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J Freyschmidt

Publications and source records attributed to J Freyschmidt.

At least 19 recordsLinked to original sources
PubMed2005

[Unusual digital articular destructions after radio-synovectomy and cortisone injection therapy for Bouchard arthrosis].

UNLABELLED: Starting in 1998, a female patient suffering from activated Bouchard arthrosis was treated with intra-articular steroid injections into digits of both hands. In September 2001, an additional therapy with erbium-169 injections into the same joints was begun. The injections were continued until March 2003. No benefit was observed. Instead, severe destruction of the involved joints with articular necroses and marked periarticular calcifications had occurred. The course of events are documented by plain film examinations. CONCLUSIONS: The indication for alternating steroid injections and radio-synovectomies in patients with activated Bouchard arthrosis has to be reconsidered. In vivo and in vitro experiments are necessary to evaluate the potential harms of this combination of therapies. A close clinical and radiological control of treatment outcome with reevaluation of the indication is necessary.

Arthritis↗
PubMed2002

[Standardized procedure for suspected bone tumor].

Real bone tumors are rarely encountered in the daily routine of radiological practice. For a general radiologist or surgeon is therefore no need for a specialist knowledge on this field.However, he should be able to distinguish "leave-me-alone-lesions" in order to avoid unnecessary biopsies.A systematic approach towards the interpretation of osteolytic lesions in projection radiograms, e.g. according to the classification of Lodwick, is mandatory. CT and MRI are additional diagnostic tools and are indicated to clear up the true anatomy,e.g. in areas of superposition artefacts in conventional radiology (e.g. axial skeleton) and to determine the inner structure of a lesion, e.g. fatty tissue, liquid/solid. This paper highlights the advantages and disadvantages and the cost-effective use of the imaging modalities including scintigraphy in the diagnosis of bon tumors and tumor-like lesions. Guidelines for the management of bony lesions will be given in detail. The option and necessity for a specialist second opinion is emphasized.

Adult↗
PubMed2001

The apple core sign.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed2001

[Radiological diagnosis in contracted elbow joint. Value of CT and MRI].

A contracture of the elbow joint is a challenge for diagnostic radiology. Radiographs remain the method of choice for primary diagnosis, however, diagnostic confidence can be limited if periarticular ossifications or contracture do not permit evaluation of the whole joint. In these cases, CT or MRI can be used for specific diagnostic problems. Additional multiplanar or three-dimensional reformations can be used by the orthopedic surgeon for planning the surgical procedure. MRI has a great advantage in allowing visualization of muscles, capsula-ligamentous complex and articular cartilage. The main disadvantages are duration of examination time and artifacts. CT is superior in terms of spatial resolution and visualization of bony structures. MRI and CT examinations of the elbow will increase with the number of minimal invasive surgical procedures. Protocols must therefore be optimized with attention to positioning, sequence selection and image processing. This article reviews the current standards of high resolution imaging with CT and MRI, including arthrographic techniques. The pros and cons of both methods are discussed in the setting of a contracture of the elbow joint.

Arthrography↗
PubMed2001

Melorheostosis: a review of 23 cases.

The aim of this study was to review clinical and radiological signs of melorheostosis in a large series of cases. Family history, patient history, clinical data and radiological features of 23 consecutive cases of melorheostosis were investigated. Criteria for establishing the diagnosis "melorheostosis" were defined. Sixteen patients (mean age 34 years, equal ratio between genders) had chronic pain in the affected limb(s) and/or subcutaneous fibrosis and/or various skin lesions. Number of involved bones: one bone (n = 10); two bones (n = 4); three or more bones (n = 9). Anatomic distribution: upper extremity (n = 5); lower extremity (n = 16); upper and lower extremity (n = 1); sacrum (n = 1). Radiologic pattern: osteoma-like (n = 7); classic candle wax appearance (n = 5); myositis ossificans-like (n = 1); osteopathia striata-like (n = 6); mixed pattern (n = 4). Patterns different from the appearance formerly judged to be "classic" prevail. The standard concept of disease manifestation has to be adjusted. Pathogenesis remains unclear. The classic theory claims the presence of an early embryonic infection of a sensory nerve inducing changes in the respective sclerotome, but we propose the concept of mosaicism as a better explanation for the sporadic occurrence, the asymmetric "segmental" pattern with variable extent of involvement and equal gender ratio of the disease.

