Syndrome of inadequate antidiuretic hormone secretion in pulmonary tuberculosis - a therapeutic challenge.

A forty-nine-year-old female patient with pulmonary tuberculosis developed syndrome of inadequate antidiuretic hormone secretion. Consequent restriction of fluid intake as a therapeutic measure was just as ineffective as a medication with tolvaptan which was performed later on. A probable explanation for the inefficacy of the aquaretic drug is an interaction of rifampicine and tolvaptan. This case report gives a short summary of SIADH in pulmonary TB and discusses possible reasons for the difficult antituberculotic treatment in this patient.

[Analysis of image acquisition, post-processing and documentation in adolescents with spine injuries - comparison before and after referral to a university hospital]. / Bildgebung bei wirbelsäulenverletzten Kindern und jungen Erwachsenen - eine Analyse von Umfeld, Standards und Wiederholungsuntersuchungen bei Patientenverlegungen.

PURPOSE: Systematic evaluation of imaging situation and standards in acute spinal injuries of adolescents. MATERIALS AND METHODS: Retrospective analysis of imaging studies of transferred adolescents with spinal injuries and survey of transferring hospitals (TH) with respect to the availability of modalities and radiological expertise and post-processing and documentation of CT studies were performed. Repetitions of imaging studies and cumulative effective dose (CED) were noted. RESULTS: 33 of 43 patients (77 %) treated in our hospital (MA 17.2 years, 52 % male) and 25 of 32 TH (78 %) were evaluated. 24-hr availability of conventional radiography and CT was present in 96 % and 92 % of TH, whereas MRI was available in only 36 %. In 64 % of TH, imaging expertise was guaranteed by an on-staff radiologist. During off-hours radiological service was provided on an on-call basis in 56 % of TH. Neuroradiologic and pediatric radiology expertise was not available in 44 % and 60 % of TH, respectively. CT imaging including post-processing and documentation matched our standards in 36 % and 32 % of cases. The repetition rate of CT studies was 39 % (CED 116.08 mSv). CONCLUSION: With frequent CT repetitions, two-thirds of re-examined patients revealed a different clinical estimation of trauma severity and insufficient CT quality as possible causes for re-examination. A standardization of initial clinical evaluation and CT imaging could possibly reduce the need for repeat examinations.

[Assessment of pedicle screws following dorsal instrumentation of the spine: a comparison of conventional radiographs with multidetector CT]. / Lagebeurteilung transpedikulA currencyrer Schrauben nach dorsaler Spondylodese mittels konventioneller RA paragraph signntgenaufnahmen: ein Vergleich zur Mehrzeilen-Computertomografie.

PURPOSE: To evaluate the performance of conventional radiographs (CR) for the assessment of pedicle screws in comparison with CT including MPR. MATERIALS AND METHODS: Comparison of CR and CT for the evaluation of screw length, extracorporal perforation (grade A: 0 - 2 mm, B: 3 - 4 mm, C: 5 - 6 mm, D: > 6 mm, relevant: grade C and D), screw contact/loosening, and subjective image quality (1: excellent to 4: non-diagnostic). The sensitivity (SE), specificity (SP), positive (PPV) and negative predictive value (NPV), and overall accuracy (OA) were calculated with 4x4 contingency tables. The subjective image quality was evaluated using the Wilcoxon test (p < 0.05). RESULTS: 411 screws were evaluated. The relevant medial perforation was diagnosed with CR/CT in 53(13 %)/ 11(3 %) screws, while the relevant lateral perforation was found in 3(1 %)/ 43(11 %) screws. Pedicle screw contact was diagnosed by CR/CT in 10(2 %)/ 18(4 %) cases and incorrect length was confirmed in 80(20 %)/ 90(22 %) screws. A diagnosis of loosening was established in 10(2 %) screws by CR and in 7(2 %) screws by MDCT. In summary, CR demonstrated SE, SP, PPV, NPV, and OA for the following variables: relevant medial perforation = 64 / 89 / 13 / 99 / 88 %, relevant lateral perforation = 4 / 99 / 67 / 90 / 90 %, screw contact = 11 / 98 / 20 / 96 / 94 %, incorrect screw length = 86 / 58 / 89 / 51 / 81 %, and screw loosening = 71 %/ 99 %/ 50 %/ 100 %/ 98 %. The subjective image quality of CR was significantly lower compared to CT (2.19 A + or - 0.84 and 1.11 A + or - 0.31; p < 0.001). CONCLUSION: CR evaluation of pedicle screws following dorsal instrumentation of the spine demonstrated an OA < or = 90 % for relevant medial and lateral perforation and for incorrect screw length compared to CT. Thus, reliable evaluation of pedicle screws based solely on CR does not seem feasible.

[Extraskeletal mesenchymal chondrosarcoma: rare differential diagnosis of pleural calcifications]. / Das extraskelettale mesenchymale Chondrosarkom: Seltene Differenzialdiagnose pleuraler Verkalkungen.

We report on a 78-year-old male patient with unilateral pleural effusion who underwent multiple diagnostic tests including thoracoscopy without establishing a final diagnosis. In the course of time, the patient developed multiple pleural tumors with calcifications. A CT-guided transthoracic biopsy was performed; the specimen revealed histopathological and immunohistochemical evidence for an extraosseous mesenchymal chondrosarcoma. Besides a short review of the literature, the case is discussed as an extremely rare differential diagnosis of pleural calcifications. To the best of our knowledge, this is the first patient in whom the diagnosis of an extraosseous chondrosarcoma, most likely of the pleura, could be established by CT-guided transthoracic biopsy.