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The diagnosis of glenohumeral instability is based on the patient's history and physical examination. The main objective in using imaging techniques is to define the type and extent of the underlying pathology for therapeutic planning. Plain radiography is the initial step in the diagnostic procedure but can miss typical lesions of the glenohumeral joint structures. CT arthrography and MR imaging offer great sensitivity and accuracy for the detection of traumatic abnormalities of the labral-capsular complex, fractures of the glenoid rim and Hill-Sachs lesions. The advantages and pitfalls of both imaging techniques are discussed.

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Dynamic MR imaging of the breast is viewed as an examination technique which is supplementary to mammography and sonography and which can provide important additional diagnostic information. Proven indications for MR mammography include examinations of patients who have undergone lumpectomy and patients with prosthetic breast implants. The method also appears to be useful to differentiate between postoperative scarring and carcinoma as well as to exclude a multicentric breast carcinoma prior to lumpectomy. The sensitivity of MR mammography, however, is limited in cases of DCIS. Hypervascular benign lesions can be difficult to distinguish from malignant lesions.

To examine the clinical use of a reduced dose in high-resolution spiral-CT (HR-SCT) in combination with a multiplanar volume reconstruction technique (MPVR) to decrease image noise.Facial bones, skull and extremities of 33 patients with different pathological findings were examined with spiral-CT using a slice thickness of 1 mm (pitch 1.7-2.0), a tube amperage of 40 mA and tube voltages of 80 or 120 kV. Additionally, 2-D, 3-D, and MPVR images reconstructions were performed. MPVR takes advantage of displaying planar volumes of variable thickness.Increased image noise was negligible if high contrast structures like bones were examined. However, very small bony structures like the stapes of the middle ear were not seen. Soft tissues could also be imaged by using the MPVR-technique. This technique did reduce image noise while at the same time partial volume averaging was increased. The skin entrance dose per investigation did not exceed 3 mGy, which is based on twelve dose measurements in two patients.It is feasible to perform HR-SCT with secondary reconstructions of facial bones, skull and extremities using reduced skin entrance doses by 10 to 20 fold to below 3 mGy. With the exception of imaging very small structures, sufficient image quality can be accomplished in routine examinations without relevant diagnostic compromise.

A retrospective study was performed in 70 patients with peripheral vascular disease who underwent MR angiography of the lower extremity.MR angiography was performed with a 2-D-TOF sequence including a travelling presaturation to suppress the venous signal. Postprocessing images were obtained with the MIP algorithm. The MRA results were compared with conventional or digital angiography in all patients.Only 19 stenoses out of 31 which showed a degree of stenosis between 30 and 99% could be visualised by MR angiography. 9 stenoses were correctly classified by MRA. In 9 cases the degree of stenosis was overestimated, in one case it was underestimated. All 56 occlusions were correctly detected. 12 severe stenoses diagnosed with conventional angiography were graded as occlusions with MR angiography.MR angiography cannot be accepted in preoperative staging of patients with peripheral vascular disease. The postoperative examination seems to be a practical noninvasive alternative.

The impact of different anode materials (tungsten and rhodium) on spatial resolution, image contrast and radiation exposure was studied.Two mammographic systems providing bimetal x-ray tubes (Mo/W and Mo/Rh) were compared by imaging a breast radiography phantom with additional acrylic plates from 3 to 8 cm thickness. Spatial resolution was evaluated using a line bar pattern. Image contrast was assessed by measuring the ratio of optical densities in a acrylic step-wedge. The entrance dose was measured with a low energy ionisation chamber.The spatial resolution was about 13 lp/mm regardless of the beam quality. The image contrast depended substantially on the thickness. A similar image contrast was found with Mo/Mo, Mo/Rh and Rh/Rh for simulated breast thicknesses of 4 to 6 cm and with Rh/Rh and W/Rh for 7 cm. In comparison to Mo/Mo the dose reduction was significant for Mo/Rh (35%), Rh/Rh (50%) and W/Rh (60%).Bimetal x-ray tubes provide optimal conditions for screen film mammography of both normal and dense breasts, allowing good contrast and dose reduction by using the adequate anode/filter-combination.

