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  • ZIB Catalog
  • Articles: DFG German National Licenses  (230)
  • 2000-2004  (230)
  • Magnetic resonance imaging  (158)
  • Therapy  (72)
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  • ZIB Catalog
  • Articles: DFG German National Licenses  (230)
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  • 1
    Electronic Resource
    Electronic Resource
    Analysis of the Anatomic Changes in the Thoracic Cage After a Lung Resection Using Magnetic Resonance Imaging (2000)
    Springer
    Surgery today 30 (2000), S. 879-885 
    Details
    ISSN: 1436-2813
    Keywords: Key words Lung lobectomy ; Magnetic resonance imaging ; Left ventricular geometry ; Mediastinum ; Diaphragm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The thoracic cage after a lung resection is filled by the remaining lobes, the elevated diaphragm, the diminished thoracic cage, and by mediastinal shifting. The changes in the thorax after a lung resection were quantified using magnetic resonance imaging. The study group consisted of 39 patients who had undergone a lobectomy, four who had undergone a pneumonectomy, and 14 controls. The left ventricular angle, ascending aortic angle, mediastinal shift, longitudinal length of the thoracic cage, the distance between the thoracic apex and the level of the aortic valve, and diaphragmatic elevation were all measured. After a right lower lobectomy, the mediastinum shifted more rightward than after a right upper lobectomy. The diaphragm became more greatly elevated after a right upper lobectomy than after a right lower lobectomy. When a chest wall resection was added to a right upper lobectomy, the mediastinal anatomical changes decreased. After a left upper lobectomy, the degree of mediastinal shifting was greater than after a left lower lobectomy. A left upper lobectomy shifted the mediastinum at the level of the right atrium. This method is easily reproducible and was found to be effective for quantifying the changes in the thorax after a lung resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070038
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Diagnostisches und therapeutisches Management von Begleitverletzungen beim komplexen Beckentrauma (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 28-38 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Beckenverletzung ; Begleitverletzung ; Diagnostik ; Therapie ; Algorithmus ; Keywords ; Pelvic trauma ; Concomitant lesions ; Diagnosis ; Therapy ; Algorithm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The injuries that typically accompany pelvic fractures are lesions of the urogenital tract, the lumbosacral plexus, and the retroperitoneal and intra-abdominal organs. The prognosis depends heavily on early recognition of the abdominal- and retroperitoneal injuries, which are frequently a primary threat to vital functions. Missing these injuries would be very serious, as the mortality with early diagnosis and adequate treatment is normally low; according to the results reported in the literature, delayed therapy leads to increasing mortality rates of up to 80%. Experience in trauma centres has shown that for complete ascertainment of accompanying injuries it is necessary to perform a systematic diagnosis according to a fixed algorithm. The treatment of the concomitant injuries accompanying a complex pelvic trauma is fundamentally different from the treatment of patients with isolated injuries. A high survival rate with a low postoperative complication rate cannot be achieved except with specialist surgical management tailored to the primary life-threatening lesions. After determination and recording of the injury pattern a therapy concept must be made at once. A trauma algorithm can be helpful when treatment is selected. Step-by-step treatment with several operative phases alternating with recovery and stabilization periods under intensive care conditions has proved worthwhile.
