Bone age determination based on the study of the medial extremity of the clavicle

The development of the medial clavicular epiphysis and its fusion with the clavicular shaft have been a subject of medical research since the second decade of this century. Computed tomography provides the imaging modality of choice in analyzing the maturation process of the sternal end of the clavicle. In a retrospective study, we analyzed normal development in 380 individuals under the age of 30 years. The appearance of an epiphyseal ossification center occurred between ages 11 and 22 years. Partial union was found from age 16 until age 26 years. Complete union was first noted at age 22 years and in 100 % of the sample at age 27 years. Based on these data, age-related standardized age dis…

Quantitative ECG analysis for individual risk assessment of future myocardial infarct-results from the MARISK study

From 1980 to 1990 the authors performed an epidemiological cohort study in order to explore the predictive power of computer electrocardiogram (ECG) measurements for individual risk assessment of future myocardial infarct in combination with commonly known risk factors. Out of 7542 participants, 83 experienced a myocardial infarct during the course of the study. Multivariate logistic regression analysis revealed that vector cardiogram (VCG) measurements provide significant additional information to risk estimation which is equivalent to that of other risk factors. Measurement changes are stronger risk indicators than single measurements. The results confirm previous findings from H.V. Pipbe…

Chromoscopy-Guided Endomicroscopy Increases the Diagnostic Yield of Intraepithelial Neoplasia in Ulcerative Colitis

Background & Aims: Because of the large number of biopsy specimens, surveillance colonoscopy in ulcerative colitis (UC) is currently time consuming and significant flat lesions still may be missed. In this study we assessed the value of combined chromoscopy and endomicroscopy for the diagnosis of intraepithelial neoplasias in a randomized controlled trial. Methods: A total of 161 patients with long-term UC in clinical remission were randomized at a 1:1 ratio to undergo conventional colonoscopy or chromoscopy with endomicroscopy. Eight patients were excluded because of insufficient bowel preparation. In the conventional colonoscopic group (n = 73), random biopsy examinations and targeted bio…

Shock-wave therapy for tennis and golfer's elbow - 1 year follow-up

Thirty patients with chronic medial epicondylitis were treated with low-energy shock waves. They received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. At 1 year follow-up examinations were performed. According to the Verhaar criteria, only seven patients reached excellent or good results. In eight cases a fair outcome was recorded, and in 14 patients the outcome was poor. Only six patients were satisfied with the treatment. The average relief of pain was 32%. These data were significantly worse than for identically treated patients with chronic tennis elbow. Thus, the question arises as to whether extracorporal shock-wave therapy is indicated in medial epicondylitis.

Impact of routine angiographic follow-up after angioplasty

Abstract Background There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA). Methods We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate analysis (Cox model) was performed to identify predictors of adverse events. Results During the 10-year follow-up peri…

EVALUATION OF LOW-ENERGY EXTRACORPOREAL SHOCK-WAVE APPLICATION FOR TREATMENT OF CHRONIC PLANTAR FASCIITIS

Background: Although the application of low-energy extracorporeal shock waves to treat musculoskeletal disor- ders is controversial, there has been some limited, short-term evidence of its effectiveness for the treatment of chronic plantar fasciitis. Methods: From 1993 to 1995, a prospective, two-tailed, randomized, controlled, observer-blinded pilot trial was performed to assess whether three applications of 1000 impulses of low-energy shock waves (Group I) led to a su- perior clinical outcome when compared with three applications of ten impulses of low-energy shock waves (Group II) in patients with intractable plantar heel pain. The sample size was 112. The main outcome measure was patien…

Bedeutung der Kalkdepot-elimination bei Tendinosis calcarea der Schulter

Aim: To evaluate the effect of complete elimination of the calcific deposit on the clinical outcome in patients with a recalcitrant calcifying tendinitis of the shoulder. Patients and methods: 50 patients with a chronic calcifying tendinitis of the shoulder (Type Gartner I or II) underwent a single application of extracorporeal shock waves (3000 impulses, energy flux density 0.60mj/ mm 2 ). After one year 45 patients were evaluated radiologically and clinically. Results: Radiologically a complete absorption of the calcific deposit was observed in 21 patients (47%). In 9 patients there was no radiological change. The radiological success was closely related to the radiomorphology of the depo…

Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS.

