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Objective To discover whether Floppy Kid Syndrome can be prevented by separating kids at birth from their dams and rearing them on bovine colostrum followed by cows’ milk. Design Clinical field study during the period of 2000–2010. Materials and methods The study was conducted on a goat farm in South Tyrol, Italy. Kids were separated at birth from their dams and reared on bovine colostrum followed by cows’ milk (group 1); kids were also reared traditionally leaving them to suckle with their respective dams (group 2). In both groups, clinical symptoms were recorded. In those exhibiting FKS, associated symptoms and recovery after treatment were documented. Cumulative probability of survival and determination of hazard rate were plotted using the Kaplan–Meier method. Results A total of 414 kids born on this farm over this period (2000–2010) were examined. None of the 146 kids of group 1 acquired FKS. In group 2, 16 from the 268 kids reared traditionally developed typical FKS. The symptoms of FKS, which were observed included altered general condition (apathy, somnolence, and lethargy), altered posture (knuckling over in the carpal joints, ataxia, and recumbency), salivation and abomasal distension. The difference between the groups was significant (χ2 test, p = 0.003). Distribution of FKS in group 2 revealed that in January and February no cases of FKS occurred. In March, April, and May morbidity was at 2.6%, 69.2%, and 71.4%, respectively. Survival analysis in group 1 revealed a cumulative probability of survival of 1.00 and a hazard rate of 0.00 during the whole observation period (January to May). In group 2, a cumulative probability of survival of 1.00 for the first two days after birth, declining to 0.94 on the 11th day, was demonstrated. The difference in time between the groups was significant (p = 0.003) applying the Log Rank test. In group 2, for the period of March to May survival analysis revealed a cumulative probability of survival of 1.00 for the first day after birth, declining to 0.84 on the 11th day. This indicates a morbidity rate of 16% for this period. On the 4th and 5th day post partum the hazard rate was highest (HR = 0.04). After 11 days neither cumulative probability of survival nor hazard rate declined. The results of this study demonstrate an 100% probability that FKS will not affect kids after 11 days of age. A positive correlation was apparent between the recorded outdoor temperature and the incidence of Floppy Kid Syndrome. Conclusions and clinical relevance In this long-term study conducted on a goat farm in South Tyrol Floppy Kid Syndrome in goat kids can be prevented by separating neonate kids from the dams, and rearing the kids with bovine colostrum/milk. The important factor seems to be the separation of new born kids from adults, thus preventing exposure of kids via sucking/licking to the bacterial agent causing d -lactic acidosis, originating from the adult goats or their immediate environment. Greatest susceptibility for Floppy Kid Syndrome is in the period from March to May between the 3rd and 6th day post partum.

Purpose To evaluate renal allograft vessels in the early period after kidney transplantation with three-dimensional (3D) contrast-enhanced MR angiography (3D CE MRA) using a parallel imaging technique. Materials and Methods Sixty-three consecutive patients were examined with 3D CE MRA and integrated SENSE technique (Sensitivity Encoding) 2 to 21 days after renal transplantation. MR angiography studies were analyzed for the presence of arterial stenosis. The degree of renal transplant artery stenosis was graded qualitatively as 0.19) but significantly different from those with severe stenoses (P < 0.05). Conclusion The incidence of mild and moderate vessel narrowing at the arterial anastomosis is unexpectedly high in the early period after kidney transplantation and is most likely due to surgery-related tissue edema. J. Magn. Reson. Imaging 2009;29:909–916. © 2009 Wiley-Liss, Inc.

AIM The aim of our controlled retrospective study was to assess the diagnostic value of sonography for detection and characterisation of changes compared to mammography and palpation. METHOD In 80 patients sonographic and clinical follow-up examinations were performed every 3 to 6 months, mammography examinations were performed every 6 to 12 months during the first 2 years after breast-preserving therapy (BPT) and irradiation. Extension, echogenicity, and configuration of lesions in sonography, and semiquantitiative description of diffuse or circumscribed changes in mammography were the basis of comparative follow-up observation. RESULTS Postoperative seromas and haematomas, initially presenting echo-free or as hypoechoic lesions, showed an increase in echogenicity within 18 months after irradiation. Fat necrosis occurred in 9.5% of patients, lymph cysts developed in 4%, granuloma in 3%, recurrence of neoplasma in 1.6%. The diffuse loss of transparency in mammography that was associated with radiation therapy, showed a peak 6-12 months after irradiation. CONCLUSION Sonography and sonographic guided puncture are mandatory tools to characterise circumscribed unclear lesions after breast-conserving therapy and irradiation in specialised centers. We recommend a 6-month interval for combined sonography, palpation, and mammography within the first 2 years after BPT and irradiation, because shorter control intervals did not result in relevant diagnostic advantages.

AIM According to the German guidelines for quality control of ultrasonic equipment, the following conditions are required for breast ultrasound: A transducer frequency between 5-7.5 MHz and a minimum field of view of 5 cm. Satisfactory images must be obtained in a depth between 0.5 and 4 cm with a wide tolerance of the focal zones. This allows the use of poor quality equipment which does not produce satisfactory image quality and it excludes a number of high frequency and high resolution transducers with a field of view below 5 cm. This study with a test phantom was performed to define image quality objectively. METHOD Sixteen ultrasound instruments in different price categories were used to perform standardized examinations on a breast phantom model 550 (ATS Laboratories, Bridgeport, USA). Contrast and spatial resolution in different penetration depths were investigated on cyst phantoms from 1-4 mm diameter and wire targets with defined distances between 0.5-3 mm 4 investigations reported the images. RESULTS A positive correlation was seen between price category and image quality. CONCLUSION This study demonstrates that transducer frequency and image geometry do not allow sufficient quality control. An improvement of ultrasound diagnosis is only possible if equipment guidelines are based on standard examinations with test phantoms.

