[Back pain : State of the art and guidelines]. / Rückenschmerz : Aktuelle Entwicklungen und Leitlinien.

Pain in general and back pain in particular are associated with a variety of pathological, clinical, and sociocultural factors. There are numerous clinical and therapeutic treatment as well as imaging-options available and comprehensive knowledge is required to meet the individual clinical needs of those affected. This requires a high degree of interdisciplinary cooperation. In addition, back pain is covered differently by various numbers of insurance companies. Imaging methods, including the example of periradicular image-assisted interventions, are presented with regard to their indication and efficiency. The existing guidelines and evaluation recommendations with different structural and targeted approaches are discussed in addition to extensive legal aspects in the literature. In addition, the structured reports and the certificated curricula of the AG Bildgebende Verfahren des Bewegungsapparates (Working Group "Imaging Procedures of the Musculoskeletal System") of the Deutsche Röntgengesellschaft ("German Society of Radiology") are recommended for the quality assurance.

[The description of meniscopathy in the sense of German occupational disease No. 2102 : Results of an interdisciplinary working group]. / Das Krankheitsbild im Sinne der Berufskrankheit 2102 Meniskopathie : Ergebnisse einer interdisziplinären Arbeitsgruppe.

On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

[Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton]. / Arthrose-Klassifikationen : Modifizierungsvorschlag für die Kriterien nach Kellgren und Vallotton.

BACKGROUND: In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50 years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. AIM: In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. METHODS: The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X­ray and MRI findings are compared. RESULTS: Suggestions for both a modification of the Kellgren classification as far as the criteria are concerned and a hierarchy (ranking) of X­ray and MRI findings to make clinical decisions more valuable are proposed. CONCLUSION: These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

[Bone infections]. / Knocheninfektionen.

Even in recent traumatology and orthopedic surgery infectious diseases of the bone (i.e. osteomyelitis) and it's surrounding tissues remain serious complications. The therapy is demanding and oftenly does not lead to a complete restitutio ad integrum. In order to create the optimal treatment one has to have a profound knowledge about the "state of the art" therapy of bone infections and the basic phases: Reassurance of the local infection (bone and surrounding tissues) and reconstruction of the bone and surrounding tissues. The local infection treatment is based on the consequent surgical eradication of infected tissue. In addition (as a supportive therapy) antibiotics have to be applied according to the local and systemic response of the patient to the infection. Also further supportive methods like hyperbaric oxygenation may be taken into consideration. The following paper provides an overview of diagnostic features and the different surgical procedures as well as the current literature in order to reach the above mentioned goals.

[Clinical value of bronchoalveolar lavage]. / Uitlité clinique du lavage bronchoalvéolaire.

Bronchoalveolar lavage (BAL) is a minimally invasive procedure used to characterize the status of the alveolar space. Standardization of the procedure and the analysis of samples taken is essential for their proper interpretation. In nonresolving or ventilator-associated pneumonia, BAL contributes to the detection of resistant pathogens and noninfectious etiologies. In immunocompromised hosts with radiological infiltrates, BAL should be performed early during work-up since outcome is significantly modified in this population group. In cases of interstitial lung disease, BAL can exclude infectious or neoplastic causes. Associated with a clinical and radiological evaluation, it provides valuables additional diagnostic information.

Alterations of the Wnt signaling pathway during the neoplastic progression of Barrett's esophagus.

Aberrant activation of the Wnt signaling pathway has been reported during neoplastic progression in Barrett's esophagus (BE). However, mutations in APC and CTNNB1 genes were rarely observed. In this study, expression pattern of Wnt ligands, Frizzled receptors and APC, as well as the methylation status of the APC, SFRP1 and SFRP2 promoter genes were investigated in normal esophageal mucosa and in preneoplastic and neoplastic lesions of BE patients. Promoter methylation of APC was found in all BE samples and in 95% of esophageal adenocarcinomas (EAC). Full methylation of APC correlated with lack of expression. In EAC, nuclear translocation of beta-catenin was observed regardless of the expression of APC. WNT2 expression was higher in dysplasia and EAC than in BE, with 20/26 (77%) of the EAC showing high expression of WNT2. SFRP1 methylation occurred in all BE samples and in 96% of EAC, while SFRP2 was methylated in 73% of the normal squamous esophageal mucosa samples. In conclusion, (1) alterations of key regulators of the Wnt signaling are frequent in the pathogenesis of BE; (2) the APC and SFRP1 genes are inactivated by promoter methylation in BE; (3) the WNT2 gene is upregulated along the progression from low-grade dysplasia to EAC.

