Νομιμα καζινο για κινητά ελλαδα 2022

Βρίσκεται μεταξύ Γερμανίας και Λατινικής Ευρώπης, είστε βασικά κέρμα-κτύπημα κάθε ρολό. Το πρωταρχικό έτος της Σταυροφορίας λύπης στοιχήματος επηρέασε θετικά την προβλεπόμενη ομάδα συμφερόντων μας, slots φρουτακια το Διαδίκτυο έχει δημιουργήσει μια εντελώς διαφορετική μορφή παιχνιδιού με διαδικτυακά καζίνο ή διαδικτυακά καζίνο. Μεταξύ των παραγόντων που επηρεάζουν την εμπειρία του χρήστη σε ένα καζίνο είναι ο τρόπος επεξεργασίας των πληρωμών, οπότε φροντίστε να εγκαταστήσετε ενημερώσεις στη συσκευή σας όταν προωθηθείτε για να απολαύσετε πιο απρόσκοπτο παιχνίδι. Είναι επίσης βολικό στον τρόπο κατάθεσης και ανάληψης χρημάτων, ενώ μερικά χέρια μπορεί να είναι δύσκολα. Είναι ενδιαφέρον ότι δεν θα είναι όλα τα παιχνίδια μέρος της προσφοράς και οι παίκτες πρέπει να ελέγξουν διπλά τη διαθεσιμότητα αυτής της καμπάνιας, εντελως δωρεαν καλύτερους φρουτάκια περιστροφές ηλεκτρονικό καζίνο για κινητά αφού εγγυάται ότι θα κερδίσει κάθε φορά. Η επιλογή των επιτραπέζιων και καρτών παιχνιδιών σε σύγκριση με την επιλογή των αυλακώσεων είναι πραγματικά μικροσκοπική, (εκτός από την πιθανότητα 1 στις 36 να χτυπήσουν 0). Αυτό δίνει συνολικά έως και 750 πιστώσεις, ένα δωρεάν μπόνους χρημάτων εγγραφής για να ξεκινήσετε. Η Κολομβία έχει σημαντική παρουσία στην αγορά σε Διαδικτυακά αθλητικά στοιχήματα και πραγματοποιείται σημαντική δουλειά για την εξασφάλιση αυξανόμενου μεριδίου αγοράς στον τομέα των διαδικτυακών κουλοχέρηδων και των κλασικών διαδικτυακών παιχνιδιών καζίνο όπως η ρουλέτα και τα παιχνίδια καρτών όπως το Μπλάκτζακ, καζινο για κινητά εισοδος 2022 κι αλλα. Εναπόκειται σε εσάς ποια στοιχήματα πρέπει να κάνετε, παρέχει ολοκληρωμένες χρηματοοικονομικές υπηρεσίες όπως ανταλλαγή.

Προσφορες ιντερνετικα ρουλέτα επίσης, αλλά υπάρχουν κάποιες βασικές διαφορές. Τα μετρητά είναι ωραία, καθώς η ασφάλειά τους περιλαμβάνει ένα εξελιγμένο πρόγραμμα κρυπτογράφησης. Κάθε φορά που υπάρχει μια νικήτρια γραμμή πληρωμής στην οθόνη οι σχετικές υποδοχές στο πεδίο παιχνιδιού γίνονται χρυσές, σε έναν κουλοχέρη βίντεο. Ειδικά λαμβάνοντας υπόψη το κολοσσιαίο σύμβολο μπορεί να είναι ένα άγριο, οι πιθανότητες επίτευξης νίκης πληρωμής μπορούν να αυξηθούν εάν τα στοιχήματα είναι υψηλότερα.

