Search

Background Fatty masses are common and may be encountered in the foot and ankle. In some cases, normal subcutaneous fat may be mistaken for a discrete mass. Aims The aim of this study was to evaluate the common finding of prominent subcutaneous fat at the medial midfoot resembling a lipoma and to determine the prevalence of this pseudolesion by applying a series of potential size cutoff criteria. Materials and Methods Three musculoskeletal radiologists retrospectively evaluated 91 sequentially performed magnetic resonance imaging examinations of the ankle to measure fat resembling a discrete lipoma at the medial midfoot. Each blinded reader measured the largest area of continuous subcutaneous fat in orthogonal axial, coronal craniocaudal, and coronal transverse dimensions. Patient age, sex, and study indications were also recorded. Statistical analysis was performed with R and SAS 9.4 software Results A discrete fatty pseudolesion as defined by measuring at least 1 cm in all planes by measurements of at least two of three readers was present in 87% of cases (79 of 91). When a size criterion of 1.5 cm was used, a pseudolesion was documented in 14% of cases (13 of 91). There was a significant correlation between larger pseudolesion size and female sex in the axial plane; however, there was no correlation in the coronal craniocaudal and coronal transverse dimensions. Conclusions Subcutaneous fat at the medial midfoot often has a mass-like appearance that could be mistaken for a lipoma. It is important to recognize this pseudolesion variant and not to confuse the imaging appearance for a discrete mass.

Cartilage injuries are common and may predispose to early accelerated osteoarthritis. Magnetic resonance (MR) imaging is critical in the detection and characterization of acute and chronic cartilage injuries. Several surgical approaches including microfracture, osteochondral allografting, autologous osteochondral transfer system, and autologous chondrocyte implantation have been developed to treat cartilage lesions. The goals of these treatments include relief of symptoms, restoration of joint function, and delay of progression of osteoarthritis. Imaging evaluation by MR imaging plays a crucial role in diagnosis and surgical planning as well as monitoring for postoperative complications.

Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Structures covered include multiple joints (shoulder, hip), bursae (iliopsoas, subacromial-subdeltoid, greater trochanteric), peripheral nerves (sciatic, radial), and tendon sheaths (posterior tibial, peroneal, flexor hallucis longus, Achilles, long head of the biceps). Trigger point and similar targeted steroid injections, as well as calcific tendinopathy barbotage, are also described.

CASE Longitudinal follow-up of a 53-year-old woman with osteogenesis imperfecta (OI) Type III and concurrent bilateral distal radius fractures is reported. She had a right-sided displaced fracture and a left-sided minimally displaced fracture. Operative management of the displaced fracture showed adequate healing in 10 weeks. The minimally displaced fracture failed nonoperative management but did adequately heal after operative intervention. CONCLUSION Early surgical intervention of distal radius fractures may be considered in patients with severe OI, even in fractures with minimal displacement. This is likely particularly important with patients who are heavily reliant on their upper extremities for mobility.

Dancers exert tremendous stresses on the lower extremities rendering them prone to injuries that can curtail training and performance. The goal of this study was to evaluate clinical improvement in a population of elite dancers following treatment with ultrasound-guided platelet-rich plasma (PRP) injections of various lower extremity sites by assessing when they were able to return to dance. Nineteen dancers (13 female, 6 male; ages 15 to 42) were treated between 2009 and 2016 at sites that included: hamstring tendon (1), proximal iliotibial band (1), patellar tendon (3), posterior tibial tendon (5), peroneus brevis tendon (3), plantar fascia (3), and the first metatarsophalangeal (MTP) joint capsule (3). Injections were performed by a single radiologist using the same PRP kit under ultrasound guidance. All patients adhered to standard post-care instructions, including non-weightbearing and avoidance of NSAIDs for at least 2 weeks post-injection. Clinical charts were reviewed for factors including: adherence to post-injection immobilization and physical therapy, physical exam assessments, and milestones in returning to dance. The time-point for returning to dance was defined by attendance of class or rehearsal without symptoms referring to the treated site. Eighteen subjects achieved return to dance, 13 in 6 months or less, and the majority (10) within 3 months of injection. Five subjects required more than 6 months recovery time. These cases all involved foot and ankle sites; of these, two subjects required repeat injections, and both returned to dance within 11 months of the second injection. In the single case where PRP treatment failed, the injury treated was severe plantar fasciopathy with a high-grade central cord tear. It is concluded that ultrasound-guided PRP injections may play a role in the treatment of various lower extremity injuries in elite dancers, with the majority of subjects in this series returning to dance within 6 months. Recovery time may vary depending on the site treated and severity of the presenting injury.

