It is well established that plant xylem is composed of a complex and interconnected system of vascular elements, but little is known about how the three-dimensional (3D) organization of this network influences properties such as plant hydraulics (Tyree & Zimmermann, 2002), and few studies have measu...
Systemic autoimmune diseases are responsible for about 25% of all deaths due to interstitial lung disease; therefore, an early identification of patients with pulmonary manifestation changes the management. Detection, differential diagnostic classification and staging of the pneumological pattern of findings are largely based on high-resolution computed tomography (HR-CT). The main differential diagnostic challenges are interstitial manifestations which present with radiological-histopathological phenotypes of interstitial pneumonia. The most common form of interstitial pulmonary reaction form of connective tissue diseases is the nonspecific interstitial pneumonia (NSIP) pattern. In rheumatoid arthritis, a usual interstitial pneumonia (UIP) pattern is dominant. Uncharacteristic reactions of airways and pleura can be the leading symptom or present as accompanying findings. A serious complication is pulmonary hypertension. Drug-induced lung lesions can present with similar HR-CT morphology as connective tissue diseases and can only be differentiated in the temporal and clinical context. PMID:25693496
Memis, A; Memis, A; Alper, H; Calli, C; Ozer, H; Ozdamar, N
Mucocele of the petrous apex is very rare, only three cases having been reported. Since this area is inaccessible to direct examination, imaging, preferably high resolution computed tomography (HR CT) is essential. We report a case showing an eroding, non enhancing mass with sharp, lobulated contours, within the petrous apex. The presence of a large air cell on the opposite side suggested a mucocele. PMID:7862284
We present a case of maxillary and orbital floor reconstruction with a microvascular fibula graft and an individualized titanium mesh. Both were planned virtually; templates were made by rapid prototyping. The postoperative computertomography scans showed that the planned positions were achieved correctly. This case report illustrates maxillary reconstruction performed with a special template technique and demonstrates the possibilities of computer aided design/computer aided manufacturing (CAD/CAM) applications in reconstructive surgery. PMID:20642821
Firoozabadi, Reza; Morshed, Saam; Engelke, Klaus; Prevrhal, Sven; Fierlinger, Anke; Miclau, Theodore; Genant, Harry K
Fractures of the distal radius are one of the most common injuries presented to orthopaedic surgeons. A variety of treatment options are available for the vast array of fracture patterns. Research that explores bone fragility and fracture healing has led to new treatment modalities. As new products and methods are derived to aid in fracture healing it is essential to develop noninvasive and/or nondestructive techniques to assess structural information about bone. Quantitative assessment of macro-structural characteristics such as geometry, and microstructural features such as relative trabecular volume, trabecular spacing, and connectivity may improve our ability to estimate bone strength. Methods for quantitatively assessing macrostructure include (besides conventional radiographs) dual x-ray absorptiometry (DXA) and computed tomography (CT), particularly volumetric quantitative computed tomography (vQCT). Methods for assessing microstructure of trabecular bone include high resolution computed tomography (hrCT), micro computed tomography (microCT), high resolution magnetic resonance (hrMR), and micro magnetic resonance microMR. Volumetric QCT, hrCT and hrMR are generally applicable in vivo; microCT and microMR are principally applicable in vitro. Clinically, the challenges for bone imaging include balancing the advantages of simple bone densitometry versus the more complex architectural features of bone, or the deeper research requirements versus the broader clinical needs. PMID:18753895
Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor
True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459
Kaftan, Jens N.; Bakai, Annemarie; Maier, Florian; Aach, Til
Das Segmentieren von Pulmonalgefäßen in Computertomographie (CT) Daten wurde schon vielfach behandelt und wird z.B. bei der computerunterstützten Detektion von Lungenembolien angewendet. Vielen Segmentierverfahren fehlt jedoch eine quantitative Validierung aufgrund mangelnder Referenzsegmentierungen. Wir stellen ein System zur halbautomatischen Segmentierung von Blutgefäßen in definierten Bereichen der Lunge basierend auf dem Random-Walker-Algorithmus vor. Durch Initialisierung der Methode mittels automatisch generierter Saatpunkte wird die Effizienz des Verfahrens erhöht und die erforderliche Benutzerinteraktion reduziert. Die resultierenden Segmentierungen können zur Validierung von automatischen Verfahren verwendet werden. Exemplarisch evaluieren wir ein vollautomatisches Segmentierverfahren basierend auf dem Fuzzy-Connectedness-Algorithmus.