Digital image DNA cytometry: a useful tool for the evaluation of malignancy in biliary strictures.

BACKGROUND: Cytologic evaluation of the biliary tract strictures is nowadays widely used for distinguishing between benign and malignant lesions but remains a challenge for some problematic cases. Digital Image cytometry (DNA-cytometry) helps cytopathologists to resolve some unclear situations. METHODS: We have analysed 41 specimens of bile duct brushings obtained from patients during ERCP (11 benign cases, 7 suspicious for malignancy cases and 23 malignant cases) by DNA-cytometry and correlated them with the histological biopsy counterpart. RESULTS: All eleven cytological and histological benign cases were DNA-diploid and among 22 patients with malignant cytological and histological diagnosis 21 were DNA-aneuploid. One case considered malignant by the cytopathologist revealed DNA-aneuploid but malignancy could not be confirmed by histology. The analysis of the suspicious for malignancy cases revealed that all DNA-aneuploid cases were malignant and all DNA-diploid cases were benign referring to the follow-up of the patients. The comparison between cytology alone and cytology combined with DNA-cytometry related to the histological diagnosis (gold standard) resulted in a sensitivity of 100% and a specificity of 79% for cytology alone; a specificity of 94% and a sensitivity 92% for DNA-cytometry and a specificity of 93% and a sensitivity of 100% with combined analyses. The positive predictive value was 90% for cytology, 96% for DNA-cytometry and for both analyses. The negative predictive value showed 100% for cytology, 89% for DNA-cytometry and 100% for combined studies. CONCLUSIONS: Despite the limited number of patients involved in the study, the results obtained indicate an increased of specificity and of positive predictive value using DNA-cytometry. These results confirm the pertinence of these method for challenging cases, in conjunction with other available diagnostic tools.

[Comments on the standards for acceptance and consistency testing of systems for digital radiography]. / Kommentierungen zu den Normen zu Abnahme- und Konstanzprüfungen bei digitalen Radiographiesystemen (Projektionsradiographie).

Due to German regulations, acceptance and consistency tests have to be obtained by 12.31.2005 for all equipment used for computed radiography according to special standards published in DIN 6868. This article familiarizes all users with the most important aspects of these standards. In addition, explanatory and background information for establishing these regulations are provided.

Digital radiography.Results of a survey (part A) and a consensus conference (part B)

Digital imaging (digital image intensifier radiography, storage phosphor/selenium radiography) is increasingly becoming commonplace in radiology departments for diagnostic purposes. Despite 10 years of experience, the advantages and disadvantages of those methods are still heavily discussed among users, financiers and prescribers. This paper is to offer additional arguments for a thorough and objective discussion. No further comments or interpretations have been added to this paper. This paper consists of two main parts, A and B. The first part deals with the results of a user survey, the other part presents the results, i. e. statements, of a consensus conference.

[Image quality evaluation and dosage requirements of digital image intensifier radiography]. / Bildgütebestimmung und Dosisbedarf der digitalen Bildverstärkerradiographie.

In the course of a study of the advantages and disadvantages of digital image intensifier radiography, image quality and dose requirements were measured, using a phantom. Spatial resolution was related to exposure parameters, the differentiation of structural details at varying contrast concentrations and the phantom entry doses. Spatial resolution was approximately 1.8-2.0 line pairs/mm (lp/mm) and there was no recognisable effect from increasing the dose or the thickness of the phantom. Additional subsequent edge enhancement led to increased detail recognition up to 2.0 lp/mm. Also, phase inversion of the image (negative image) can improve detail recognition. Radiation dose can be reduced to 15% compared with conventional imaging methods. Digital radiography with image intensifier techniques can therefore be recommended. Optimal spatial and contrast resolution is obtained at 80-90 keV. However, some reduction in perception of the finest structural details must be accepted.

[The renaissance of simultaneous tomography with the fluorescent-film storage system]. / Renaissance der Simultantomographie mit dem Speicherleuchtstoffoliensystem.

