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Sinding-Larsen-Johansson syndrome is an osteochondrosis affecting the inferior pole of the patella. Most cases can be easily diagnosed with adequate clinical history, physical examination, and proper imaging, including conventional radiography, ultrasound, and magnetic resonance imaging. Differentiating this condition from patellar sleeve avulsion fractures is important, since treatment is frequently surgical in the latter. Overlap between these two conditions can also occur. We present a case of an 11-year-old boy, with Sinding-Larsen-Johansson syndrome on both knees and a minimally displaced acute patellar avulsion sleeve fracture of the left knee, which was treated conservatively., (© 2022. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background: This study compares the preferences of Dutch orthopaedic surgeons for different diagnostic modalities in performing tarsal fusions versus consensus, evidence or expert opinion reported in the literature., Methods: A literature search of Medline was performed to obtain evidence-based information on various diagnostic tools. In addition, 89 registered Dutch foot and ankle surgeons were sent a questionnaire concerning the diagnostic modalities use in tarsal fusion., Results: Fifty-eight (65%) questionnaires were returned. The experienced surgeons measured outcomes significantly more often than other surgeons. Diagnostic injections were often used, although scant evidence exists in the literature. Postoperative diagnostics mainly consist of X-ray examination, although there is consensus in the literature that computed tomography is more accurate., Conclusions: The study revealed some surprising discrepancies concerning the use of diagnostic imaging in tarsal fusion. More clinical research is needed to identify the most effective diagnostic imaging modalities so as to encourage their wider adoption., (Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Objective: To test the hypothesis that laparoscopic staging improves outcome in patients with peripancreatic carcinoma compared to standard radiology staging., Summary Background Data: Diagnostic laparoscopy of peripancreatic malignancies has been reported to improve assessment of tumor stage and to prevent unnecessary exploratory laparotomies in 10% to 76% of patients., Methods: Laparoscopy and laparoscopic ultrasound were performed in 297 consecutive patients with peripancreatic carcinoma scheduled for surgery after radiologic staging. Patients with pathology-proven unresectable tumors were randomly allocated to either surgical or endoscopic palliation. All others underwent laparotomy., Results: Laparoscopic staging detected biopsy-proven unresectable disease in 39 patients (13%). At laparotomy, unresectable disease was found in another 72 patients, leading to a detection rate for laparoscopic staging of 35%. In total, 145 of the 197 patients classified as having "possibly resectable" disease after laparoscopic staging underwent resection (74%). Average survival in the group of 14 patients with biopsy-proven unresectable tumors randomly allocated to endoscopic palliation was 116 days, with a mean hospital-free survival of 94 days. The corresponding figures were 192 days and 164 days in the 13 patients allocated to surgical palliation., Conclusions: Because of the limited detection rate for unresectable metastatic disease and the likely absence of a large gain after switching from surgical to endoscopic palliation, laparoscopic staging should not be performed routinely in patients with peripancreatic carcinoma.

Background: Hepatocellular carcinoma (HCC) is often detected at a relatively late stage when tumour size prohibits curative surgery. Screening to detect HCC at an early stage is performed for patients at risk., Aim: The aim of this study was to compare prospectively the diagnostic accuracy and classification for management of the two state of the art secondline imaging techniques: triphasic spiral computer tomography (CT) and super paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI)., Patients: Sixty one patients were evaluated between January 1996 and January 1998. Patients underwent CT and MRI within a mean interval of 6.75 days., Methods: CT and MRI were evaluated blindly for the presence and number of lesions, characterisation of these lesions, and classification for management. For comparison of the data on characterisation, the CT and MRI findings were compared with histopathological studies of the surgical specimens and/or follow up imaging. Data of patients not lost to follow up were available to January 2001., Results: SPIO enhanced MRI detected more lesions and overall smaller lesions than triphasic spiral CT (number of lesions 189 v 124; median diameter 1.0 v 1.8 cm; Spearman rank's correlation coefficient 0.63, p<0.001). There was no significant difference in accuracy between CT and MRI for lesion characterisation. The agreement in classification for management was very good (weighted kappa 0.91, 95% CI 0.83-0.99)., Conclusion: SPIO enhanced MRI detects more and smaller lesions, but both techniques are comparable in terms of classification for management. SPIO enhanced MRI may be preferred as there is no exposure to ionising radiation.