de Baat, C; Peters, R; van Iperen-Keiman, C M; de Vleeschouwer, M
Facial shields are used when practising contact sports, high speed sports, sports using hard balls, sticks or bats, sports using protective shields or covers, and sports using hard boardings around the sports ground. Examples of facial shields are commercially available, per branch of sport standardised helmets. Fabricating individual protective shields is primarily restricted to mouth guards. In individual cases a more extensive facial shield is demanded, for instance in case of a surgically stabilised facial bone fracture. In order to be able to fabricate an extensive individual facial shield, an accurate to the nearest model of the anterior part of the head is required. An accurate model can be provided by making an impression of the face, which is poured in dental stone. Another method is producing a stereolithographic model using computertomography or magnetic resonance imaging. On the accurate model the facial shield can be designed and fabricated from a strictly safe material, such as polyvinylchloride or polycarbonate. PMID:15932045
Genant, H. K.; Gordon, C.; Jiang, Y.; Link, T. M.; Hans, D.; Majumdar, S.; Lang, T. F.
Noninvasive and/or nondestructive techniques are capable of providing more macro- or microstructural information about bone than standard bone densitometry. Although the latter provides important information about osteoporotic fracture risk, numerous studies indicate that bone strength is only partially explained by bone mineral density. Quantitative assessment of macro- and microstructural features may improve our ability to estimate bone strength. The methods available for quantitatively assessing macrostructure include (besides conventional radiographs) quantitative computed tomography (QCT) and volumetric quantitative computed tomography (vQCT). Methods for assessing microstructure of trabecular bone noninvasively and/or nondestructively include high-resolution computed tomography (hrCT), micro-computed tomography (muCT), high-resolution magnetic resonance (hrMR), and micromagnetic resonance (muMR). vQCT, hrCT and hrMR are generally applicable in vivo; muCT and muMR are principally applicable in vitro. Although considerable progress has been made in the noninvasive and/or nondestructive imaging of the macro- and microstructure of bone, considerable challenges and dilemmas remain. From a technical perspective, the balance between spatial resolution versus sampling size, or between signal-to-noise versus radiation dose or acquisition time, needs further consideration, as do the trade-offs between the complexity and expense of equipment and the availability and accessibility of the methods. The relative merits of in vitro imaging and its ultrahigh resolution but invasiveness versus those of in vivo imaging and its modest resolution but noninvasiveness also deserve careful attention. From a clinical perspective, the challenges for bone imaging include balancing the relative advantages of simple bone densitometry against the more complex architectural features of bone or, similarly, the deeper research requirements against the broader clinical needs. The
Barton, Olivia; Naumann, Steffen C.; Diemer-Biehs, Ronja; Künzel, Julia; Steinlage, Monika; Conrad, Sandro; Makharashvili, Nodar; Wang, Jiadong; Feng, Lin; Lopez, Bernard S.; Paull, Tanya T.; Chen, Junjie; Jeggo, Penny A.
