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Description / Table of Contents: Epidemiologic data for the prevalence of oral cancer show marked geographic differences. The incidence of oral cancer in younger individuals seems to be on the increase. Prevalence of oral leukoplakia in German men is 2.3%, in women 0.9%. Risk factors for oral cancer and most variants of oral leukoplakia are identical. Etiologically, tobacco and alcohol are the most important factors. Tobacco in smoked, chewed or snuffed varieties has toxic, tumorigenic and carcinogenic properties. Consumption of tobacco has markedly increased during the last 15 years in some geographic areas. In Germany tobacco consumption has increased 7.5% during the last 4 years. Alcohol affects the permeability of oral mucosa. Oral cancer as well as most forms of oral leukoplakia are avoidable diseases. Strategies for prevention encompass primary, secondary and tertiary prevention. Primary prevention focuses on principal avoidance of tobacco. Anti-tobacco counselling and therapy is actively practised in dental practices in some countries. Intervention includes the 4 A’s as principles (ask, advise, assist, arrange) and is based on nicotine replacement therapy. General dental practice and hospital dentistry should introduce the principles of primary prevention of tobacco consumption. A questionnaire which was sent to EU countries indicated that dental teams are willing to introduce tobacco and alcohol counselling and relevant prevention strategies.

Description / Table of Contents: The reconstruction of extensive jaw defects is frequently only possible with microvascular bone flaps. Here we are presenting an operative technique using prefabricated fibular flaps and osseointegrated implants. In a first operation, the fibula is prepared with implants, split skin graft, and a nonresorbable membrane. The jaw defect is reconstructed 6 weeks later and can be treated directly with a prosthesis thanks to osseointegrated implants. The technique is described with reference to 5 patients already operated according to this technique and the initial findings are evaluated.

Description / Table of Contents: Background In addition to standard X-rays, photographic documentation, cephalometric and model analysis, a computer-aided, three-dimensional (3D) simulation system has been developed in close cooperation with the Institute of Communications of the Friedrich-Alexander-Universität Erlangen-Nürnberg. With this simulation system a photorealistic prediction of the expected soft tissue changes can be made. Prerequisites are a 3D reconstruction of the facial skeleton and a 3D laser scan of the face. After data reduction, the two data sets can be matched. Cutting planes enable the transposition of bony segments. The laser scan of the facial surface is combined with the underlying bone via a five-layered soft tissue model to convert bone movements on the soft tissue cover realistically. Conclusion Further research is necessary to replace the virtual subcutaneous soft tissue model by correct, topographic tissue anatomy.

Description / Table of Contents: Background. The development of arterial chemotherapy in the course of the twentieth century is recapitulated, emphasizing the implications of advancements which have been made in anatomic examination and cell biology. Chemotherapy. The literature is reviewed to determine the current position of arterial chemotherapy among other treatment strategies. As a single modality treatment, it is exclusively employed as palliative treatment. Combined with surgery, radiation or immune therapy, arterial chemotherapy is of further significance as part of multimodality treatment. The best chance for cure is achieved if applied as induction therapy.

Description / Table of Contents: Background. Systemic sclerosis (SSc) is a generalized disorder of the interstitial tissues and vasculature with distinct abnormalities in three systems, immune and autoimmune, vascular and microvascular, and mesenchymal extracellular matrix (ECM), that lead to exuberant fibrosis. The aim of this study was to compare the number of blood vessel profiles in the marginal gingiva between SSc patients and patients with periodontitis but without SSc by using biopsies. Methods. Marginal gingiva and gingival papilla were obtained from 13 scleroderma patients and 8 patients with periodontitis after routine tooth extraction and gingival curettage. On the histological sections, immunohistochemical investigations were performed using the avidin-biotin complex method (ABC) and the monoclonal antibody CD 31/Clone JC70A (platelet endothelial cell adhesion molecule-1). Blood vessels were identified by light microscopy (original magnification × 400) and counted within 0.3615 mm2. Medians of blood vessel profiles were compared by Mann-Whitney U-test. Results. There is no statistical difference between the median of blood vessel profiles in the marginal gingiva of SSc patients as compared to the median of blood vessel profiles in the marginal gingiva of patients with periodontitis (P = 0.665). We did not discover avascular areas in the subepithelial connective tissue. Discussion. The pathological changes in the microvasculature in the dermis of SSc patients are not transferable to the marginal periodont, as intraindividual histological examinations of dermis and oral mucosa in relation to the degree of the disease are not available yet.

Description / Table of Contents: Background: Schwannomas are rare benign neurogenic tumors that arise from Schwann cells of the peripheral nervous system. The most frequent localisation is the head and neck area. Extracranial schwannomas are most often located in the deep soft tissues. Intraosseous tumortypes are rare; the mandible is the most common site. Case report: We present the case of a 63-year-old woman with a schwannoma which originated from the mandible nerve and describe the therapy of this neoplasm. A rare malignant transformation cannot be excluded. Therefore, the treatment of choice is radical local resection.

