Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness.

Living kidney donation is safe and established, but can lead to long-term complications such as chronic fatigue. Since the adrenal vein is usually transected during left-sided donor nephrectomy-which is not necessary on the right-we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanation. In this prospective open label, monocentric cohort study, adrenal function was compared in left- and right-sided living kidney donors. The primary endpoint was plasma cortisol response to low-dose adrenocorticotropic hormone (ACTH) stimulation. Secondary endpoints included plasma renin and ACTH concentration as well as adrenal volume in response to donor nephrectomy. A total of 30 healthy donors-20 left- and 10 right-sided donations-were included. On postoperative day 1, response to low-dose ACTH stimulation was intact, but significantly lower after left-sided donor nephrectomy. After 28 days, adrenal responsiveness to ACTH stimulation did not differ any longer. Magnetic resonance imaging volumetry showed no significant adrenal volume change over 4 weeks, neither after left- nor after right-sided nephrectomy. In conclusion, left-sided living kidney donation entails a transiently reduced adrenocortical responsiveness, which returns to baseline after 28 days.

[Chronic sports injuries of the knee joint]. / Chronische Sportverletzungen des Kniegelenks.

Chronic sports injuries of the knee joint are common and mainly caused by repetitive (micro) trauma and exertion. Chronic insertion tendinopathies and avulsion fractures and symptoms related to entrapment, friction and impingement can be pathophysiologically distinguished in athletes. In this review, we depict the characteristic magnetic resonance imaging (MRI) findings of the most commonly occurring pathologies.

18F-FDG-PET and MRI in patients with malignancies of the liver and pancreas. Accuracy of retrospective multimodality image registration by using the CT-component of PET/CT.

PURPOSE: To evaluate the accuracy of retrospective rigid image registration and fusion between F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) of the upper abdomen. PATIENTS, MATERIAL, METHODS: Image fusion of PET and MRI was performed in 30 patients with suspected malignancy of the liver or pancreas. Using a commercially available image fusion tool capable of rigid manual point-based registration, PET-Images were retrospectively registered and fused by matching eight homologous points in the 3D spoiled gradient echo (GRE) MRI sequences acquired in portal venous phase and in the CT-component of PET/CT. Two separate observers (R1, R2) assessed accuracy of image registration by determining the distances in the x-, y- and z-axis as well as the absolute distance between anatomical landmarks which differed from the landmarks chosen for registration. Quality of fusion was graded using a three point grading scale (1 poorly fused; 2 satisfactory fused; 3 correctly fused) and compared to hybrid PET/CT fusion. RESULTS: Mean time of registration per patient was less than 2 minutes. Objective registration assessment showed errors between 2.4-6.3 mm in x-axis: mean 3.6 mm (R1); 4.6 mm (R2), 2.3-9.3 mm in y-axis (mean 5.1 mm; 5.5 mm) and 3.3-12.0 mm in z-axis (mean 5.9 mm; 5.9 mm.) The mean error in absolute distance between points was 6.0-16.8 mm (mean 9.9 mm; 10.6 mm). In visual assessment, most fusions were graded to be satisfactory or correctly fused: R1, R2: grade 3, 11/30 (36.7%), 22/30 (73.3%); grade 2, 13/30 (43.3%), 8/30 (26.7%); grade 1, 6/30 (20%), 0/30 (0%). Fusions were mostly comparable to hybrid PET/CT fusions. All of the fusions were defined as diagnostically relevant by both observers. CONCLUSION: Retrospective rigid image fusion of FDG-PET and MRI of the upper abdomen using the CT-component of PET/CT for registration is feasible without adaptation in image acquisition protocols and shows sub-centimeter registration errors in most cases.

USPIO-enhanced magnetic resonance imaging of the knee in asymptomatic volunteers.