DNA double-strand breaks (DSBs) are repaired by nonhomologous end joining (NHEJ) or homologous recombination (HR). The C terminal binding protein–interacting protein (CtIP) is phosphorylated in G2 by cyclin-dependent kinases to initiate resection and promote HR. CtIP also exerts functions during NHEJ, although the mechanism phosphorylating CtIP in G1 is unknown. In this paper, we identify Plk3 (Polo-like kinase 3) as a novel DSB response factor that phosphorylates CtIP in G1 in a damage-inducible manner and impacts on various cellular processes in G1. First, Plk3 and CtIP enhance the formation of ionizing radiation-induced translocations; second, they promote large-scale genomic deletions from restriction enzyme-induced DSBs; third, they are required for resection and repair of complex DSBs; and finally, they regulate alternative NHEJ processes in Ku−/− mutants. We show that mutating CtIP at S327 or T847 to nonphosphorylatable alanine phenocopies Plk3 or CtIP loss. Plk3 binds to CtIP phosphorylated at S327 via its Polo box domains, which is necessary for robust damage-induced CtIP phosphorylation at S327 and subsequent CtIP phosphorylation at T847. PMID:25267294
D’Elia, Giovanni; Caracchini, Giuseppe; Cavalli, Loredana; Innocenti, Paolo
Bone fragility is a silent condition that increases bone fracture risk, enhanced by low bone mass and microarchitecture deterioration of bone tissue that lead to osteoporosis. Fragility fractures are the major clinical manifestation of osteoporosis. A large body of epidemiological data indicates that the current standard for predicting fragility fracture risk is an areal BMD (aBMD) measurement by DXA. Although mineral density measurements assess the quantity of bone, the quality of the tissue is an important predictor of fragility. Thus, bone strength is explained not only by BMD but also by macrostructural and microstructural characteristics of bone tissue. Imaging diagnostics, through the use of X-rays, DXA, Ultrasonography, CT and MR, provides methods for diagnosis and characterization of fractures, and semi- and quantitative methods for assessment of bone consistency and strength, that become precious for bone fragility clinical management if they are integrated by clinical risk factors. The last employment of sophisticated non-invasively imaging techniques in clinical research as high-resolution CT (hrCT), microCT (μ-CT), high-resolution MR (hrMR) and, microRM (μRM), combined with finite element analysis methods, open to new challenges in a better bone strength assessment to enhance the comprehension of biomechanical parameters and the prediction of fragility fractures. PMID:22461252
Jung, Ioan; Gurzu, Simona; Balasa, Rodica; Motataianu, Anca; Contac, Anca Otilia; Halmaciu, Ioana; Popescu, Septimiu; Simu, Iunius
Abstract A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern. PMID:26039124
Sablatnig, Robert; Kammerer, Paul; Zolda, Ernestine
The origin of works of art can often not be attributed to a certain artist. Likewise it is difficult to say whether paintings or drawings are originals or forgeries. In various fields of art new technical methods are used to examine the age, the state of preservation and the origin of the materials used. For the examination of paintings, radiological methods like X-ray and infra-red diagnosis, digital radiography, computer-tomography, etc. and color analyzes are employed to authenticate art. But all these methods do not relate certain characteristics in art work to a specific artist -- the artist's personal style. In order to study this personal style of a painter, experts in art history and image processing try to examine the 'structural signature' based on brush strokes within paintings, in particular in portrait miniatures. A computer-aided classification and recognition system for portrait miniatures is developed, which enables a semi- automatic classification and forgery detection based on content, color, and brush strokes. A hierarchically structured classification scheme is introduced which separates the classification into three different levels of information: color, shape of region, and structure of brush strokes.
Bahr, Detlef; Langhans, Knut; Gerken, Martin; Vogt, Carsten; Bezecny, Daniel; Homann, Dennis
In this paper, an innovative approach of a true 3D image presentation in a space filling, volumetric laser display will be described. The introduced prototype system is based on a moving target screen that sweeps the display volume. Net result is the optical equivalent of a 3D array of image points illuminated to form a model of the object which occupies a physical space. Wireframe graphics are presented within the display volume which a group of people can walk around and examine simultaneously from nearly any orientation and without any visual aids. Further to the detailed vector scanning mode, a raster scanned system and a combination of both techniques are under development. The volumetric 3D laser display technology for true reproduction of spatial images can tremendously improve the viewers ability to interpret data and to reliably determine distance, shape and orientation. Possible applications for this development range from air traffic control, where moving blips of light represent individual aircrafts in a true to scale projected airspace of an airport, to various medical applications (e.g. electrocardiography, computer-tomography), to entertainment and education visualization as well as imaging in the field of engineering and Computer Aided Design.