The aim of the study was to improve the objectivity of X-ray image comparison for the identification of unknown dead individuals. CT-data were collected for 30 macerated skulls. An already presented computer program which uses CT data to establish virtual X-ray images was used to obtain X-rays with different beam angulations simulating rotation, dorsal flexion, and ventral flexion. Specific parameters were measured on the simulated images. The frontal sinus reveals the highest variability not only between the individual skulls but also within an individual skull in different positions. The most consistent parameters with respect to different positions were the skull breadth, the biorbital b…

Robotic total knee arthroplastyThe accuracy of CT-based component placement

Accurate alignment of the components in total knee arthroplasty is important. By use of postoperative CT controls, we studied the ability of a robotic effector to accurately place and align total knee arthroplasty (TKA) components according to a purely CT-based preoperative plan.Robotic TKA was performed in 13 patients (6 men) with primary gonarthrosis. Locator screws were placed into femur and tibia under spinal anesthesia. A CT-scan including the femoral head, knee and ankle was performed. In the preoperative planning software, virtual components were positioned into the CT volume. In a second operation, the robot milled femur and tibia with a high-speed milling tool according to the preo…

Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study.

The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the treatment, any other therapy was stopped for a period of 6 weeks. The shock waves were applied by an experimental device allowing exact localization through an integrated fluoroscopy unit. Patients were treated three times at weekly intervals. Each time 1000 impulses of 0.06 mJ/mm2 were given …

Comparison of Arterial and Venous Blood Flow Between Patients with Pressure Dressing or a New Hemostatic Puncture Closure Device After Cardiac Catheterization

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio-Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio-Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheteriza…

Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison.

Background and study aims Endoscopic staining methods are increasingly being used to evaluate lesions in the esophagus and colon. The aim of this prospective study was to investigate chromoendoscopy and magnification endoscopy for the evaluation of mucosal lesions in the duodenum. Patients and methods Consecutive patients were randomly assigned to undergo conventional endoscopy without staining (group A) or intravital staining of the duodenal mucosa with indigo carmine and evaluation with a conventional video endoscope (group B) or a magnification endoscope (group C). Visible lesions were characterized before and after staining, and biopsies were taken for histological assessment. Results A…

Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.

Timely diagnosis of intraepithelial neoplasias (IN) and colitis-associated colon carcinomas (CRC) is crucially important for the treatment of ulcerative colitis (UC). We performed a randomized, controlled trial to test whether chromoendoscopy (CE) might facilitate early detection of IN and CRC in UC.A total of 263 patients with long-standing UC (or=8 years) were screened for potential inclusion in the study, 165 of whom were randomized at a 1:1 ratio to undergo conventional colonoscopy or colonoscopy with CE using 0.1% methylene blue. Five mucosal biopsy specimens were taken every 10 cm between the rectum and cecum. Circumscript lesions in the colon were evaluated according to a modified pi…

Ten-year outcome after coronary angioplasty in patients with single-vessel coronary artery disease and comparison with the results of the Coronary Artery Surgery Study (CASS).

The 10-year results of randomized trials comparing percutaneous transluminal coronary angioplasty (PTCA) in patients with single-vessel coronary artery disease (CAD) with coronary artery bypass grafting (CABG) and medical treatment are not available yet. The aim of this evaluation was to compare our 10-year follow-up results after PTCA in patients with single-vessel CAD with the 10-year follow-up results after CABG and medical treatment in the Coronary Artery Surgery Study (CASS) trial. We evaluated the clinical outcome of 509 patients with single-vessel CAD 10 years after coronary angioplasty. The data were compared with the results of 214 patients with single-vessel CAD after CABG or medi…

Clinical predictors of unstable coronary lesion morphology.

We evaluated prospectively clinical and angiographic data in 400 patients, 200 with unstable and 200 with stable angina in order to determine which clinical markers could reliably predict unstable coronary artery lesions. Comparison of the angiogram of 200 patients with unstable and 200 with stable angina revealed a high-grade lesion (42% vs 23%, P < 0.0001), complex lesion morphology (49% vs 20%, P < 0.0001) and thrombus-containing lesions (7% vs 1%, P = 0.006) as typical findings in patients with unstable angina. A high-grade lesion and/or complex lesion (including thrombotic lesions but excluding total occlusion) was found in 61% of unstable and 34% of stable patients (P < 0.0001). Clini…

Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design.

Background In contrast to standard video endoscopy, magnifying endoscopy after local acetic acid application enables recognition of mucosal surface architecture. Objective To investigate the diagnostic yield of magnifying endoscopy with acetic acid–targeted biopsies compared to random, 4-quadrant biopsies. Design Prospective randomized trial (ratio 1:1) with crossover design. Setting Two referral hospitals in Germany. Patients Thirty-one patients with Barrett's esophagus or visible columnar-lined lower esophagus. Interventions Patients were randomized to undergo either standard video endoscopy with 4-quadrant biopsies or magnifying endoscopy in conjunction with acetic acid application. All …

Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial.