Description / Table of Contents: Abstract Computer-assisted prefabricated skull implants of pure titanium as a bone replacement material have been used in 22 departments since 1994. Our experience with 104 implants includes clinical aspects (indication; tissue quality; surgical technique; patient guidance), but also geometric and material-specific parameters (acquisition, transfer, and evaluation of CT data; construction; manufacturing; cleaning; postoperative use of radiologic techniques). While the clinical aspects are responsibly defined by the respective surgeon, the geometric and material-specific parameters of individual implants have to comply with the laws on medical products. Therefore, the prospective documentation for each implant includes: helical CT acquisition parameters; geometric data of the computer-based skull model and implant; the cleaning procedure; and the individual marking. Medically specified pure titanium is processed by milling only so that neither purity nor structure is impaired. A specially developed milling technique guarantees the fabrication of all constructed elements down to fine details of 50 μm. Considering the necessary radiologic follow-up of defects after tumor surgery, all patients in our hospital undergo postoperative MRI examination, partly with preoperative documentation as an intraindividual control. Such comprehensive documentation and quality assurance is essential for techniques of prefabricated bone substitution. Hand in hand with scientific research and clinical application, these formal criteria have to be elaborated and fulfilled for the respective techniques. The successful determination of specifically adapted MRI sequences goes even one step further: spin-echo sequences minimize inhomogeneities of the magnetic field induced by the titanium implants and enable accurate postoperative documentation and diagnostics especially in the follow-up after tumor surgery.

Description / Table of Contents: Problem: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer – some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. Patients: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. Results: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. Conclusion: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

Description / Table of Contents: Abstract The diagnostic procedure in viral encephalitis is based on the synopsis of clinical signs and symptoms, serological data, CSF analysis and diagnostic imaging findings. This article summarizes the findings of those viral encephalitides most frequently encountered in Western Europe. MRI is more sensitive than CT for the detection of inflammatory brain lesions due to the higher contrast resolution. The pattern of parenchymal damage is highly specific in only some viral encephalitides (e. g., the frequently hemorrhagic lesions of structures of the limbic system in herpes simplex virus type I encephalitis; the symmetric and confluent lesions of the frontal white matter of progressive diffuse leukoencephalopathy in AIDS). In the majority of viral encephalitides MRI demonstrates the location and extension of parenchymal damage. The specific diagnosis in terms of the causative agent is based on serological studies.

Description / Table of Contents: Abstract Background: About 10% of all schoolchil- dren are suffering from migraine and 50% from tension-type headache. Headache of acute onset usually will be treated with analgesic substances like paracetamol, acetylsalicylic acid or ibuprofen, the first one being the reference drug for tension-type headache in childhood. In case of lacking improvement or side-effects there is demand for an alternative safe substance for the acute analgesic therapy. Methods: In a double-blind randomised investigation flupirtine and paracetamol were given in two consecutive attacks of episodic tension-type headache. 30 children, 6–12 years old, were included. Dosage was determined according to age and weight. The children documented the acute headache intensity and duration in a special diary. Results: Headache intensity was reduced during 2 h after intake in 89% of the 19 children treated. The reduction was 6,5 to 3,1 for flupirtine and 6,9 to 3,3/10 for paracetamol. There was no statistically significant difference between the two substances. Relevant side-effects could not be observed. Conclusion: Flupirtine has shown a convincing clinical effect treating acute episodic tension-type headache for children. The substance was well tolerated by the patients. In addition, flupirtine provides a high degree of safety.

Description / Table of Contents: Abstract Introduction: The loss of functional capacity by peripheral nerve lesion is easy to be estimated: A certain neurologic dysfunction results in a characteristic reduction of the former individual capacity. In contrast, the effect of accompanying pain to every-day life and working ability is not known exactly. In this study, we compared the results of judgement in nerve lesions under the circumstances of additional pain syndromes. Methods: From January 1994 until Dezember 1998 we saw 57 patients with peripheral nerve lesions, part of them with an additional pain syndrome. Beside conventional neurological examination a detailed pain analysis has been done. Results: Lesions of the median or ulnar nerves showed regularly disturbences in neurological functions (10/14 for the mediane nerve, 13/16 for the ulnar nerve). Astonishing is the fact, that serious pain after nerve lesion only occurs in cases of partial nerve lesion. We saw neuralgias in 6 patients with ulnar neuropathy, in three cases of median nerve lesions we could see severe neuralgia (causalgia we found in 3 cases of ulnar neuropathy, in 6 cases after Median Nerve lesion). Patients with a lesion of the central plexus brachialis showed in 10 of 11 cases an additional pain syndrome. Other nerves have been affected more rarely. For the judgement of the loss of earning capacity we saw an additional pain related diminuition of at least 10% compared to those patients without pain problems. Conclusions: The common grading scales for peripheral nerve lesions are not suitable in cases accompanied by an additional pain syndrome. Beside a functional deficit the effect of severe pain in these patients has to be estimated. On an average, patients with addtitional pain-problems get a 10% extended loss of earning capacity, even more in particular cases.

