Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.     

Flexor carpi radialis tendinitis. Part I: Operative anatomy

The anatomical characteristics of the flexor carpi radialis tendon, the tendon sheath, the tunnel boundaries, and the adjacent structures were examined in twenty-five adult cadaveric specimens. Transverse and sagittal sections of the wrist and forearm, tenograms, and histological sections of the tendon were made from two additional specimens each. The musculotendinous portion of the flexor carpi radialis tendon begins an average of fifteen centimeters (range, twelve to seventeen centimeters) proximal to the radiocarpal joint; the muscular fibers end an average of eight centimeters (range, six to nine centimeters) proximal to the wrist. The synovial sheath extends from the origin to the insertion. The tendon enters a fibro-osseous tunnel at the proximal border of the trapezium and is separated from the carpal canal by a thick septum that functions, at its distal border, as a pivot point for the flexor pollicis longus. Within the tunnel, the tendon occupies 90 per cent of the available space and is in direct contact with the slightly roughened surface of the trapezium. The tendon lies within a few millimeters of the distal aspect of the radius, the scaphoid tubercle, the scaphoid-trapezium-trapezoid joint, and the carpometacarpal joint of the thumb. In most patients, the flexor carpi radialis tendon is inserted at three locations. A small slip is connected to the trapezial crest or tuberosity; 80 per cent of the remaining tendon is inserted on the base of the second metacarpal and 20 per cent, on the base of the third metacarpal. The deep palmar arch is located two to three millimeters distal to the insertion of the tendon.     

Transnasal endoscopic approach to expose the medial rectus from the annulus of Zinn to the penetration of Tenon''s capsule

Conventional strabismus surgery employs a conjunctival incision to gain access to Tenon's space where a wide variety of procedures are routinely performed on the tendon and anterior aspect of the extraocular muscles. Recently, transnasal endoscopic surgical techniques have gained acceptance as effective means of decompressing the medial wall and floor of the orbit in patients with thyroid-related orbitopathy. The orbital surface of the medial rectus and inferior rectus are exposed from the annulus of Zinn to a position close to where the muscles penetrate Tenon's capsule. In theory, this technique also provides the exposure necessary to locate and retrieve a "lost" medial rectus when the usual sub-Tenon's approach fails to recover the muscle. Cadaver studies demonstrate the feasibility of exposure and suture placement in the stump of a lost medial rectus with passage of the suture through Tenon's capsule to transmit the force of the muscle to the globe, provided that the lost muscle is retrieved before severe contracture develops.     

Ruptured or intact: what can linear echoes within silicone breast implants tell us?

OBJECTIVE: During sonographic evaluation of silicone breast implants for possible rupture, we have frequently encountered several patterns of linear echoes within the implants. To our knowledge, the significance of this finding has not been established in the literature. The purpose of this study was to determine whether internal echoes are significant in predicting implant rupture. SUBJECTS AND METHODS: Thirty-three patients with 64 silicone implants were prospectively entered into a study that included gray-scale sonography of the implants and subsequent surgical removal. Echo patterns within the implants were retrospectively evaluated on hard-copy films and compared with the integrity of the implant at surgery. RESULTS: Three categories of internal echo patterns were identified: "thick linear echoes." "thin linear echoes," and "commas." One or more of these echo patterns were seen in 57 (89%) of the 64 implants. Thick linear echoes were seen in 23 (36%) of the 64 implants, thin linear echoes were seen in 33 (52%) of the 64 implants, and commas were seen in 47 (73%) of the 64 implants. All echo patterns were seen in intact and ruptured implants with nearly equal frequency. We found no statistical significance for any echo pattern in predicting whether an implant was ruptured or intact. Of the 64 implants, four were entirely free of internal echoes. All four implants were intact. CONCLUSION: A variety of linear echoes can be seen in most silicone breast implants on gray-scale sonography. The presence or absence of linear echoes is not useful in predicting implant rupture. Complete absence of internal echoes, while highly predictive of an intact implant, is infrequently seen.     