In der Praxis hangt die Behandlung von Patienten mit stabilen anginaverdachtigen Symptomen oder einer fraglichen Ischamie masgeblich davon ab, ob eine strukturelle Koronarstenose sicher auszuschliesen bzw. zu bestatigen und ein Bild der koronaren Plaquelast zu erhalten ist, um die Frage der Risikofaktorenbehandlung zu klaren. Dies lasst sich durch die nichtinvasive CT-Angiographie (CTA) mittels Kardio-CT erreichen. Bei Patienten mit einer regelmasigen, niedrigen Herzfrequenz wird eine robuste Bildqualitat erzielt, sofern keine extreme Koronarverkalkung besteht. In zunehmendem Mase gelingt eine diagnostische Bildqualitat auch bei Patienten mit einer hoheren Herzfrequenz und Arrhythmien. Der sicherlich groste Nachteil der neuen Methode besteht in der Strahlendosis von 7–18 mSv. Die technische Entwicklung lasst aber eine deutliche Senkung der Strahlendosis erwarten, u. a. durch eine Reduktion der Aufnahmezeiten. Bereits jetzt bietet das Verfahren bei geeigneten Patienten eine wichtige diagnostische Moglichkeit im Rahmen der KHK-Abklarung. Hochgradige Koronarstenosen lassen sich mit sehr hoher Sicherheit ausschliesen; analog zu den Erfahrungen aus der invasiven Koronarangiographie besteht bei diesen Patienten eine sehr gunstige Prognose. Hochgradige Koronarstenosen werden ebenfalls mit hoher Sicherheit erkannt. Intermediaren Stenosen konnen bezuglich ihrer hamodynamischen Bedeutung ahnlich schwer einzuschatzen sein wie bei der invasiven Angiographie. Durch die nichtinvasive Plaqueerkennung ergeben sich aber auch wichtige prognostische Aspekte. Wenn die Strahlenexposition unproblematisch erscheint, ist die CTA bestens zum Einsatz bei Patienten mit einer niedrigen oder intermediaren Vortestwahrscheinlichkeit einer stenosierenden KHK geeignet. Sie vermeidet die akuten Risiken der invasiven Diagnostik, bietet aber erstmals in der Geschichte der Kardiologie ein zuverlassiges Abbild der Koronararterien mit gleichzeitiger Darstellung von Koronarlumen und -wand.

Objective To determine seroprevalence of small ruminant lentivirus (SRLV) infections among goats in South Tyrol, Italy. Design Prospective serological study. Material and methods-animals 15,980 goats older than 6 months from 1973 goat herds in South Tyrol were tested by an ELISA for the presence of SRLV antibodies. 3148 goats were 6–14 months old (AG 1), 3273 goats were 15 to 26 months old (AG 2) and 9559 goats were older than 26 months (AG 3). Results Serological examination revealed that seroprevalence of SRLV among goats was 23.6% and herd prevalence was 38.0%. Seroprevalence was significantly higher ( P P P Conclusions and clinical relevance SRLV infections among goats in South Tyrol, Italy, are evident. Birth indoors with its consequences (close contact, kids suckling by diverse dams or by milk pool) is also a risk factor for SRLV infections in South Tyrol. In future more clinical outbreaks may occur, and therefore establishing measures to prevent the spreading of the disease is necessary. Installing a control or eradication programme seroprevalence and genetic and economic aspects must be considered.

Zusammenfassung Gegenstand und Ziel: In der vorliegenden Arbeit wird über ein alternatives Protokoll zur Kontrolle der CAE berichtet, das die Gegebenheiten des Betriebes (hohe Seroprävalenz, seltene Ziegenrasse mit hohem Zuchtwert, gemeinsame Alpung) berücksichtigte. Das Ziel war, die Krankheit bzw. die klinischen Symptome zurückzudrängen und das hohe genetische Potenzial dieser Ziegenherde möglichst zu erhalten. Material und Methode: Die Neugeborenen wurden vom Muttertier getrennt und mit Rinderkolostrum/-milch aufgezogen. Im Alter von fünf bis sechs Monaten hatten sie auf der Weide Kontakt zu den Adulten. Seropositive Tiere wurden nicht a priori geschlachtet. Ziegen mit geringem Zuchtwert wurden verkauft oder geschlachtet, jene mit hohem Zuchtwert wurden so lange wie möglich in der Herde belassen. Ergebnisse und Schlussfolgerung: Obwohl eine Infektion erwartungsgemäß nicht verhindert werden konnte, blieben die Krankheitsfälle bis dato aus. Im vorliegenden Betrieb dürfte eine aerogene und sexuelle Übertragung eine nicht unerhebliche Rolle gespielt haben. Das hohe genetische Potenzial dieser Ziegenherde ließ sich weitgehend erhalten. Klinische Relevanz: Bei der Erstellung eines »Sanierungsmodells« müssen Ziel, Wille und Ausdauer des Besitzers und das Umfeld mitberücksichtigt werden. Die beschriebene Methode scheint zum derzeitigen Zeitpunkt als geeignet, wenn der Betrieb überdurchschnittlich wertvolle Ziegen hält, die Seroprävalenz bereits hoch ist und die benachbarten Ziegen einen unbekannten serologischen Status aufweisen. Eine erneute Beurteilung zu einem späteren Zeitpunkt ist gewiss erforderlich. Die Nachteile umfassen die Viruspersistenz und den großen Arbeitsaufwand durch die jährliche mutterlose Aufzucht der Neugeborenen.