To assess the impact of a method for anatomically adapted tube current variation. The resulting CT image quality was evaluated quantitatively and qualitatively.CT scans of 100 patients were performed with a constant tube current (Group 1) and another 100 patients with an anatomically adapted tube current (Group 2). The CT tube current was varied during a 360 degrees tube rotation reflecting the measured density values extracted from two perpendicular scout views. The standard deviation of densities of defined regions was measured. The image quality was ranked (1 = non-diagnostic-5 = excellent) by three radiologists.The effective tube current could be reduced by an average of 8.9% (0-20.4%). The mean tube current reduction depended on the body region: pelvis (13.2%), abdomen (8.4%) and thorax (3.3%). The image quality was not significantly reduced in Group 2.The method for anatomically adapted tube current variation leads especially in the pelvis to a significant mAs reduction without considerable loss of image quality.

This report presents a case of a ruptured intracranial dermoid accidentally found in a 51-year old patient. The tumour appears as a large lesion located in the posterior fossa. The CT and MRI studies identify fatty material into the CSF spaces providing intraventricular fat-fluid levels. These characteristic findings are indicative of the diagnosis.

Spongy bone produces local magnetic field inhomogeneities and leads to shortening of the transverse relaxation time from bone marrow. This increased signal decay affects the T2 relaxation time. Measurements of the T2* time from the 4th lumbar vertebra were carried out in 48 normals and 20 patients with osteoporosis. A special multigradient echo technique was used, the echo times selected in relation to phase coherence of the water and fat signals. T2* times showed slight increase in relation to age. Patients with osteoporosis showed significantly increased T2* times (19.9 +/- 3.8 ms) compared to the normal control group (13.4 +/- 1.9 ms). From these findings it is possible to judge the quality of the trabecular structure.

T1 and T2 weighted signals derived from various radiological contrast media were studied during MRT spin-echo sequences. In addition, the interaction between radiological contrast media and Gadolinium-DTPA concerning T1 signals was evaluated. Ionic (ioxitalaminic acid) and non-ionic radiological contrast media (Iopromid, Iotrolan) were used in diagnostic concentrations. Measurements were carried out with a superconductive magnet of 1.5 Tesla. Radiological contrast media produced significantly higher signals than a physiological sodium chloride solution in T1-weighted spin-echo sequences. Even small amounts (15% of total volume) of radiological contrast media during T1-weighted spin-echo sequences led to a significant reduction (about 25%) of the signal intensity of a 2 mM Gadolinium-DTPA solution. This may lead to diagnostic problems, as was shown in a series of 25 MR arthrograms of the shoulder. It is recommended than an interval of at least 6 hours should elapse between the use of a radiological contrast medium and an MRT examination.

Diagnostik und Therapie der Osteoporose stutzen sich in grosem Mase auf die Bestimmung des Knochenmineralgehalts. Die etablierten Techniken der Knochendensitometrie umfassen gegenwartig die Quantitative Computertomographie (QCT) und die verschiedenen Varianten der Photonenabsorptiometrie wie die Single- oder die Dual-Photonen-Absorptiometrie (SPA und DPA) sowie deren Weiterentwicklung in Form der Dual-Rontgen-Absorptiometrie (DXA). Bevorzugter Mesort all dieser Verfahren ist die Lendenwirbelsaule. Der entscheidende Unterschied zwischen der QCT und den Absorptiometrieverfahren besteht in der Art der Berechnung der Knochendichte. Beim QCT-Standardverfahren werden jeweils ca. 10 mm dicke Schichten an mehreren Wirbelkorpern angefertigt. Aufgrund der Schnittbildtechnik ist eine selektive Analyse der Wirbelspongiosa mit Bestimmung der Knochenmineraldichte pro Volumeneinheit moglich. Das Mesergebnis weist demzufolge die Einheit mg/cm3 auf. Im Gegensatz dazu basiert die Photonenabsorptiometrie auf einer integralen Messung der Strahlenabsorption nach Durchtritt durch den Korper. In der Auswerteprozedur wird der gemessene Knochenmineralgehalt (BMC) auf die projizierte Flache einer spezifizierten Region wie z.B. die LWS bezogen. Das Resultat wird als sog. Mineralflachendichte (BMD) mit der Einheit g/cm2 ausgegeben.

TPS157 Background: The insulin growth factor (IGF) axis is overactive in many tumors and affects several downstream signaling pathways including PI3K/Akt/mTOR. Synergism between IGF and mTOR inhibi...

