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BackgroundOsteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions.PurposeTo evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty.Study DesignCase series; Level of evidence, 4.MethodsClinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography–computed tomography (SPECT-CT) analysis of both the ankle and the knee joint.ResultsTwelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n 5 11) and poor in 8% (n 5 1). The average VAS pain score was 3.9 (preoperative, 5.9; P 5 .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P< .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P 5 .035), and ankle dorsiflexion was significantly reduced (P 5 .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%.ConclusionIndications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

A 39-year-old woman was referred to our hypertension clinic with refractory hypertension. The patient history gave certain clues for pheochromocytoma. The diagnosis was proven with elevated metanephrines and computer tomography. The tumor was surgically removed.

As definition, a "kissing" osteochondroma is a typical new bony formation with erosion on the adjacent paired bone, provoked by pressure of the outgrowth. Further diagnostics for incidentally diagnosed solitary osteochondroma should be performed only in cases where malignant transformation is suspected.

Fluorine-18 fluordeoxyglucose positron emission tomography (FDG-PET) is an useful tool in diagnosing and monitoring of malignant cutaneous melanoma. However, the feasibility and usefulness of FDG-PET in uveal melanoma is not yet established. We present a patient with suspected advanced uveal melanoma who underwent combined FDG-PET/computed tomography (CT) for staging. FDG-PET/CT images demonstrated vital intraocular tumor. Anatomical assignment of the malignancy to the choroid was possible by means of the coregistered computed tomography. Furthermore, PET revealed an unknown otherwise undetected vital liver metastasis. We conclude that combined FDG-PET/CT has potential to further improve staging and therapy planning in patients with advanced uveal melanoma.

To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities. Neurosurgical Department, University of Essen, Germany. Between 1990 and 2000, a consecutive series of 78 patients were referred to our institution and underwent surgical treatment. There were 46 (59%) male and 32 (41%) female patients. Mean age was 43.3 years. Functional outcome was analyzed depending on histological features, age, tumor localization and the extension of involved spinal segments. The mean follow-up period was 34.4 months. Operative removal of the IMSCT was performed under standard microsurgical conditions with intraoperative monitoring of somatosensory-evoked potentials (SSEP). The most frequently involved localization was the cervical and cervicothoracic region (55%) followed by the thoracic region (32%) and the medullar conus (13%). The most frequent IMSCTs were neuroepithelial tumors in 44 patients (56.5%) including 32 patients with ependymomas, 15 astrocytomas, and two lesions without further histological classification. Non-neuroepithelial tumors included 10 metastases, nine cavernomas, eight hemangioblastomas, one dermoidal cyst and one enterogenetic cyst. Complete tumor removal was achieved in 65 cases (83.3%) and subtotal resection in nine cases. In four cases a biopsy was performed only. The overall postoperative neurological state was improved or unchanged in 51 patients (65.4%) and worsened in 27 patients (34.6%). A favorable functional outcome was observed in 94.1% of patients with vascular tumors, in 61.3% of patients with low-grade neuroepithelial tumors and in 53.3% of patients with malignant tumors. The strongest predicting factor of functional outcome was the preoperative neurological condition beyond the histological differentiation of the IMSCT. Although there was no outcome difference with respect to the age and tumor extension, thoracically located IMSCTs proved to harbor an increased risk of postoperative surgical morbidity.

Increased sarcolemmal permeability has been implicated as a major pathological event in muscular dystrophies. In our study, we evaluated whether damaged muscle fibres can be specifically targeted using albumin as a carrier. We tagged human serum albumin (HSA) with Gadolinium (Gd) and systemically applied this compound (Gd-DTPA-HSA) to wildtype and dystrophin-deficient mdx mice. We performed magnetic resonance imaging before and after intravenous administration of Gd-DTPA-HSA and found localised signal enhancement only in mdx skeletal muscle. We also examined skeletal muscle after contrast enhanced magnetic resonance imaging using anti-human albumin antibodies and demonstrated intracellular accumulation of Gd-DTPA-HSA in clusters of damaged mdx muscle fibres. Comparison of magnetic resonance imaging and histological data emphasised the value of contrast agent enhanced magnetic resonance imaging for the in vivo assessment of fibre damage in muscular dystrophies. Furthermore, our data provide evidence that albumin can be used as a carrier to target covalently bound molecules to degenerating muscle fibres.