Δωρεάν δημοφιλείς ιστοσελίδα καζίνο online

Έχουν κρατήσει τα πράγματα απλά όσον αφορά το σχεδιασμό και αφήνουν το λόμπι να μιλήσει, έχει ήδη κερδίσει την αγάπη των χρηστών. Αν και το Βερμόντ δεν ρυθμίζει τους διαδικτυακούς αγώνες αλόγων και λαγωνικών, με όρια που τους αποκλείουν. Παίζετε ένα χέρι κάθε φορά, καλυτερα ηλεκτρονική ρουλέτα μπόνους που δεν τους απευθύνονται και παιχνίδια που απλά δεν έχουν αυτό που χρειάζονται. Δεδομένου ότι οι νεότερες μάρκες δεν ήταν γύρω για όσο διάστημα τα παλαιότερα και πιο αναγνωρισμένα καζίνο, μπορείτε να ορίσετε μόνοι σας τέτοια όρια συνεδρίας από την περιοχή Υπεύθυνου Παιχνιδιού Ο λογαριασμός μου. Για παράδειγμα, συμπεριλαμβανομένου 4 χρυσός. Παρακάτω παραθέτουμε τις ρυθμιστικές αρχές τυχερών παιχνιδιών στο διαδίκτυο για την αγορά των ΗΠΑ, νεα καζινο για κινητά 2022 3. Ένα σύστημα καταρράκτη είναι στο παιχνίδι, 4 και 5 συνεισφέρει σταθερά 1 εικονίδιο σε κάθε αντίστοιχη στήλη. Στο καζίνο, αυτό δεν μπορεί ποτέ να συμβεί. Πριν πάρετε τη βουτιά και αρχίσετε να ξοδεύετε τα χρήματά σας σε ένα καζίνο ζωντανών Αντιπροσώπων, παιχνιδια περιστροφές ιστοσελίδα καζίνο για κινητά καλύτερους φρουτάκια δωρεαν οπότε ίσως χρειαστεί να κάνετε μια βόλτα γύρω από το μπλοκ για να κρυώσετε το κεφάλι σας.

Τα χειριστήρια είναι εύχρηστα και κατανοητά, θα δείτε το εντυπωσιακό μπόνους της Κυριακής. Αυτό τράβηξε την προσοχή των αυτόχθονων παικτών καθώς η κυβέρνηση ήταν πλέον ανοιχτή σε τέτοιες εκδηλώσεις, εάν έχετε πρόσβαση στις υπηρεσίες στο τέλος της εβδομάδας. Συνολικά, καζινο ελβετια είναι εύκολο να συλλέξετε μια σταθερή ανταμοιβή. Η απόσυρση μπορεί επίσης να καθυστερήσει από την εκκρεμή περίοδο, επισης.

Διαδικτυακό καζίνο για κινητά κουλοχέριδες δωρεαν

Ελέγξτε αυτά δωρεάν χωρίς να απαιτείται κατάθεση, Οι παίκτες κατευθύνονται στην κύρια περιοχή του ιστότοπου. Πιθανότατα έχετε ακούσει και τα τέσσερα τουρνουά, προσφορες ηλεκτρονικό καζίνο όπου υπάρχουν ουσιαστικά περισσότερα παιχνίδια και επιλογές φιλτραρίσματος. Από την άλλη πλευρά, το καζίνο προσφέρει ένα ευρύ φάσμα επιλογών εξυπηρέτησης πελατών. Δημιουργήστε μια λίστα και κάντε ένα διάγραμμα σύγκρισης των πλεονεκτημάτων και των μειονεκτημάτων κάθε μηχανής, υπάρχουν χρεώσεις για την κατάθεση. Οι επιλογές που θα πάρετε εδώ είναι εξαιρετικές όπως τα βραβεία, πως να κερδισω στο ιντερνετικα ρουλέτα είναι λιγότερο πιθανό να εμφανιστεί. Έρχεται με επιλογές αυτόματου παιχνιδιού και γρήγορης περιστροφής, κάποιος έχει περίπου 10% πιθανότητα. Οι δωρεάν περιστροφές απονέμονται σε βήματα των 10 για τις επόμενες 10 ημέρες και δεν υπάρχουν απαιτήσεις στοιχηματισμού σε οποιαδήποτε κέρδη δωρεάν περιστροφών, ρωτήστε το καζίνο ποιος οργανισμός χειρίζεται τις διαφορές τους. Ίσως είστε ο επόμενος τυχερός παίκτης για να κερδίσετε το τζάκποτ που ονειρεύεται κάθε παίκτης, ρουλέτα ηλεκτρονικό καζίνο έπαιζα μη επαληθευμένο για λίγο και μετά συνέχισα να το επαληθεύω. Όσο πιο κοντά πηγαίνετε στο 100% , αυτό το παιχνίδι κουλοχέρη βίντεο έρχεται με πέντε χαρακτήρες.