Adolescent↗
PubMed2001

SKIBO diseases: a concept to avoid bloody diagnostic procedures in ambiguous skeletal lesions.

In cases with an "atypical" radiologic pattern-osteolytic as well as osteosclerotic or mixed - the radiologist should pay attention to the patient's skin. There he will often find specific changes that are the key to a correct interpretation of the radiologic abnormalities. In such cases the synopsis is of more value in differential diagnosis than more or less unspecific histologic findings. Entities with a non-arbitrary conjunction of changes of the skin and bones we call SKIBO diseases. Some of them have a high potential for mimicking malignant bone lesions, often with the consequence of unnecessary biopsies. In this article we present the typical dermatologic and radiologic signs and symptoms of neurofibromatosis, sarcoidosis and pustulotic arteroosteitis (PAO) with special focus on such skeletal lesions that may mimic malignancy.

Bone Neoplasms↗
PubMed2001

Digital radiography with a large-scale electronic flat-panel detector vs. screen-film radiography: observer preference in clinical skeletal diagnostics.

The imaging performance of a recently developed digital flat-panel detector system was compared with conventional screen-film imaging in an observer preference study. In total, 34 image pairs of various regions of the skeleton were obtained in 24 patients; 30 image pairs were included in the study. The conventional images were acquired with 250- and 400-speed screen-film combinations, using the standard technique of our department. Within hours, the digital images were obtained using identical exposure parameters. The digital system employed a large-area (43x43 cm) flat-panel detector based on amorphous silicon (Trixell Pixium 4600), integrated in a Bucky table. Six radiologists independently evaluated the image pairs with respect to image latitude, soft tissue rendition, rendition of the periosteal and enosteal border of cortical bone, rendition of cancellous bone and the visibility of potentially present pathological changes, using a subjective five-point scale. The digital images were rated significantly (p=0.001) better than the screen-film images with respect to soft tissue rendition and image latitude. Also the rendition of the cancellous bone and the periosteal and enosteal border of the cortical bone was rated significantly (p=0.05) better for the flat-panel detector. The visibility of pathological lesions was equivalent; only large-area sclerotic lesions (n=2) were seen superiorly on screen-film images. The new digital flat-panel detector based on amorphous silicon appears to be at least equivalent to conventional screen-film combinations for skeletal examinations, and in most respects even superior.

Aged↗
PubMed1998

[Standards and diagnostic strategies in diagnosis of bone tumors and tumor-simulating lesions].

Real bone tumors are rarely encountered in the daily routine of radiological practice. Therefore, for a general radiologist there is no need for a specialist knowledge on this field. However, he should be able to distinguish benign from malignant lesions in order to avoid unnecessary biopsies. A systematic approach towards osteolytic lesions, e.g. according to the classification of Lodwick, is mandatory. CT and MRI are indicated to clear up the anatomy in areas of superposition artefacts in conventional radiology and to determine the inner structure of a lesion, e.g. fatty tissue, liquid/solid. This paper highlights the advantages and disadvantages and the cost-effective use of the imaging modalities including scintigraphy in the diagnosis of bone tumors and tumor-like lesions. Guidelines for the management of bony lesions will be given in detail. The option and necessity for a specialist second opinion is emphasized.

Bone Diseases↗
PubMed1998

[The staging of malignant bone tumors].