Modern imaging techniques such as ultrasound, computer tomography and magnetic resonance imaging serve an increasingly important role as an extension of conventional radiological methods for clarification of shoulder disorders. The precise representation of bony, cartilaginous and soft tissue injuries has become indispensable for successful therapeutic decision making. A stepwise employment of the various examination techniques of the shoulder should be utilized while keeping in mind the patient's particular complex of symptoms.

The measurement of broadband ultrasound attenuation (BUA) of the calcaneus has been introduced as a new technique that provides information about both bone mass and structure without the use of ionizing radiation. BUA measurements of the calcaneus were obtained in 324 patients, 109 of whom had osteoporosis. Two hundred and fifteen patients served as control group. BUA values were compared with dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine, the neck and the heel. The precision error of BUA was 4.1%. The correlation with spinal bone mineral density was r = 0.49, with DXA of the neck r = 0.52 and of the calcaneus r = 0.56, respectively. Patients with osteoporosis showed a significant decrease in BUA compared with healthy subjects (61.4 dB/MHz vs 74.6 dB/MHz). Roc analysis demonstrated that BUA was inferior to DXA of the lumbar spine in detecting osteoporosis.

Bilateral apparently bony structures of different forms and sizes located in the inferior and superior ventral parts of the sacroiliac joints were observed on axial CT images of the pelvic region of juvenile patients. No other pathological changes were noted in the sacroiliac joints of these individuals. In one patient the bony structures could also be seen on a conventional plain radiograph. We also examined 3 juvenile autopsy specimens of this joint using radiology, CT, macroscopical evaluation and histology. In two of them, structures could be detected on the CT scans which were similar to those observed in the young patients. Macroscopic investigations revealed the structures to be secondary ossification centres located in the articular cartilage of the lateral part of the os sacrum at the levels of the first and third sacral segments. According to older anatomical literature, these epiphysial ossification centres contribute to the auricular surface of the lateral part of the os sacrum and the free lateral surface of the inferior sacral parts. They can be observed between the ages of 12 and 25 years and begin to synostose with the lateral part around the age of 18 years. In macerated juvenile specimens of the bony pelvis, free ossicles were not detectable in the region of the sacroiliac joints. Histological peculiarities of the ossification process observed are discussed. These physiologically occurring ossification centres are to be differentiated from pathological alterations appearing as bony or bone-like structures on CT scans.

3043 Background: Prior data of dual VEGF-ligand/receptor blockade with B and S showed promising efficacy. P is active against many tumor types, and combined with B improves efficacy in breast and l...

Measurements of bone density were carried out in 25 patients on dialysis for terminal renal insufficiency, using quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA). Unlike in subjects with normal kidneys, there was no significant correlation between these methods in this series. Ten patients showed an increase in bone density of the vertebral spongiosa on QCT measurements, which was interpreted as due to osteosclerotic bone changes in renal osteopathy. QCT showed advantages over DXA in demonstrating these changes.

Between the ages of 12 and 18 years apophyseal elements appear within the SI joints which fuse subsequently with the sacrum. These apophyses could be demonstrated during two autopsies on juveniles and were seen in 7 CT examinations of patients between the ages of 15 and 19. On CT they appeared as narrow, round or band-like opacities situated on the ventral aspect of the joint. The differentiation of these normal findings from pathological changes within the SI joints is discussed.

X-ray examinations represent a variety of indications with different demands on exposure latitude, spatial and contrast resolution of screen-film-system combinations in paediatric radiography. The value of digital luminescent radiography (DLR) was compared to conventional x-ray examinations carried out with screen-film-systems, speed class 200, by analysing matched digital and conventional exposures in 200 abdominal, 600 skeletal and 300 chest examinations. The exposure of DLR was reduced to 50% of conventional exposure. Analysing the results in abdominal and skeletal radiography, DLR proved to be diagnostically equivalent to conventional radiography despite the reduction in exposure dose. DLR of the newborn chest compared to conventional x-ray studies was not always sufficient due to lower digital spatial resolution.