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3–7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.

A 56-year-old woman was admitted to the hospital because of progressive paresis of the left arm. Clinical examination revealed upper brachial plexus palsy and complete anesthesia and analgesia in segments C5–7. MRI demonstrated diffuse tumorous infiltration of the left brachial plexus with centrifugal growth from the dorsal spinal root of segment C6. Biopsy of the lesion revealed a malignant …

BACKGROUND AND PURPOSE: Aneurysmal rupture during endovascular treatment is one of the most feared complications of endovascular aneurysm therapy. The purpose of this study was to determine the frequency, causes, management, and outcome of aneurysmal rupture that occurred during treatment with Guglielmi detachable coils (GDCs) in an unselected series of patients with ruptured cerebral aneurysms. METHODS: Between July 1997 and December 2000, we treated 164 acutely ruptured cerebral aneurysms with GDCs. All charts were reviewed, and patients with aneurysmal rupture occurring during embolization were identified. RESULTS: Five patients had an intraprocedural aneurysmal rupture. In one patient, rupture was due to guidewire perforation of the wall. In two patients, the microcatheter itself perforated the aneurysm. In another two patients, rupture occurred during placement of the first coil. Endovascular packing was continued in all patients. One patient died as a result of the aneurysmal rupture. No negative long-term effects were observed in the remaining four patients. In summary, we observed intraprocedural aneurysmal rupture in 3% of our patients, with a mortality rate of 20% and no long-term morbidity. CONCLUSION: Aneurysmal rupture during endovascular treatment with GDCs is a rare event; clinical severity may be variable. Embolization of the aneurysm can be continued in most cases, and most patients with treatment-related subarachnoid hemorrhage survive without serious sequelae.

To assess the influence of initial preoperative brain edema in malignant gliomas on regrowth patterns.79 patients with histologically verified supratentorial malignant glioma were prospectively studied by magnetic resonance imaging (MRI) before and every 2-3 months after surgery. The median follow-up time was 11 months. We correlated the configuration of the initial vasogenic edema on T2-weighted images with tumor regrowth patterns on contrast-enhanced T1-weighted images.35/47 tumor regrowths (75%) imitated the initial edema configuration, while 11/47 occurred within the initial tumor bed; in one case tumor recurrence was multilocal.In glioblastoma, tumor regrowth patterns correlate positively with the configuration of the initial vasogenic brain edema. The initial, "presurgical" peritumoral edema should thus be considered when planning further treatment.

Serial observations of acute ischaemic cerebral infarcts by MRI in order to define signal patterns, contrast uptake, oedema and secondary haemorrhage over a period of three months.Prospective serial examinations of 34 patients with acute cerebral ischaemia who were examined during the first 48 hours, on days 3 or 4, 7, 14, 21, 28 and after three months by MRI (spin echo TR/TE 2200/100/20, 500/20, +/- Gd).T2 weighted spin echo sequences showed the highest sensitivity (88%) during the first 8 hours of cerebral ischaemia when compared with other spin echo sequences. Parenchymal contrast enhancement showed a distinct peak during the second and third weeks. The use of contrast did not improve diagnosis of an infarct during any stage. 87% of lesions showed haemorrhage at some stage. Vascular enhancement was observed in 25% of infarcts during the first 24 hours and was still present after three months in 20%. Parenchymal and vascular enhancement, and haemorrhage correlate with the size of the infarct.Focal cerebral ischaemia produces an abnormality of the blood-brain barrier, oedema and finally necrosis, depending on the severity and duration of the lesion. Haemorrhage in 87% was considerably more common than has been described previously. Vascular enhancement is not an early sign of an infarct, contrary to what has been described in the literature.