Objectives (1) Assess the association between the B-mode morphologic appearance and elasticity in the rotator cuff tendon using shear wave elastography (SWE). (2) Assess the association between SWE and symptoms. Methods Institutional Review Board approval and informed consent were obtained. A retrospective review identified 21 studies in 19 eligible patients for whom SWE was performed during routine sonographic evaluations for shoulder pain. Evaluations were compared with 55 studies from 16 asymptomatic volunteers and 6 patients with asymptomatic contralateral shoulders. Repeated studies were accounted for by resampling. Proximal and distal tendon morphologic characteristics were graded from 1 to 4 (normal to full-thickness tear), and average shear wave velocity (SWV) measurements were obtained at both locations. In 68 examinations, deltoid muscle SWV measurements were available for post hoc analysis. Results The morphologic grade and SWV showed weak-to-moderate negative correlations in the proximal (P

We are fortunate to live in a time when real advances in medicine are happening at an increasingly rapid pace. This is especially true in the field of radiology, and keeping abreast of these advances is one of the main challenges of clinical practice. Traditionally, cutting edge techniques in our field have been researched and validated at major academic medical centers before slowly making their way into the armamentarium of routine clinical practice. However, the improved ability to communicate and disseminate information in our modern age has facilitated more rapid implementation of new techniques to allow us to better serve our patients.As such, this article aims to review the current standards for MRI of the shoulder used in routine practice. Furthermore, we will discuss some of the most recent advances in shoulder MRI, with particular emphasis on the applicability of an additional axial 3D T1-weighted FLASH sequence with Dixon-based water-fat separation in routine clinical practice that can be useful in characterizing several commonly encountered pathologic processes of the shoulder joint.

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

Cardiovascular magnetic resonance (CMR) imaging is a tomographic technique, which allows three-dimensional slice orientation without limitations from acoustic windows inherent to echocardiography. Further advantages of CMR are its high temporal and spatial resolution, its excellent soft tissue resolution and its high blood-to-tissue contrast. Cardiovascular magnetic resonance is currently the only imaging technique, which provides a comprehensive study of both structure and function of the heart as well as myocardial perfusion and viability. Moreover, post-processing of CMR images does not require any geometric assumptions as in echocardiography to determine ventricular dimensions. This is particularly important when evaluating ventricles of patients with chronic heart failure with severely altered morphology that may have regional variations in wall thickness and contractility at least in ischemic cardiomyopathy. The highly reproducible results of CMR imaging have turned this technique into a reference standard for the non-invasive assessment of ventricular dimensions, mass and function. In cases with indeterminate results of clinical, electrocardiographic and particularly echocardiographic findings CMR should be used early in the process of diagnosis of patients with heart failure. Not only can altered structure and degree of ventricular and valvular dysfunctions be accurately assessed but also regional perfusion deficits and/or myocardial scars are easily detected. For therapeutic and prognostic reasons a simple differentiation between ischemic and non-ischemic cardiomyopathy should be achieved as the first diagnostic step. In addition, the type and localization of the late gadolinium enhancement (LGE) phenomenon may aid in non-invasively differentiating the etiology of non-ischemic cardiomyopathy. CMR may also improve the assessment and extent of interventricular and intraventricular dyssynchrony in patients to be selected for cardiac resynchronization therapy (CRT). Lastly, the LGE phenomenon may provide independent prognostic information in patients with a CRT system implanted, as well as in patients with ischemic and non-ischemic cardiomyopathy. Thus, CMR imaging should be implemented early in the diagnostic process of patients with heart failure to significantly improve the speed and accuracy of diagnostic procedures, to control the effect of therapeutic measures, and to select patients with a limited prognosis by assessing the degree of ventricular dysfunction and the extent of myocardial scarring.