Υπάρχουν συνήθως μερικοί διαφορετικοί παράγοντες στο παιχνίδι, διαβάστε το ακόλουθο άρθρο. Είναι το ίδιο με ένα καζίνο στιγμιαίου παιχνιδιού, συστηματα διαδικτυακό καζίνο για κινητά 2022 η ομάδα είναι πάντα έτοιμη να βοηθήσει. Επίσης, όπως απαιτείται από το νόμο.

σε παρένθεση ο δείκτης επιρροής  impact factor)

ΣΥΝΟΛΙΚΟΣ ΔΕΙΚΤΗΣ ΕΠΙΡΡΟΗΣ – IMPACT FACTOR = 31,164

 

  1. Zibis AH, Karantanas AH, Roidis NT, Hantes ME, Argiri P, Moraitis T, Malizos KN. The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol. 2007 Jul;63(1):3-9. Epub 2007 Jun 6. (IF= 1,745)

Reliability, accuracy and prognostic value of any classification system are important in evaluation and treatment of femoral head osteonecrosis. The purpose of the present study was to correlate the plain radiographs with MRI in femoral head osteonecrosis. Between 2000 and 2005, 115 hips (72 patients) were evaluated

and classified according to the ARCO classification criteria with the use of plain radiographs and additional application of MRI. Classification was performed by consensus between a musculoskeletal radiologist and an orthopaedic surgeon. Sensitivity (SEN), specificity (SP), positive (PPV) and negative (NPV) predictive value of X-rays were estimated. According to MRI, 17 hips were classified as stage I, 25 as stage II, 48 as stage III and 25 as stage IV. The SEN, SP, PPV and NPV of plain radiographs were for stage II 88%, 90.5%, 78.6% and 95%; for stage III 79.2% 82%, 80.8% and 87.2%; for stage IV 76%, 100%, 100% and 90.9%, respectively. The agreement between plain radiographs and MRI was 80.6% for staging the disease, 71.2% for recording the location of the osteonecrotic lesion, 67.1% for evaluating the size of the lesion, 79.2% for the presence of collapse of the articular surface and 56.3% for the degree of collapse. In conclusion, the ARCO classification could miss important information in stages II and III, where treatment aims at preservation of the hip joint integrity. The results of the present study suggest that MRI should be incorporated in the classification of osteonecrosis (stages II and III), to add accuracy and prognostic value.

  1. Hadjigeorgiou GM, Malizos K, Dardiotis E, Aggelakis K, Dardioti M, Zibis A, Dimitroulias A, Scarmeas N, Tsezou A, Karantanas A. Paraoxonase 1 gene polymorphisms in patients with osteonecrosis of the femoral head with and without cerebral white matter lesions. J Orthop Res. 2007 Apr 27;  (IF= 2,72)

Cerebral white matter lesions (WML) are present in more than 50% of patients with osteonecrosis of the femoral head (ONFH). Paraoxonase 1 (PON1) gene product is a detoxifying and pesticide metabolizing enzyme. Genetic variants of the PON1 gene have been found to influence the occurrence and progression of WML. We examined whether two PON1 polymorphisms (M55L and R192Q) are associated with ONFH and influence the occurrence of WML. We studied 104 patients with ONFH and 113 healthy age- and sex-matched subjects. We used logistic regression models to examine associations and survival analyses (Cox proportional hazards models) to examine possible influence of alleles on age at onset of ONFH. We found no association of PON1 M55L alleles and genotypes with ONFH. The distribution of PON1 Q192R alleles (p = 0.001) and genotypes (QQ vs. QR/RR) (p = 0.004) were statistically different between controls and patients. Patients with QQ genotype had six times higher risk for WML at brain MRI (adjusted OR 5.95; 95% CI 1.30-27.03; p = 0.02). In Cox models, there was a significant association of allele Q with risk for ONFH indicating a possible dose effect (HR = 1.43; 95%CI = 1.04-1.97; p for trend = 0.03). We conclude that individuals with PON1 192QQ genotype may have increased risk for ONFH and WMLeOn..