The aim of this study was to compare signal characteristics of the synovium in knees of asymptomatic volunteers before and after intravenous administration of ultrasmall superparamagnetic iron oxide particles (USPIO). Ten knees of 10 asymptomatic volunteers were examined before and 36 h after intravenous administration of USPIO on a 1.5-T MR system using T1-weighted spin-echo, T2-weighted fast spin-echo, T2*-weighted gradient-echo (GRE), and short inversion time inversion-recovery sequences. In addition, synovial perfusion was measured using Gd-enhanced GRE imaging during the first imaging session. Images were analyzed qualitatively for any visual changes before and after USPIO administration. Signal-to-noise ratios (SNR) of the synovium were determined on unenhanced and USPIO-enhanced sequences. All MR images were reviewed for presence of any degenerative changes. Qualitative image analysis revealed no visually detectable changes of any knee joint before and after USPIO administration. The SNR values of the synovium on T1w, T2w, and T2*w images before and after USPIO administration showed no significant difference (T1, P = 0.86; T2, P = 0.95; T2*, P = 0.86). None of the volunteers showed any relevant degenerative changes of the knee and synovial perfusion was within normal limits. In knees of asymptomatic volunteers without any relevant degenerative changes and normal synovial perfusion neither visual changes nor changes of SNR values of the synovium can be depicted after USPIO administration. This means that USPIO-enhanced MRI may be used for assessment of knee disorders with increased macrophage activity.

Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders?

BACKGROUND: Patients with a rectocele often suffer from such symptoms as obstructed defaecation, urine or stool incontinence and pain. The aim of this study was to assess other concomitant pelvic floor disorders and their influence on pelvic function. METHODS: Included in the study were 37 female patients with a significant rectocele and defaecation disorder. Medical history and symptoms were analysed in terms of validated functional scores. All patients underwent open magnetic resonance defaecography (MRD) in a sitting position. Imaging was analysed for the presence and size of the rectocele, intussusception and other pelvic floor disorders. RESULTS: Patients with a higher body mass index tended to have a larger rectocele, whereas age and vaginal birth did not correlate with the size of the rectocele. In 67.5% of the patients with a previously diagnosed rectocele, an intussusception was diagnosed on MRD. This group suffered from significantly worse urine incontinence (p=0.023) and from accessory enteroceles 64%, compared with 17% (p=0.013) for those with a simple rectocele. Patients with higher grade intussusception suffered more frequently from incontinence than from constipation. CONCLUSION: Patients with a symptomatic rectocele frequently have other pelvic floor disorders that significantly influence the pattern of symptoms. Knowledge of all the afflictions is essential for determining the optimal treatment for each individual patient.

Unsuspected osteomyelitis is frequent in persistent diabetic foot ulcer and better diagnosed by MRI than by 18F-FDG PET or 99mTc-MOAB.

AIM: Prevalence, optimal diagnostic approach and consequences of clinically unsuspected osteomyelitis in diabetic foot ulcers are unclear. Early diagnosis of this infection may be crucial to ensure correct management. METHODS: We conducted a prospective study in 20 diabetic patients with a chronic foot ulcer (>8 weeks) without antibiotic pretreatment and without clinical signs for osteomyelitis to assess the prevalence of clinically unsuspected osteomyelitis and to compare the value of magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 99mTc-labelled monoclonal antigranulocyte antibody scintigraphy (99mTc-MOAB). Those with suggestive scans underwent bone biopsy for histology (n = 7). RESULTS: Osteomyelitis was confirmed by biopsy in seven of the 20 clinically unsuspected foot ulcers. Presence of osteomyelitis was not related to age, ulcer size, ulcer duration, duration of diabetes or HbA1c. C-reactive protein was slightly elevated in patients with osteomyelitis (35.1 +/- 16.0 mg L(-1) vs. 12.2 +/- 2.6 mg L(-1) in patients with and without osteomyelitis respectively; P = 0.07). MRI was positive in six of the seven patients with proven osteomyelitis, whereas 18F-FDG PET and 99mTc-MOAB were positive only in (the same) two patients. Of the seven patients with osteomyelitis, five had lower limb amputation and in one patient the ulcer was persisting after 24 months of follow-up. In contrast, of the 13 patients without detectable signs of osteomyelitis on imaging modalities only two had lower limb amputation and two persisting ulcers. CONCLUSIONS: Clinically unsuspected osteomyelitis is frequent in persisting foot ulcers and is a high risk factor for adverse outcome. MRI appears superior to 18F-FDG PET and 99mTc-MOAB in detecting foot ulcer-associated osteomyelitis and might be the preferred imaging modality in patients with nonhealing diabetic foot ulcers.

Implementation of Dose Monitoring Software in the Clinical Routine: First Experiences.