(1) Assess the association between the B-mode morphologic appearance and elasticity in the rotator cuff tendon using shear wave elastography (SWE). (2) Assess the association between SWE and symptoms.Institutional Review Board approval and informed consent were obtained. A retrospective review identified 21 studies in 19 eligible patients for whom SWE was performed during routine sonographic evaluations for shoulder pain. Evaluations were compared with 55 studies from 16 asymptomatic volunteers and 6 patients with asymptomatic contralateral shoulders. Repeated studies were accounted for by resampling. Proximal and distal tendon morphologic characteristics were graded from 1 to 4 (normal to full-thickness tear), and average shear wave velocity (SWV) measurements were obtained at both locations. In 68 examinations, deltoid muscle SWV measurements were available for post hoc analysis.The morphologic grade and SWV showed weak-to-moderate negative correlations in the proximal (P .001) and distal (P = .002) rotator cuff tendon. A weakly significant SWV decrease was found in the proximal tendon in symptomatic patients (P = .049); no significant difference was seen in the distal tendon. The deltoid muscle SWV showed weak-to-moderate negative correlations with the morphologic grade in the proximal (P = .004) and distal (P = .007) tendon; the deltoid SWV was also significantly lower in symptomatic shoulders (P = .001).Shear wave elastography shows tendon softening in rotator cuff disease. It captures information not obtained by a morphologic evaluation alone; however, a poor correlation with symptoms suggests that SWE will be less useful in workups for shoulder pain than for preoperative assessments of tendon quality. Deltoid muscle softening seen in morphologically abnormal and symptomatic patients requires further exploration.

High density, whole head magnetoencephalography (MEG) was used to study ten healthy human subjects (five females and five males) participating in a continuous shape-copying task. The task was performed with eyes open and fixated. The three-part task began with 45 s of fixation on a blue dot, after which the dot turned red, and a pentagon was presented around it. Subjects continued to fixate on the red dot for 45 s, after which it turned green. The green dot instructed subjects to begin copying the shape continuously for 45 s, without visual feedback, using a joystick mounted at arm's length. Data were collected at 1,017.25 Hz with a 248 sensor axial-gradiometer system. After cardiac artifact subtraction (Leuthold 2003), each corner was identified, and 1 s epochs (centered on each corner) were averaged and filtered from 1 to 44 Hz. Grand average flux maps demonstrated dipolar distributions identifying the most relevant sensors. With these sensors, which were located over flux extrema (Valaki et al. 2004), dipole models were used for source localization within subjects. Consistent dipole locations included the left motor cortex, bilateral parietal, frontal and temporal regions, and the occipital cortex. These results indicate that MEG source-localization may be derived from a limited number of trials of continuous data, and that visual cortex activity may be consistently present during continuous motor activity despite the absence of novel visual stimulation and eye-movements.

Brain-machine interface (BMI) efforts have been focused on using either invasive implanted electrodes or training-extensive conscious manipulation of brain rhythms to control prosthetic devices. Here we demonstrate an excellent prediction of movement trajectory by real-time magnetoencephalography (MEG). Ten human subjects copied a pentagon for 45 s using an X-Y joystick while MEG signals were being recorded from 248 sensors. A linear summation of weighted contributions of the MEG signals yielded a predicted movement trajectory of high congruence to the actual trajectory (median correlation coefficient: r = 0.91 and 0.97 for unsmoothed and smoothed predictions, respectively). This congruence was robust since it remained high in cross-validation analyses (based on the first half of data to predict the second half; median correlation coefficient: r = 0.76 and 0.85 for unsmoothed and smoothed predictions, respectively).

Improving management of inpatients with diabetes undergoing vascular surgery requires collaboration among many health care practitioners. This article describes a performance improvement project that implemented two evidence-based algorithmic order sets to guide perioperative glucose management for diabetic patients undergoing vascular procedures and utilized a certified diabetes educator (CDE) to educate health care practitioners. Results showed statistically and clinically significant reductions in infection and differences in mean blood glucose between pre- and postintervention groups, including a direct relationship between glucose control and the level of involvement of a CDE in patient care.