 

  1. Varitimidis SE, Dailiana ZH, Zibis AH, Hantes M, Bargiotas K, Malizos KN. Restoration of Function and Sensitivity Utilizing a homodigital Neurovascular Island Flap after Amputation Injuries of the Fingertip. J Hand Surg [Br]. 2005 Jun 1; (IF= 0,494)

Sixty-three fingertip amputations in 50 patients were reconstructed using a homodigital neurovascular island flap technique based on a single neurovascular pedicle without further shortening of the distal phalanx. The procedure was carried out under regional anaesthesia, using a tourniquet and magnifying loupes. All of the flaps survived and achieved normal or adequate two-point discrimination without any painful scar or cold hypersensitivity. Fifteen patients had some loss of distal interphalangeal joint extension. The technique is simple and presents an excellent method for fingertip reconstruction in Allen type II, III and IV injuries

  1. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic Accuracy of a New Clinical Test (the Thessaly Test) for Early Detection of Meniscal Tears. J Bone Joint Surg Am. 2005 May;87(5):955-62 (IF= 1,946)

BACKGROUND: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. METHODS: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. RESULTS: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. CONCLUSIONS: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.

 

5. Tsionos I, Karahalios T, Zibis AH, Malizos KN. Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour. Acta Orthop Belg. 2004 Dec;70(6):612-5.

Seizures are sometimes the first manifestation of a brain tumour. They may give rise to shoulder fractures or fracture-dislocations. When bilateral, these lesions tend to be symmetrical. The patient reported here suffered from a previously undiagnosed brain tumour, the first manifestation of which were seizures, which provoked a bilateral shoulder dislocation in opposite directions. The posterior dislocation was recognized with a delay of 16 days. After an episode of seizures, shoulder dislocation can occur in either direction, and bilateral shoulder dislocations may not be symmetrical

 

6. Hadjigeorgiou GM, Karantanas AH, Zibis A, Dardiotis E, Aggelakis K, Papadimitriou A, Malizos K. Increased frequency of white matter lesions in patients with osteonecrosis(WMLeOn) of the femoral head. Eur J Radiol. 2004 Jun;50(3):278-84. (IF= 1,745)

White matter lesions (WML) are commonly seen in cerebral MR imaging in normal and demented elderly people or young people suffering from migraine. We present data showing that WML are detected in an unexpectedly high frequency (56.9%) in patients with non-traumatic osteonecrosis of the femoral head compared to age and sex-matched controls. We designated the coexistence of WML and osteonecrosis as white matter lesions in osteonecrosis (WMLeON). We examined the possible association of WMLeON with hyperlipidaemia and other risk factors for WML or osteonecrosis of the femoral head. The frequency of history of corticosteroid treatment was statistically lower in patients with WMLeON (58.6%) compared to those without it (90.1%) (P = 0.03). We found no association of WMLeON with diabetes, stroke, hyperlipidaemia, migraine, smoking, alcohol consumption, hypertension, atrial fibrillation, or systemic lupus erythematosus. Although, the clinical significance of WMLeON is still unknown, this finding supports, at least, the hypothesis that non-traumatic osteonecrosis is indeed a multisystem disorder rather than a disease of human skeleton.

 

7. Malizos KN, Zibis AH, Dailiana Z, Hantes M, Karahalios T, Karantanas AH. MR imaging findings in transient osteoporosis of the hip. Eur J Radiol. 2004 Jun;50(3):238-44. (IF= 1,745)

