Fatal Pseudomonas aeruginosa pneumonia in a previously healthy woman was most likely associated with a contaminated hot tub.

Community-acquired pneumonia due to Pseudomonas aeruginosa in previously healthy individuals is a rare disease that is associated with high fatality. On 14 February 2010 a previously healthy 49-year-old woman presented to an emergency room with signs and symptoms of pneumonia, 2 days after returning from a spa holiday in a wellness hotel. Blood cultures and respiratory specimens grew P. aeruginosa. Despite adequate antimicrobial therapy, the patient died of septic multiorgan failure on day nine of hospitalization. On February 26, nine water samples were taken from the hotel facilities used by the patient: In the hot tub sample 37,000 colony-forming units of P. aeruginosa/100 ml were detected. Two of five individual colonies from the primary plate used for this hot tub water sample were found to be genetically closely related to the patient's isolates. Results from PFGE, AFLP and MLST analysis allowed the two lung isolates gained at autopsy and the whirlpool bathtub isolates to be allocated into one cluster. The patient most likely acquired P. aeruginosa from the contaminated water in the hotel's hot tub. The detection of P. aeruginosa in high numbers in a hot tub indicates massive biofilm formation in the bath circulation and severe deficiencies in hygienic maintenance. The increasing popularity of hot tubs in hotels and private homes demands increased awareness about potential health risks associated with deficient hygienic maintenance.

Update: Multinational listeriosis outbreak due to 'Quargel', a sour milk curd cheese, caused by two different L. monocytogenes serotype 1/2a strains, 2009-2010.

We previously reported an outbreak of listeriosis in Austria and Germany due to consumption of Quargel cheese. It comprised 14 cases (including five fatalities) infected by a serotype 1/2a Listeria monocytogenes (clone 1), with onset of illness from June 2009 to January 2010. A second strain of L. monocytogenes serotype 1/2a (clone 2) spread by this product could be linked to further 13 cases in Austria (two fatal), six in Germany (one fatal) and one case in the Czech Republic, with onset of disease from December 2009 to end of February 2010.

Listeriosis outbreak caused by acid curd cheese Quargel , Austria and Germany 2009.

We report an outbreak of listeriosis in Austria and Germany due to the consumption of Quargel cheese produced by an Austrian manufacturer. At the time of writing this report, the outbreak was known to account for 14 outbreak cases in 2009, including four cases with lethal outcome. On 23 January 2010, the cheese product was voluntarily withdrawn from the market.

[Femoral head necrosis]. / Hüftkopfnekrose.

The epidemiology and pathohistogenesis of avascular femoral head necrosis has still not been clarified in detail. Because the course of the disease runs in stages and over a long time period nearly always culminates in the necessity for a total hip prosthesis, an exact radiological evaluation is of paramount importance for the treatment. There is a need for a common staging system to enable comparison of different therapy concepts and especially their long-term results. In this article the ARCO staging system is described in full detail, which includes all radiological modalities as well as histopathological alterations.

[Imaging examinations of the patellofemoral joint]. / Bildgebende Untersuchungen des Patellofemoralgelenks.

Lesions in the patellofemoral region can be caused by trauma, chronic overloading, and especially regarding cartilage alterations by normal aging or pathologic processes. Very commonly these lesions lead to early arthrosis. An accurate clinical evaluation in all these patients is recommended. The combination of clinical information and radiological examinations should end up with an exact diagnosis.As part of the radiological evaluation of complaints of the patellofemoral region MR imaging is of special value since this method allows direct visualization of all intra- and extra-articular structures and their alterations, ultimately aiding in planning sufficient therapy. Moreover, is it possible to exclude pathology by MR imaging, which helps to prevent useless treatment and surgical procedures.

Meticillin-resistant Staphylococcus aureus: occurrence of a new spa type in two acute care hospitals in Austria.