    Notes: Typische Begleitverletzungen von Beckenfrakturen sind Verletzungen des Urogenitaltrakts, des Plexus lumbosacralis und intraabdominaler Organe. Entscheidend für die Prognose ist das rechtzeitige Erkennen v. a. der häufig primär vital gefährdenden Abdominal- und Retroperitonealverletzungen. Das Übersehen dieser Verletzungen ist besonders tragisch, da bei rechtzeitiger Diagnostik und adäquater Versorgung die Letalitätsrate in der Regel gering ist; bei verzögerter Therapie resultieren nach den Angaben in der Literatur Letalitätsraten bis zu 80%. Die Erfahrung in Traumazentren hat gezeigt, dass zur vollständigen Erfassung der Begleitverletzungen die systematische Diagnostik nach einem festgelegten Algorithmus erfolgen sollte. Die Behandlung der Begleitverletzungen im Rahmen eines komplexen Beckentraumas unterscheidet sich prinzipiell von der bei Monoverletzten. Voraussetzung für eine hohe Überlebensrate mit geringer postoperativer Komplikationsrate ist ein prioritätenorientiertes chirurgisches Vorgehen. Nach Erfassung des Verletzungsmusters muss bereits initial ein Therapiekonzept erstellt werden. Zur Entscheidungsfindung kann ein Traumaalgorithmus herangezogen werden. Es hat sich eine abgestufte Versorgung mit mehreren operativen Phasen und zwischengeschalteten Erholungs- und Stabilisierungsphasen unter Intensivbedingungen bewährt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390050088
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  • 3
    Electronic Resource
    Electronic Resource
    Komplexverletzung des Schultergürtels (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 240-248 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Komplexe Schultergürtelverletzung ; Diagnostik ; Therapie ; Interdisziplinäres ¶Management ; Keywords ; Complex shoulder girdle trauma ; Diagnosis ; Therapy ; Interdisciplinary management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The particular injury pattern of complex joint trauma means that a standardized operative procedure would be difficult to devise and an individual therapy plant is therefore essential for each patient. One of the main problems consists in the recognition and adequate treatment of associated vascular and neural lesions. The treatment of a complex joint trauma makes extremely high demands on the trauma-team in terms of both diagnostis and therapy and is an interdisciplinary challenge. On the basis of a detailed literature search and evaluation of the procedures we have adopted in sample cases, we suggest an algorithm for interdisciplinary management of severe combination injuries of the shoulder region.
    Notes: Die Problematik des komplexen Gelenktraumas besteht darin, dass aufgrund des besonderen Verletzungsmusters ein standardisiertes operatives Vorgehen erschwert und deshalb ein individuelles Therapiekonzept essenziell ist. Ein Hauptproblem besteht in ¶der Erkennung und der adäquaten Behandlung assoziierter Gefäß- und Nervenläsionen. Die Behandlung eines komplexen Gelenktraumas stellt höchste diagnostische und therapeutische Ansprüche an das Traumateam und bedeutet eine interdisziplinäre Herausforderung. Aufgrund einer eingehenden Literaturrecherche und der Auswertung des eigenen Vorgehens anhand exemplarisch ausgewählter Fälle wird versucht, einen Algorithmus der interdisziplinären Komplexversorgung schwerer Kombinationsverletzungen der Schulterregion zu erstellen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/
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  • 4
    Electronic Resource
    Electronic Resource
    Was man über die kindliche Fraktur des Ellbogengelenks wissen sollte (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S51 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Ellbogenverletzungen ; Wachstumsalter ; Diagnostik ; Therapie ; Key words ; Ellbow joint injuries ; Adolescence ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in the course of sport and play, for example as the result of falling from apparatus used in gymnastics or a bike, or falling while engaging in such popular sports as in-line-skating or skateboarding. Elbow injuries can be divided into dislocations of the joint alone and fractures, of the distal humerus or the proximal radius and ulna, or combinations of both dislocation and fracture. In addition, a differentiation is made between extra- and intraarticular fracture types, the latter being seen as either partial or complete joint lesions.
    Notes: Zusammenfassung Luxationen und/oder Frakturen am Ellbogen gehören zu den häufigsten Verletzungen im Wachstumsalter überhaupt. Sie entstehen überwiegend bei Sport und Spiel, z. B. durch Sturz von einem Turngerät, von Zweirädern oder während der Ausübung moderner Sportarten wie In-line-Skating, Rollschuhlauf und Skateboardfahren. Bei den Verletzungen werden reine Luxationen von Frakturen entweder am körperfernen Oberarmende oder an den gelenkbildenden Anteilen von Radius und Ulna unterschieden. Ein weiteres Unterscheidungsmerkmal ist die Abgrenzung extraartikulärer von intraartikulären Frakturformen, wobei letztere entweder als partielle oder komplette Bruchform imponieren.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014924
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  • 5
    Electronic Resource
    Electronic Resource
    Stumpfe Schultergelenkverletzungen und ihre Begutachtung (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S186 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Schultergürtel ; Stumpfe Verletzungen ; Rotatorenmanschettenruptur ; Schulterluxation ; Therapie ; Keywords Shoulder girdle ; Blunt injuries ; Rupture of rotator cuff ; Shoulder dislocation ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract It is difficult to assess blunt injuries in the region of the shoulder girdle because of the overlying acute and chronic processes. In assessments of rotator cuff ruptures in particular, in over 50% of cases the rupture could be explained by a degenerative process. This makes the assessment difficult, and also the decision as to whether or not the injury is due to an occupational accident. The diagnostic procedures applied should exclude a degenerative aetiology immediately after an accident in all cases. Rupture of the rotator cuff is often associated with an impingement syndrome and leads to corresponding symptoms in the subacromial space. Treatment of a rotator cuff rupture always involves a diagnostic arthroscopy as the first step, after which a reconstruction can be undertaken, either by way of the anterolateral approach after Neer or, in many cases, arthroscopically. Reconstruction of the rotator cuff must include outward mobilization of the muscles and a secure, mostly transosseous suture. Transference of a pedunculated tendon is indicated for large defects in the rotator cuff. In the case of dislocation of the shoulder with subsequent shoulder instability degenerative change and any possible multidirectional instability should be defined. Unidirectional instability with a demonstrable Bankart lesion has a good prognosis when surgery is performed without delay. In view of the high recurrence rate early treatment is indicated especially in young persons and in patients with a high activity level. Following detection of the Bankart lesion an arthroscopic procedure with refixation of the capsule–labrum complex is the method of choice.