Description / Table of Contents: Abstract Introduction: Chronic pain is an individually variable experience, incorporating physical, psychological and social dimensions. Chronic pain occurs in a broad spectrum of severity; therefore, a grading procedure is of crucial importance in clinical research and in epidemiologic studies. The Mainz Pain Staging System is an interview-administered, multi-dimensional measure of chronic pain severity. The system suggests grading chronic pain in terms of 4 axes: time (persistence), spreading of pain site, medication use, and health care utilization. The whole scale consist of 10 items. The resulting score is used to classify the pain problem in three stages (I, II, III). Analysing the broader validity and parametric properties of the staging system is the purpose of the present study. Methods: The staging system and psychosocial data were administered to 542 consecutive patients of different diagnoses who attended one of six pain clinics in the year 1995/96. In a time period of 3 months since first contact, treatment procedures were registered. Three months after first contact patients rated the effectiveness of treatment concerning reduction of pain intensity. Results: According to the criteria of the staging system 25% of the sample belonged to each stage I and stage III, whereas 50% were classified to stage II. As a measure of validity, chronic pain status demonstrated significant correlation with psychological impairment, disability and time off work, whereas there was no correlation to pain intensity and persistence of pain. Surprisingly we found no difference in amount and quality of treatment between patients who were graded as severe pain patients (stage III) and the other stages. Furthermore, effectiveness of treatment also did not differ between the three stages. We made several proposals for optimizing the staging system. Conclusion: Given the high prevalence of recurrent and chronic pain as well as the broadness of severity, an important issue on further research is identification of factors which influence the chronification process. For this purpose improved measures of graded classification of pain status are needed.

Description / Table of Contents: Abstract Case report: The worker O.H., born in 1959, had in 1992 an accident as a car driver. His injuries were a severe acceleration trauma of the cervical spine with rupture of the longitudinal ligament, a concussion of the brain, and an eye injury. Therapy: After the emergency treatment, the multidisciplinary management could not resolve the persistent musculoskeletal cervicocephal and -brachial pain syndrome. The long-term application of 100 mg flupirtine tid improved the chronic pain state for 50–60%. Due to this regimen, the patient could be rehabilitated.

Description / Table of Contents: Summary Magnetic resonance tomography (MRT) has become the most important method in the workup of infantile cerebral complications after primary sonography. Cerebral MR examination and image interpretation during the infantile period require extensive knowledge of morphological manifestations, their pathophysiological background, and frequency. The choice of imaging parameters and image interpretation is demonstrated in infarctions and hemorrhages of the mature and immature brain. A review of the main differential diagnoses is also given. The relevance of MR spectroscopy and fetal MRI is discussed.

Description / Table of Contents: Summary Purpose: Multirow-detector-spiral-CT (MSCT) allows for 250 ms effective exposure time. The purpose of this study was to demonstrate the possibilities and limitations of this CT technology for non enhanced and contrast enhanced investigation of the coronary arteries. Methods: Investigation of the coronary arteries without contrast medium for quantification of coronary calcifications was performed in an obese patient (140 kg) with MSCT and electron beam CT (EBCT). In 56 patients contrast enhanced CT angiography of the coronary arteries was performed to determine image quality depending on the heart rate. Results: In the obese patient superior image quality could be achieved with MSCT allowing for reliable quantification of coronary calcifications. With MSCT angiography of the coronary arteries good image quality was achieved in patients with a heart rate of 59±8 beats per minute. Conclusion: Even if there are limitations in patients with higher heart rates with an effective exposure time of 250 ms MSCT has clear advantage of image quality in the assessment of non enhanced and contrast enhanced coronary arteries.

Description / Table of Contents: Summary Purpose: To find and describe potential MRI criteria of nutrient vessel canals of carpal bones. Methods and Material: 16 wrists of 13 patients with pain and radiographic depiction of cystic changes within the lunate were examined. The MRI protocol included coronal and sagittal T1- and T2-weighted SE sequences (4 mm slices, 120 FOV, 256×256 matrix) as well as coronal STIR images. Final diagnosis was confirmed by surgery (n=5) and follow up. 10 cadaveric ossa lunata were studied to describe size, number, location and shape of nutrient vessel canals. Results: Ganglion cysts (n=6) showed characteristic signs. In ulnar impaction syndrome (n=1) small cystic lesions in the lunate were surrounded by a sclerotic rim and located near the proximal ulnar surface. In Kienböck’s disease (n=3) cystic components were irregular and surrounded by bone marrow edema. Nutrient vessel canals (n=7) imaged as 1 to 3 small cystic lesions within the palmar or dorsal subchondral region. Conclusion: MRI can aid in differential diagnosis of cystic carpal lesions. Nutrient vessel canals may not be mistaken for pathologic cystic lesions. Carpal ganglion cysts show distinct diagnostic pattern.