Objective of this paper is to describe the challenges associated with the implementation of the control programme of Caprine arthritis encephalitis virus infections in goats in South Tyrol, Italy. From 2007 to 2010, a total of 72,714 goats older than 6 months were serologically tested by means of an ELISA for the presence of Caprine arthritis encephalitis virus antibodies. Seropositive animals were culled. In total, 2576 goats were found to be positive in 2007, 657 goats in 2008, 329 goats in 2009 and 196 goats in 2010. Prevalence of seropositive animals decreased from 14% in 2007 to 1% in 2010. Prevalence of herds with seropositive animals decreased from 32% in 2007 to 6% in 2010. The programme did not disturb the future of the local breed ‘Passeirer Mountain Goat’, although the quality of the breed was considered to have decreased, as the highest rates of infection were recorded in herds with high pedigree goats. Price of animals for slaughter decreased by 50%, due to the surplus of available animals. Trading activities had nearly stopped, as only few herds were fulfilling the requirements of the programme regarding movements of animals to markets. All possible results of the serological test should be explained to farmers, in order to maintain their confidence in the programme and their cooperation.

Zusammenfassung Gegenstand und Ziel: Die caprine Arthritis-Enzephalitis (CAE) kommt bei Ziegen weltweit vor und verläuft in den meisten Fällen subklinisch. In einem Betrieb konnten dagegen gehäuft klinische Symptome mit beträchtlichen wirtschaftlichen Verlusten festgestellt werden. Ziel war, über den klinischen Verlauf der CAEV-Infektion, das Ausmaß der wirtschaftlichen Verluste und deren Wertung durch den Besitzer zu berichten. Material und Methode: Im Zeitraum von 1997-1999 wurden 47 Ziegen der Rasse »Passeirer Gebirgsziege« klinisch und serologisch untersucht. Ergebnisse: Die Seroprävalenz lag 1997 bei 75,7% und 1998 bei 91,1%. Im Jahr 1997 wiesen zwei Ziegen (5,4%) Abmagerung und struppiges Haarkleid bzw. Rückgang der Milchleistung auf. Im Jahr 1998 bzw. 1999 zeigten bereits 15 (31,9%) bzw. 16 Ziegen (29,6%) ein oder mehrere Symptome. Am häufigsten traten (Peri)Arthritis gefolgt von Abmagerung und struppigem Haarkleid, Rückgang der Milchleistung und Atembeschwerden auf. Im Jahr 1997 musste kein Tier, 1998 ein Tier (2,1%) und 1999 mussten 11 Tiere (20,4%) aufgrund der hochgradigen Symptomatik vorzeitig geschlachtet bzw. getötet werden. Die wirtschaftlichen Verluste ergaben sich vor allem durch das verloren gegangene genetische Potenzial dieser Ziegen, während der entgangene Fleisch- bzw. Milchgewinn vom Landwirt als nicht bedeutend angesehen wurde. Schlussfolgerung und klinische Relevanz: Während Kolostrum bzw. Milch zweifelsohne als Hauptansteckungsquelle einer CAEV-Infektion anzusehen ist, scheint die horizontale Übertragung bei Vorliegen eines hohen Infektionsdrucks eine gewichtige Rolle einzunehmen. Ein solcher dürfte insbesondere dann gegeben sein, wenn CAEV erstmalig in einer Herde auftritt. In derartigen Fällen können die Verluste besonders hoch sein, während sonst eine CAEV-Infektion in der Regel subklinisch verläuft. Bei Ziegen mit Dyspnoe und rapider Abmagerung ist differenzialdiagnostisch eine CAEV-Infektion in Betracht zu ziehen.

Purpose The purpose of this work was to compare dynamic MRI measurement results from patients with pelvic organ prolapse before and after surgical repair and to correlate postoperative MRI findings with the results of physical examination and patients' complaints. Materials and methods Thirty women were included in this prospective study. Fifteen patients with uterovaginal or vaginal vault descent and 15 asymptomatic female volunteers underwent dynamic MRI using a single-shot, fast spin-echo sequence with half-Fourier data acquisition. Single-slice midsagittal images of pelvic organs were obtained at maximal pelvic strain and at perineal contraction. Dynamic MRI was repeated on all patients 2-4 months after surgical repair. Postoperative and preoperative dynamic MRIs were compared with the normal values of the volunteer group. Postoperative MRIs were correlated with the clinical findings after surgical repair. Results Seven patients reported symptoms after surgical repair, although only two had pathologic findings on physical examination (residual urine associated with third-degree stress urinary incontinence, and bladder neck descent). MRI showed pathologic changes in five of these patients. Two patients with persistent first-degree stress incontinence had no pathologic findings on MRI. Conclusion Dynamic MRI is helpful in the evaluation of persistent patient complaints after surgery for pelvic organ prolapse and detects more defects than physical examination does.

