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Evaluation of acute soft tissue injury of the temporomandibular joint (TMJ) with type I–VI fractures immediately after trauma and investigation of the longitudinal evolution including response to conservative treatment using MRI. The joints of 24 patients with 33 condylar fractures (15 unilateral, nine bilateral) were imaged on a 1 Tesla MR system within the first 24 h post-trauma. 12 of these patients with 16 condylar fractures (eight unilateral, four bilateral) were clinically re-evaluated using MRI after 3 months of closed treatment. The position, morphology, and signal intensities of the disc, capsule, retrodiscal tissue, and osseous structures were documented. In the acute phase, disc displacements (DDs) were diagnosed in 8 out of 33 joints with fracture, including posterior DDs in two joints and tears of the inferior retrodiscal lamina in 11 joints. The follow-up MRI in 12 patients revealed new DD in four joints on the fractured side (FS) including a posterior DD and an increased degree of displacement, and new DDs in two joints in the non-fractured side (NFS). Preexisting and traumatic DD and soft tissue injuries are frequent findings in patients with condylar fracture. Independent of the degree of trauma, condylar fractures may determine the subsequent development of DD on both FS and NFS. Early MR imaging may help initiate well-directed specific measures for better outcomes in the acutely injured TMJ. [ABSTRACT FROM AUTHOR]

Objectives: Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first to be caused by the serotype O104:H4. This EHEC strain was found to carry genetic features of Entero Aggregative E. coli (EAEC) and extended spectrum β lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany. Methods: The courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were recorded prospectively. These data include the patients’ histories, clinical findings, and complications. Results: EHEC O104 infection was confirmed in 61 patients (female = 37; mean age: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated. Conclusions: EHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as “EAHEC disease”. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the role of radiofrequency ablation (RFA) as treatment of colorectal cancer liver metastases (CLMs). Method: A PubMed literature search for original articles published until August 2008 was performed. Studies with ⩾40 patients, ⩾18month median follow-up and reported ⩾3year overall survival (OS) rates after RFA of CLM were selected for analysis. Results: Thirteen clinical series and 8 non-randomised comparative studies were analysed. Median progression free survival after RFA ranged between 6 and 13months. Median and 5-year OS after RFA (RFA plus resection) ranged between 24–59months and 18–40% (36–46months and 27–30%). Comparative studies indicated significantly improved OS after RFA versus chemotherapy alone, RFA plus chemotherapy versus RFA alone and up-front RFA versus RFA following second-line chemotherapy. Conclusion: Our findings support that RFA prolongs time without toxicity and survival as an adjunct to hepatectomy and/or chemotherapy in well-selected patients, but not as an alternative to resection. [Copyright &y& Elsevier]

Background Atrio-oesophageal fistula has been reported as a rare but life-threatening complication of ablation of atrial fibrillation (AF). Therefore, the position of the oesophagus in relation to the left atrium (LA) is of major importance for AF ablation. Methods and results In order to investigate the possible anatomical variability between the oesophagus and the left atrium, multidetector-row spiral computed tomography (MDCT) of 60 healthy males (age 58.1 ± 5.1 years; LA diameter 5.4 ± 0.7 × 3.8 ± 0.6 cm; LA volume 60.5 ± 15.4 ml) was analyzed. The distance between the oesophagus and the ostia of the pulmonary veins (PV) ranged between 0 and 50.7 mm. Especially for the left PV, the oesophagus was closer than 5 mm to the ostia in 29 cases (48%; n = 24 for left superior PV; n = 10 for left inferior PV; n = 0 for right superior PV; n = 1 for right inferior PV). In addition, the oesophagus was very close to the LA wall (0.8 ± 0.9 mm; range 0–3.3 mm). Intraobserver variability was 1.1 ± 0.7 mm or 3.5%. Conclusion The position of the oesophagus in relation to the LA and the PV demonstrates high variability. In many cases, the oesophagus is very close to the ostia of the PVs and lies only a short distance from the LA wall. Thus, an anatomical localization of the oesophagus may be critical before or during AF ablation to prevent atrio-oesophageal fistula, especially as there is a need for transmural atrial lesions. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the feasibility of visualizing the stent lumen using coronary magnetic resonance angiography in vitro. Material and methods: Nineteen different coronary stents were implanted in plastic tubes with an inner diameter of 3 mm. The tubes were positioned in a plastic container filled with gel and included in a closed flow circuit (constant flow 18 cm/sec). The magnetic resonance images were obtained with a dual inversion fast spin-echo sequence. For intraluminal stent imaging, subtraction images were calculated from scans with and without flow. Subsequently, intraluminal signal properties were objectively assessed and compared. Results: As a function of the stent type, various degrees of in-stent signal attenuation were observed. Tantalum stents demonstrated minimal intraluminal signal attenuation. For nitinol stents, the stent lumen could be identified, but the intraluminal signal was markedly reduced. Steel stents resulted in the most pronounced intraluminal signal voids. Conclusions: With the present technique, radiofrequency penetration into the stents is strongly influenced by the stent material. These findings may have important implications for future stent design and stent imaging strategies. [ABSTRACT FROM AUTHOR]