Description / Table of Contents: Abstract The authors report the case of a young patient suffering from plasmacellular osteomyelitis of the thoracic spine, a unusual localisation of this type of chronic osteomyelitis. They discuss the role of imaging diagnostic modalities in this disease, focussing on MRI.

Description / Table of Contents: Abstract Purpose. MRI-guided interventional maneuvers in the breast, when closed MRI scanners are employed are relatively complex and time consuming. The purpose of our investigations was to develop a special device for the localization and biopsy of breast lesions using an open low-field MRI Scanner (Magnetom Open, Siemens, Erlangen, Germany) permitting free access to the patient. Materials and Methods. Due to its particular material and construction characteristics, a newly developed device for localization and biopsy of breast lesions is appropriate to remain within the magnetic field during the examination without degrading image quality. We performed 125 tests in a phantom and 31 investigations in patients including 26 wire-localizations and 5 biopsies. Results. The interventional maneuvers in the phantom could be performed very precisely. In all 125 phantom studies, the needle (14G coaxial biopsy cannula, Bard) was positioned close to the simulated lesion. In 25 out of 26 patients the needle was positioned within a distance less than 5 mm from the lesion. When using the 14G coaxial biopsy cannula (Bard, Karlsruhe, Germany) the needle tip was found adjacent next to the lesion in all 12 cases (7 wire-localizations, 5 biopsies). Conclusions. Our results indicate that our device allows very precise preoperative localization of breast lesions within the Magnetom Open. Using MRI-compatible, large-core needles, biopsy under direct MRI control resulted in good results.

Description / Table of Contents: Abstract MRI is the most accurate noninvasive technique available for assessment of normal articular cartilage and cartilage lesions. MRI cannot only provide morphologic information about the area of damage, but can also provide unique insight into the biochemical composition of the articular cartilage. New image processing techniques such as three-dimensional mapping of cartilage thickness will help to establish automated analysis of cartilage loss. Theses techniques are ideally suited for monitoring patients who undergo treatment with new chondroregenerative drugs.

Description / Table of Contents: Abstract Physiology and age dependant changes of human bone marrow are described. The resulting normal distribution patterns of active and inactive bone marrow including the various contrasts on different MR-sequences are discussed.

Description / Table of Contents: Abstract Purpose. Skeletal manifestation of Non-Hodgkin's lymphoma is rare in pediatric patients. Objective of the study was to determine imaging features, before and after treatment, and to correlate these features with clinical outcome. Methods. A retrospective analysis of 1246 patients from two therapy studies (NHL-BMF-90 and 95) was performed. Imaging studies of 63 patients with bone involvement of lymphoma were reevaluated. Results. Incidence of initial bone involvement in Non-Hodgkin's lymphoma was 6.8%. Distribution was best assessed by bone scan, MRI revealed larger areas of marrow involvement and detected additional lesions. Sites of prediliction were long bones of the lower extremities with epiphyseal involvement in 39%. Residual signal alterations in MRI after succussful therapy remained in 71%. Osteonecrosis after therapy was a common finding. Clinical outcome war not correlated to the presence of bone involvement. Conclusions. Since clinical outcome is not effected by bone involvement in childhood NHL, value of screening may be limited. Knowledge of imaging characteristics is mandatory for inital evaluation of primary osseous lymphomas and symptomatic lesions as well as for therapy controlls.

Description / Table of Contents: Abstract The hematogenous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion.