    Notes: Zusammenfassung Stumpfe Verletzungen im Bereich des Schultergürtels sind aufgrund einer Überlagerung akuter und chronischer Prozesse schwer beurteilbar. Insbesondere bei der Beurteilung der Rotatorenmanschettenruptur ist diese nachweislich in über 50% der Fälle auf dem Boden eines degenerativen Prozesses begründet. Dies macht die Begutachtung und die Abgrenzung eines Arbeitsunfalls schwierig. Die Diagnostik sollte auf jeden Fall unmittelbar nach einem Unfall eine degenerative Genese abgrenzen. Zusätzlich muss die Schmerzsymptomatik gezielt untersucht und von vertebragenen Beschwerden abgegrenzt werden. Die Rotatorenmanschettenruptur geht häufig mit einem Impingementsyndrom einher und führt zu entsprechenden Beschwerden im Subakromialraum. Die Behandlung der Rotatorenmanschettenruptur beinhaltet immer im ersten Schritt ¶eine diagnostische Arthroskopie, anschließend kann entweder über den anterolateralen Zugang nach Neer oder in vielen Fällen auch arthroskopisch eine Rekonstruktion vorgenommen werden. Die Rekonstruktion der Rotatorenmanschette muss eine ausgiebige Mobilisation der Muskulatur und eine ¶sichere, meist transossäre Naht beinhalten. Der gestielte Sehnentransfer ist bei großen Defekten der Rotatorenmanschette angezeigt. Bei der Schulterluxation mit anschließender Schulterinstabilität sind ebenfalls ¶eine degenerative Veränderung und eine mögliche multidirektionale Instabilität abzugrenzen. Bei unidirektionaler Instabilität mit nachweisbarer Bankart-Läsion ist die Prognose bei unmittelbarer operativer Versorgung gut. Gerade beim jungen Menschen und bei Patienten mit hohem Aktivitätsniveau ist aufgrund der hohen Reluxationsrate ein frühes Vorgehen angezeigt. Nach Nachweis der Bankart-Läsion ist ein arthroskopisches Vorgehen mit Refixation des Kapsel-Labrum-Komplexes die Methode der Wahl.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014885
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  • 6
    Electronic Resource
    Electronic Resource
    Psychische Beeinträchtigungen als Unfallfolgen aus ärztlicher Sicht (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S456 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Trauma ; Akute Belastungsstörung ; Posttraumatische Belastungsstörung ; Therapie ; Medizinische Begutachtung ; Keywords Trauma ; Acute stress disorder ; Posttraumatic stress disorder ; Therapy ; Medico-legal expertise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract ‘Psychopathology after trauma’ mostly refers to cognitive or affective impairment after direct or indirect damage to brain tissue. Patients who have suffered a whiplash injury of the cervical spine, even without direct trauma to brain tissue, also often complain of cognitive or affective dysfunction for prolonged periods after the injury. Even more difficult to evaluate is psychopathology arising in the aftermath of severely distressing events, such as major disastrous accidents, natural catastrophes or assault. The medical expert must be aware of a variety of posttraumatic psychiatric disorders with different courses and symptoms and must be able to distinguish these from endogenous or merely coincident psychiatric disorders. In this paper, we outline the relevant diagnoses and diagnostic criteria, with special refrence to posttraumatic stress disorder (PTSD). It should be emphasized that while acute stress disorder is common after stressful experiences, PTSD is most likely to develop in the presence of personality traits or a concurrent psychiatric illness predisposing to the disorder. The nature of the trauma sustained is significant: for example, trauma inflicted by human aggression causes PTSD significantly more often than similar injuries suffered as the result of a motor vehicle accident. Finally, therapeutic strategies for posttraumatic disorders are briefly reviewed.