Smell disorders are common and can be found in 3 – 5 % of the population under 65 years. With growing age these numbers increase up to 50 % and more. Qualitative disorders which cannot be measured are differentiated from quantitative disorders. Self-assessment of olfactory function is rather poor therefore olfactory testing is mandatory in cases of patients complaining about an olfactory disorder. Olfactory screening smell tests are available for orientation, however, for detailed testing or in cases of a pathological screening test an extensive psychophysical olfactory test battery such as the Sniffin' Sticks Test battery should be used. According to the result of the test battery olfactory function can be qualified as norm, hyp- or anosmic. Additionally, in cases of medicolegal questions, olfactory evoked potentials can be recorded. Smell disorders are classified according to the history, clinical and endoscopic examination of the nose. Imaging techniques such as magnetic resonance imaging (MRI) or computertomography may contribute to classify the disorder. Sinunasal olfactory disorders are considered to be the most common ones. If the etiology remains unclear a neurological examination has to be performed in order to rule out a concomitant neurodegenerative disease. Olfactory disorders in the elderly might have to be considered as a sign of a reduced regeneration capacity in general being depicted in an increase in overall mortality in affected subjects. PMID:27132644
Reichl, Tobias; Passenger, Josh; Acosta, Oscar; Salvado, Olivier
Trotz der zunehmenden Verbreitung jüngerer bildgebender Verfahren bleibt medizinischer Ultraschall (US) weiterhin ein wichtiges Hilfsmittel bei chirurgischen Eingriffen und der klinischen Diagnose. Viele US-gestützte medizinische Prozeduren erfordern allerdings ausgiebiges Training, so dass es wünschenswert ist, eine realistische Simulation von US-Bildern zur Verfügung zu stellen. Im Gegensatz zu früheren Ansätzen simulieren wir solche Bilder auf der "Graphics Processing Unit“. Wir erweitern hierzu eine Methode, die von Wein et al. für die Abschätzung von US-Reflexionen aus Daten der Computertomographie (CT) vorgeschlagen wurde, zu einer leichter zu berechnenden Form. Zusätzlich schätzen wir die US-Absorption aus den CT-Daten ab. Mit Hilfe von NVIDIAs "Compute Unified Device Architecture“ (CUDA) simulieren wir Reflexion, Verschattung, Rauschen und radiale Unschärfe, ausgehend von unbearbeiteten CT-Daten in Echtzeit und ohne Vorausberechnung.
Jung, Ioan; Gurzu, Simona; Balasa, Rodica; Motataianu, Anca; Contac, Anca Otilia; Halmaciu, Ioana; Popescu, Septimiu; Simu, Iunius
A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern. PMID:26039124
Sader, Robert; Zeilhofer, Hans-Florian U.; Deppe, Herbert; Horch, Hans-Henning; Kling, Bettina
Ultrasound imaging of the temporomandibular joint has been problematic due to the lower frequency of the transducers used up to the present time. Imaging of temporomandibular joint structures being utilizable for diagnosis and therapy was only possible through time-consuming and expensive radiological image yielding procedures (computertomography, magnetic resonance imaging). 84 temporomandibular joints in 42 patients were examined clinically, radiologically, by axiographic tracing, magnetic resonance imaging and ultrasound imaging. An ultrasound unit was used with a high- frequency 13MHz transducer. The temporomandibular joint was examined preauricularily; by this the lateral section of the joint could be represented. The image sequences in functional condylus movements were taped via a video output into a film recorder. Selected ultrasound images from the beginning to the end of the movement could then be digitalized and read into a personal computer to be evaluated. The computer then calculated a line of movement and the angle of the joint's course. By ultrasound imaging the joint space could be represented and measured clearly. Compared with the space measured in the magnetic resonance image the value determined by ultrasonography was a tenth power more exact. The computer-supported image analysis of the condylus movements led to an exact presentation of the condylus course. The sonographically determined condylar guidance corresponded to the value traced by axiography with high significance within a range of 3 degrees. The temporomandibular joint's disc could be localized just as exactly as with the magnetic resonance imaging. The use of a 13MHz transducer offers a new low-cost method of noninvasive dynamic imaging of important temporomandibular joint structures. The possibility of video and computer support enables movement analysis and opens new possibilities in the morphological and functional evaluation of the temporomandibular joint.