Description / Table of Contents: Zusammenfassung Myokardvitalität ist definiert als das Vorliegen lebender Myozyten. Bei Patienten mit ischämischer Herzkrankheit läßt sich die kontraktile Dysfunktion des Herzmuskels sowohl in vitalen als auch in avitalen Gebieten beobachten. In Gebieten mit vitalem Myokard kann sie durch Revaskularisation mit Thrombolytika, perkutaner transluminaler Koronarangioplastie (PTCA) oder koronarer Bypassoperation (CABG) rückgängig gemacht werden. In nekrotischen Arealen ist die kontraktile Dysfunktion dagegen irreversibel, und Revaskularisationsmaßnahmen können aufgrund ihres kleinen, aber eindeutigen Risikos kontraindiziert sein. Die Unterscheidung zwischen vitalen und avitalen Herzmuskelarealen ist daher eine klinisch wichtige Frage. Eine direkte Untersuchung von Patienten auf das Vorliegen bzw. Fehlen lebender Myozyten ist nicht möglich. Daher wird die Myokardvitalität indirekt mit klinischen Verfahren beurteilt. Beispielsweise erfaßt die Echokardiographie mit Dobutaminen Kontraktilitätsänderungen nach inotroper Stimulation, und die 99mTc-Sestamibi bestimmt die Myokardperfusion. Kernspintomographische Methoden zur Vitalitätsprüfung umfassen spektroskopische und bildgebende Verfahren. Die Phosphor-31- und Wasserstoff-1-MR-Spektroskopie aus Kreatin sowie die Natrium-23- und Kalium-29-Bildgebung liefern unmittelbar mit dem Zellstoffwechsel verbundene Informationen. Die räumliche und die zeitliche Auflösung dieser Verfahren sind jedoch aufgrund des schwachen MR-Signals begrenzt. Bei Wasserprotonen ist das MR-Signal dagegen verhältnismäßig stark und ermöglicht eine Darstellung des Herzens mit hoher räumlicher und zeitlicher Auflösung. Die Bildgebung mit Protonenresonanz beinhaltet die Untersuchung von Änderungen der intrinsischen MR-Relaxationszeiten (T1 und T2), Wanddicke und Verschwielung, Cine-MRT mit niedrigdosiertem Dobutamin sowie First-pass- und verzögerte Kontrastverstärkungsmuster. Berichten zufolge kommt es nach ischämischer Schädigung sowohl in vitalen wie in nekrotischen Myokardgebieten zu Änderungen der intrinsischen Relaxationszeiten, was den Nutzen dieses Verfahrens einschränkt. In ähnlicher Weise stehen Änderungen der Wanddicke und/oder Verschwielung nur in begrenztem Zusammenhang mit der Myokardvitalität. Die Cine-MRT mit niedrig dosiertem Dobutamin scheint das intakte Myokard zumindest ebenso gut zu erfassen wie die klinisch bereits etablierte Dobutamin-Echokardiographie. Die regionale Durchblutung, wie sie mittels First-pass-MRT erfasst wird, mag vom Vorhandensein vitalen Myokards abhängen. Die zugrunde liegende Physiologie legt aber nahe, dass Perfusion und Vitalität oft nicht in direkter Beziehung stehen. Neuere Forschungsergebnisse zur verzögerten Kontrastverstärkung weisen auf eine mögliche Definition vitalen Myokards als “Gebiete ohne starke Kontrastmittelaufnahme” hin. Derzeit liegen nur begrenzte klinische Daten vor, die diesen Ansatz unterstützen. Zusammenfassend liegen die aussagekräftigsten klinischen Daten derzeit für die Cine-MRT mit niedrig dosiertem Dobutamin zur Diagnose vitalen Myokards vor. Neueste Ergebnisse lassen vermuten, dass die verzögerte Aufnahme von Kontrastmitteln die transmurale Ausdehnung vitalen Myokards unabhängig von der kontraktilen Funktion gut abbildet und dass diese Technik auch in der Klinik zum Einsatz kommen sollte.

Description / Table of Contents: Abstract: We report on 3 children suffering from Leigh syndrome as diagnosed on clinical and laboratory results. In each child there were some deviations from the reported typical morphological picture on MRI. However, the lesions reported here fit very well to the patho-histological findings in Leigh syndrome.

Description / Table of Contents: Abstract: Chronic benign intracranial hypertension may have a variety of causes. Most frequent is this syndrome found in obese young women (“pseudotumor cerebri”), still of unknown etiology. However, venous congestion due to sinus occlusion has to be ruled out. We report a young woman with an intrasinusal meningioma of the transverse sinus and hypoplasia of the transverse sinus contralaterally. Diagnosis was achieved by MRI and angiography. Imaging signs of increased intracranial pressure comprised dilated perioptic sheaths and an empty sella. Abnormalities of the brain parenchyma or the CSF spaces were absent.

Description / Table of Contents: Abstract: Crohn's disease or regional enteritis is a granulomatous, primarily intestinal inflammatory disorder with possible extraintestinal manifestations. Affection of the eyes, liver, joints and urinay tract have been reported. Neurological symptoms are rare. We report the case of a 18-year-old woman with an unusually severe course of Crohn's disease, who developed intracerebral lesions. To discriminate between a granulomatous encephalitis and a vasculitis a cerebral angiography was performed. Multiple microaneurysms of the small cerebral arteries were found which had escaped detection with magnetic resonance angiography. Because of the angiographic diagnosis of a cerebral vasculitis a brain biopsy could be avoided.