Purpose The purpose of this work was to test whether there are statistically significant differences between dynamic MR and lateral cystourethrogram measurement results in patients with bladder neck descent. Method Twenty-seven women (39–83 years old, mean 60.6 years old) with urinary incontinence and bladder neck descent were examined by dynamic MRI using a single shot fast spin echo sequence with half-Fourier data acquisition. Bladder neck position, angle of inclination of the urethral axis, posterior vesicourethral angle, and depth of cystoceles were measured at perineal contraction and at maximal pelvic strain. The nonparametric Wilcoxon test for paired values was used to analyze whether there were statistically significant differences between lateral cystourethrogram and dynamic MR measurement results. The Spearman correlation coefficient (rs) was calculated for all parameter pairs. Results Measurements at maximal pelvic strain showed the greatest levels of agreement between MRI and cystourethrography. The best results were attained for the cystocele measurements (p > 0.5, rs = 0.95). Bladder neck position showed the second best agreement; if MR measurements were corrected by 0.46 cm, no statistically significant difference (p > 0.2, rs = 0.92) was calculated. Measurements at perineal contraction tallied least, probably due to the different positions adopted during the two examinations. Conclusion Measurement data on dynamic MRI for the bladder neck position and the extension of cystocele at maximal pelvic strain are comparable with lateral cystourethrogram data.

Twenty dual-purpose Simmental dairy cows were used in a 2 × 2 cross-over design to evaluate the effects of feeding, both pelleted vs. ensiled grass clover and whole plant maize on feed intake, milk production and composition, as well as on blood metabolites and some parameters of rumen fermentation. In addition to the pelleted/ensiled forages, all animals were offered grass hay, and, based on the individual milk performance prior to the beginning of the experiment, 1 kg of concentrate for every 2.35 kg energy-corrected milk (ECM) exceeding a daily production of 15 kg ECM. In both groups, the forage was offered so that grass hay, grass clover silage or pellets and whole plant maize silage or pellets would contribute 100, 450 and 450 g kg−1 to total forage dry matter intake (DMI), respectively. Both the treatment periods lasted for seven weeks. Average daily forage DMI was increased from 12.8 up to 18.6 kg when grass clover and whole plant maize were fed in the pelleted form. ECM production was elevated from 18.3 up to 20.3 kg (p

The analysis of the electronic data processing proved that 323 dwarf goats older than 6 months from 165 farms were kept in 63 of the 116 communes of South Tyrol. The number of dwarf goats maintained ranged from 1 to 19 animals, the average farm size revealed to be of 2 dwarf goats/farm. 47 animals were aged between 6 months and 1 year (AG1), 97 were between 1 - 2 years of age (AG2) and 179 were aged older than 2 years (AG3). The mean age amounted to 3.8 years, the age limit being 10 years. 235 animals were female and 88 animals were male (sex ratio 2.7:1). 187 animals (57.9%) were born between November and April and 136 animals (42.1%) were born between May and October. 13 animals (4.0%) proved to possess antibodies against CAEV in a serological examination performed with ELISA. The herd seroprevalence was 6.1% (10 positive farms). The seropositivity did not vary significantly in the different age groups (AG1: 4.3%; AG2: 4.1%; AG3: 3.9%). The seroprevalence of animals born outdoors between November and April (5.9%) did not differ significantly from those born indoors between May and October (1.5%). The seroprevalence of the female animals (3.4%) did not vary significantly from that of the male goats (5.7%). The low seroprevalence ascertained in the dwarf goats in South Tyrol is due to the non-existing milk production, the marginal contact among each other as well as the sparse animal trade. This study should prompt adequate means of control to be established, so that the introduction of positive animals can be prevented. An eradication programme would be advisable, due to the low disease prevalence and its chances to be successfully implemented.

PURPOSE: To examine if RARE urography may replace conventional intravenous urography in patients with suspected urinary obstruction in pelvic tumours. MATERIALS AND METHODS: In a prospective trial on 120 patients with pelvic tumours scheduled for operation, biplanar RARE urography was performed and compared to conventional intravenous urography and ultrasound findings. RESULTS: In 30 out of 120 patients an ureteric obstruction was diagnosed by ultrasound. Sensitivity of RARE urography for obstruction was 98% as compared to 60% in conventional intravenous urography. In 12 patients additional retrograde cystoureterography showed a sensitivity of 83%. Specificity of RARE urography and intravenous urography was 100%. In combination with axial MR tomography RARE urography yielded a more precise localisation of the site of obstruction and the underlying cause (98%) as compared to conventional urography (60%) and ultrasound (56%). CONCLUSION: By use of RARE urography urinary obstruction can be reliably demonstrated or ruled out. Combining RARE urography with tomographic MR imaging allows the precise depiction of the site of the obstruction and may demonstrate the underlying pathology.

Im Rahmen der vorliegenden Studie wurden von 57 Rehen und 58 Gemsen aus den Sudtiroler Jagdrevieren Moos in Passeier und Schnals die Leber, die Nieren und die Muskulatur auf ihre Schwermetallbelastung (Pb, Cd, Hg) untersucht. Dabei wurden Parameter wie Geschlecht, Alter, Korpermasse, Gesundheitsstatus, Jahreszeit, Gebiet, Seehohe und Exposition des Lebensraumes als mogliche Einflusfaktoren gepruft. Aufgrund der Eignung der Wildtiere als Bioindikatoren kann aus den ermittelten Schwermetallgehalten auf die Kontamination ihrer Lebensraume ruckgeschlossen werden.

