would be difficult to detect with MRI. This could lead to incorrect staging of Wilms' tumor examined by MRI alone.

Imaging of a pediatric abdominal mass.

The approach to the child with an abdominal mass will be aided by careful consideration of the radiographic imaging modalities available at an institution. The relative advantages, disadvantages, costs, and radiation of each modality are presented. The recommended workup of a pediatric abdominal mass, as well as the most common masses and their differential diagnosis, are outlined.

Normal pituitary stalk size in children: CT study.

A retrospective study was undertaken of 1005 normal contrast-enhanced head computed tomographic (CT) scans in children to determine normal standards for pituitary stalk diameter, basilar artery diameter, and their ratio for age and gender. The pituitary stalk enlarges with age, and girls have larger stalks than do boys after age 8. The pituitary stalk-to-basilar artery ratio is easily estimated visually. Ratios greater than or equal to 1 are unusual in normal children. A ratio greater than or equal to 1 should prompt direct measurement of the stalk and comparison with age-matched normal values. If the stalk measurement is greater than 2 SD above the age-matched mean, it is presumably abnormal and deserves further evaluation for numerous possible pathologic conditions including histiocytosis X, pituitary adenoma, hypothalamic lesions, Rathke cleft cysts, metastases, sarcoidosis, hypothyroidism, and infection.

Catecholaminergic innervation of the chicken ovary. With special reference to the follicular wall.

The innervation of the chicken ovary was investigated with special emphasis on adrenergic nerves in the follicular wall. Quantitative determinations of catecholamines (CA) by high-performance liquid chromatography and electrochemical detection (hplc-ed) revealed 15.4 +/- 3.3 ng/mg protein of norepinephrine (NE) and 3.14 ng/mg protein of epinephrine (E), with even larger amounts in the cranial part of the ovary close to the adrenal gland. Serial sections that had been processed for the visualisation of aminergic nerves (Falck-Hillarp- or glyoxylic acid techniques) showed CA localized in nerve-fibre bundles; cell bodies of chromaffin and sympathetic neurons were only found at the ovarian-adrenal junction suggesting that ovarian nerves stored considerable quantities of E. An antiserum against bovine phenylethanolamine N-methyltransferase (PNMT, the E-synthesizing enzyme) produced no immunostaining in chicken ovary or adrenal gland, due to a lack of cross-reactivity between the antiserum and chicken PNMT. Serial sections processed alternately for the visualisation of aminergic nerves and myosin (from chicken gizzard) immunoreactivity revealed a scarce nerve supply of contractile cells in the theca externa compared to an extraordinarily dense innervation of the endocrine interstitial tissue of the theca interna. This distribution pattern of nerve fibres in the follicular wall was confirmed by electron microscopy in ovarian tissue that had been pretreated with 5- or 6-hydroxydopamine (HDA). More than 90% of the terminal axons were specifically labeled by these false adrenergic transmitters. Many of these terminals were seen in close contact (20 nm) with steroidogenic cells suggesting a neuromodulatory function of CA in hormone synthesis and/or release. It is yet unclear whether E and NE are stored in separate or identical axon moieties and within the same organelles. Choline acetyltransferase activity, which was taken as a measure for a cholinergic nerve component in the ovary, amounted to only 7% of its adrenal activity. It is suggested that the chicken ovary may serve as an excellent model to investigate the modulatory role of nerves in the endocrine function of the ovary.

[Diagnosis of space-occupying renal processes: sonography and aimed fine-needle biopsy]. / Diagnostik raumfordernder renaler Prozesse: Sonographie und gezielte Feinnadel-Biopsie.

It is reported on 3 cases in which by sonographic examination a tumorous process could be established. In all cases the additional investigation by fine needle biopsy and cytological examination proved the presence of malignant cells. This local renal process proved by sonography could be verified neither by i.v. pyelographic nor arteriographic methods. For two patients the diagnosis based on sonography, fine needle puncture and cytological test could be verified by operation. The third patient was not operated in spite of malignant cells in the cytogram because of negative computer tomography provided by an external hospital.