Description / Table of Contents: Abstract: With the 2D-phase-contrast technique the volume flow of the CSF via the cerebral aqueduct can be quantified by MRI-means. In this study the stroke volume of CSF via the aqueduct per cardiac cycle (SVcc) is used to measure the extent of the volume flow. Normative values for the SVcc are not yet defined, however, they are indispensable for the clinical utility of this non-invasive method. The aim of the presented investigation is to evaluate, if the interthalamic width of the third ventricle is useful as a reference system for the extent of the SVcc via the aqueduct and if a normal CSF-flow can be defined. Hundred and seven patients (56 female, 51 male; age distribution 8 to 89 years) without clinical or imaging findings of a CSF-flow disturbance were examined on a standard 0.5 T MRI-scanner (Gyroscan, Philips). The measurements of the SVcc via the aqueduct were performed in a single slice perpendicular to the aqueduct in the level of its median third with a retrospective cardial-gated quantitative 2D-phase-contrast sequence. The interthalamic width of the third ventricle was measured in a transversal slice (bicommissural orientation, standard T1-weighted spin-echo sequence) in the level of the upper margin of the tectorial membrane. In 83 patients with a normal heart rate and without any further abnormalities in their imaging studies the SVcc is essentially dependent (r = 0.822) on the interthalamic width of the third ventricle (between 1 and 16 mm). Eleven patients with either a subcortical atrophy without leucencephalopathy, megacisterna magna, Dandy-Walker variant or bradycardia showed a significant increase of the SVcc (p 〈 0.05). On the other hand a significant decrease of the SVcc (p 〈 0.05) is seen in 13 patients with either tachycardia, Arnold-Chiari Type-1 malformation, relative aqueductal stenosis and/or severe periventricular leucencephalopathy. These results are in good agreement with the current conceptions on the physiology of the CSF-flow. As the above mentioned criterias of influence have ho pathological significance concerning a CSF-flow disturbance requiring therapy, we used the linear regression with y = B1*× +b0 (b1 = 22.2 ± 2.9; b0 = 43,5 ± 21.1) in all 107 patients to evaluate the extent of the SVcc (y) versus the interthalamic width of the third ventricle (x). This correlation offers the possibility to differentiate a hyperdynamic (above +3 standard error SE), a hypodynamic (below −3 SE) and a normodynamic (between ± 3 SE) CSF-flow via the cerebral aqueduct for the first time. Additional imaging findings and the heart rate must find their influence in the evaluation.

Description / Table of Contents: Abstract: Medulloblastoma, the most frequent pediatric brain tumor, has known propensity for subarachnoid dissemination. Spinal metastases indicate a poor prognosis. Intraventricular spread is much less common. We report a case of primary intraventricular dissemination with precocious puberty as the first clinical symptom due to a metastasis at the infundibulary stalk. This has not been reported so far as initial symptom of a medulloblastoma. Furthermore, we encountered an unusually mild contrast enhancement of the spinal and intraventricular metastases. Delayed scanning after contrast administration and FLAIR sequences proved to be particularly valuable in this case.

Description / Table of Contents: Abstract: A 65-year-old woman with persistant headache since a few weeks is presented. The day before hospitalization there was a sudden onset of protrusio bulbi and progredient swelling of the soft-tissue of the left eye. In the clinical examination left side protrusio bulbi, double-vision, chemosis and swelling of the eye-lid were found. Blood sample showed an elevation of inflammation indicators. MRI and CT revealed a thrombosis of the left superior ophthalmic vein with partial thrombosis of the left cavernous sinus.

Description / Table of Contents: Zusammenfassung Die kardiale Dysfunktion ist eine der Hauptursachen kardiovaskulärer Morbidität und Mortalität. Eine genaue und reproduzierbare Bestimmung der Herzfunktion ist essentiell für die Diagnosestellung, Prognoseabschätzung und Beurteilung des Therapieeffekts beim einzelnen Patienten. Die kardiovaskuläre Magnetresonanztomographie (CMR) bietet eine Messmethode für die globale und regionale Herzfunktion, die nicht nur genau und reproduzierbar, sondern auch nichtinvasiv, ohne ionisierende Strahlung und unabhängig von geometrischen Annahmen und einem akustischen Fenster ist, das den Einsatz der Echokardiographie limitiert. Mit der Verfügbarkeit schnellerer MR-Scanner und automatisierter Analysesysteme sowie mit zunehmender Verbreitung und reduzierten Kosten wird CMR bald den Referenzstandard für die Messung der Herzfunktion darstellen.