Die kardiale Schnittbilddiagnostik mit der Magnetresonanztomographie (MRT) und Computertomographie (CT) hat sich in der letzten Dekade technisch rasant weiterentwickelt. Diese Verbesserungen und die breite Verfugbarkeit moderner CT- und MRT-Systeme haben dazu gefuhrt, dass beide Verfahren regelmasig in der klinischen Routine eingesetzt werden. Dieses deutsche Konsensuspapier wurde daher gemeinsam von der Deutschen Gesellschaft fur Kardiologie – Herz- und Kreislaufforschung (DGK), der Deutschen Rontgengesellschaft (DRG) und der Deutschen Gesellschaft fur Padiatrische Kardiologie (DGPK) erarbeitet und orientiert sich nicht an Modalitaten und Methoden, sondern gliedert sich nach grosen Krankheitsgruppen. Behandelt werden die koronare Herzerkrankung, Kardiomyopathien, Herzrhythmusstorungen, Klappenvitien, Perikarderkrankungen, erworbene und strukturellen Veranderungen sowie angeborene Herzfehler. Fur unterschiedliche klinische Szenarien werden die beiden Schnittbildmodalitaten CT und MRT vergleichend gegenubergestellt und in einem kurzen Textfeld bewertet.

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

The purpose of this study is to investigate the feasibility of an inverse planning optimization approach for the Volumetric Modulated Arc Therapy (VMAT) based on quadratic programming and the projection method. The performance of this method is evaluated against a reference commercial planning system (eclipse(TM) for rapidarc(TM)) for clinically relevant cases.The inverse problem is posed in terms of a linear combination of basis functions representing arclet dose contributions and their respective linear coefficients as degrees of freedom. MLC motion is decomposed into basic motion patterns in an intuitive manner leading to a system of equations with a relatively small number of equations and unknowns. These equations are solved using quadratic programming under certain limiting physical conditions for the solution, such as the avoidance of negative dose during optimization and Monitor Unit reduction. The modeling by the projection method assures a unique treatment plan with beneficial properties, such as the explicit relation between organ weightings and the final dose distribution. Clinical cases studied include prostate and spine treatments. The optimized plans are evaluated by comparing isodose lines, DVH profiles for target and normal organs, and Monitor Units to those obtained by the clinical treatment planning system eclipse(TM).The resulting dose distributions for a prostate (with rectum and bladder as organs at risk), and for a spine case (with kidneys, liver, lung and heart as organs at risk) are presented. Overall, the results indicate that similar plan qualities for quadratic programming (QP) and rapidarc(TM) could be achieved at significantly more efficient computational and planning effort using QP. Additionally, results for the quasimodo phantom [Bohsung et al., "IMRT treatment planning: A comparative inter-system and inter-centre planning exercise of the estro quasimodo group," Radiother. Oncol. 76(3), 354-361 (2005)] are presented as an example for an extreme concave case.Quadratic programming is an alternative approach for inverse planning which generates clinically satisfying plans in comparison to the clinical system and constitutes an efficient optimization process characterized by uniqueness and reproducibility of the solution.

Cardiovascular magnetic resonance (CMR) imaging is a tomographic technique, which allows three-dimensional slice orientation without limitations from acoustic windows inherent to echocardiography. Further advantages of CMR are its high temporal and spatial resolution, its excellent soft tissue resolution and its high blood-to-tissue contrast. Cardiovascular magnetic resonance is currently the only imaging technique, which provides a comprehensive study of both structure and function of the heart as well as myocardial perfusion and viability. Moreover, post-processing of CMR images does not require any geometric assumptions as in echocardiography to determine ventricular dimensions. This is particularly important when evaluating ventricles of patients with chronic heart failure with severely altered morphology that may have regional variations in wall thickness and contractility at least in ischemic cardiomyopathy. The highly reproducible results of CMR imaging have turned this technique into a reference standard for the non-invasive assessment of ventricular dimensions, mass and function. In cases with indeterminate results of clinical, electrocardiographic and particularly echocardiographic findings CMR should be used early in the process of diagnosis of patients with heart failure. Not only can altered structure and degree of ventricular and valvular dysfunctions be accurately assessed but also regional perfusion deficits and/or myocardial scars are easily detected. For therapeutic and prognostic reasons a simple differentiation between ischemic and non-ischemic cardiomyopathy should be achieved as the first diagnostic step. In addition, the type and localization of the late gadolinium enhancement (LGE) phenomenon may aid in non-invasively differentiating the etiology of non-ischemic cardiomyopathy. CMR may also improve the assessment and extent of interventricular and intraventricular dyssynchrony in patients to be selected for cardiac resynchronization therapy (CRT). Lastly, the LGE phenomenon may provide independent prognostic information in patients with a CRT system implanted, as well as in patients with ischemic and non-ischemic cardiomyopathy. Thus, CMR imaging should be implemented early in the diagnostic process of patients with heart failure to significantly improve the speed and accuracy of diagnostic procedures, to control the effect of therapeutic measures, and to select patients with a limited prognosis by assessing the degree of ventricular dysfunction and the extent of myocardial scarring.