The handling, technical and exposure details of digital simultaneous tomography are explained, while particular emphasis is placed on image quality. Selected case reports demonstrate the application of this technique by using the digital storage fluorescent system (Fa. Siemens, Erlangen). Simultaneous tomography with storage fluorescent screens is particularly suitable to demonstrate or exclude osseous findings at the skull, the column and large joints.

[CT and HR-CT in the diagnosis of pulmonary complications of bone marrow transplantation]. / CT und HR-CT in der Diagnostik pulmonaler Komplikationen bei Knochenmarktransplantation.

The aim of this prospective study was to compare conventional and high resolution CT for demonstrating pulmonary complications. 23 patients treated by bone marrow transplantation were included in the study between December 1990 and August 1991. These patients were examined radiologically at regular intervals following the transplants. In 9 patients lung changes were detected by CT: there were pneumonic infiltrates, including one CMV pneumonia, two cases of mild parenchymal fibrosis, two cases of extensive lung fibrosis and one of miliary tuberculosis. The advantages and disadvantages of conventional and high resolution techniques are discussed in relation to our findings.

[Evacuation proctography: physiological variability and clinical relevance of the anorectal angle and the position of the pelvic floor]. / Evakuationsproktographie: Physiologische Streubreite und klinische Relevanz des Anorektalwinkels und der Beckenbodenlage.

Evacuation proctography is an important imaging method for the investigation of abnormalities of defecation. For this procedure, the most commonly carried out measurements are the ano-rectal angle and the position of the pelvic floor. The given mean values and the physiologically acceptable deviations vary just as much as the perceived clinical value of these measurements. 173 evacuation proctograms were evaluated in a prospective study; the subjective abnormalities were correlated with clinical findings. No significant correlation between the measurements from the proctograms and the clinical findings could be determined. The clinical relevance of these measurements is, therefore, uncertain.

[Transvenous sonography of the peripheral arterial vessels. The initial clinical results]. / Transvenöse Sonographie peripherer arterieller Gefässe. Erste klinische Ergebnisse.

Intravascular ultrasound with 20 MHz/6.2-French transducer systems was used for arterial imaging via a transvenous approach. In 20 patients suffering from chronic arterial occlusive disease, 15 iliac arteries were evaluated during diagnostic angiography and 5 femoropopliteal arteries during balloon angioplasty (n = 3) and laser-assisted angioplasty (n = 2), respectively. Transvenous sonography did not allow differentiation of arterial wall layers and determination of vessel diameters as is usually possible during intraarterial sonography. Visualisation of iliac arteries was incomplete. In femoropopliteal vessels, guide wires could be detected within the arterial lumen but not in complete occlusions. Delivery of pulsed laser energy induced bright echoes near the catheter tip within a distance of 1-2 cm. Transvenous sonography is insufficient for monitoring of peripheral angioplasty; however, improved imaging quality might be possible at lower frequencies.

[The monitor findings of digitalized conventional wrist x-rays]. / Monitorbefundung digitalisierter konventioneller Handwurzelaufnahmen.

The study aimed at proving the reliability of monitor systems with the matrix of 1024 x 768 for the detection of scaphoid fractures compared to conventional X-ray. Moreover, we were interested in the significance of procedures of digital imaging post processing, depending in particular on the experience of investigators. 5 investigators with different levels of experience analysed 57 X-rays of the wrist. They compared conventional X-rays with images on a high screen monitor system after the digitalisation of these X-rays by a CCD-scanner and analysed untreated and treated images. A 5-point scale ROC analysis was used for evaluation. The analysis covered a total of 1740 evaluations. The untreated images seen on the monitor system proved slightly better than conventional X-rays. Post-processing has no evident advantage over untreated images. Differing levels of experience had no effect whatsoever on the identification of findings.

Detection of malignant effusions: comparison of a telomerase assay and cytologic examination.

Telomerase is inactive in most somatic cells, but has been found to be reactivated in a majority of cancers. Our principal goal was to test whether the presence of telomerase activity concurred with positive cytology, and was thus of potential use in detecting cancer cells in effusions. The telomeric repeat amplification protocol (TRAP) assay and cytological examination were performed in a blinded fashion on 91 unselected effusions, for which laboratory processing was done according to standard procedures. In our series, 30% (27/91) of samples were found to be malignant by cytology. Of these, 19 (70%) were also positive in the TRAP assay. Of the 8 telomerase-negative cytology-positive samples, RNA integrity was generally poor, indicating suboptimal sample conservation for molecular analysis. Negative cytology in the presence of telomerase activity was observed in 17 effusions. Of these, 11 were from patients with advanced cancer, and thus a diagnosis of malignant effusion should be suspected. The TRAP assay for telomerase activity holds promise in the analysis of effusions, but its routine use as an adjunct to cytology awaits further confirmation of its positive predictive value.