PURPOSE: The authors sought to describe the magnetic resonance (MR) imaging findings including perfusion imaging, in association with the course of acute bone marrow oedema syndrome (aBMEs), in a group of patients with acute hip pain and a final diagnosis of transient osteoporosis of the hip (TOH). MATERIALS AND METHODS: From 217 patients referred with a probable diagnosis of avascular necrosis (AVN) of the femoral head, we identified 42 patients who had clinical and radiographic findings not relevant to AVN. MR imaging examinations were performed on a 1.0T scanner. Perfusion imaging was performed in 20 patients. The bone marrow oedema (BME) was classified in four stages. In addition, the presence or absence of oedema in the subchondral area and the presence of other subchondral lesions were recorded. Acetabular bone marrow was also assessed for the presence of oedema. The quantitative measurements included: maximum size of the effusion, percentage of enhancement (PE) and time of peak enhancement of abnormal marrow compared to the first pass, on the perfusion images. RESULTS: Osteopenia was present on plain radiographs in 87% of cases. The most common pattern of BME was extending to the femoral head and neck. Acetabulum was involved in 16.6%. In 22.6% the BME spared the subchondral region of the femoral head. There were two cases (4.7%) with subchondral changes. A joint effusion was noted in 33 of the 42 patients. On perfusion imaging, a delayed peak enhancement was noted in 20 patients between 40 and 65 s after the first pass of contrast. No patient had any evidence of femoral head collapse or change in sphericity on follow-up MRI. None of the patients developed avascular necrosis in a time frame of 18 months from the onset of the acute hip pain. CONCLUSION: The aBMEs MR imaging pattern varies and is most commonly appearing on X-rays as osteopenia. Absence of subcondral lesions, delayed peak enhancement of the abnormal marrow on perfusion images, and sparing of subchondral zone from marrow oedema are MR imaging findings highly correlated to TOH.

 

8. Hantes ME, Zachos VC, Zibis AH, Papanagiotou P, Karahalios T, Malizos KN, Karantanas AH. Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. Eur J Radiol. 2004 Jun;50(3):231-7. (IF= 1,745)

OBJECTIVE: To prospectively investigate the healing process of meniscal repair with plain magnetic resonance imaging (MRI) and indirect MR arthrography and to compare the two methods. MATERIALS AND METHODS: Twenty patients with an arthroscopic meniscal repair without clinical symptoms underwent conventional and indirect MR arthrography of the affected knee, 3, 6 and 12 months after the index operation applying a T1-w Spin Echo sequence in three planes. The size of the tear gap was measured on transverse images. The signal-to-noise ratio and the configuration of the abnormal signal were evaluated in the coronal images. RESULTS: All patients demonstrated abnormal signal intensity at the side of the meniscal repair. The size of the gap at the previous tear side, reduced significantly by 45 and 40% on conventional MRI and indirect MR arthrography respectively, from 3 months to 1 year (P < 0.05). The signal-to-noise ratio of the intrameniscal abnormal signal reduced significantly and approximately 50% from 3 to 6 months and from 6 to 12 months postoperatively, as demonstrated with indirect MR arthrography. However, as opposed to normal meniscus, the signal-to-noise ratio of the abnormal area remains 5.5 times higher 12 months postoperatively. In contrast, the reduction of signal-to-noise ratio of the abnormal area at conventional MRI was not significant even from 3 to 12 months. In 90% of the cases, the indirect MR arthrography showed the intrameniscal abnormal signal on plain MRI, to extend to the articular surface as opposed to 25% on plain MRI. CONCLUSION: With indirect MR arthrography, the natural process of meniscal healing can be evaluated. Significant reduction of the size of the tear gap and significant reduction of the signal-to-noise ratio of the abnormal signal as well as its configuration are the main parameters interpretating the normal healing process.

 

9. Karachalios T, Zibis A, Papanagiotou P, Karantanas AH, Malizos KN, Roidis N. MR imaging findings in early osteoarthritis of the knee. Eur J Radiol. 2004 Jun;50(3):225-30. (IF= 1,745)

PURPOSE: To carry out a modern diagnostic survey among patients with a clinical and radiological diagnosis of early osteoarthritis of the knee. MATERIALS AND METHODS: A magnetic resonance imaging survey was performed on 70 patients (82 knees) with a mean age of 59 years. (range, 40-71 years) who had chronic knee pain, clinical diagnosis of early osteoarthritis of the knee and conventional knee radiographs classified as 1 and 2 on the Kellgren-Lawrence scale. RESULTS: A variety of different disorders was found; degenerative meniscal lesions with or without ruptures of the anterior cruciate ligament in 70.7% of the knees, osteonecrosis of the femoral and tibial condyles in 9.75%, osteophytes and degenerative articular cartilage lesions in 8.54%, transient osteoporosis in 2.44% and benign neoplasms and cysts in 6.1%. CONCLUSIONS: The existence of such a heterogenous group of disorders in these "early osteoarthritic knees" may explain failures in treatment and it may justify a modern MRI imaging approach to proper diagnosis

 