Description / Table of Contents: Zusammenfassung Weltweit werden jährlich etwa 1,5 Millionen Kinder mit kongenitalen Herzerkrankungen (CHD, congenital heart disease) geboren. Durch Verbesserung der verschiedenen chirurgischen und interventionellen Techniken ist die Überlebensrate von CHD-Patienten drastisch gestiegen. Immer mehr Patienten mit postoperativen Residuen, Folgezuständen und Komplikationen benötigen eine umfassende Nachsorge. Die Darstellung und Quantifizierung morphologischer und funktioneller kardiovaskulärer Anomalien erfordern zuverlässige und vorzugsweise nichtinvasive bildgebende Verfahren. Die Röntgenkontrastangiokardiographie, der bisherige Goldstandard, eignet sich nicht zur wiederholten Anwendung. Die transthorakale Echokardiographie (TTE) ist die meistverwendete nichtinvasive Methode, doch bei älteren Patienten, insbesondere mit komplexen oder operativ behandelten Malformationen, sind die damit gewonnenen Informationen unter Umständen unbefriedigend. Narben-, Knochen- und Lungengewebe sowie Thoraxdeformitäten können mit dem Schallfenster interferieren. Die transösophageale Echokardiographie (TEE) liefert bei Erwachsenen mit verschiedenen CHD-Formen eindeutig einen weitaus besseren Bildausschnitt, ist jedoch als semiinvasiv einzustufen. Bei Kleinkindern ist die TEE für die auf Intensivstationen und in Operationssälen erforderliche unmittelbare prä- und postoperative Überwachung inzwischen unentbehrlich. Die Kernspintomographie (Magnetresonanztomographie, MRT) hat sich zu einem klinischen nützlichen Verfahren zur Untersuchung des Herzens entwickelt, vor allem bei angeborenen Fehlbildungen. Sie gilt heute als etablierte nichtinvasive Methode, mit der sich die Anatomie des Herzens in jeder gewünschten Ebene mit hoher Auflösung und naturgetreuen Kontrast zwischen kardialen Strukturen und strömendem Blut darstellen läßt. Das konventionelle Spin-Echo eignet sich hervorragend zur morphologischen Beurteilung, liefert jedoch nicht unbedingt funktionelle Informationen. Die durch neuere Impulssequenzen mögliche funktionelle Analyse verleiht der MRT ihren besonderen Wert. Mehrere dieser neuen MRT-Verfahren werden gegenwärtig klinisch eingesetzt. Die Gradienten-Echo-MRT liefert ein Bild des Blutflusses. Mit ihr können Stenosen, Regurgitation oder Shunts aufgrund der durch diese hämodynamischen Läsionen verursachten Strömungsturbulenzen entdeckt werden. Außerdem ermöglicht die Gradienten-Echo-MRT eine fortlaufende Schleifendarstellung der Ventrikelwandbewegung und eine Quantifizierung der Kammerfunktion. Mit der quantitativen Phasenkontrast-MR-Angiographie lassen sich Blutströmungsgeschwindigkeit und Volumendurchfluss in den mittleren und großen Gefäßen messen. Diese Besonderheit der MRT läßt sich zur Quantifizierung von Stenosen, Regurgitation, intrakardialen Shunts und des differentiellen pulmonalen Blutstroms nutzen. Vor allem ihre Fähigheit zur Messung des Volumendurchflusses ist ein klarer Vorteil der MRT. Die kontrastverstärkte MR-Angiographie ist besonders nützlich zur Darstellung der Pulmonalarterienäste und des Aortenbogens. Pulmonaler Blutfluss, rechtsventrikuläre Funktion, pathologische Aortenbefunde und Fontan-Umgehungskreislauf sind u. a. hochinteressante Fragestellungen, die mit multifunktioneller MRT untersucht wurden. Bei Patienten mit Pulmonalstenose oder Fallot-Tetralogie lassen sich mittels MRT Morphologie und Schwere jeder pulmonalen (Rest-)Stenose beurteilen, die rechtsventrikuläre Hypertrophie bewerten sowie eine postoperative Insuffizienz der Pulmonalklappe oder ventrikuläre Dysfunktion quantifizieren. Bei Patienten, die wegen Koarktation operiert wurden, kann die Morphologie von Rest- oder Restenosen MR-tomographisch mit Hilfe von Spin-Echo-Bildern und der kontrastverstärkten MR-Angiographie des Aortenbogens beurteilt werden. Die quantitative Phasenkontrastangiographie erlaubt zusätzlich, den Druckgradienten über der Stenose und das Ausmaß des Kollateralflusses zu bestimmen. Patienten mit Transposition der großen Arterien werden in der Regel mit Umkehroperationen auf Vorhofebene behandelt. Eine Dysfunktion des rechten systemischen Ventrikels ist bei diesen Patienten eine wesentliche Frage, die mit funktionellen MRT-Verfahren untersucht wurde. Andere Komplikationen nach Vorhofumkehroperation wie Obstruktionen im pulmonalen oder systemisch-venösen Kreislauf lassen sich mit der Gradienten-Echo-MRT mühelos aufdecken. Der Fongan-Umgehungskreislauf bleibt nach wie vor ein faszinierendes, in vielerlei Hinsicht noch nicht völlig verstandenes Thema. Zahlreiche Modifikationen der ursprünglichen Fontan-Operation wurden eingeführt, mit jeweils eigenen hämodynamischen Charakteristika. Zweifellos kann die kombinierte morphologisch-funktionelle MRT zur Entwicklung weiterer Verbesserungen des Fontan-Verfahrens beitragen. Trotz aller technischen Verbesserungen, insbesondere der Einführung des Atemanhalteverfahrens, bleibt die MRT nach wie vor eine Ergänzung zu Echokardiographie und Angiokardiographie. Verfügbarkeit, Ortsgebundenheit und die bei Säuglingen und Kindern erforderliche Sedierung sind bekannte Hindernisse. Nicht zuletzt gilt es, gegen die relativ begrenzte Einbeziehung von Kardiologen in die MRT-Abteilung und die eingeschränkte Verfügbarkeit von Radiologen mit Erfahrung in CHD anzugehen, um die MRT zu einem “vollwertigen Mitglied im Klub” der bildgebenden Verfahren bei CHD zu machen.