The purpose of this study was to compare prospectively computed tomography (CT) and magnetic resonance (MR) imaging before and after mangafodipir trisodium infusion for the detection and staging of focal pancreatic lesions. From November 1996 to October 1997, 43 consecutive patients suspected to have a focal pancreatic lesion were included in a phase III study. Triphasic helical CT was performed, as well as MRI at 1.5 T, as follows: axial T1-weighted (T1w) turbo spin echo (TSE), spectral presaturation with inversion recovery (SPIR) T1w TSE, T1w turbo field echo (TFE), and SPIR T2w TSE before and after mangafodipir trisodium (0.01 mmol/ml, 0.5 ml/kg) infusion. Imaging results were correlated with surgery, laparoscopy, laparoscopic ultrasound, and biopsy. Objective measurements were performed by measuring signal intensities (SIs) of lesion and parenchyma and calculating contrast indexes (CIs) and contrast-to-noise-ratios (CNRs) to assess the delineation of the tumor. SIs were correlated with four phantom standards with a known SI. Thirty-eight pancreatic adenocarcinomas were present, as well as one cystadenoma, two papillomas, and two cases of focal pancreatitis. SI measurements revealed significant increases in CIs for the lesion compared with the parenchyma in T1w TSE (69.7 vs 152.7; P = 0. 0003) and T1w TFE (107.8 vs 194.2; P = 0.0002). These series also revealed significant increases in CNRs (for T1w TSE: 9.7 vs 13.0; P = 0.0407 and for T1w TFE: 14.5 vs 26.1; P = 0.0001). In the other series, there was no significant increase. CT detected 38 lesions, MRI without mangafodipir trisodium detected 39 lesions, and MRI with mangafodipir trisodium detected 40 lesions, giving detection accuracy rates of 88%, 91%, and 93%, respectively. Staging accuracy rates for vascular ingrowth were 81%, 75%, and 81%, respectively. Overall staging accuracy rates were 57%, 54%, and 54%, respectively, mostly due to undetected small metastases in the peritoneum, omentum, or liver (< 1 cm). This study indicates that a) MRI after mangafodipir trisodium gives a better delineation of the tumor in T1w series, but b) does not significantly improve the detection rate and staging accuracy of focal pancreatic lesions over MRI without this contrast medium.

Background: The ideal method for staging tumours of the oesophagus and gastric cardia is not known. This paper was designed to assess the value of laparoscopy and laparoscopic ultrasonography in the staging of oesophageal and cardial carcinoma., Methods: From October 1993 to January 1996, 60 patients in whom no metastases were seen on gastroscopy, ultrasonography of the abdomen and supraclavicular region, helical computed tomography of the chest and abdomen or endosonography were scheduled for laparoscopy and laparoscopic ultrasonography., Results: Some 40 patients had carcinoma of the oesophagus, in one of whom liver metastases were found at laparoscopy and proven histologically. On laparoscopic ultrasonography metastases were found in four patients but were impossible to biopsy. These lymph node metastases were confirmed at exploratory laparotomy. Twenty patients had carcinoma of the gastric cardia; distant metastases were found in four at laparoscopy. On laparoscopic ultrasonography metastases were present in four further patients, all proven by biopsy., Conclusion: In this study laparoscopy was not an effective staging technique for oesophageal carcinoma. The inclusion of laparoscopic ultrasonography was of little benefit. A problem that was encountered was biopsy under laparoscopic guidance. In carcinoma of the gastric cardia, laparoscopy was more effective; adding laparoscopic ultrasonography doubled the number of patients seen to have metastatic disease.