Background:Recent articles have reported success with repeated low-energy shock wave application for treatment of chronic plantar fasciitis in runners.Hypothesis:Shock wave treatment for chronic plantar fasciitis is safe and effective.Study Design:Prospective, randomized, placebo-controlled trial.Methods:Forty-five running athletes with intractable plantar heel pain for more than 12 months were enrolled; half were assigned to a treatment group that received three applications of 2100 impulses of low-energy shock waves, and half received sham treatment. Follow-up examinations were performed at 6 months and at 1 year by a blinded observer.Results:After 6 months, self-assessment of pain on fir…

OPS — Operation Planning System for Neurosurgery

The departments for neuroradiology and neurosurgery intend to use computer aided methods for individual planning of operations in the sella region. Essential structures like the optic nerve, arteries, aneurysms, the pituitary stalk, ventricles, and tumors should be segmented, reconstructed and visualized. The computed 3D view shall simulate the neurosurgeon’s view through the operation microscope into the scene. This approach shall remedy the lack of available medical image analysis systems for neurosurgical intervention. The emphasis in this article will be on the segmentation algorithms and the impact of the system on daily neuroradiological work.

Effectiveness of low-energy extracorporal shock waves for chronic plantar fasciitis

Summary Over a period of 4 years we performed a prospective randomized trial on 100 patients in order to compare the effects of low-energy extracorporal shock-wave therapy (ESWT) in the treatment of painful heel (chronic plantar fasciitis). Patients in group I were treated three times at weekly intervals with 1000 impulses of 0.08 mJ/mm 2 given around the heel spur. Group II received treatment three times with 10 impulses of the same energy density at weekly intervals. Follow-up examinations were done at 12 and 52 weeks, respectively. The main outcomes assessed were reduction in severity of pressure pain, period of pain-free walking, and patient satisfaction. At 12 weeks, 16 of 50 patients …

Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo

Background & Aims: Aconfocal laser endoscopy system has recently been developed that may allow subsurface imaging of living cells in colonic tissue in vivo. The aim of the present study was to assess its potential for prediction of histology during screening colonoscopy for colorectal cancer. Methods: Twenty-seven patients underwent colonoscopy with the confocal endoscope using acriflavine hydrochloride or fluorescein sodium with blue laser illumination. Furthermore, 42 patients underwent colonoscopy with this system using fluorescein sodium. Standardized locations and circumscript lesions were examined by confocal imaging before taking biopsy specimens. Confocal images were graded accordin…

Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis

Background: It remains unclear whether application of local anesthesia (LA) interferes with clinical e!cacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. Aims: To evaluate the e"ect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis. Methods: Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n = 45; 3 · 2000 pulses, total energy flux density per shock 0.09 mJ/mm 2 ) or identical ESWT with LA (Group II, n = 41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in …

Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.

A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3,000 impulses of an energy flux density of 0.6 mJ/mm2) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no calcific deposit in 85% of the …

Erratum to “Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS” [Forensic Sci. Int. 117 (2001) 89–98]

In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy.

Background & Aims: Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy. Here, we have applied this technique to the in vivo diagnosis of Barrett's epithelium and associated neoplasia. Methods: Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus. Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed. In vivo histology was compared with the histologic specimens. All digitally stored images were re-assessed by a b…

Minimal Change Esophagitis: Prospective Comparison of Endoscopic and Histological Markers between Patients with Non-Erosive Reflux Disease and Normal Controls Using Magnifying Endoscopy

&lt;i&gt;Introduction:&lt;/i&gt; More than half the patients with gastroesophageal reflux disease (GERD) show no endoscopic abnormality or minimal change esophagitis (non-erosive reflux disease, NERD). We investigated the value of endoscopic and histological markers for the prediction of NERD before and after treatment with 20 mg esomeprazole. &lt;i&gt;Methods:&lt;/i&gt; Between July and October 2002, consecutive patients presenting for upper endoscopy were stratified into GERD and non-reflux patients (control group) with the help of a questionnaire. The endoscopist was blind to the presence of reflux symptoms. Using magnifying endoscopes minimal change esophagitis was defined by the presen…

Langzeitverlauf über 10 Jahre nach Ballondilatation bei stabiler und instabiler Angina pectoris

OBJECTIVE To assess the cardiac status of patients ten years after percutaneous transluminal coronary artery angioplasty (PTCA). PATIENTS AND METHODS Data of 534 patients (436 men, 98 women; mean age 53.2 +/- 8 years) in whom a PTCA had been performed between 1983 and 1986 were analysed, based on a questionnaire answered 121 +/- 11 months after the initial procedure. At the time of PTCA 184 patients (35%) had unstable angina, 350 (65%) stable angina. RESULTS 116 patients (63%) with unstable angina and 164 (47%) with stable angina had at least one cardiac event after the initial PTCA (repeat PTCA, bypass operation, myocardial infarction, death). None of these events occurred in 68 patients (…