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  • 1
    ISSN: 1279-8517
    Keywords: Paranasal sinuses, anatomy ; Paranasal sinuses, childhood ; Paranasal sinuses, MR-Imaging ; Sphenoid bone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Afin de démontrer les aspects fondamentaux du développement du sinus sphénoïdal pendant l'enfance, nous avons revu l'aspect en IRM du sinus sphénoïdal de 401 patients agés de moins de 15 ans. L'étude de la moelle osseuse, le développement de la pneumatisation, la croissance et le cloisonnement du sinus sphénoïdal ont été explorés en séquences pondérées en T1 et en T2. Le sinus sphénoïdal se présente, en séquence pondérée en T1, avec un signal faible et uniforme (moelle osseuse rouge) chez tous les enfants agés de moins de 4 mois. Ce signal hypo-intense devient hyper-intense (transformation de la moelle osseuse) à partir du 4 ème mois. Le début de la pneumatisation est noté à 13–15 mois. A l'âge de 43–48 mois, la partie antérieure du sinus sphénoïdal est pneumatisée chez 85 % des enfants. La pneumatisation est complète chez tous les patients agés de plus de 10 ans. La croissance dans chaque direction de l'espace est caractéristique. L'apparition d'un septum médian est observée à une fréquence variable par tranche d'âge, avec un maximum de 77 %. Les variations existent dans 4,5 % à 20 % des cas. La connaissance de ce phénomène peut servir de référence pour évaluer le développement normal et anormal du sinus sphénoïdal et être d'un grand intérêt dans le diagnostic et le traitement des affections du sinus sphénoïdal et des régions voisines chez l'enfant.
    Notes: Summary To obtain baseline standards of normal age-related development of the sphenoid sinus during childhood magnetic resonance images of the sphenoid sinus in 401 patients less than 15 years old were reviewed. T1-weighted sagittal and T2-weighted axial scans were evaluated for bone marrow conversion, development of pneumatization, spatial enlargement and septation of the sphenoid sinus. The sphenoid sinus had a uniformely low signal intensity (red bone marrow) on T1-weighted images in all children less than 4 months old. Signal intensity changes from hypo- to hyperintense (bone marrow conversion) started at age of 4 months. Onset of pneumatization was observed in 12% of the patients at age 13–15 months. By age 43–48 months, 85% of the patients showed pneumatization of the anterior part of the sphenoid bone. Pneumatization was complete in all patients older than 10 years. Enlargement of the sinus showed a characteristic profile in each dimension. Median septation was observed irregularly with age, with a maximum of 77%. Septum variants were noticed between 4.5% and 20%. The recognition of this phenomenon may serve as a reference for evaluating normal and abnormal development of the sphenoid sinus and may be of great value for diagnostic and therapeutic management of pathologic conditions of the child's sphenoid sinus and its surrounds.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0509
    Keywords: Key words: Intussusception〈+〉—〈+〉Biliary obstruction〈+〉—〈+〉Pancreatic atrophy〈+〉—〈+〉Peutz-Jeghers polyp.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Enteroenteric intussusceptions in adults are rare events caused by tumors in most cases. A case of duodenojejunal intussusception is presented which became manifest because of marked biliary obstruction and extensive pancreatic atrophy. As lead point, a large duodenal polypous hamartoma could be identified. The role of ultrasound and CT as diagnostic imaging of choice in this entity are discussed.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0509
    Keywords: Key words: Focal nodular hyperplasia (FNH)—Power Doppler sonography—Conventional color Doppler sonography—Resistive index—Vascularity.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. The aim of this study was to assess the value of power Doppler sonography versus conventional color Doppler imaging in the depiction of hypervascular focal nodular hyperplasia (FNH) of the liver and to investigate the resistive index (RI) in the lesions' feeding arteries. Eighteen histologically proved FNHs in 14 patients were evaluated by gray-scale ultrasound, conventional color Doppler, and power Doppler sonography. With conventional color Doppler, a feeding arterial vessel could be depicted in only 4/18 lesions and hypervascularization was detected in 6/18 lesions. Power Doppler was more sensitive in detecting feeding arteries (16/18) within hypervascular lesions (15/18). RI values in the feeding arteries (mean = 0.51) significantly differed from those in the main hepatic artery or its intraparenchymal branches (mean = 0.68) in the same patient. The mean RI-difference was 0.19, suggesting hemodynamically significant arteriovenous shunting. Power Doppler sonography significantly increases sensitivity in the diagnosis of focal nodular hyperplasia of the liver and reliably permits the distinction of these lesions from hepatocellular carcinomas.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Solid State Ionics 53-56 (1992), S. 849-852 
    ISSN: 0167-2738
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Gynäkologe 33 (2000), S. 206-212 
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Qualität der Versorgung ; Qualitätssicherung ; Gynäkologie ; Gesundheitssystemforschung ; Key words Quality of care ; Quality assurance ; Gynecology ; Health services Research
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Since 1996 German gynecologists can assure quality of care by implementing a quality assurance program that was developed mainly by their specialty society. The program's principal feature lies in the fact that the quality of operations performed in an outpatient setting as well as in the hospital are assessed by using the same specific quality indicators. Unfortunately, until now the program has been fully implemented only in the state of Hesse where almost all hospitals report every gynecological operation. In the outpatient setting the two existing programs for quality assurance, one under the social security legislation and the other on a voluntary basis, only allow for an incomplete assessment of the quality of care. However, because of recent developments in health policy, i.e., changes in legislation concerning quality assurance, promotion of practice guidelines, development of a certification system for hospitals, and a call for integrated health care delivery systems, gynecologists should seize the opportunity to press ahead with implementing their quality assurance program. At the same time, gynecologists could adapt the program to recent legislative changes and they could learn from the 3-year experience in Hesse to improve the existing program. After all, by taking advantage of their 20-year-long preparatory work, gynecologists should be able to keep their leading role in the field of quality assurance in Germany.