Typing multiply-resistant bacteria using molecular techniques is high priority for national health authorities. Routine typing of meticillin-resistant Staphylococcus aureus (MRSA) was initiated in Austria 2005 and was performed by sequence analysis of the variable X region of protein A gene (spa), characterisation of the mec gene (SCCmec) and testing for Panton-Valentine leukocidin (PVL), enterotoxins, toxic shock syndrome toxin and the epidermolytic toxin genes. Ten different spa types, including newly identified t2023, were found among 66 clinical MRSA isolates originating from two neighbouring hospitals under the same management. Spa type t2023 was initially isolated in December 2005 from hospital A, where it became the dominant spa type during 2006 (nine of 16 isolates). The occurrence of type t2023 in hospital B remained a unique event and could be epidemiologically linked to a patient transferred from hospital A. Spa type t2023 is very similar to spa type t001. An isolate of spa type t001 from hospital A showed an enterotoxin gene pattern, multilocus sequence type (MLST) and SmaI macrorestriction PFGE pattern indistinguishable from that of t2023. Epidemiological differences suggested that infection control measures can prevent MRSA cross-transmission. Hospital B had a more stringent MRSA isolation policy, a higher nurse:patient ratio and provided more resources for infection control than hospital A.

Suitability of partial 16S ribosomal RNA gene sequence analysis for the identification of dangerous bacterial pathogens.

AIMS: In a bioterrorism event a rapid tool is needed to identify relevant dangerous bacteria. The aim of the study was to assess the usefulness of partial 16S rRNA gene sequence analysis and the suitability of diverse databases for identifying dangerous bacterial pathogens. METHODS AND RESULTS: For rapid identification purposes a 500-bp fragment of the 16S rRNA gene of 28 isolates comprising Bacillus anthracis, Brucella melitensis, Burkholderia mallei, Burkholderia pseudomallei, Francisella tularensis, Yersinia pestis, and eight genus-related and unrelated control strains was amplified and sequenced. The obtained sequence data were submitted to three public and two commercial sequence databases for species identification. The most frequent reason for incorrect identification was the lack of the respective 16S rRNA gene sequences in the database. CONCLUSIONS: Sequence analysis of a 500-bp 16S rDNA fragment allows the rapid identification of dangerous bacterial species. However, for discrimination of closely related species sequencing of the entire 16S rRNA gene, additional sequencing of the 23S rRNA gene or sequencing of the 16S-23S rRNA intergenic spacer is essential. SIGNIFICANCE AND IMPACT OF THE STUDY: This work provides comprehensive information on the suitability of partial 16S rDNA analysis and diverse databases for rapid and accurate identification of dangerous bacterial pathogens.

[MRI after meniscus and cruciate ligament surgery]. / MRT nach Meniskus- und Kreuzbandoperationen.

Nowadays, due to its high diagnostic accuracy, MR imaging is the method of choice for the evaluation of knee joint disorders pre- and postoperatively. Accurate diagnosis is sometimes possible only if the reporting radiologist has knowledge of the therapeutic procedures and the surgical report. Frequently, further therapeutic management is strongly influenced by MR examinations and radiological reports.

[Muscle and tendon injuries of the knee joint]. / Muskel- und Sehnenverletzungen am Kniegelenk.

Muscles and tendons contribute greatly to stabilization of the knee joint and are crucial elements for normal joint function. Therefore, injuries of those structures cause variable degrees of disability, depending on the severity of the lesion. Due to the characteristic structural changes and alterations of signal intensities, MR imaging allows accurate identification and staging of acute injuries of muscles and tendons, as well as assessment of chronic or degenerative disease. The knowledge of anatomy and normal function of muscles and tendons, together with a thorough understanding of the mechanism and usual combinations of their injuries (e.g., posterolateral structures) allows an exact evaluation of injury-induced functional impairments to the knee joint. A detailed and exact radiological report is of the greatest importance for the referring clinician and the patient to determine optimal therapeutic strategies.

Virtual reality of the lower urinary tract in women.