MacDessi, Samuel; Solayar, GN; Thatcher, N; Chen, Darren B
Objectives: Accelerometer-based, portable navigation instrumentation is a new method of achieving desired resection alignments in total knee arthroplasty (TKA). Methods: After randomisation and the application of exclusion criteria, 79 knees were analysed. 42 patients which underwent TKA using conventional intra-medullary (IM) alignment guides were compared to 37 patients with the use of accelerometer-based, portable navigation device (KneeAlign; OrthoAlign Inc, Aliso Viejo, California). Radiographic results were obtained from post-operative computer-tomography following the CT Perth Protocol. Results: In the IM cohort, 81.0% of patients had a coronal alignment within 3° of a neutral mechanical axis (vs 83.8% with KneeAlign, p=0.74), 81.0% had a femoral coronal alignment within 2° of perpendicular to the femoral mechanical axis (vs 89.2% with KneeAlign, p=0.31), and 92.9% had a tibial coronal alignment within 2° of perpendicular to the tibial mechanical axis (vs 81.1% with KneeAlign, p=0.12). Regarding sagittal alignment, the IM cohort had 90.5% of patients with femoral component alignment within 2° of optimum (vs 91.9% with KneeAlign, p=0.83) and 92.9% had a tibial component alignment within 2° of the optimal tibial slope (vs 89.2% with KneeAlign, p=0.57). The mean tourniquet time (from incision to completion of coronal bone resections) in the IM cohort was 16.5± 8.9 minutes vs 22.2 ± 7.6 minutes in the KneeAlign cohort (p<0.003). Conclusion: Accelerometer-based, portable navigation has a statistically similar outcome in alignment following TKA as IM guides. It is noted that using the portable navigation device does prolong surgical time compared to conventional IM surgery and this may be due to the learning curve.
Rotaru, H; Armencea, G; Spîrchez, Diana; Berce, C; Marcu, Teodora; Leordean, D; Kim, Seong Gon; Lee, Sang Woon; Dinu, C; Băciuţ, G; Băciuţ, Mihaela
The objectives of this study were to test the biocompatibility and to evaluate the osseointegration of Titanium-Aluminum-Niobium (Ti6Al7Nb) alloy used in the manufacturing of personalized implants with selective laser melting (SLM) technology and to compare the growth viability of osteoblastic-like cells on different Ti6Al7Nb alloy samples (plain, coated with hydroxyapatite or SiO2-TiO2) implanted into the cranial bone of Wistar rats. In terms of biocompatibility, the cone-beam computer-tomography head scans taken at the moment of sacrifice of each group (one, two and three months) showed no implant displacement, no osteolysis and no liquid collection around the implants. At one month, around all types of implants new bone formation was noticed, although around the plain Ti6Al7Nb implant a large amount of powder debris was present. Still, no inflammatory reaction was seen. At two months, the distance between the implants and the calvarial bone margins diminished. A thin layer of fibrous tissue was noticed around the Ti6Al7Nb implant coated with hydroxyapatite but no bone contact was achieved. In the group sacrificed at three months there was still no bone contact, but noticeable were the SiO2-TiO2. In the group sacrificed at three months SiO2-TiO2 particles detached from the implant and completely integrated in the tissue were noticeable. All results suggested that the Ti6Al7Nb alloy with or without infiltration is well biologically tolerated. PMID:24322029
Dyczynski, J; Schweitzer, L
To evaluate the right ventricular size and free wall thickness a new echocardiographic para-apical technique was developed. All cases were examined from the para-apical window in the extreme left lateral decubitus position, on a special mattress that allowed us to investigate the total apical region. The para-apical transducer position makes it possible to cut the right ventricle cross-sectionally in serial bread-loafing fashion from the apex to the base, like the left ventricle. In this way, using the M-mode technique, either diameters and/or right ventricular free wall thickness as well as shortening fraction could be estimated. To estimate the usefulness of the para-apical technique, a study was performed in 50 normal subjects as well as in 16 patients with dilated cardiomyopathy. In all patients, standard views and the new para-apical view were performed. In five cases, contrast echocardiography of the heart was performed to verify the right-heart anatomy. In five patients, computer-tomography of the heart was performed to see the position of the right-heart chambers in the chest and to evaluate the new para-apical ultrasound window. The standard values for the right ventricle in the control group were (in mean values): diastolic diameter, 28.61 +/- 3.19 mm; systolic diameter, 19.10 +/- 2.40 mm; free wall thickness, 4.46 +/- 1.06 mm and shortening fraction, 32.42% +/- 4.02%. The examined parameters in patients with dilated cardiomyopathy were: diastolic diameter, mean value 38.63 +/- 5.80 mm; systolic diameter, mean value 32.48 +/- 4.96 mm; free wall thickness, mean value 8.70 +/- 1.05 mm and shortening fraction, mean value 15.96 +/- 4.02%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3439250
Karthaus, Eleonora G.; Post, Ivo C.J.H.; Akkersdijk, George J.M.