A study of oral morphine preference in inbred mouse strains

The generative potential of free perichondrial grafts from rabbit auricular and rib cartilage around a self-reinforced polyglycolic acid (SR-PGA) rod was examined in eight growing rabbits. A 15 x 15 mm perichondrial graft was dissected away from the posterior side of each auricular cartilage. One graft was wrapped around a 1.1 x 10 mm SR-PGA rod and the other served as a control and was shaped into a tube without an implant. Fifth rib cartilages were then resected subperichondrially on both sides. The remaining perichondrium on the other side was wrapped around a 1.1 x 10 mm SR-PGA rod, while the other served as a control and was shaped into a tube without an implant. All the grafts were placed inside pectoralis major muscles. Grafts were biopsied six weeks postoperatively. Neocartilage formation was seen in all grafts with one exception on both the implant and control sides. It formed a tube-like structure around the implant in four cases after grafting of auricular perichondrium and in three cases after grafting of rib perichondrium. New bone formation was also observed. SR-PGA implants did not seem to disturb the generative potential of perichondrium.     

Leptin receptor of Zucker fatty rat performs reduced signal transduction

Arthroscopy of the first carpometacarpal joint has been developed as a reliable surgical procedure offering an opportunity for direct evaluation of the joint's intra-articular status, with minimal morbidity to the joint capsule. The procedure uses a 1.9-mm short barrel arthroscope with standard supportive electronic equipment. After adequate anesthesia is established, approximately 5 lb. of longitudinal traction is applied to the thumb. Arthroscopic portals are located on the radial side of the abductor pollicis longus tendon (1-R portal) and the ulnar side of the extensor pollicis brevis tendon (1-U portal). Care must be exercised in establishing these portals so that injury to the radial artery and branches of the superficial radial nerve can be avoided.     

Prerequisites for offering ultrasound services in general practice]

In the course of the past few years, sonography has become firmly established in clinical practice. The accuracy of the investigations does not only depend on the quality of the equipment used but also to a considerable degree on the standards of investigator training. To reduce the discrepancy between the number and quality of the investigations in the German Federal Republic, the "Kassen?rztliche Vereinigung" has released guidelines requiring the users of sonographic equipment to undergo theoretical and practical training. These guidelines are reviewed and commented.     

The proposal to certify nurse anesthetists

RATIONALE AND OBJECTIVES: The application of information technology to teaching radiology will profoundly change the way learning is mediated to students. In this project, the integration of veterinary medical students' knowledge of sonography was promoted by a computer-assisted instruction program and a subsequent practical class. METHODS: The computer-assisted instruction program emphasized the physical principles of clinical sonography and contained simulations and user-active experiments. In the practical class, the students used an actual sonographic machine for the first time and made images of a tissue-equivalent phantom. Students' responses to questionnaires were analyzed. RESULTS: On completing the overall project, 96% of the students said that they now understood sonographic concepts very or reasonably well, and 98% had become very or moderately interested in clinical sonography. CONCLUSIONS: The teaching and learning initiatives enhanced an integrated approach to learning, stimulated student interest and curiosity, improved understanding of sonographic principles, and contributed to an increased confidence and skill in using sonographic equipment.     

Tumours aneurysms

Ultrastructural and cytochemical studies on the remodelling of the rat tracheal cartilage have been carried out. The thickness of the tracheal cartilage was constant, during the observation periods (1 to 54 days after birth). The external perichondrium of the tracheal cartilage consisted of active fibroblasts and intercellular fibrils. The inner part of this perichondrium was a chondrogenic layer, where appositional growth was taking place. On the other hand, the internal perichondrium contained fibroblast-like cells, which were nearly twice as large as the external perichondrial fibroblasts in size and were arranged in three or four layers. The cells had well developed organella and large vacuoles which contained numerous fragments of fibrils and/or glycosaminoglycan. Many cytoplasmic processes protruded to the cartilage matrix, where the intercellular fibrils were particularly irregular in arrangement. Some vacuoles included collagen fibrils. Based on an intense acid phosphatase activity in these vacuoles and other findings, the fibrils were thought to be phagocytosed collagen of the cartilage matrix. An extensive alkaline phosphatase activity was demonstrated on the plasma membrane of fibroblasts and chondroblasts in the external perichondrium. The present investigation revealed distinct functional difference between the external and internal perichondrium of the tracheal cartilage. It is resorbed at the internal perichondrium, while it appositionally grows at the external perichondrium. The fibroblast-like cells of the internal perichondrium play an essential role in resorption of the matrix in cartilage remodelling.     

The study reports on a case of habitual dislocation of the hip-joint in a 6-year-old girl (author''s transl)

During the operative reposition the capsule was found extremely wide, and extended capsular fibrosis was exhibited. Resection of an ovoid capsular segment and a double capsular suture, secured by superfixation of the m. rectus tendon, resulted in a stabile hip-joint position.     

Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study

The extensor tendons of the fingers and toes form part of the capsule of the interphalangeal joint and press against the proximal phalanx during flexion. Previous work on the fingers has shown that there is a "sesamoid" fibrocartilage on the deep surface of each tendon that labels immunohistochemically for a variety of glycosaminoglycans and collagens. However, we know little about the molecular composition of the tendon in the toes. This question is of special interest, because the mechanics of the interphalangeal joints differ in the upper and lower limbs-the toes balance the forefoot, distribute load during the gait cycle, and transmit the pull of larger muscles. This means that their extensor tendons are more often under higher tension than those in the fingers. Here, we report the presence of an equivalent fibrocartilage and compare its immunolabelling characteristics in all the toes. Six forefeet were removed from elderly cadavers, and the interphalangeal (IP) joints were fixed in 90% methanol. The extensor tendon and its enthesis were dissected out from the IP joint of the big toe and from the proximal interphalangeal (PIP) joint of all lesser toes, decalcified, cryosectioned, and immunolabelled with a panel of monoclonal and polyclonal antibodies for type I, II, III, and VI collagens; chondroitin 4 and 6 sulphates; and dermatan and keratan sulphate. Antibody binding was detected with the Vectastain ABC Elite avidin-biotin-peroxidase kit (Vector Laboratories, Burlingame, CA). The extensor tendon in all the toes had a metachromatic, sesamoid fibrocartilage on its deep surface that immunolabelled for all glycosaminoglycans and for type I, III, and VI collagens. Labelling for type II collagen was seen in the sesamoid fibrocartilage of all toes but was particularly characteristic of the 2nd through 5th toes. The immunolabelling patterns of the enthesis fibrocartilage were similar in all toes and to results reported previously for fingers. The normal occurrence of type II collagen in the sesamoid fibrocartilage of the 2nd through 5th toes is in contrast to our published data on the fingers. The finding can be related to the more constant loading of the tendon in the toes. The greater prominence of type II collagen in the sesamoid fibrocartilage of the 2nd through 5th toes could be related to a difference in joint position during walking between the 1st toe and the 2nd through 5th toes--the PIP joints of the latter are usually more flexed than the IP joint of the former.     

Applications of health risk adjustment: what can be learned from experience to date?

BACKGROUND: Despite having appropriate sonographic equipment available many radiologists remain unfamiliar with B mode sonography of the eye. OBJECTIVE: This article reviews the advantages and disadvantages of B mode sonography of the paediatric eye. We illustrate the spectrum of eye abnormalities occurring in paediatric practice and the sonographic appearance of clinical entities for which sonography is appropriate. MATERIALS AND METHOD: We reviewed our experience of eye sonography within a paediatric radiology department over 8 years. A total of 212 sonographic examinations were performed on 206 eyes in 103 children, aged from 3 days to 16 years (mean 4.6 years). RESULTS: Sonography was well tolerated by the children, was a very useful imaging modality and was the only diagnostic imaging modality required in 94%. Supplementary computed tomography (CT) was performed in ten of 206 eyes (5%) and magnetic resonance imaging (MR) was performed in two of 206 eyes (1%). CONCLUSIONS: B mode sonography is a very useful imaging modality for suspected ocular or orbital pathology in children and is often the appropriate first line investigation following clinical evaluation. Radiologists familiar with sonography of the eye can provide valuable support to their ophthalmology colleagues.     

Endobronchial sonography: feasibility and preliminary results

Endobronchial sonography, a new ultrasound technique, has been evaluated for the assessment of normal lungs and bronchial carcinomas. The procedure was performed with ultrasound catheters, which were introduced into central and peripheral bronchi through the operating channel of fibreoptic bronchoscopes. The bronchial wall is highly echogenic and laminated. The lung parenchyma appears echo rich and patchy. Pulmonary arteries can be identified by the pulsatile changes and floating echoes within the echo free lumen. Echo poor bronchial carcinomas were detected in 69 out of 74 patients with endoscopically visible tumours and in 19 out of 26 patients with peripheral carcinomas. The correct implantation of metallic stents was facilitated by endobronchial sonography in nine patients. The sonographic examination carried no particular risk and caused little discomfort.     

The knee joint--imaging

In the assessment of knee joint abnormalities plain films must still be used today as primary imaging modality. For soft tissue, cartilage, tendon and ligament lesions, sonography, CT and MRI (with arthrography) is available today. Especially MRI leads to a significantly extended diagnosis.     