    Notes: Zusammenfassung Zur Sicherung der Qualität operativer Leistungen verfügt die deutsche Gynäkologie seit 1996 über eine von der Fachgesellschaft maßgeblich entwickelte Qualitätssicherungsmaßnahme. Deren Kennzeichen ist, dass die Qualität sowohl stationär als auch ambulant erbrachter Operationen in gleicher Weise differenziert anhand von Qualitätsindikatoren bewertet werden kann. Leider hat diese Maßnahme in der zunächst vorgesehenen Form der Vollerfassung aller stationären operativen Eingriffe bisher nur in Hessen den Sprung in die Routineversorgung geschafft. Im ambulanten Bereich existieren Qualitätssicherungsmaßnahmen aufgrund sozialgesetzlicher Vorgaben und auf freiwilliger Basis, die jedoch beide nur eine sehr lückenhafte Qualitätsbewertung ermöglichen. Einige aktuelle gesundheitspolitische Entwicklungen – veränderte gesetzliche Rahmenbedingungen zur Qualitätssicherung, Förderung der Einführung von Versorgungsleitlinien, Entwicklung von Zertifizierungsverfahren und Propagieren von Versorgungsnetzwerken – bieten derzeit die Chance, zum einen die Einführung der Qualitätssicherungsmaßnahme in der operativen Gynäkologie voranzutreiben. Zum anderen fordern sie dazu auf, im Zuge dieser breiteren Implementierung die vorhandene Maßnahme zu optimieren, indem die Erfahrungen der 3-jährigen Routinephase in Hessen und die veränderten Rahmenbedingungen der Qualitätssicherung für eine Weiterentwicklung genutzt werden.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1920
    Keywords: Key words Dermoid cyst ; nasal ; Nose ; tumours ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a child with a nasal dermoid cyst, the intracranial extension of which was shown on contrast-enhanced MRI, facilitating complete surgical removal
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1920
    Keywords: Key words Chordoma chondroid ; Drop metastases ; Dumbbell tumours
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Metastasising chordomas are extremely rare and only four cases with drop metastases have been reported. We report a patient with an intracranial chondroid chordoma, typically involving the clivus, treated by repeated resection, percutaneous transluminal embolisation and radiosurgery. During follow-up with MRI asymptomatic intradural drop metastases were observed throughout the spine, with transgression of the intervertebral foramen, forming a “dumbbell”.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Gefässchirurgie 2 (1997), S. 179-186 
    ISSN: 1434-3932
    Keywords: Schlüsselwörter Karotis-TEA ; Externe Qualitätssicherung ; Chirurgische Tracerdiagnosen ; Fallpauschalen und Sonderentgelte ; Key words External quality assurance ; Tracers ; Carotid revascularization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract External quality assurance by standardized data collection for tracer diagnosis has been used in Germany for several years. In some regions all surgical departments participate in programmes with the tracers cholecystectomy, inguinal hernia repair and hip fracture. A nationwide programme is currently beeing conduct-ed in obstetrics. Recently an extended nationwide programme was developed by the Servicestelle Qualitätssicherung (SQS) at the Deutsches Krankenhausinstitut (DKI). Due to the federal structure in Germany the project has been implemented in different ways in different places. In vascular surgery there are different programmes for carotid revascularization and for surgery of leg varicosis. There is a need for a standardized, generally accepted means of data collection. The evaluation of the data is presently based on the concept of benchmarking, i.e. continuous quality improvement by orientation to the most favourable results.
    Notes: Zusammenfassung Externe Qualitätssicherungsmaßnahmen mittels standardisierter Datensätze zu sog. Tracerdiagnosen werden in Deutschland seit vielen Jahren durchgeführt. Eine flächendeckende Umsetzung erfolgte bislang in einzelnen Bundesländern für die chirurgischen Tracerdiagnosen Cholezystektomie, Leistenhernie und Schenkelhalsfraktur sowie in der Gynäkologie und Geburtshilfe durch die Peri- und Neonatalerhebung. Nach Einführung pauschalierter Entgeltsysteme wurden für über 80 Fallpauschalen und Sonderentgelte bundesweit flächendeckende Qualitätssicherungsmaßnahmen geplant, die Datensätze wurden durch Fachgruppen an der Servicestelle Qualitätssicherung (SQS) am Deutschen Krankenhausinstitut (DKI) entwickelt. Die Umsetzung der Qualitätssicherungsmaßnahmen erfolgt auf Länderebene, aufgrund der föderalen Struktur sind uneinheitliche Entwicklungen zu beobachten. Im Bereich der Gefäßchirurgie existieren für die Karotis-TEA Datensätze der Deutschen Gesellschaft für Gefäßchirurgie (DGG) und der SQS. Auch im Bereich der Varizenchirurgie liegen unterschiedliche Datensätze der SQS und der Arbeitsgemeinschaft niedergelassener Gefäßchirurgen in Deutschland (ANG) vor. Auf beiden Gebieten ist eine Angleichung der Datensätze zu fordern. Ebenso erscheint eine Vereinheitlichung der Qualitätssicherung bei stationär und ambulant erbrachten Leistungen unabdingbar. Bei den Auswertungskonzepten kommt heute allgemein das Prinzip des Benchmarking d.h. die prozeßbegleitende kontinuierliche Datenerfassung mit Orientierung an den günstigsten Ergebnissen zur Anwendung.
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