Introduction Primary aortoenteric fistula (PAEF) is a pathological communication between the aorta and any portion of the gastrointestinal tract. The pathology is very rare and easily overlooked during the diagnostic process. Presentation of Case We report the exceptional case of an 86-year-old man with episodes of abdominal pain and rectal bleeding of unknown cause over a period of 1,5 months due to a PAEF to the sigmoid. A sigmoidectomy was performed and a rifampicin-soaked aortic graft was placed. The patient had an uneventful post-operative recovery. The duration of symptoms, the anatomic location of the fistula and the outcome after surgery makes this case unique. Discussion With an incidence of 0.04–0.07% in all patients with aortic aneurysms a PAEF is very rare. Only 2% of PAEF's involves the sigmoid. The most common cause is an atherosclerotic aortic aneurysm. Patients with PAEF can present with a triad of symptoms including gastrointestinal bleeding, abdominal pain and a pulsating mass. A contrast-enhanced computer-tomography scan (CTa) is the most accurate tool to demonstrate a PAEF. Without a strong clinical suspicion, diagnosing a PAEF is hard and frequently delayed. The overall PAEF-related mortality is high (61–100%) and decreases after surgery (30–40%). Conclusion A primary aortoenteric fistula involving the sigmoid is very rare. Clinical presentation can vary, diagnosis can be difficult and surgical options may differ. Even with low suspicion of PAEF, we recommend performing a CTa. With a high overall mortality of more than 60% due to exsanguinating, surgical treatment is always indicated. PMID:26741274
Ohkubo, Hirotsugu; Kanemitsu, Yoshihiro; Uemura, Takehiro; Takakuwa, Osamu; Takemura, Masaya; Maeno, Ken; Ito, Yutaka; Oguri, Tetsuya; Kazawa, Nobutaka; Mikami, Ryuji; Niimi, Akio
Background Although several computer-aided computed tomography (CT) analysis methods have been reported to objectively assess the disease severity and progression of idiopathic pulmonary fibrosis (IPF), it is unclear which method is most practical. A universal severity classification system has not yet been adopted for IPF. Objective The purpose of this study was to test the correlation between quantitative-CT indices and lung physiology variables and to determine the ability of such indices to predict disease severity in IPF. Methods A total of 27 IPF patients showing radiological UIP pattern on high-resolution (HR) CT were retrospectively enrolled. Staging of IPF was performed according to two classification systems: the Japanese and GAP (gender, age, and physiology) staging systems. CT images were assessed using a commercially available CT imaging analysis workstation, and the whole-lung mean CT value (MCT), the normally attenuated lung volume as defined from −950 HU to −701 Hounsfield unit (NL), the volume of the whole lung (WL), and the percentage of NL to WL (NL%), were calculated. Results CT indices (MCT, WL, and NL) closely correlated with lung physiology variables. Among them, NL strongly correlated with forced vital capacity (FVC) (r = 0.92, P <0.0001). NL% showed a large area under the receiver operating characteristic curve for detecting patients in the moderate or advanced stages of IPF. Multivariable logistic regression analyses showed that NL% is significantly more useful than the percentages of predicted FVC and predicted diffusing capacity of the lungs for carbon monoxide (Japanese stage II/III/IV [odds ratio, 0.73; 95% confidence intervals (CI), 0.48 to 0.92; P < 0.01]; III/IV [odds ratio. 0.80; 95% CI 0.59 to 0.96; P < 0.01]; GAP stage II/III [odds ratio, 0.79; 95% CI, 0.56 to 0.97; P < 0.05]). Conclusion The measurement of NL% by threshold-based volumetric CT analysis may help improve IPF staging. PMID:27031615
Wilhelm, Thomas; Stelzer, Tim; Wiegand, Susanne; Güldner, Christian; Teymoortash, Afshin; Günzel, Thomas; Hagen, Rudolf