Pitfalls in TRAP assay in routine detection of malignancy in effusions.

Telomerase has been found to be reactivated in a majority of cancers but is inactive in most somatic cells. Our principal goal was to determine the potential use of the telomeric repeat amplification protocol (TRAP) assay as marker for malignancy in cytological effusions. The simple selection criterion was the cytological diagnosis, and routine samples were classified into malignant (58 samples) and nonmalignant (233 samples). Of the malignant samples, 44/58 (76%) were positive by TRAP assay. Of the 14 telomerase-negative cytology-positive samples, RNA integrity was poor in 9, indicating suboptimal sample conservation for molecular analysis. In 3 of the remaining 5 samples with a negative TRAP assay, a high number of malignant cells was observed, and these cells might have been telomerase-negative. Thus, the sensitivity of TRAP assay for the presence of malignant cells was about 76%. In the cytologically nonmalignant effusions, the presence of telomerase activity was observed in 24% (55/233). Of these, 6% were highly suspicious for malignancy, 9% were doubtful, and 9% were cytologically nonmalignant effusions confirmed by a follow-up of 12 mo or more. According to these data, the specificity of the TRAP assay to detect tumor cells in effusions ranged only between 82-91%. Our results indicate that, although the TRAP assay is positive in 6-15% of putative malignant effusions, the relatively high number of TRAP false-negative and false-positive cases renders this test unsuitable for routine diagnostic purposes.

[Ovarian carcinoid tumors: immunohistochemical and ultrastructural study of 8 cases]. / Carcinoïdes ovariens: étude immunohistochimique et ultrastructurale de 8 cas.

Eight ovarian carcinoids, 4 trabecular and 4 strumal have been studied immunohistochemically for polypeptide hormones; three of them were also examined with the electron microscope. Seven of eight cases were positive for at least one polypeptide hormone. The trabecular parts of the 4 cases of strumal carcinoid were positive for pancreatic polypeptide. As the vesicular regions of these 4 cases were positive for thyroglobulin and for pancreatic polypeptide, we suspect the existence of "hybrid" thyroid and neuroendocrine cells. The electron microscopic examination revealed: the cell in the insular carcinoid had no distinct polarization and contained electron-dense granules of varying shape; in the trabecular part of the strumal carcinoid the cells were polarized and contained round electron-dense granules.

[Double-contrast arthro-CT in diagnosis of shoulder instability]. / Doppelkontrast-Arthro-CT zur Diagnostik von Schulterinstabilitäten.

Timeless and lesion-related treatment are important in the different shoulder instabilities in order to get a good functional result. Within the step-by-step programme of diagnostic possibilities the double contrast computerised arthrotomography is particularly indicated in recurrent posttraumatic and habitual dislocations, in subluxations as well as for clarification of causes of postoperative recurrence. Besides the documentation of skeletal changes (Hill-Sachs-lesion, Bankart defect), double-contrast arthro-CT offers the possibility to identify detachments of the joint capsule or labral tears. Between 11/90 and 9/93 we performed 38 double contrast arthro-CTs for recurrent shoulder instabilities. 35 men and 3 women were examined. The mean age of the sportive patients were 29 years. Preoperatively we diagnosed in 21 cases a recurrent posttraumatic, in 7 cases a habitual shoulder instability. Apart from one multidirectional and three posterior instabilities we found two cases of subluxation. In the meantime 24 patients were treated with an open stabilising operation of the shoulder. The operative findings were compared with the results of double contrast arthro-CT. In a total of 38 performed arthro-CTs we found labral tears in 4 cases, 14 labral dissections, and 10 times a complete labral discontinuity. 8 of 9 labrum dissections found intraoperatively were correctly identified on CT. One dissection was not even seen retrospectively on arthro-CT. Six of nine complete labrum discontinuities were seen on arthro-CT, three described as a dissection. All capsular detachments and bony Bankart lesions found on CT were confirmed intraoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)