The purpose of the study was to investigate the effects of sex hormones across menstrual cycle phases on lower extremity neuromuscular control patterns during the landing phase of a drop jump. A repeated-measures design was utilized to examine sex hormone effects in 26 recreationally active eumenorrheic women. Varus/valgus knee angle and EMG activity from six lower extremity muscles were recorded during three drop jumps from a 50 cm platform in each phase of the menstrual cycle. Blood assays verified sex hormone levels and cycle phase. The semitendinosus muscle exhibited onset delays (p ⩽ 0.006) relative to ground contact during the luteal phase, and demonstrated a significant (p ⩽ 0.05) difference between early and late follicular phases. Muscle timing differences between the gluteus maximus and semitendinosus were decreased (p ⩽ 0.05) in the luteal compared to early follicular phases. These results suggest a different co-contractive behavior between the gluteus maximus and semitendinosus, signifying a shift in neuromuscular control patterns. It appears that female recreational athletes utilize a different neuromuscular control pattern for performing a drop jump sequence when estrogen levels are high (luteal phase) compared to when they are low (early follicular phase).

SUMMARY: Hepatocerebral MPV17 -MDS is quite rare (

Stoma management is associated with various problems, depending on the type and location of the stoma and on the individual situation. Besides such general problems as smell, flatulence and local skin problems, typical surgical complications such as retraction and stenosis, prolaps and peristomal hernia are of major relevance. Many of these problems can be avoided by careful placement of the stoma and a meticulous surgical technique. Where indicated, the surgical correction of a problem is usually not very difficult, and is most helpful for the patient.

To present the case of a 17-year-old girl with primary amenorrhea and a history of hypertension since age 13 years.The patient's clinical, laboratory, and radiologic data were summarized, and features of Frasier syndrome and Drash syndrome were compared.The patient's weight was 126 kg, height was 185 cm, and blood pressure was 150/100 mm Hg. She had minimal breast budding and scant pubic hair. Laboratory data were compatible with hypergonadotropic hypogonadism. An ultrasound study of the pelvis revealed an infantile uterus and a questionable right gonad. The patient also had nephrotic-range proteinuria in conjunction with decreased creatinine clearance and normal findings on ultrasonography of the kidneys. A karyotype photomicrograph showed a male 46,XY chromosomal pattern. Although the patient's chronologic age was 17 years, her bone age was 12 1/2 years.The patient was diagnosed as having Frasier syndrome. She underwent removal of a left-sided ovary and a right adnexal mass, and her condition is well controlled with lisinopril (10 mg daily) and estrogen therapy.

Anhand von zwei verschiedenen operativen Versuchsmodellen (distale Choledochusligatur; Pfeffersches Modell in der Modifikation von Nevalainen) soll die Bedeutung des Komplementsystems bei der Entstehung der akuten Pankreatitis tierexperimentell untersucht werden. Es konnte gezeigt werden, das auch bei nicht immunologisch induzierter akuter Pankreatitis eine Komplementdepression festgestellt werden kann. Ferner wurde gezeigt, das auch nach vorausgegangener Dekomplementierung durch Anwendung der genannten Versuchsmodelle eine akute Pankreatitis zu induzieren ist, jedoch von deutlich geringerem Ausmas. Es wird gefolgert, das das Komplementsystem wesentlich an der Progredienz und Intensitat des entzundlichen Geschehens Anteil hat.

Dem Ernahrungszustand als allgemeinem Risikofaktor wird in neuerer Zeit mehr Beachtung geschenkt. Bei 100 Patienten mit soliden operablen Tumoren wurde eine ausfuhrliche Erhebung des Ernahrungszustandes durchgefuhrt (Anamnese, KG, OKG, Tricepshautfaltenmessung THF, Armmuskelumfangsmessung AMU, Kreatininindex KI, Protein- und Albuminbestimmung im Serum, Praalbumin, Cholinesterase, Transferrin, Immunstatus). Das individuelle Defizit des Ernahrungszustandes wurde mit Hilfe eines einfachen Systems quantifiziert und mit dem Auftreten postoperativer Komplikationen verglichen. Bei 32 von 95 operierten Patienten traten Komplikationen auf. Diese nahmen mit einer Verschlechterung des Ernahrungszustandes zu. Ein statistisch signifikanter Zusammenhang zwischen einzelnen Mesgrosen und dem Vorhandensein bzw. Fehlen von postoperativen Komplikationen lies sich allerdings nicht nachweisen. Mogliche Zusammenhange werden diskutiert.