PURPOSE: Radiation exposure of the public as a result of medical imaging has significantly increased during the last decades. To have a tool to register and control patient dose exposure, we implemented dose monitoring software at our institution and first connected our computed tomography (CT) scanners. MATERIALS AND METHODS: CT dose data from July 2014 to February 2015 was retrospectively analyzed using dose monitoring software. We evaluated a number of scans above predefined dose thresholds ("alerts"), assessed reasons for alerts and compared data of two CT scanners, one located close to the emergency room ("emergency CT scanner") and one mainly used on an outpatient basis ("clinical routine CT scanner"). To check for statistically significant differences between scanners, chi-square-tests were performed. RESULTS: A total of 8883 scans were acquired (clinical routine CT scanner, n = 3415; emergency CT scanner, n = 5468) during which 316 alerts were encountered (alert quota, 4 %). The overall alert quota ranged from 2 - 5 % with significantly higher values for the clinical routine CT scanner. Reasons for alerts were high BMI (51 %), patient off-centering (24 %), scan repetition (11 %), orthopedic hardware (9 %), or other (5 %). Scan repetition was necessary significantly more often with the emergency CT scanner (p = 0.019), while high BMI, off-centering and orthopedic hardware were more frequently seen with the clinical routine CT scanner (for all, p < 0.05). There was a good correlation between high body weight and dose above threshold (r = 0.585). CONCLUSION: Implementation of dose monitoring software in the clinical routine was successfully accomplished and provides important information regarding patient radiation protection. KEY POINTS: ∙ Implementation of dose monitoring software in the clinical routine can be successfully accomplished. · Dose notifications are due to human error or patient-specific factors. · Dose monitoring software provides important information regarding radiation protection of patients.

Improving Radiation Awareness and Feeling of Personal Security of Non-Radiological Medical Staff by Implementing a Traffic Light System in Computed Tomography.

PURPOSE: Non-radiological medical professionals often need to remain in the scanning room during computed tomography (CT) examinations to supervise patients in critical condition. Independent of protective devices, their position significantly influences the radiation dose they receive. The purpose of this study was to assess if a traffic light system indicating areas of different radiation exposure improves non-radiological medical staff's radiation awareness and feeling of personal security. MATERIAL AND METHODS: Phantom measurements were performed to define areas of different dose rates and colored stickers were applied on the floor according to a traffic light system: green = lowest, orange = intermediate, and red = highest possible radiation exposure. Non-radiological medical professionals with different years of working experience evaluated the system using a structured questionnaire. Kruskal-Wallis and Spearman's correlation test were applied for statistical analysis. RESULTS: Fifty-six subjects (30 physicians, 26 nursing staff) took part in this prospective study. Overall rating of the system was very good, and almost all professionals tried to stand in the green stickers during the scan. The system significantly increased radiation awareness and feeling of personal protection particularly in staff with ≤ 5 years of working experience (p < 0.05). The majority of non-radiological medical professionals stated that staying in the green stickers and patient care would be compatible. Knowledge of radiation protection was poor in all groups, especially among entry-level employees (p < 0.05). CONCLUSION: A traffic light system in the CT scanning room indicating areas with lowest, intermediate, and highest possible radiation exposure is much appreciated. It increases radiation awareness, improves the sense of personal radiation protection, and may support endeavors to lower occupational radiation exposure, although the best radiation protection always is to re-main outside the CT room during the scan. KEY POINTS: • A traffic light system indicating areas with different radiation exposure within the computed tomography scanner room is much appreciated by non-radiological medical staff. • The traffic light system increases non-radiological medical staff's radiation awareness and feeling of personal protection. • Knowledge on radiation protection was poor in non-radiological medical staff, especially in those with few working experience.

[Hypoplasia of the descending thoracic and abdominal aorta in Williams-Beuren syndrome]. / Hypoplasie der deszendierenden Aorta thoracalis und der Aorta abdominalis bei Williams-Beuren-Syndrom.

Hypoplasia of the descending thoracic and abdominal aorta is a very rare condition and its etiology is poorly understood. Associations with congenital and acquired disorders have been reported. In this article we present the case of a 24-year-old woman with hypoplasia of the thoracic and abdominal aorta and Williams-Beurensyndrome. This rare syndrome is attributed to deletions of genes on chromosome 7, among other the elastin-gene, and is characterized by cardiovascular anomalies, dysmorph facial features and mental retardation. The patient presented with a history of severe hypertension and recurrent abdominal pain since childhood. Diagnosis was established by duplex-sonography and magnetic resonance angiography. The patient was treated by an aortoaortic bypass from the ascending to the infrarenal aorta with reinsertion of the visceral and the right renal arteries. It is essential to recognize the condition early to withhold high morbidity and mortality resulting from long standing severe hypertension.