Viral infections of the upper respiratory airways can lead to a delayed viral otitis media (VOM) caused by a diffusion of viruses/virus particles through the round window membrane and resulting in sensorineural hearing loss. The treatment of choice is immediate paracentesis, evacuation of all fluids from the middle ear cavity, and haemorrheological infusions. However, in some cases, persistent symptoms may be an indication for a surgical approach using mastoidectomy. In high-resolution computed tomography, an extended small-sized pneumatisation of the mastoid cells with complete shading was found in these non-responsive cases. Therefore, a direct means of inner ear affliction through weak parts of the labyrinthine bone may be hypothesised. Patients suffering from a toxic inner ear lesion (TIEL) following a common cold, treated over a 10-year period in a Tertiary Care Centre (N = 52, 57 ears), were identified and the morphological characteristics of the temporal bones of affected patients were examined by means of high-resolution computed tomography (hrCT). The findings were compared with a matched control group of 64 normal ears (CONT). Measurements included the grade of pneumatisation, distances within the temporal bones and Hounsfield units (HU) at defined anatomical structures. In the TIEL group, we found a small-sized pneumatisation in 79.4 % and a medium-sized pneumatisation in 10.9 %, thus differing from the CONT group and the literature data. Thickness of the bone wall of the lateral semicircular canal (LSC) and distances within the aditus ad antrum were significantly reduced in the TIEL group. HU's were markedly lower in the TIEL group at the precochlea, the LSC, and dorsolateral to the promentia of the LSC. There was a correlation between the HU's at the prominentia of the LSC and the hearing loss (p = 0.002). Persisting interosseous globuli, as described in 1897 by Paul Manasse, form an osseochondral network within the otic capsule and may be responsible
Evans, B A J; James, T W; James, K; Cox, A; Farr, L; Paisey, S J; Dempster, D W; Stone, M D; Griffiths, P A; Hugtenburg, R P; Brady, Sir M; Wells, T
The utility of HR-CT to study longitudinal changes in bone microarchitecture is limited by subject radiation exposure. Although MR is not subject to this limitation, it is limited both by patient movement that occurs during prolonged scanning at distal sites, and by the signal-to-noise ratio that is achievable for high-resolution images in a reasonable scan time at proximal sites. Recently, a novel MR-based technique, fine structure analysis (FSA) (Chase et al. Localised one-dimensional magnetic resonance spatial frequency spectroscopy. PCT/US2012/068284 2012, James and Chase Magnetic field gradient structure characteristic assessment using one-dimensional (1D) spatial frequency distribution analysis. 7932720 B2, 2011) has been developed which provides both high-resolution and fast scan times, but which generates at a designated set of spatial positions (voxels) a one-dimensional signal of spatial frequencies. Appendix 1 provides a brief introduction to FSA. This article describes an initial exploration of FSA for the rapid, non-invasive characterization of trabecular microarchitecture in a preclinical setting. For L4 vertebrae of sham and ovariectomized (OVX) rats, we compared FSA-generated metrics with those from CT datasets and from CT-derived histomorphometry parameters, trabecular number (Tb.N), bone volume density (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). OVX caused a reduction of the higher frequency structures that correspond to a denser trabecular lattice, while increasing the preponderance of lower frequency structures, which correspond to a more open lattice. As one example measure, the centroid of the FSA spectrum (which we refer to as fSAcB) showed strong correlation in the same region with CT-derived histomorphometry values: Tb.Sp: r -0.63, p < 0.001; Tb.N: r 0.71, p < 0.001; BV/TV: r 0.64, p < 0.001, Tb.Th: r 0.44, p < 0.05. Furthermore, we found a 17.5% reduction in fSAcB in OVX rats (p < 0.0001). In a longitudinal
Dickschas, Jörg; Strecker, Wolf; Harrer, Jörg; Ferner, Felix
Aims and Objectives: Anterior knee pain or patellofemoral instability are typical symptoms of patellofemoral dysbalance. Beside other reasons, this pathology can be caused by a femoral deformity. The two dimensions leading to this problems are torsional- and valgus deformities. This constellation often stays unrecognized. When diagnosed and analyzed, a femoral torsional or varization-osteotomy is the adequate treatment. Aim of this study was to show the diagnostic approach, the gold standard of therapy and the follow up results. Can patellofemoral stability be archived? Is the pain relief significant and how do clinical scores develop at the follow up? Materials and Methods: 33 femoral torsional osteotomies and 18 femoral varization osteotomies were included in this study, 5 of these were combined