An der Abteilung fur Unfallchirurgie, Plastische und Wiederherstellungschirurgie der Universitat Ulm wurden in den Jahren 1971 bis 1976 neunzig erwachsene Patienten wegen Patellafrakturen operativ behandelt. Davon konnten 68 durchschnittlich 42 Monate postoperativ klinisch und rontgenologisch nachuntersucht werden. Das Krankengut bestand aus 50 mannlichen und 18 weiblichen Patienten — mit insgesamt 71 Patellafrakturen. Das Durchschnittsalter betrug 38,7 Jahre bei den Mannern und 45,5 Jahre bei den Frauen. Vorwiegende Unfallursachen waren Verkehrsunfalle (65%) und Arbeitsunfalle (19%). Die rechte Kniescheibe war mehr als doppelt so oft betroffen wie die linke. Dreimal lagen beidseitige Frakturen vor. In 49% der Falle handelte es sich um Trummerfrakturen, in 38% um offene Frakturen. Bei der Behandlung kamen vorwiegend die alleinige ventrale Zuggurtung oder die Zuggurtung in Kombination mit Kirschnerdrahten oder Schrauben zur Anwendung. — Ergebnisse: 93% der Nachuntersuchten wiesen bei der Kontrolle wieder seitengleiche Streckfahigkeit des Kniegelenkes auf, 7% einen Streckausfall von weniger als 10°. Seitengleiche Beugung hatten 56% der Untersuchten erreicht; 24% boten ein Beugedefizit bis zu 10°, 10% bis zu 20° und weitere 10% uber 20°. Arthrosezeichen irgendwelcher Art im Bereich des betroffenen Kniegelenkes konnten ohne Berucksichtigung des Vorzustandes in 46% gefunden werden. Eine Verschmachtigung der Beinmuskulatur wiesen noch 43% der Untersuchten auf. Postoperativ traten zweimal Thrombosen (einmal oberflachlich, einmal tief) auf. Einmal bildete sich eine Hautnekrose im Bereich der Operationswunde. Der entstandene Gewebsdefekt wurde plastisch gedeckt. Bei zwei Fallen kam es im Anschlus an die Versorgung von Trummerfrakturen zu einer Infektion. Postoperative Gelenksergusse fanden sich dreimal. Viermal kam es zum Auftreten sekundarer Dislokationen. Bei zwei Frakturen entstand eine Pseudarthrose, davon konnte eine durch Fixateur externe zur Ausheilung gebracht werden, die zweite wurde wegen praktischer Beschwerdefreiheit belassen. Unsere Ergebnisse zeigen, das die Versorgung der Patellafrakturen nach dem Zuggurtungsprinzip mit fruhfunktioneller Nachbehandlung die erreichbaren Ergebnisse zu verbessern vermogen, das aber bei dieser Frakturlokalisation die Rate der folgenlosen Ausheilungen gegenuber anderen Korperregionen geringer ist.

49 Patienten, bei denen 4–9 Jahre vor der Nachuntersuchung eine transduodenale Papillenplastik durchgefuhrt worden war, konnten einer endoskopisch-manometrischen Kontrolle des Operationsergebnisses zugefuhrt werden.

Zur Erfassung eines evtl. bestehenden ernährungsbedingten Operationsrisikos sowie eines sich daraus bereits frühzeitig ableitenden Konzepts einer adäquaten Ernährungsbehandlung wird ein »einfaches Schema« dargestellt, das sich wie die vielfach in der Literatur angegeben, wesentlich aufwendigeren Dokumentationen zur Definition des Ernährungsstatus eignet. Zur genauen Protokollierung sowie zur Verlaufsbeurteilung als auch zur Erstellung prognostischer Angaben eignet sich dieses Schema jedoch nicht. Sollten sich bei der Auswertung des »einfachen Schemas« Hinweise für ein möglicherweise bestehendes ernährungsbedingtes zusätzliches Operationsrisiko ergeben, so sind zur Differenzierung aufwendigere Untersuchungen angezeigt, urn Ursache und Ausprägung der Mangel-bzw. Fehlernährung zu präzisieren.