[Verification of thumb-specific muscles in a triphalangeal thumb with magnetic resonance imaging]. / Nachweis daumenspezifischer Muskulatur beim triphalangealen Daumen mittels MRT.

The presence of three phalanges in the first digit is considered to be a relatively rare congenital hand malformation. Six groups of this deformity can be distinguished: some digits are opposable, others resemble a non-opposable five-fingered hand. In cases of a hypoplastic thenar region with a restrained opposition, a clear verification of thumb-specific musculature has been hardly possible. We report of the possibility of a non-invasive identification of thumb-specific muscles by means of magnetic resonance imaging.

Analysis of the meal-dependent intragastric performance of a gastric-retentive tablet assessed by magnetic resonance imaging.

BACKGROUND: Modern medical imaging modalities can trace labelled oral drug dosage forms in the gastrointestinal tract, and thus represent important tools for the evaluation of their in vivo performance. The application of gastric-retentive drug delivery systems to improve bioavailability and to avoid unwanted plasma peak concentrations of orally administered drugs is of special interest in clinical and pharmaceutical research. AIM: To determine the influence of meal composition and timing of tablet administration on the intragastric performance of a gastric-retentive floating tablet using magnetic resonance imaging in the sitting position. METHODS: A tablet formulation was labelled with iron oxide particles as negative magnetic resonance contrast marker to allow the monitoring of the tablet position in the food-filled human stomach. Labelled tablet was administered, together with three different solid meals, to volunteers seated in a 0.5-T open-configuration magnetic resonance system. Volunteers were followed over a 4-h period. RESULTS: Labelled tablet was detectable in all subjects throughout the entire study. The tablet showed persistent good intragastric floating performance independent of meal composition. Unfavourable timing of tablet administration had a minor effect on the intragastric tablet residence time and floating performance. CONCLUSION: Magnetic resonance imaging can reliably monitor and analyse the in vivo performance of labelled gastric-retentive tablets in the human stomach.

Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the diagnostic value of MR arthrography in detecting a lesion of the common insertion of the coracohumeral and the superior glenohumeral ligaments and the superior border of the subscapularis tendon (pulley lesion), which predisposes to biceps tendon subluxation and subsequent degeneration. METHODS: Parasagittal T1-weighted turbo spin-echo and axial gradient-echo (three-dimensional fast imaging with steady state-precession [FISP]) MR arthrographic images were obtained in 14 patients with surgically confirmed pulley lesions and in 10 patients with an intact pulley. Various MR arthrographic signs potentially associated with a pulley lesion were evaluated separately and independently in a blinded fashion by two radiologists. RESULTS: Abnormalities of the superior border of the subscapularis tendon on axial and parasagittal images, extra-articular contrast collection, and biceps tendon subluxation were the MR findings of a pulley lesion. The coracohumeral and superior glenohumeral ligaments were not readily visible in all patients and were not helpful in diagnosing pulley lesions in this study. The overall sensitivity for detecting a pulley lesion by MR arthrography was 86% and 93% for readers 1 and 2, with a specificity of 100% and 80% and an accuracy of 92% and 87% (kappa = 0.75). CONCLUSIONS: Based on the authors' experience, MR arthrography is valuable in detecting lesions of the reflection pulley of the long biceps tendon, although differentiation from an isolated lesion of the superior border of the subscapularis tendon may not be possible.

Indirect MR arthrography of the knee: effects of low-intensity ultrasound on the diffusion rate of intravenously administered Gd-DTPA in healthy volunteers.