Advances in computerized and imaging technology permit both students and doctors to depict the anatomy of the human pelvis more realistically than with previous methods. Further refinements outline fine pelvic structures, such as the nerve plexus, which may as a result be spared during major pelvic surgery, thus preserving the function of the bladder neck and urethra. Dynamic computerized tomography or magnetic resonance imaging, coupled with three-dimensional depiction of the lower urinary tract and its adjacent structures, enable visualization of the whole lower urinary tract and the pelvic floor musculature in both continent and incontinent women. In patients with a reconstructed lower urinary tract computer-assisted image processing shows the postoperatively altered topographical anatomy. This may be clinically useful for interpretation of unexpected findings with conventional imaging modalities, postoperative morbidity, and surgical planning of a lower abdominal reoperation. Examples of our own work regarding the innervation of female pelvic organs, dynamic depiction of the bladder and pelvic floor musculature during straining in normal and incontinent women, and the situation of female patients after undergoing an anterior pelvic exenteration with subsequent orthotopic neobladder procedure, are given. In addition, the data of these patients have been compiled for virtual reality endoscopy, which is useful for patient consent and for teaching residents, students and nurses.

[Tibial growth after isolated femoral shaft fracture in the growth stage]. / Das Tibiawachstum nach isolierter Femurschaftfraktur im Wachstumsalter.

The aim of the present study is to investigate the growth of the tibia after femoral shaft fractures in children. We were able to follow up 44 patients (32 male and 12 female) after a mean of 8 years (range, 5 to 15 years). The age in the time of injury was 3 till 13 years (mean 7 years). The length of the femur, tibia and leg was measured on X-rays of the entire leg, and the measurements were compared with the contralateral side. A statistically significant number of tibial elongations were observed in fractures that had healed in considerable malalignment (at least 1 cm shortening, dislocation of at least a half of the breadth of the femoral shaft, angular deformity of more than 10 degrees) (p = 0.003) and in fractures that were subjected to manipulation (secondary reduction, change of treatment or traction weight) during the healing process (p = 0.007). Furthermore, all 7 patients who had infection requiring treatment at the tibial plateau extension had more pronounced tibial growth. No significant difference was found between tibial growth and the age of the child at the time of injury, the type of fracture, the location of fracture and the mode of treatment. The following factors were evaluated as being clinically relevant: primary, largely anatomic reduction, avoidance of secondary manipulation and prevention of infection at the tibial plateau extension.

The Austrian Academic Computer Network and its usefulness for teleradiology.

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94-341). During the test phase, no major problems with image transfer occurred. Assuming that problems like security of patient data-sets, data compression and data verification can be solved, the ACOnet service would be a useful additional tool for telemedicine applications throughout Austria and eastern Europe.

[ACOnet (Austrian Academic Computer Network) as data carrier for teleradiologic consultations]. / Das ACOnet (Austrian Academic Computer Network) als Datenträger für teleradiologische Konsultationen.

PURPOSE: To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions. MATERIALS AND METHODS: 1740 test image data sets and 620 image data sets for teleradiological consultations were exchanged without annotations between the Departments of Diagnostic Radiology of the universities of Innsbruck and Graz, using the ACOnet. RESULTS: Data transmission was reliable and fast with an average transfer capacity of 170.2 kBytes/s (94-341 kBytes/s). There were no major problems with image transfer during the test phase. CONCLUSION: Due to its high transfer capacity, the ACOnet is considered a reasonable alternative to the ISDN service.

Virtual computed tomography gastroscopy: a new technique.