Malignant bone tumors require the same careful staging as, for example, lung cancer. However, well-established staging systems for non-osseous tumors are not suitable for bone tumors. Therefore we present Enneking's staging system for malign bone tumors here, which is better adapted to the special problems of these entities because it integrates clinical, radiological and histological findings. The weak points of Enneking's staging system (e.g. inflexibility, changes in radiological modalities in the past 20 years) are discussed.

Bone Neoplasms↗
PubMed1998

The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis.

OBJECTIVE: The purpose of this retrospective study was to examine the value of whole-body nuclear medicine imaging and to evaluate the typical scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO). In this entity the correct diagnosis is frequently missed because of uncharacteristic changes in other imaging modalities. MATERIALS AND METHODS: Forty-nine patients (age range 15-65 years old, mean age 36 years) with sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examined with whole-body scintigraphy and conventional radiography. RESULTS: Forty-three of 49 patients with SCCH/PAO showed a characteristic "bullhead"-like high tracer uptake of the sternocostoclavicular region with the manubrium sterni representing the upper skull and the inflamed sternoclavicular joints corresponding to the horns (= bullhead sign). Scintigraphy revealed additional skeletal manifestations (spondylitis, sacroiliitis, osteitis) in 33 of 49 patients with SCCH and/or PAO. CONCLUSIONS: Bone scintigraphy is the imaging modality of choice for the diagnosis of skeletal involvement in PAO. Nuclear medicine reveals unexpected locations and shows the typical pattern of focal hot spots of the spine, sacroiliac joints and/or appendicular skeleton in the large majority of cases in combination with a bullhead-like tracer uptake of the sternocostoclavicular region. The bullhead sign is the typical and highly specific scintigraphic manifestation of SCCH and PAO in radionuclide bone scans and helps to avoid unnecessary biopsies.

Adolescent↗
PubMed1997

[Comparison of ventilation-/perfusion scintigraphy with spiral CT in acute lung embolism].

AIM: Evaluation of the validity of spiral-CT compared with ventilation/perfusion (v/p) scintigraphy, the standard diagnostic tool in patients with suspected pulmonary embolism. PATIENTS AND METHODS: Prospective study of 70 patients with symptoms of acute pulmonary embolism: examination with both methods within 4 hours. RESULTS: In 46 patients pulmonary embolism could be unequivocally excluded by both methods. Patients with high-probability-Tc-scans predominantly had central emboli on CT. In cases with medium or low probability-Tc-scans thrombi were usually visible in segmental arteries. In one patient with a non-suspicious scintigram spiral-CT was able to detect emboli in multiple segmental arteries. CONCLUSION: Spiral-CT is a fast, safe and almost always available method for detection of pulmonary embolism. In our hands it is superior to v/p-scintigraphy. It allows direct detection of a thrombus and has additional advantages in differential diagnosis (e. g. lung carcinoma, infectious infiltration). In patients with clinical suspicion of pulmonary embolism spiral-CT should be the primary diagnostic modality.

Aged↗
PubMed1997

[Percutaneous therapy of osteoid osteoma].

Osteoid osteomas are tumors with intense clinical symptoms and extensive reactive bone changes far exceeding the volume of the lesion itself. Because of their small size they can be approached by minimally invasive surgical procedures. We treated ten symptomatic patients with osteoid osteomas (n 6 hip point, n 1 iliac bone, n 1 femoral diaphysis, n 2 tibial diaphysis) by excision of the nidus with a 3-mm Harlow-Wood needle using a percutaneous CT-guided approach. Seven patients with residual tumor were treated with either thermocautery (n 2) or sclerosis with 1 ml of 96% ethanol (n 5). Six patients had instant and constant relief (3 years' observation) of their pain. In two patients a second transcutaneous intervention was successful. Only two patients needed open resection. Compared with the invasive open resection of the tumors, sometimes even putting the stability of the femoral neck at risk, transcutaneous CT-guided enucleation of the nidus of the osteoid osteoma with additional sclerotherapy is a good alternative method, especially in the region of the femoral neck.

Adolescent↗