The differential diagnosis of cystic tumours in the region of the so-called Trigonum femorale is presented and discussed. In this context the topography of this area is demonstrated. In addition to the clinical findings sonography and computed tomography are the method of choice in finding the right diagnosis. Invasive methods such as angiography and lymphography are indicated in only few cases. US-guided fine-needle-aspiration should be preferred instead, if it is of any therapeutic relevance.

The fatty acid composition including trans fatty acids of 12 brands of nut-nougat creams were analyzed by capillary gas chromatography. The creams consisted mainly of sugar and partially hydrogenated vegetable oil. The lipid content, which was quantified gravimetrically, amounted to between 30 and 38.2% in the different brands. The fatty acid composition varied considerably between the different creams. Linoleic acid, the major polyunsaturated fatty acid (PUFA), ranged from 12 to 39%. Palmitic acid (16:0), which was the main fatty acid, varied from 9 to 27%. The total trans fatty acid content of the 12 creams ranged from 0.9 to 12.3%. Only two of the creams contained less than 1% of trans fatty acids; 18:1t was the trans fatty acid found in the greatest amounts, whereas 16:1t and 14:1t were only found in trace amounts. Three samples had amounts of 18:2tt, 18:2ct, and 18:2tc between 0.7 and 1.06%; only small amounts of linoleate isomers were detected in the other creams. Our results show that trans fatty acids are present in every brand of chocolate cream tested. Since the potential risk of arteriosclerosis and cancer resulting from the consumption of trans fatty acids is not yet clear, different ways of production should be used in order to eliminate them from the creams that are a preferred bread spread of infants and children.

Reflection electron energy loss measurements of CuInSe2 single crystals are reported and when possible, the losses are compared with former results by Kazmerski and Jamjoum et al. Their identification of the transitions is confirmed and refined by spectrum simulations with total and partial densities of states from band structure calculations of Jaffe, Bendt, Zunger, and Bullett.

The authors present an exact solution for the one-dimensional Ising model in a random field. The distribution of field strengths is site independent, symmetric and has a three-peak structure. The free energy is obtained for all finite temperatures. The low-temperature behaviour is studied in detail. They find an expansion for the free energy in integer powers of temperature. The ground-state energy and the zero-point entropy are calculated explicitly. The specific heat is linear for low temperatures, in contradiction with mean-field theory. The origin of an additional exponential parameter is discussed.

A four-variable, a five-variable and a six-variable vector autoregression (VAR) is used in the study to test empirically the linkages among changes in money, outstanding public bonds, interest rates, output, real asset prices, and real investment expenditures in West Germany. After estimating Sims-type and Hsiao-type vector autoregressions the VAR models are the converted to their moving-average representations and the innovation accounting technique is used to examine the impact of changes in asset prices and output on investment behaviour.

We investigate the vacuum state of (1+1)-dimensional ${\ensuremath{\varphi}}^{4}$ quantum field theory utilizing a modification of the powerful coupled cluster method by the additional maximum-overlap condition. This permits us to construct the ground state of that field theory for nearly all values of the coupling strength. Only a small region has to be excluded where our method still fails. This is most probably due to critical behavior showing up in a change of the order parameter of the model. Our procedure predicts a behavior of the (${\ensuremath{\varphi}}^{4}$${)}_{2}$ model in complete agreement with some rigorous mathematical statements which is not possible in the case of a Gaussian approximation only. Perhaps somewhat unexpectedly, the symmetry-breaking Hamiltonian does not have any critical point.

A liver abscess was diagnosed by sonography and surgery in a sewer-man who had never left Germany 14 weeks after he fell into a clearing basin and swallowed sewage. The causative agent of the abscess was confirmed immunologically to be Entamoeba histolytica.

Aberration in the physical structure or alignment of the eyes may produce pathologic neurocompensatory changes in the brain that, if left unattended, become irreversible. Two common examples of this abnormal state are accommodative esotropia and amblyopia. Both have a large optic component in their etiology and in most cases are correctable by optic methods. Generated retinal reflex photometry is a screening method that can detect, in the eyes of children, optic defects that tend to be the antecedents of more serious neurocompensatory processes. Detection at an early age permits more effective management and treatment of amblyopia. This technique is fast, safe, and inexpensive and provides a permanent record. It requires no response from the subject except a modicum of cooperation. It is attractive as an ocular screening method because it does not require highly trained personnel to administer the examination, yet appears to be accurate. The results lend themselves to mechanized processing.