femoral varization and torsional corrections so that 46 knees are included in 41 patients, as 5 patients were operated on both legs. Major symptoms were patellofemoral dislocations in 28 cases and anterior knee pain in 26 cases. Beside clinical and radiographic evaluation full weight bearing long leg views and a torsional computertomography was always performed. Follow up examination was after 41 (6-113) months. Visual analog scala score, Japanese Knee Society Score, Tegner activity score and Lysholm score were taken before surgery and at the follow up. Results: Mechanical femorotibial valgus was on average 6,4° (5°-10°), femoral internal torsion was in average 40,9° (29°-66°; normal: 24°). Surgical treatment was performed with an arthroscopy followed by an acute femoral varization 7,2°(5°-10°) and / or external torsion osteotomy of 13.8° (5°-26°). Tegner activity score, Japanese knee society score and Lysholm score all significantly improved. Pain relief could be demonstrated as shown by a significant decrease of the VAS score. No further dislocation was reported during the follow up period. Conclusion: Valgus or torsional deformities of the femur frequently
Kulawik, Susan; Wunch, Debra; O'Dell, Christopher; Frankenberg, Christian; Reuter, Maximilian; Oda, Tomohiro; Chevallier, Frederic; Sherlock, Vanessa; Buchwitz, Michael; Osterman, Greg; Miller, Charles E.; Wennberg, Paul O.; Griffith, David; Morino, Isamu; Dubey, Manvendra K.; Deutscher, Nicholas M.; Notholt, Justus; Hase, Frank; Warneke, Thorsten; Sussmann, Ralf; Robinson, John; Strong, Kimberly; Schneider, Matthias; De Mazière, Martine; Shiomi, Kei; Feist, Dietrich G.; Iraci, Laura T.; Wolf, Joyce
-predicted bias uncertainty of 0.4 ppm at many stations. We find that GOSAT and CT2013b underpredict the seasonal cycle amplitude in the Northern Hemisphere (NH) between 46 and 53° N, MACC overpredicts between 26 and 37° N, and CT2013b underpredicts the seasonal cycle amplitude in the Southern Hemisphere (SH). The seasonal cycle phase indicates whether a data set or model lags another data set in time. We find that the GOSAT measurements improve the seasonal cycle phase substantially over the prior while SCIAMACHY measurements improve the phase significantly for just two of seven sites. The models reproduce the measured seasonal cycle phase well except for at Lauder_125HR (CT2013b) and Darwin (MACC). We compare the variability within 1 day between TCCON and models in JJA; there is correlation between 0.2 and 0.8 in the NH, with models showing 10-50 % the variability of TCCON at different stations and CT2013b showing more variability than MACC. This paper highlights findings that provide inputs to estimate flux errors in model assimilations, and places where models and satellites need further investigation, e.g., the SH for models and 45-67° N for GOSAT and CT2013b.
Kulawik, Susan; Wunch, Debra; O’Dell, Christopher; Frankenberg, Christian; Reuter, Maximilian; Chevallier, Frederic; Oda, Tomohiro; Sherlock, Vanessa; Buchwitz, Michael; Osterman, Greg; Miller, Charles E.; Iraci, Laura T.; Wolf, Joyce
-to-year variability of 0.3 parts per million, with biases larger than the TCCON predicted bias uncertainty of 0.4 parts per million at many stations. We find that GOSAT and CT2013b under-predict the seasonal cycle amplitude in the Northern Hemisphere (NH) between 46 and 53 degrees North latitude, MACC over-predicts between 26 and 37 degrees North latitude, and CT2013b under-predicts the seasonal cycle amplitude in the Southern Hemisphere (SH). The seasonal cycle phase indicates whether a data set or model lags another data set in time. We find that the GOSAT measurements improve the seasonal cycle phase substantially over the prior while SCIAMACHY measurements improve the phase significantly for just two of seven sites. The models reproduce the measured seasonal cycle phase well except for at Lauder_125HR (CT2013b) and Darwin (MACC). We compare the variability within 1 day between TCCON and models in June-July-August; there is correlation between 0.2 and 0.8 in the NH, with models showing 10-50 percent the variability of TCCON at different stations and CT2013b showing more variability than MACC. This paper highlights findings that provide inputs to estimate flux errors in model assimilations, and places where models and satellites need further investigation, e.g., the SH for models and 45-67 degrees North latitude for GOSAT and CT2013b.