Purpose: The purpose of this study was to point out MR characteristics of non-Hodgkin lymphomas of the orbits and the paranasal sinuses and the benefit of fat-suppressed contrast-enhanced sequences. Method: The MR images of 16 patients with lymphoma of the orbits and the paranasal sinuses were retrospectively analyzed for signal intensity, contrast enhancement, bone destruction, and mass effect. The findings were confirmed by means of biopsy (Stage IE disease) or follow-up imaging after chemotherapy (Stage IV disease). Results: MRI clearly delineated the extension of the lymphomas. On the T1-weighted images, the signal intensity of the lymphoma was hypointense compared with the gray matter of the brain in 12 cases and intermediate in 4 cases. The T2-weighted fast SE images showed a hyperintense signal in 12 cases, intermediate in 3 cases, and even hypointensity in 1 case. All lesions enhanced after intravenous Gd-DTPA administration, reliably visible in the T1-weighted fat-suppressed sequences but not visible in three cases in the T1-weighted SE sequences. Bony wall destruction was evident in cases with paranasal but never in isolated orbital lymphoma. Conclusion: While extension of lymphoma can be accurately described by MRI, a specific diagnosis is not achievable on the basis of signal intensities and enhancement patterns alone. Therefore, at least in cases of suspected Stages IE and IIE, biopsy proof is needed. Fat-suppressed contrast-enhanced sequences possess the highest detection rate and should therefore always be applied.

Purpose: Shoulder lesions are usually examined with the joint in only one or two positions. We examined the shoulder with the joint in a variety of positions. We also assessed the application of cine-MR to the detection of instability and impingement Material and Methods: the cine-MR examinations were performed in 30 patients and 15 healthy volunteers. We used an open 0.2 T system and a closed 1.0 T system. Spoiled gradient echo 2D T1-weighted images and turbo spin-echo T1- and T2-weighted images were obtained with a field of view of 180 mm. the examinations were videotaped and evaluated later Results: Normal variations of the glenohumeral joint were easy to recognize. Subluxations and luxations of the humeral head as well as rupture of the labrum were identified. It was also possible to identify the labrum with a signal change after arthroscopic refixation. and we were able to objectively assess distances between the osseous structures during dynamic movement Conclusion: Unlike static MR, cine-MR would appear to be useful in visualizing the capsular ligament complex of the gleno-humeral joint in impingement and instability. It also provides information on dynamic changes and may thus prove to be an important tool for shoulder diagnostics. the method may provide an early diagnosis in the sub-acromial impingement syndrome

Objective: Investigations were conducted regarding changes of carpal tunnel shape during wrist motion and the variations of space for the median nerve as well as the preoperative signs of carpal tunnel syndrome (CTS) and the postoperative restitution. Methods: Axial MR images (1.0 T) were performed at the level of the distal radioulnar joint, pisiforme bone and hook of hamate level of 20 wrists of patients with clinical symptoms of CTS and further 20 wrists of volunteers. This was conducted with the wrist in neutral postion, 45° extension and 45° flexion. T2-weighted signal intensity of the median nerve were measured in 18 patients pre- and postoperatively. Results: The increase of the cross-sectional area of the median nerve at the pisiform level and the flattening of the median nerve at the hook of hamate level as well as the volar bowing of the flexor retinaculum at the pisiform and hook of hamate level were significantly greater in patients with CTS than in those with normal wrists (P < 0.05-0.001). In postoperative follow-up studies the distal flattening of the median nerve recovered in 94%. The signal intensity of the median nerve on T2-weighted images decreased in 67%. Conclusion: Flexion at the pisiform and hamate level as well as extension at the pisiform level narrows the space available for the median nerve potential leading to compression of the median nerve. MR imaging is accurate and reliable for diagnosis and postoperative follow-up of CTS.

BACKGROUND & AIMS: Hepatic encephalopathy (HE) is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance (MR) spectroscopy consisting of a depletion of myo- inositol and an increase of glutamine. The aim of this study was to determine whether abnormalities in brain metabolism in neurologically asymptomatic patients with liver cirrhosis can be detected by spectroscopy. METHODS: In a prospective study, 39 patients with liver cirrhosis were examined clinically according to standardized neuropsychological tests to define whether overt, subclinical, or no hepatic encephalopathy was present. All patients underwent proton MR spectroscopy at short echo times. RESULTS: Spectroscopy allowed for the diagnosis of subclinical HE in 4 of 4 cases and of overt HE in 10 of 11 cases. In 24 cases of mere liver cirrhosis and normal neuropsychological testing, a typical metabolic pattern with a depletion of myo-inositol and an increased glutamine peak were found. A good correlation between the glutamine signal and the clinical grading was found. CONCLUSIONS: Proton MR spectroscopy allows for the diagnosis of HE and subclinical HE, also shows the typical pathological metabolite pattern in patients with cirrhotic livers without subclinical HE, and might be more sensitive than neuropsychological testing. Glutamine could serve as a spectroscopic marker for the clinical state of the patients. (Gastroenterology 1997 May;112(5):1610-6)