    Notes: Zusammenfassung Mit posttraumatischen psychischen Störungen sind in der Regel kognitive oder affektive Beeinträchtigungen in der Folge direkter oder indirekter Hirngewebeschäden gemeint. Aber auch Patienten mit Halswirbelsäulenschleudertrauma beklagen häufig und über lange Zeit kognitive oder affektive Störungen ohne Nachweis einer Hirnschädigung. Noch problematischer sind psychische Störungen in der Folge erheblich belastender Ereignisse, wie Unfälle katastrophalen Ausmaßes, Naturkatastrophen oder Überfällen, zu beurteilen. Dem ärztlichen Gutachter obliegt die Aufgabe, eine Reihe posttraumatischer Störungen, die sich hinsichtlich des Verlaufs und der Symptome unterscheiden, zu kennen und von anlagebedingten oder koinzidierenden psychischen Störungen zu differenzieren. In der vorliegenden Arbeit werden die relevanten Diagnosen ¶und diagnostischen Kriterien mit besonderer Behandlung der posttraumatischen Belastungsstörung (PTSD) besprochen. Hervorzuheben ist, dass es nach erheblich belastenden Erlebnissen recht häufig zu akuten Belastungsreaktionen kommt, während die PTSD in der Regel dann auftritt, wenn eine besondere persönliche Disposition oder psychiatrische Komorbidität vorliegen. Ferner kommt der Art des belastenden Erlebnisses Bedeutung zu. So wird eine PTSD häufiger nach Ausbrüchen menschlicher Aggression als nach z. B. Verkehrsunfällen gefunden. Abschließend wird ein kurzer Überblick über therapeutische Möglichkeiten bei posttraumatischen Störungen gegeben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014970
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  • 7
    Electronic Resource
    Electronic Resource
    Arthroskopische Behandlung der traumatischen Schulterinstabilität (akut – chronisch) (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S400 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Schulterinstabilität ; Arthroskopische Stabilisierung ; Therapiestrategie ; Akut ; Chronisch ; Keywords Instability of the shoulder ; Arthroscopic repair ; Therapy ; Acute ; Chronic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Traumatic instability of the shoulder has to be distinguished from instability due to capsular hyperlaxity if a stable shoulder and good functional results are to be achieved after surgery. Physical examination, radiological studies and arthroscopy are the most important diagnostic tools for this distinction. On the basis of our own experience and the results reported in the literature, we propose a strategy of patient selection for an arthroscopic stabilizing procedure. This procedure is indicated for first-time, traumatic dislocation and for chronic instability with a history of fewer than five recurrences without hyperlaxity.
    Notes: Zusammenfassung Die traumatische Schulterinstabilität muss von der Instabilität aufgrund hyperlaxer Kapsel-Band-Strukturen unterschieden werden, um dem therapeutischen Ziel einer stabilen und in ihrer Funktion nicht gestörten Schulter nahe zu kommen. Hierzu sind die klinische, radiologische und arthroskopische Diagnostik entscheidend. Auch der Enstehungsmechanismus und die Häufigkeit der Luxationen müssen berücksichtigt werden. Aufgrund der bisher gemachten Erfahrung und den in der Literatur verfügbaren Ergebnissen entstand eine Therapiestrategie der traumatischen Schulterinstabilität, die in Abhängigkeit von der präoperativen Reluxationsrate, den anatomischen Gegebenheiten und dem Anspruch des Patienten eine Selektion für oder wider eine arthroskopische Stabilisierungsoperation vorschlägt. Die Indikation zu diesem Eingriff sehen wir bei der traumatischen Erstluxation und der rezidivierenden traumatischen Schulterinstabilität ohne Hyperlaxität, wenn weniger als 5 Rezidive in der Anamnese zu erheben sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014955
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  • 8
    Electronic Resource
    Electronic Resource
    Die ausgedehnte venös-aneurysmatische Malformation der V. poplitea (2000)
    Springer
    Gefässchirurgie 5 (2000), S. 188-191 
    Details
    ISSN: 1434-3932
    Keywords: Schlüsselwörter Venöses Poplitealaneurysma ; Differentialdiagnose ; Knieschmerz ; Therapie ; Keywords Popliteal venous aneurysm ; Differential diagnosis ; Knee pain ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract  A rare cause of painful swelling of the knee cavity can be an aneurysm of the popliteal vein. Only 28 cases are reported in the literature. We treated a 20-year-old male patient who underwent three arthroscopies, one operation and one MRI; finally, phlebography detected a popliteal vein aneurysm and a malformation of the deep venous system of the popliteal and proximal calf veins. To avoid the threat of pulmonary embolism a resection of the aneurysm with interposition of a venous autograft was performed. Twelve months after the operation the patient is free of symptoms with a patent autograft.