BACKGROUND AND STUDY AIMS: The aim of the present study was to establish a suitable method for virtual computed tomography (CT) gastroscopy. PATIENTS AND METHODS: Three-millimeter helical CT scans of a pig stomach were obtained after air insufflation and instillation of diluted diatrizoic acid (Gastrografin), and with double contrast. In addition, three patients with gastric tumors were studied after ingestion of an effervescent agent (Duplotrast, 6 g) and intravenous injection of hyoscine butylbromide (Buscopan, 1 ml). Virtual endoscopy images were computed on a Sun Sparc 20 workstation (128 megabytes of random access memory, four gigabytes of hard disk space), using dedicated software (Navigator, General Electric Medical System Company). The endoscopy sequences were compared with real endoscopic examinations and with anatomical specimens. RESULTS: In the cadaver studies, the best results were obtained with plain air insufflation, whereas virtual CT gastroscopy with diluted contrast and with double contrast showed artifacts simulating polyps, erosions, and flat ulcers. Patient studies showed good correlation with the fiberoptic endoscopy findings, although large amounts of retained gastric fluid substantially reduced the quality of the surface reconstruction. CONCLUSION: These preliminary results show that virtual CT gastroscopy is able to provide insights into the upper gastrointestinal tract similar to those of fiberoptic endoscopy. However, due to the limited spatial resolution of the CT protocol used, as well as inherent image artifacts associated with the Navigator program's reconstruction algorithm, the form of virtual CT gastroscopy studied was not capable of competing with the imaging quality provided by fiberoptic gastroscopy.

[Open questions on the topic of teleradiology from the current viewpoint]. / Offene Fragen zum Thema Teleradiologie aus aktueller Sicht.

A review on the theoretical challenges and potential risks of teleradiology is given. Based on the authors two years clinical experience and the current literature unsolved problems are discussed, which are to a smaller extent the technical implementation but much more the still missing regulation of various concomitant circumstances.

[Virtual CT colonoscopy. Examination technique, limitations and perspectives]. / Virtuelle CT-Koloskopie. Untersuchungstechnik, Limitierungen und Perspektiven.

Virtual CT-colonoscopy is a post-processing method which allows for reconstruction of inner bowel surface structures from helical CT datasets. The reconstructed images simulate the views which are known from fiberoptic endoscopy. Since colorectal cancer is the second main cause of death in USA and Europe today and since recent screening recommendations are often ignored by the public, a non-invasive or minimal-invasive procedure for colonic evaluation would offer some benefits. Virtual CT-colonoscopy generally involves three essential steps: patient preparation with cleansing of the bowel and administration of an air enema, helical CT-examination by using appropriate scan parameters, and interactive 3D rendering of the volume data-set. Although recent studies have demonstrated that polypoid lesions of about 5 mm size are well detectable and although virtual colonoscopy offers many advantages over fiberoptic endoscopy, some technical and clinical limitations must still be noted. Thus, the current inability of virtual colonoscopy to provide texture and color leads to problems in identifying flat lesions; the presence of retained or adherent fecal matter may result to false positive diagnosis and collapsed segments of bowel may cause problems as they cannot subsequently be evaluated during image reconstruction. Virtual endoscopy is still in its infancy and further technical and clinical developments are necessary. Virtual CT-colonoscopy may then prove to be equal or superior to colonoscopy in sensitivity and specificity for polyp detection and be able to reduce the number of unnecessary colonoscopic procedures.

[Establishment of an emergency CT service by means of teleradiology]. / Etablierung eines computer-tomographischen Notfallbetriebes mittels Teleradiologie.

UNLABELLED: The teleradiological connection between the University Hospital in Innsbruck, Tyrol, and the Regional Hospital in Zwettl, Lower Austria, is presented as an example of a routine online connection of two helical CT systems. PURPOSE: To establish a practicable and cost-efficient emergency CT service in a remote hospital during night time and on weekends. MATERIAL AND METHODS: Online connection of a GE HiSpeed Advantage-Spiral-CT and a GE Prospeed-Spiral-CT via two Sun SPARC 10 work stations and ISDN. RESULTS: The transmission of 121 CT data sets from 116 patients revealed a sufficiently fast average transmission time of 15 (6-53) minutes and average transmission costs of DM 9.00 per examination. The system was technically reliable, cost-efficient and practicable in clinical routine application. CONCLUSIONS: Teleradiology enables remote hospitals to provide an emergency CT service even if there is no radiological specialist available outside office hours. Thus time-consuming and cost-intensive patient transfers and delay of therapy can be reduced.