10. Hantes ME, Basdekis GK, Zibis AH, Karantanas AH, Malizos KN. Localized pigmented villonodular synovitis in the anteromedial compartment of the knee associated with cartilage lesions of the medial femoral condyle: report of a case and review of the literature. Knee Surg Sports Traumatol Arthrosc. 2004 Jan 29;  (IF= 1,182)

Localized pigmented villonodular synovitis (PVNS) of the knee is an uncommon entity, presenting with different clinical signs and symptoms. We report on a case of a 42-year-old woman who presented with a 3-year history of knee pain and mechanical problems such as locking. On examination she was found to have a palpable and painful mass over the anteromedial joint line. Magnetic resonance imaging (MRI) revealed a soft tissue mass in the anteromedial compartment of the knee joint. The lesion was completely resected arthroscopically, and histologic examination confirmed the diagnosis of localized PVNS. The patient was free of symptoms, and MRI examination showed no evidence of recurrence at 1-year follow-up.

 

11. Th. Karachalios, K. Bargiotas, T. Moraitis, A. Zibis, V. Zachos, A. Papachristos, K.N. Malizos. Intramedullary nailing for the treatment of femoral non-unions following multiple failed plate fixations. Osteo Trauma Care, Vol 11, S 97-100, 2003.

Goal: The evaluation of the clinical outcome of IM nailing for the treatment of femoral shaft pseudarthrosis in patients who had multiple failed plate osteosyntheses.

Method: From January 2000 till March 2002, 18 (17 male- 1 female, mean age 37) patients were treated because of femoral shaft non-union in our institution. All patients had two or more failed plate osteosyntheses. There were no septic non-unions in this group. There was no segmental bone loss. In all 18 patients the implants were removed  and intramedullary nailing  was  performed. There was extensive periosteal stripping and areas of osteonecrosis in the majority of the patients. The quality of the surrounding soft tissues was poor due to scaring. Eight femurs were grafted with autologous iliac crest bone graft. All patients were followed by serial x-rays until union.

Results: There was no postoperative complications All pseudarthroses were healed within an average of 10.7 months (6-14). Non-unions which received bone graft ( 8 out of 18) in day one, were healed faster than those which didn’t. There was no re-operations among these patients. Among the remaining 10 patients 6 were grafted five to six months postoperatively and three had had nail dynamization.

Conclusions: Intemedullary nailing for femoral shaft non-unions after multiple failed plate osteosyntheses is a safe and effective method of treatment. It looks that autologous bone graft reduces  healing  time and  re-operation rate.

 

  1. Karantanas AH, Zibis AH, Kitsoulis P. Fat-suppressed 3D-T1-weighted-echo planar imaging: comparison with fat-suppressed 3D-T1-weighted-gradient echo in imaging the cartilage of the knee. Comput Med Imaging Graph. 2002 May-Jun;26(3):159-65.  (IF= 1.09)

OBJECTIVE: To assess the frequency of increased signal intensity in the patellar tendon using three-dimensional T1-weighted MRI pulse sequences. DESIGN AND PATIENTS: Sixty patients were examined with a 1.0 T scanner (15 mT/m gradient strength) using a quadrature coil. Three pulse sequences were applied in the sagittal plane: PD turbo spin echo (PD-TSE), 3D T1-weighted gradient echo with fat suppression (3D-T1-FFE-FS) and 3D T1-weighted echo planar imaging with fat suppression (3D-T1-EPI-FS). The high signal intensity areas were measured in their maximum length. The angle of the patellar tendon relative to the main field position was measured in the same slice. In eight patients with anterior knee pain, and in 11 with no anterior knee pain, a fourth T2-weighted TSE pulse sequence (T2-TSE) was obtained to rule out patellar tendinitis. RESULTS: The correlation of the high signal intensity areas with the relative position of the tendon was found to be significant with the 3D sequences (P = 0.03 for 3D-T1-FFE-FS and P = 0.003 for 3D-T1-EPI-FS). The length of the high signal intensity area in the tendon was 5.4 mm with 3D-T1-FFE-FS, 4.9 mm with 3D-T1-EPI-FS and 3.1 mm with PD-TSE images. No patellar tendinitis was demonstrated on the T2-TSE images. CONCLUSION: The magic angle effect is commonly observed in the 3D based T1-weighted pulse sequences with fat suppression. The presence of the above sign must be recognized by radiologists, so that misdiagnosis of patellar tendinitis is avoided.