    Notes: Zusammenfassung  Eine seltene Ursache schmerzhafter Schwellungen in der Kniekehle kann ein Aneurysma der V. poplitea sein. Bisher wurden 28 Fälle dieser Fehlbildung in der Weltliteratur beschrieben. Wir sahen einen 20-jährigen männlichen Patienten, bei dem nach 3 Arthroskopien, einer Arthrotomie und einer MRT durch eine Phlebographie ein venöses Aneurysma der V. poplitea mit venös-aneurysmatischer Malformation der proximalen Unterschenkelvenen festgestellt wurde. Um eine potentiell tödliche Lungenembolie zu vermeiden, erfolgte die Resektion mit Interposition der kontralateralen gedoppelten V. saphena magna. 12 Monate nach der Operation hat der Patient bei duplexsonographisch gutem Flow im Interponat keine Beschwerden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010592
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  • 9
    Electronic Resource
    Electronic Resource
    Gelenkfortsatzfrakturen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S110 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Unterkiefer ; Gelenkfortsatzfrakturen ; Diagnostik ; Therapie ; Key words ; Mandible ; Condylar neck fracture ; Diagnostic ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Among mandibular fractures, those of the condylar neck hold a special position due to the exceptional anatomical situation. Computer assisted tomography and magnetic resonance tomography have improved diagnostic evaluation. Indication for surgical treatment is given in cases of severely displaced or dislocated fractures. In surgical management, the preauricular, submandibular, retromandibular, and oral approach have been established. For sufficient fixation of fragments, procedures rendering a functional stability, like osteosynthesis with lag screw or by miniplating, are required.
    Notes: Zusammenfassung Die Gelenkfortsatzfrakturen nehmen aufgrund der besonderen anatomischen Situation eine Sonderstellung innerhalb der Unterkieferfrakturen ein. Die Computertomographie und das MRT haben die Diagnostik wesentlich verbessert. Die Indikation zur operativen Behandlung besteht bei stark dislozierten oder luxierten Frakturen. Als operativer Zugang sind der präaurikuläre-, sub- bzw. perimandibuläre, retromandibuläre und orale Zugang etabliert. Zur Fixation der Fragmente sollten ausschließlich funktionsstabile Verfahren, wie die Miniplatte oder Zugschraube verwendet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014531
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  • 10
    Electronic Resource
    Electronic Resource
    Malignes Melanom der Kopf-Hals-Region (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S177 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Malignes Melanom ; Inzidenz ; Diagnostik ; Therapie ; Key words ; Malignant melanoma ; Incidence ; Diagnostic procedure ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Malignant melanoma is one of the most frequent malignancies of the skin. This is particularly true of malignant melanoma in juveniles. Its incidence has more than doubled from the 1970s to the mid-1990s. Presently, 15 new cases are recorded per 100,000 inhabitants a year in Germany. At Fachklinik Hornheide, a tumor center specializing in skin neoplasm with patients being referred from all over Germany, the number of melanoma patients treated per year has been approximately 500–¶550 for the past 10 years. In the present study, the state-of-the-art therapy for primary melanoma and treatment of the regional lymph node system is discussed. The radical treatment formerly advocated with wide tumor resection plus radical neck dissection is no longer justified for this immunogenic malignant tumor caused by endogenic as well as exogenic factors. “Sentinel lymph node” imaging by means of radioactive substances for diagnosing possible melanoma metastases in adjacent lymph nodes has changed the therapeutical concept. Tumor staging by means of ultrasound, CT, MRT, or PET allows the differentiation of tumors without distant metastases and a favorable prognosis, from melanomas which have to be considered as generalized disease. In addition to surgical resection of the tumor and neck dissection for removal of lymph nodes, adjuvant immunotherapy with interferon-α is capable of prolonging survival without a recurrence. Palliative chemotherapy or immunotherapy are valuable options for cases with generalized melanoma. Vaccination with a melanoma-associated antigen or dendritic cells is at an experimental stage and may become part of future treatment strategies.