Background Conventional radiography has limitations in the detection of physeal fractures before the closure of the physis occurs. Fracture detection may be improved by using magnetic resonance imaging (MRI). Purpose To evaluate the usefulness of MRI for the detection of occult fractures involving the physis when radiography results are negative. Material and Methods In this prospective study, 24 children (age range, 3–15 years; mean age, 10.7 years) received MRI if they met the following criteria: acute joint trauma, swelling and tenderness around the joint, limitations in bearing weight, an open physis, and negative radiography results for fractures. Fractures revealed by the MRI were classified according to the Salter-Harris classification system. Joint effusion, bone marrow edema, and periosteal alterations were graded on a three-point scale. The non-parametric Wilcoxon test and Fisher's exact test were used for the statistical evaluation. Results From a total of 24 MR data-sets, 23 were evaluated (one patient was excluded due to poor MR image quality). Elbow injuries were present in 10 patients (43.5%), distal tibia injuries in 10 patients (43.5%), and distal femur injuries in three patients (13%). MRI results excluded physeal fractures in 15 (65.2%) of the 23 children. An occult physeal fracture was detected with MRI in eight (34.8%) patients; of these, five (21.7%) had fractures of the elbow, two (8.7%) had fractures of the distal tibia, and one (4.3%) had a fracture of the distal femur. All of the patients with fractures and 11 of the 15 patients without fractures demonstrated bone marrow edema. Conclusion The frequency of occult fracture, as detected by MRI, was 34.8%. Thus, MRI is a useful additional imaging method for the detection of occult fractures when radiography is negative.

Purpose: To assess a patient-oriented digital optical card (OC) for documentation and communication of images using the analysis of breast microcalcifications to illustrate its resolution power. Methods: Fifty film mammograms with histologically proved clustered microcalcifications were digitized using a 5 lp/mm CCD-scanner. A region of interest containing the cluster was selected for documentation on an OC as an overview OC-image and as a magnified OC-image (5 lp/mm). The shape (spherical/nonspherical) as well as the total number of microcalcifications were quantitatively analyzed by 2 radiologists. Results: The detection rate for total number of overall and spherical microcalcifications using digital media was significantly reduced (pConclusion: According to our results, this technology is not appropriate for diagnosis of breast microcalcifications, but may be a promising communication digital medium for transmitting an image/report unit to referring physicians.

Das Mammakarzinom stellt in den meisten Industriestaaten die haufigste Malignomerkrankung der Frau dar. Eine moglichst fruhzeitige Diagnose kann die Heilungschancen wesentlich verbessern. Durch Mammographie, Sonographie, bioptische Methoden und MR-Mammographie konnten in der Brustkrebsdiagnostik entscheidende Fortschritte erzielt werden. Trotz Einsatz aller diagnostischen Moglichkeiten treten immer noch Probleme bei der Abklarung von Brusterkrankungen auf. So hat bekanntermasen die Mammographie ihre Limitationen bei jungen Frauen mit dichtem Brust-drusenparenchym, die Sonographie u.a. bei voluminosen fettreichen Mammae, die Kernspintomographie in ihrer nur masigen Spezifitat.

Purpose: To evaluate the capabilities of breast ultrasound (US) for identifying microcalcifications in benign breast changes, in situ carcinomas, and small non-palpable invasive carcinomas. Material and Methods: Forty-six consecutive patients with 49 clustered microcalcifications detected by mammography were included in this prospective study. Patients with palpable breast lesions were excluded. Breast US was performed with knowledge of mammographic findings for presence and visibility of microcalcifications, and for parenchymal structure abnormalities. Mammographic and US findings were compared with histology. Results: Nine ductal in situ carcinomas, 2 lobular in situ carcinomas, 11 invasive carcinomas and 27 benign lesions were confirmed by histology. For all lesions, US achieved a sensitivity of 75% in the detection of microcalcifications. The detection rate for microcalcification in invasive and in situ carcinomas was 100%. In 11 cases, no microcalcifications were visible on US; they all proved to be benign on histology. Conclusion: Microcalcifications in malignant lesions are reliably recognized by US. They are, however, difficult to detect in fibrocystic breast changes.

Atrophic rhinitis was diagnosed in a 10-month-old heifer with the assistance of computed tomography. The aetiology of the condition in cattle is uncertain and the clinical disease may be overlooked owing to the lack of signs such as the shortening or deformity of the snout observed in pigs.

Death, abortion, decreased milk yield and emaciation in dairy goats occurred due to calcinosis in a goat operation on 1100 meter sea level in Tyrol. This could be diagnosed by the clinical, sonographical and pathomorphological investigation. In the basic fodder yellow oat grass proportion was present with 40%. Clinically the apathic goats showed reduced appetite, emaciation, dyspnea, anaemic mucous membranes, heart noises and less activity to move. The blood-chemical examination of one goat revealed an increased activity of AP (199 U/l), calcium and phosphor-concentrations were in normal range. Sonographically liquidothorax and -perikard, calcified pulmonary and aortic valves and a thickened aortic orifice as well as calcification of kidneys, enlargment of liver and ascites could be diagnosed in this goat. The sonographical findings were confirmed by pathomorphological examination.