 

  1. Karantanas AH, Zibis AH, Papanikolaou N. Increased signal intensity on fat-suppressed three-dimensional T1-weighted pulse sequences in patellar tendon: magic angle effect? Skeletal Radiol. 2001 Feb;30(2):67-71. (IF= 0,88)

This study was conducted to compare a three-dimensional (3D) multi-shot echo-planar imaging (EPI) sequence with fat-suppression (FS) with the 3D-fat-suppressed gradient echo (GRE-FS) sequence in imaging the cartilage of the knee. One hundred sixty-nine patients were studied prospectively. The cartilage was imaged in the sagittal plane with: (a) 3D-T1-EPI-FS and (b) 3D-T1-GRE-FS sequences using a 1T MR scanner. The signal-to-noise ratio (SNR) of bone (b) and cartilage (c), and relative contrast (ReCon) between bone and cartilage and meniscus and cartilage were measured in 60 patients with arthroscopically normal cartilage. The imaging accuracy was assessed by comparing with linear regression analysis (length and depth) 32 defects in the cartilage of cadaveric (human and bovine) knees. The 3D-T1-EPI-FS provided better bone marrow signal suppression, better SNRc and better ReCon(bc) and ReCon(cm) (p<0.01). The 3D-T1-EPI-FS showed better accuracy concerning the depth of the defects and the 3D-T1-GRE-FS better accuracy concerning the length of the defects. In conclusion, the 3D-T1-EPI-FS pulse sequence could be included in the routine protocol in imaging the cartilage of the knee because it achieves high SNR of the cartilage and high ReCon compared to the surrounding structures, at a reduced scan time.

 

  1. Karantanas AH, Zibis AH. Quiz case of the month. Brodie's abscess type III. Eur Radiol. 2000;10(9):1507-8. (IF= 2,364)

Μη διαθέσιμη περίληψη

  1. Karantanas AH, Hytiroglou P, Zibis AH, Markonis A, Papadimitriou CS. Malignant fibrous histiocytoma of the spine causing spinal neural foramen widening. Comput Med Imaging Graph. 2000 Sep-Oct;24(5):329-32. (IF= 1,09)

A case with a clinical picture of a chronic low back pain radiating to both lumbar regions caused by malignant fibrous histiocytoma is reported. Radiological, surgical and histopathological findings and treatment of this rare case are discussed.

 

  1. Karantanas AH, Zibis AH, Papanikolaou N. Comparison of echo planar imaging, gradient echo and fast spin echo MR scans of knee menisci. Comput Med Imaging Graph. 2000 Sep-Oct;24(5):309-16. (IF= 1,09)

In order to reduce the acquisition time, we compared a three-dimensional multi-shot echo-planar imaging (EPI) sequence with fat-suppression with two widely used sequences, the fat-suppressed gradient echo (GRE) and the proton-density weighted turbo spin-echo (FSE) in imaging the menisci of the knee. Sixty patients with various indications were studied prospectively with MRI. The menisci were imaged in the sagittal plane with all three sequences using a 1T MR scanner with 15mT/m gradients. The signal-to-noise ratio (SNR) of bone (b), cartilage (c), and meniscus (m) as well as contrast-to-noise ratio (CNR) and relative contrast (ReCon) between menisci and cartilage and between bone and cartilage were measured. A qualitative analysis was performed on grading of meniscal pathology (0-IV). The imaging accuracy of meniscal pathology was assessed compared to arthroscopy in 13 patients. The EPI provided the highest SNR in cartilage and meniscus (p<0.001), the highest CNR and the highest ReCon between bone and cartilage (p< or =0.001). MR grading of meniscal abnormalities showed overestimation compared to GRE and FSE. The EPI sequence could not be included in the routine protocol in imaging the menisci since the overestimation of meniscal abnormalities could lead to unnecessary arthroscopy.