Description / Table of Contents: Summary Magnetic resonance imaging (MRI) is used frequently in the diagnosis of knee injuries. The aim of this study was to compare the accruracy of MRI and clinical examination in diagnosing meniscal and cruciate ligament tears. Between January 1997 and June 1998, a total of 883 patients had undergone knee joint arthroscopy, operated on by one orthopedic surgeon. Of these, 144 patients had a preoperative MRI (group 1). This group was compared with 309 patients who had undergone arthroscopy without MRI between January 1997 and June 1997 (group 2). Sensitivity, specificity and accuracy for tears of the medial meniscus were 80.6%/58.8%/72.9% in group 1 and 83.3%/78.5%/80.3% in group 2, respectively, for tears of the lateral meniscus 44.4%/88.9%/83.3% in group 1 and 60.6%/98.8%/92.5% in group 2 and for tears of the anterior cruciate ligament 58.1%/92.0%/¶84.7% in group 1 and 80.1%/96.6%/¶89.6% in group 2. This study demonstrates that an experienced orthopedic surgeon can rely on the clinical diagnosis and decide whether arthroscopy is necessary in most cases without MRI. He will find intraarticular pathology in almost all cases if arthroscopy is performed. MRI should be reserved for special cases and should not be performed without first conducting a thorough clinical examination. The orthopedic surgeon should decide whether MRI is needed.

Description / Table of Contents: Most procedures currently in use for the treatment of full thickness cartilage defects lack solid data as a proof of quality. Various techniques for quality control are advisable. Meticulous documentation of adverse events and treatment failures is crucial. Patient self-assessment and clinical scores are often biased but focussed on the basis of medical efforts: the well-being of the patient. Second-look arthroscopies produce fewer facts for quality control than expected but enable therapeutical intervention. Magnetic resonance imaging will be essential for cartilage assessment in the future. To date, the evaluation of tissue quality is experimental. Histology and immunohistochemistry are widely accepted as precise tools to characterize cartilaginous tissue. Ethical reasons prohibit daily use. Quality control following the repair of cartilage defects is complicated, expensive, and of variable outcome, but dangerous if neglected. Multiple insignificant results can lead to a sharp image of the postoperative condition and may enable quality control of treatment and surgery.

Description / Table of Contents: Therapeutical inseminations from the donor take place in Germany for more than tens of years. The 73th German Phycians × Meeting has given consent in 1970. Today more than 60,000 to 70,000 children live in Germany born after fecundation by donor sperm. Selection of spermdonors takes place in aggreement to international criteria. The priciples of treatment of donogen insemination are in hand as recommendation. But some legal problems demand lawfull regulation for instance anonymity of the donor, law of family and successions, safe-keeping of documents, fees for the donor.

Description / Table of Contents: Abstract During the menopausal transition biological and psychosocial factors are closely interrelated. The retrospective view on the previous life span and the attitudes towards the menopause influence the severity of climacteric complaints and symptoms as well as the acceptance of hormone therapy. Most women use hormones to suppress symptoms and not to prevent e. g. osteroporosis. Depressive symptoms become more frequent, however, more than half of the variance results from psychosocial factors and a positive history of depression. Sleep disturbances increase and can only in part be explained as the result of vasomotor symptoms or as correlates of depression. Sexual activity often changes. However, subjective feelings of being attractive and/or the quality of partnership are more important than the widely discussed genital atrophy and dyspareunia. Hormone therapy should be restricted to cases with objective vaginal atrophy. Sleep disturbances frequently respond to hormones, as well as minor depressive symptoms. More pronounced depressive syndromes should be referred to “classical” psychological and psychopharmacological treatments. Results obtained in studies with surgical menopause must not be easily generalized to women with a natural menopause.

Description / Table of Contents: Abstract This article presents the heuristics concerning description of individual generative behavior. The aim is to describe the development of the desire for children, the generative action and the dealing with generative decisions for intended and unintended childless women and men as well as parents. The main emphasis of the existing heuristics is placed on psychological questions. These heuristics explain patterns and influencing factors of generative action as well as positive and negative influencing factors of the coping process. It may be helpful to use heuristics which describe development of and coping with generative action as background information to ensure comprehensive consultation and therapy planning.

Description / Table of Contents: Abstract „MicroSort” promises to become a reliable method for preselecting the sex of our children. As so many innovations in the field of assisted reproductive technology, however, sex selection raises difficult moral and legal issues. In this paper, we focus on the question whether or not sex selection calls for a legal ban. Since it does not seem to imply any serious harm to others, we argue in favour of the legalization of sex selection.

Description / Table of Contents: Abstract Erectile failure after radical prostatectomy is a common postoperative disorder. However, nerve-sparing technique provides in about 50–60 % erections sufficient for sexual intercourse. Damage to the cavernous nerves or vascular injuries are responsible for erectile dysfunction. Alprostadil is most commonly used for self-injection monotherapy or in combination with other vasoactive drugs. Intraurethral administration of alprostadil failed to reproduce promising early results. The oral drug Sildenafil showed to be effective in patients with partial erections, however, it failed to work after non nerve-sparing radical prostatectomy. Negative pressure devices and penile prosthesis can be considered as alternative therpeutic options. Autologous N. suralis transplantation during radical prostatectomy might further improve erection rates in the near future.