RATIONALE AND OBJECTIVES: To evaluate whether application of low-intensity ultrasound may increase the diffusion rate of intravenously administered gadopentetate dimeglumine (Gd-DTPA) and increase the amount of joint fluid on indirect magnetic resonance (MR) arthrography. METHODS: Conventional MR imaging, indirect MR arthrography, and power Doppler ultrasonography were performed before and after application of therapeutic, pulsed low-intensity ultrasound in 12 asymptomatic knees of 12 volunteers. Intra-articular diffusion of intravenously administered Gd-DTPA as measured by signal intensity differences of the intra-articular joint fluid before and after ultrasound treatment was assessed. In addition, the amount of joint fluid was rated, and differences in synovial blood flow as evidenced by power Doppler ultrasonography were noted. RESULTS: All volunteers tolerated well the application of therapeutic low-intensity ultrasound. A significant increase in intra-articular diffusion of intravenously administered Gd-DTPA was noted in all knees, and an increase in joint fluid was noted in 8 of 12 knees (66.6%). Detection of power Doppler flow signal in the synovium of the suprapatellar recess was possible in one instance at posttreatment exam. CONCLUSIONS: Use of pulsed, therapeutic low-intensity ultrasound may increase the diffusion rate of intravenously administered Gd-DTPA and may induce joint effusion.

[Contrast-enhanced MR angiography for differentiation between perigastric and submucosal gastric fundal varices]. / Kontrastmittelverstärkte MR-Angiographie zur Differenzierung zwischen perigastrischen und submukösen Fundusvarizen des Magens.

PURPOSE: To evaluate contrast-enhanced MR angiography for the distinction between perigastric and submucosal fundal varices. MATERIALS AND METHODS: Nineteen consecutive patients with clinically suspected fundal varices underwent contrast-enhanced MR angiography and endoscopic ultrasound (EUS) within one week. Diagnostic confidence for the detection of perigastric and submucosal fundal varices was compared between MR angiography (two radiologists) and EUS (one gastroenterologist), and the agreement of size and location was evaluated. RESULTS: Both MR angiography and EUS detected perigastric varices in all 19 patients and submucosal fundal varices in 14 of the 19 patients. The interobserver reliability of MR angiography was good for measuring the variceal diameter (kappa = 0.76) and excellent for localizing the varices (kappa = 1.0). EUS and MR angiography agreed in 12 of 14 patients (86 %) in determining variceal diameter and location. CONCLUSIONS: Contrast-enhanced MR angiography is comparable to endoscopic ultrasound in the detection and characterization of gastric fundal varices.

Multi-detector row CT: effect of iodine dose reduction on hepatic and vascular enhancement.

PURPOSE: To evaluate the impact of different iodine concentrations of intravenous contrast agent on hepatic and vascular enhancement during arterial and porto-venous phase imaging using a 4-channel multi-detector row CT (MDCT). MATERIAL AND METHODS: One hundred consecutive patients referred for triphasic abdominal MDCT were randomly assigned into four groups receiving different iodine concentration (200, 250, 300 or 350 mg/ml). Non-contrast, arterial, and porto-venous phase 4-channel MDCT imaging was performed (VolumeZoom, Siemens, Germany). A fixed volume of 150 ml intravenous contrast agent at a rate of 3 ml/s was injected using an automatic bolus-tracking system (Care Bolus, Siemens, Erlangen). Hepatic and vascular enhancement values were measured over time and non-contrast values were subtracted in order to compute arterial and porto-venous mean hepatic (MHE) and mean aortic (MAE) enhancement for each group. Mean change of enhancement > 80 HU for the aorta and > 40 HU for the liver during porto-venous phase imaging was considered as sufficient enhancement. RESULTS: All groups achieved sufficient vascular enhancement during arterial phase imaging; MAE with 350 mg/ml (222 HU) and 300 mg/ml (213HU) was significantly better than with 250 mg (196HU) and 200 mg/ml (169 HU), whereas MHE showed no statistically significant difference between the groups (range 16 - 25 HU). Porto-venous MHE showed increased enhancement with larger concentrations, with significant differences among the groups. Only the higher concentration groups (350 mg/ml und 300 mg/ml) fulfilled in every individual the guidelines for sufficient porto-venous MHE. In the lower concentration groups, 8 patients with 200 mg/ml and 3 patients with 250 mg/ml showed enhancement values below the required minimum. CONCLUSION: A decrease in iodine contrast agent down to 200 mg/ml concentration is only tenable for propose of vascular aortic and hepatic arterial enhancement, whereas hepatic porto-venous phase imaging still requires concentrations at or above the level of 300 mg/ml.

The use of ultrasound and computed tomography for the diagnosis of a squamous cell carcinoma of the oesophago-cardial region of the stomach in a rhesus monkey.