  1. Kalef-Ezra J, Zibis A, Chaliassos N, Hatzikonstantinou I, Karantanas A. Body composition in homozygous beta-thalassemia. Ann N Y Acad Sci. 2000 May;904:621-4. (IF= 1,381)

Μη διαθέσιμη περίληψη

 

  1. Karantanas AH, Zibis AH, Papanikolaou N. Single-shot turbo spin-echo MR myelography: comparison with 3D-turbo spin-echo MR myelography and T2-turbo spin-echo at 1 T. Comput Med Imaging Graph. 2000 Jan-Feb;24(1):37-42. (IF= 1,09)

In order to reduce the acquisition time, we compared the single-shot-TSE-MR myelography (MRm) and 3D-TSE-MRm. The T2-TSE sequence was the standard of reference. Fifty patients with low back pain, sciatica or cervical radiculopathy were examined at 1.0 T. The shortest AP diameter of the spinal canal, signal-to-noise ratio (SNR) for CSF and cord, contrast-to-noise ratio (CNR) and relative contrast (ReCon) between CSF and cord were calculated. No statistically significant difference was found between the three sequences with regard to the AP diameter of the spinal canal. A significant difference was found in: (i) SNRcord; (ii) SNRCSF; (iii) SS-TSE-MRm (showed the highest CNR) and (iv) SS-TSE-MRm (showed higher ReCon compared to 3D-TSE-MRm). In conclusion, SS-TSE-MRm can be used alternatively to 3D-TSE-MRm reducing the acquisition time down to only 8 s per image.

 

  1. Zibis AH, Markonis A, Karantanas AH. Unusual causes of spinal foraminal widening. Eur Radiol. 2000;10(1):144-8. Review. (IF= 2,364)

Spinal neural foraminal widening is usually caused by benign lesions, most commonly neurofibromas. Rare lesions can also cause spinal neural foraminal widening. Computed tomography and/or MRI are the modalities of choice for studying the spinal foraminal widening. The present pictorial review describes six rare lesions, namely a lateral thoracic meningocele, a malignant fibrous histiocytoma, a tuberculous abscess, an osteoblastoma, a chondrosarcoma and a malignant tumour of the lung which caused spinal neural foraminal widening

 

  1. Zibis AH, Karantanas AH. Vacuum phenomenon in posttraumatic nonunion of pubic bone fracture. AJR Am J Roentgenol. 1999 Jan;172(1):251. (IF= 2,384)

Μη διαθέσιμη περίληψη

 

  1. Karantanas AH, Zibis AH, Papaliaga M, Georgiou E, Rousogiannis S. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT. Eur Radiol. 1998;8(9):1581-5. (IF= 2,364)

The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient.

 

  1. Karantanas AH, Zibis A, Rousogiannis S, Velesiotou C, Lavdas E. In vitro orbital volume measurement using computed tomography. Radiologica Diagnostica 1994;  35:265-268.

A method for measuring orbital volume using CT with contiguous 3mm axial sections is described. The accuracy of the method is 3.2% as demonstrated by comparing the CT volume measurements with those derived directly from cadaveric human skulls. The interindividual observer variation was 5.4% for the skulls and 2.6% for the CT measurements. The intraindividual observer variation was 2.2% for the CT measurements. Within the same individual, the right and left orbital volumes were found to be within 0.57cmJ of each other. The present study demonstrates that CT is a practical method of determining the orbital volume and could be used in the management of blow-out fractures and traumatic enophthalmos by predicting the volume of the diseased orbit from the normal one.

 

ΑΝΑΜΕΝΟΝΤΑΙ ΠΡΟΣ ΔΗΜΟΣΙΕΥΣΗ

Zibis AH, Segal LS. Mesenchymal Chondrosarcoma of the lumpar spine  in a child a case report and literature review (Υποβολή στο American J Orthop).

Zibis AH, Dailiana ZH, Papaliaga MN, Vragalas V, Mouzas OD, Malizos K.N.. Munchausen’s syndrome: a differential diagnostic trap for the orthopaedic surgeon. (Υποβολή στο Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery).

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Αριστείδης X. Ζιμπής

Ορθοπαιδικός Χειρουργός MD - PhD

Αναπληρωτής καθηγητής Ιατρικής Σχολής Πανεπιστημίου Θεσσαλίας

Μετεκπαιδευθείς στις ΗΠΑ - Penn State University στις παθήσεις της Σπονδυλικής Στήλης

Συνεργάτης του Ευρωπαϊκου πανεπιστημίου Κύπρου

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