Simple arthrolysis for flexor rigidity of the proximal interphalangeal joint

The authors report 19 cases of simple arthrolysis of the proximal interphalangeal joint for flexion rigidity. Their cases were limited to isolated lesions of the joint without any flexor or extensor tendon involvement. The technique is described, and the importance of postoperative physical therapy is stressed. The results in these cases, in contrast with those in complicated cases of rigidity, are very satisfactory. The etiology is primarily sprains and dislocations of the proximal interphalangeal articulation, immobilized for too long a time in flexion (in the so-called "functional position").     

Rab5 GTPase and endocytosis

PURPOSE: We studied the effect of horizontal transposition of the vertical rectus muscles on incyclotropia and excyclotropia in terms of the amount of correction obtained and the stability of the outcome. METHOD: Preoperative measurements for cyclotropia were compared in 11 patients with measurements during the immediate postoperative period and last follow-up. Excyclotropia was treated with nasal transposition of the inferior rectus muscle and incyclotropia with nasal transposition of the superior rectus muscle, to which we added temporal transposition to the inferior rectus muscle in one patient to enhance the effect. RESULTS: Fusion in all gaze positions was restored in six patients and functional improvement occurred in five. The average effect of horizontal transposition of one vertical rectus muscle for cyclotropia was a correction of 7 degrees in primary position and of 11 degrees in depression. This effect remained stable after a mean follow-up of 17 months, and additional improvement occurred in one patient. One patient developed a hypertropia, eliminated by an additional operation, in the treated eye. CONCLUSIONS: For excyclotropia, nasal transposition of the inferior rectus muscle is a viable alternative to lateral and anterior transposition of the anterior portion of the superior oblique tendon. It becomes the procedure of choice when surgery on the superior oblique tendon is precluded, either by the tendon's congenital absence or by previous surgery on the tendon. Nasal transposition of the superior rectus muscle or temporal transposition of the inferior rectus muscle is ideally suited for incyclotropia. No comparably effective operation exists.     

Editorial comment on "the link between local recurrence and distant metastasis in human breast cancer" by Serge Koscielny and Maurice Tubiana

A new anatomical variation of extensor digiti minimi (EDM) was discovered during our anatomical studies. The EDM usually gives one tendon to the little finger to extend the metacarpophalangeal joint (MPJ) independently from the other fingers. The EDM in our cadaver had three tendon slips. It supplied the MPJ of the little finger with two tendon slips. Along with the extensor digitorum communis (EDC), the EDM also had an additional slip to the ring finger MPJ extensor hood apparatus. The little finger also received a separate tendon from EDC.     

Endoscopic sonography of the stomach: findings in benign and malignant lesions

Endoscopic sonography combines direct visualization of the luminal surface of the gut with sonographic examination of the gut wall and surrounding structures. Lesions arising from different layers of the wall can be identified, staged, and in some cases characterized. Endoscopic sonography is complementary to endoscopy, barium studies, transabdominal sonography, and CT examination of gastrointestinal lesions. A thorough examination with endoscopic sonography may determine the layer of origin, size, echogenicity, and extent of gastric lesions and allows differentiation of lesions arising in the stomach from lesions arising outside the stomach. The purpose of this essay is to illustrate the findings from endoscopic sonography of a variety of benign and malignant lesions of the stomach.     

Acute heavy alcohol intake increases silent myocardial ischaemia in patients with stable angina pectoris

PURPOSE: The purpose was to determine tumor neovascularisation via colour-coded Doppler (duplex) sonography and the "power mode", both visually and quantitatively, by means of videodensitometry. MATERIAL AND METHODS: 6 VX2 tumours of 4 to 11 mm size were implanted in 4 rabbits at various sites. The colour-coded duplex sonography and the new sonographic power technique were tested before and after having injected a new contrast medium (SH U 616A). RESULTS: If no contrast medium was injected, tumour neovascularisation was identified in only 50% of the cases. Injection of contrast medium increased signal intensity three to fourfold with all examined tumors. Combined use of the sonographic method by the power technique with injection of contrast medium is outstandingly suitable for tumor vessel imaging even of small tumors, as these initial results seem to show. CONCLUSION: If these results are corroborated by further studies, contrast-medium supported sonographic technique may possibly become established as an alternative method to other imaging procedures.