A 5-year-old female rhesus macaque (Macaca mulatta) suddenly began suffering from anorexia, dysphagia, vomiting, diarrhoea, and anaemia. Clinical examination and conventional radiography were uneventful. Additionally an ultrasound (US) and computed tomography (CT) were performed which revealed a large tumorous mass in the upper abdomen and a lung metastasis. Using sonographic guidance, a biopsy of the abdominal masse was taken. Histopathological analysis revealed the diagnosis of a squamous cell carcinoma. At autopsy, an advanced gastric carcinoma, which originated from the cardia, was found with infiltration of the retroperitoneum, and metastatic involvement of the mesenterial lymph nodes as well as metastasis in the lung parenchyma. This case illustrates the usefulness of modern non-invasive imaging techniques, including US and CT, in enabling a quick and accurate diagnosis in laboratory animals.

[Rectus sheath hematoma--detection of hemorrhage of ruptured aneurysm of the epigastric artery in CT]. / Das Rektusscheidenhämatom--Nachweis einer Blutung eines rupturierten Aneurysmas der A. epigastrica im CT.

A case of rectus sheath hematoma is described. Computed tomography demonstrated a still active bleeding from an aneurysm which was situated at the junction of the inferior and superior epigastric artery. The recognition of a continuous hemorrhage contributed to the decision of an immediate surgical intervention.

[Wartenberg's Sign of Ulnar Nerve Lesion. A Contribution to Pathophysiology and to the Differential Diagnosis]. / Das Wartenberg-Zeichen des Nervus ulnaris. Ein Beitrag zur Pathophysiologie und Differenzialdiagnose1.

The abduction stance of the small finger is frequently, but not necessarily due to ulnar nerve paresis. Five cases suffering from bothersome permanent abduction of the small finger and referred under the diagnosis of ulnar nerve paresis are presented. Clinical, electrodiagnostic and imaging evaluation revealed different causes. While partial paresis with the function of the abductor digiti minimi muscle preserved usually results in a disturbing abduction stance, complete paresis of the ulnar nerve causes a less severe abduction posture of the small finger. Operative measures are indicated when the stance of the small finger is disturbing and when sufficient time has passed to make sure that spontaneous recovery cannot be presumed. Clinical, electrodiagnostic and imaging evaluation of three neurogenic cases disclosed a lesion of the ramus profundus distal to the branches innervating hypothenar muscles in one case, ulnar nerve injury with neuromuscular hyperactivity of the abductor digiti minimi muscle following split repair in another case and syringomyelia in the third case. Two patients revealed an abduction posture of the little finger of non-neurogenic origin. One of them showed closed ligament injuries. The other patient revealed necrosis, scarring and contracture of hypothenar muscles and atrophy of the third palmar interosseous muscle following compression in a tight cast.

[Radioscapholunate fusion: long-term results]. / Erfahrungen mit der radiokarpalen Teilarthrodese nach Gordon und King im Langzeitverlauf.

INTRODUCTION: A review of the literature on long-term results (> or = 10 years) following radiocarpal arthrodesis as recommended by Gordon and King shows a paucity of data. Regarding the suitability of this procedure for treating radiocarpal arthrosis, especially in younger patients, we collected and evaluated long-term results of this surgical procedure. MATERIALS AND METHODS: Five patients (four men, one woman), who were treated between 1978 and 1984 at our institution with a partial radiocarpal arthrodesis as described by Gordon and King were reexamined clinically and radiologically by the same examiner in the year 1990 and again in the year 2000. RESULTS: All five patients were very satisfied with the result of the operation. Two patients were completely free of pain, whereas the other three patients reported minor pain in the radiocarpal joint when applying strain. The active range of motion in the operated joint remained constant over the years (mean 60 degrees dorsopalmar, 30 degrees ulnoradial, 162 degrees pro-/supination). Conventional radiological imaging showed proper osseous consolidation in the areas of partial arthrodesis, and slight degenerative intercarpal alterations in the distal radioulnar joint were observed. Complete postprocedural reintegration into the workforce, including manually demanding work, was achieved. CONCLUSIONS: The results of the follow-up examinations of these five patients indicate that satisfying long-term results can be achieved after radiocarpal arthrodesis provided that the procedure is correctly indicated and the operation is conducted in a technically proper manner. This method of radiocarpal arthrodesis is likely also appropriate for young manual labourers suffering from painful radiocarpal arthrosis after distal intraarticular fracture of the radius, scaphoid non-union, scapholunar dissociation and Kienbock's disease.

Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines.

The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.