Dynamic magnetic resonance imaging (MRI) using a single shot fast spin-echo technique was evaluated as a noninvasive alternative to cystourethography or colpocystorectography in patients with pelvic organ prolapse and/or urinary incontinence. Thirty-two patients were included in this prospective study. Colpocystorectography was performed in 10 patients who previously had undergone hysterectomy and in 2 patients without history of hysterectomy with clinical suspicion of rectoceles. Bead-chain cystourethrography was performed in 20 patients without hysterectomy. For dynamic MRI, a single-slice half-Fourier RARE sequence (imaging time 2 seconds) was used to depict the pelvic organs at different levels of pelvic strain. The results obtained with dynamic MRI were correlated with the x-ray findings. All 17 cystoceles, 10 rectoceles, 2 enteroceles, and 7 vaginal prolapses could be demonstrated on MRI. Diagnostic information gained from these images was equivalent to that obtained with colpocystorectography and superior to that obtained with cystourethrography; with the latter, important findings were missed (four rectoceles). We conclude that dynamic MRI of the pelvic floor with a half-Fourier RARE sequence can reliably detect descents of all three pelvic compartments, that it requires no contrast agent, and that no radiation exposure is involved.J. Magn. Reson. Imaging 1999;9:378–383. © 1999 Wiley-Liss, Inc.

To examine if RARE urography may replace conventional intravenous urography in patients with suspected urinary obstruction in pelvic tumours.In a prospective trial on 120 patients with pelvic tumours scheduled for operation, biplanar RARE urography was performed and compared to conventional intravenous urography and ultrasound findings.In 30 out of 120 patients an ureteric obstruction was diagnosed by ultrasound. Sensitivity of RARE urography for obstruction was 98% as compared to 60% in conventional intravenous urography. In 12 patients additional retrograde cystoureterography showed a sensitivity of 83%. Specificity of RARE urography and intravenous urography was 100%. In combination with axial MR tomography RARE urography yielded a more precise localisation of the site of obstruction and the underlying cause (98%) as compared to conventional urography (60%) and ultrasound (56%).By use of RARE urography urinary obstruction can be reliably demonstrated or ruled out. Combining RARE urography with tomographic MR imaging allows the precise depiction of the site of the obstruction and may demonstrate the underlying pathology.

Goal of this two-part report is to provide clinical MRI radiologists with a guide to the world of new and clinically available MRI pulse sequences. Discussed are the principles of rapid scan techniques like multiple spin-echo imaging, multiple gradient echo imaging, echo planar imaging, diffusion and perfusion imaging, and future perspectives (review article).

A 69-year-old diabetic male with salmonella bacteremia developed hypovolemic shock and swelling of the neck. A CT examination revealed massive mediastinal hemorrhage extending into the neck soft tissues caused by false aneurysm rupture of the descending thoracic aorta. Aortography showed continuous extravasation from a large leak at the medial side of the descending thoracic aorta. Although surgical intervention was immediately performed, the patient died 3 weeks later from multiple-organ failure. In this report, CT and angiographic findings of mycotic aneurysm rupture are presented and a review is given.

In an experimental study, the correlation between the trabecular bone density of the different regions of the proximal femur and the fracture load in the setting of femoral neck fractures was examined.The bone mineral density of 41 random proximal human femora was estimated by single-energy quantitative CT (SE-QCT). The trabecular bone density was measured at the greatest possible extracortical volume at midcapital, midneck and intertrochanteric level and in the 1 cm3 volumes of the centres of these regions in a standardised 10 mm thick slice in the middle of the femoral neck axis (in mg/ml Ca-hydroxyl apatite). The proximal femora were then isolated and mounted on a compression/bending device under two-legged stand conditions and loaded up to the point when a femoral neck fracture occurred.Statistical analysis revealed a linear correlation between the trabecular bone density and the fracture load for the greater regions, with the highest value in the maximal area of the head (coefficient factor r = 0.76).According to our data, the measurement of the trabecular bone by SE-QCT at the femoral head is a more confident adjunct than the neck or trochanteric area to predict a femoral neck fracture.

The purpose of this study was to evaluate the differences of blood supply in benign and malignant breast tumors by color Doppler flow measurements. The study included 471 patients, 133 with carcinomas, 325 with benign breast lesions, and 13 with mastitis. An ATL UM9/HDI was used with an electronic 10-MHz linear array broadband transducer. The following flow data were analyzed: Presence of vascularity; number of tumor arteries; the mean, minimum, maximum RI index, and AB ratio; the mean, minimum, and maximum peak systolic flow velocity and the sum of all peak systolic flow velocities in each tumor. In all cancers and in most benign pathologies vascularity was found. Highly significant differences between benign and malignant were found for all quantitative flow data such as number of tumor arteries and blood flow velocity (P0.0001). Flow profiles analyzed by RI index and AB ratio showed a trend for increased flow resistance in malignancies. However, due to the wide overlap between benign and malignant, indices did not allow a sufficient differentiation. The study showed that standardization of the Doppler examination technique and equipment parameters is essential for vascularity assessment of tumors.

Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur. On plain radiographs the fracture line is clearly seen. However, some fractures and musculotendinous injuries may display subtle features and may be difficult to detect even with optimal images. We explain the mechanism of injury, discuss the diagnostic work-up and the operative and nonoperative management.

In a retrospective study the diagnostic accuracy of computed tomography for the differentiation of benign from malignant adrenal masses in patients with extra-adrenal malignancies was evaluated. For this differentiation a new score system was tested.Size, density, structure, and borders of adrenal masses in 60 patients with extra-adrenal tumours were analysed and scored. The single criteria and the total score values were correlated with the final diagnosis achieved either by histology or by follow-up CT examinations.Score values above 4 indicated always metastases and score values below 2 were benign lesions. An overlap occurred at score values between 2 and 3 resulting in an overall accuracy of 83.3%.Single CT criteria are not reliable enough to differentiate benign from malignant adrenal lesions: better results are achieved by using our scoring system.

According to the German guidelines for quality control of ultrasonic equipment, the following conditions are required for breast ultrasound: A transducer frequency between 5-7.5 MHz and a minimum field of view of 5 cm. Satisfactory images must be obtained in a depth between 0.5 and 4 cm with a wide tolerance of the focal zones. This allows the use of poor quality equipment which does not produce satisfactory image quality and it excludes a number of high frequency and high resolution transducers with a field of view below 5 cm. This study with a test phantom was performed to define image quality objectively.Sixteen ultrasound instruments in different price categories were used to perform standardized examinations on a breast phantom model 550 (ATS Laboratories, Bridgeport, USA). Contrast and spatial resolution in different penetration depths were investigated on cyst phantoms from 1-4 mm diameter and wire targets with defined distances between 0.5-3 mm 4 investigations reported the images.A positive correlation was seen between price category and image quality.This study demonstrates that transducer frequency and image geometry do not allow sufficient quality control. An improvement of ultrasound diagnosis is only possible if equipment guidelines are based on standard examinations with test phantoms.

The aim of our controlled retrospective study was to assess the diagnostic value of sonography for detection and characterisation of changes compared to mammography and palpation.In 80 patients sonographic and clinical follow-up examinations were performed every 3 to 6 months, mammography examinations were performed every 6 to 12 months during the first 2 years after breast-preserving therapy (BPT) and irradiation. Extension, echogenicity, and configuration of lesions in sonography, and semiquantitiative description of diffuse or circumscribed changes in mammography were the basis of comparative follow-up observation.Postoperative seromas and haematomas, initially presenting echo-free or as hypoechoic lesions, showed an increase in echogenicity within 18 months after irradiation. Fat necrosis occurred in 9.5% of patients, lymph cysts developed in 4%, granuloma in 3%, recurrence of neoplasma in 1.6%. The diffuse loss of transparency in mammography that was associated with radiation therapy, showed a peak 6-12 months after irradiation.Sonography and sonographic guided puncture are mandatory tools to characterise circumscribed unclear lesions after breast-conserving therapy and irradiation in specialised centers. We recommend a 6-month interval for combined sonography, palpation, and mammography within the first 2 years after BPT and irradiation, because shorter control intervals did not result in relevant diagnostic advantages.

To assess a patient-oriented digital optical card (OC) for documentation and communication of images using the analysis of breast microcalcifications to illustrate its resolution power.Fifty film mammograms with histologically proved clustered microcalcifications were digitized using a 5 lp/mm CCD-scanner. A region of interest containing the cluster was selected for documentation on an OC as an overview OC-image and as a magnified OC-image (5 lp/mm). The shape (spherical/nonspherical) as well as the total number of microcalcifications were quantitatively analyzed by 2 radiologists.The detection rate for total number of overall and spherical microcalcifications using digital media was significantly reduced (p0.01) compared to analog mammography. There were no significant differences in the detection rate of nonspherical microcalcifications between film mammograms (100%) and magnified section OC-images (92.7%). The overview OC-image revealed 72% of those calcifications (p0.01).According to our results, this technology is not appropriate for diagnosis of breast microcalcifications, but may be a promising communication digital medium for transmitting an image/report unit to referring physicians.

In der Nachsorge von Karzinompatienten erfolgt bei Vorliegen metastasenverdachtiger Herde im Skelettszintigramm eine Abklarung ublicherweise mittels konventioneller Rontgenaufnahmen [4]. Demgegenuber hat die Kernspintomographie (KST, Magnetresonanz-Tomographie, MRT) als neues Schnittbildverfahren, welches durch kontrastreiche Darstellung des Markraumes eine fruhzeitige Erfassung der uberwiegend vom Knochenmark ausgehenden Skelettmetastasen ermoglicht [1, 8–10], noch keinen festen Platz im diagnostischen Procedere.

The diagnostic value of a digitization system for analogue films based on a charge-coupled-device (CCD) scanner with adjustable resolution of 2.5 or 5 lp/mm was assessed. Some 110 skeletal radiographs, 50 contrast studies, including 25 of patients with Crohn's disease, and 70 abdominal plain films before and after successful lithotripsy for renal stones were digitized. Receiver operating characteristic (ROC) studies showed improved detection of cortical and trabecular defects with contrast-optimized digitized films. Edge enhancement algorithms yielded no additional information. Inflammatory lesions of Crohn's disease were detected equally well by conventional films and digitized images. A statistically significant improvement (p less than 0.05) in the recognition of disintegration after lithotripsy was found for the processed digitized images. On the basis of this initial investigation, the digitization system tested appears to be useful for diagnostic purposes, especially when contrast resolution plays an important part, as with stone fragmentation or cortical defects.

Apiculture in South Tyrol To day there are 40 000 bee swarms in South Tyrol. By their production of honey and wax the highlanders can increase their income. Furthermore the bees pollinate almost 7 millions of fruit trees as well as the plants of natural vegetation. In consequence of the using of insecticides in some regions the number of swarms has been strongly reduced. Unfortunately there is no rule in Italy which prohibits the using of toxical preparations during flower time. But altogether the apiculture in South Tyrol didn't decrease in last years in contrast to the most other European countries. The Agricultural School of Dietenheim near Bruneck harbours a station for apicultural information and research. But the equipment is antiquated. In the interest of rearing pure-blood bees (carnica-race) as well as of a better promotion of South Tyrolian apiculture it is urgent to build up a modern apicultural centre.