    Notes: Zusammenfassung Das maligne Melanom gehört, insbesondere in jugendlichen Altersgruppen, zu den häufigsten malignen Tumoren der Haut. Seine Inzidenz hat sich von den 70er Jahren bis zur Mitte der 90er mit etwa 15 Fällen/¶100.000 Einwohnern und Jahr mehr als verdoppelt. In der Fachklinik Hornheide, einer Tumorklinik der Haut mit bundesweiten Zuweisungen, hat sich dagegen im letzten Jahrzehnt die Zahl der behandelten Patienten auf etwa 500–550 Fälle pro Jahr stabilisiert. Die vorliegende Arbeit soll den aktuellen Standard der Therapie der Primärtumoren und der regionären Lymphabflussregion darstellen. Dabei soll vermittelt werden, dass das frühere radikale Behandlungskonzept mit großflächigen lokalen Tumorresektionen und einer radikalen Ausräumung aller Lymphknotenstationen des Halses diesem immunogenen bösartigen Tumor, dessen Entwicklung teils endogenen und teils exogenen Faktoren unterliegt, nicht mehr gerechtfertigt ist. Schon im Bereich der Diagnostik der fraglichen lymphogenen Metastasierung des Melanoms hat die Darstellung des „sentinel-lymph-node“ mit radioaktivem Material eine Änderung des Therapiekonzepts erzwungen. Das Tumorstaging mit Hilfe der Sonographie, der CT-, der MRT- und PET-Untersuchungen vermag prognostisch günstige Tumoren ohne Nachweis von Fernmetastasen von solchen Melanomen zu unterscheiden, die als generalisierte Erkrankung zu bewerten sind. Neben der operativen Entfernung des Tumors und der Ausräumung der Lymphknotenstationen des Halses ist in bestimmten Stadien die adjuvante Immuntherapie mit Interferon α geeignet, das rezidivfreie Überleben zu verlängern. Bei einer Generalisierung besteht die Option einer palliativen Chemo- oder Immunochemotherapie. Experimentelle Behandlungsansätze überprüfen den Einsatz von Vakzinierungsstrategien mit melanomassoziierten Antigenen und dendritischen Zellen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014539
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  • 11
    Electronic Resource
    Electronic Resource
    Röntgendiagnostik in der Mund-, Kiefer-, Gesichtschirurgie (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S270 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Röntgendiagnostik ; Panoramaschichtaufnahme ; Strahlenexposition ; Computertomographie ; Kernspintomographie ; Key words ; X-ray diagnostics ; Panoramic X-ray ; Radiation exposure ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A vital X-ray imaging technique in oral and craniomaxillofacial surgery is the panoramic X-ray. Due to its variety of special projections, including imaging of the transversal level and low exposure to radiation, it is suitable for answering many clinical questions and for diagnostics of various findings. It has become possible to minimize the necessary doses by further development of technology and devices, as well as of X-ray films and by new detection systems, such as sensors or screens. In some clinical cases, the diagnostic deficiencies of conventional imaging techniques make computed tomography (CT) and magnetic resonance (MR) imaging indispensable. Although MR is particularly suitable for soft tissue imaging, it has also become helpful in finding cortical changes by shorter measuring times. In certain cases, e. g., changes to bone metabolism, differentiated methods of nuclear medicine make image-aided analysis of function possible.
    Notes: Zusammenfassung Zentrale Aufnahmeart in der Röntgendiagnostik der Mund-, Kiefer- und Gesichtschirurgie ist die Panoramaschichtaufnahme. Mit ihren zahlreichen Spezialprojektionen einschließlich der Abbildung der Transversalebene ist sie für die Abklärung zahlreicher Fragestellungen mit geringer Strahlenexposition geeignet. Die Verringerung des Dosisbedarfs ist weiterhin durch Fortentwicklungen der Gerätetechnik, der Röntgenfilme und durch neue Detektionssysteme wie z. B. Sensoren oder Speicherfolien möglich geworden. Diagnostische Unzulänglichkeiten der konventionellen Aufnahmearten machen bei zahlreichen klinischen Fragestellungen der Mund-, Kiefer- und Gesichtschirurgie eine Bildgebung mittels Computertomographie und Kernspintomographie unumgänglich. Obgleich die Kernspintomographie v. a. für die Weichteildiagnostik vorrangig geeignet ist, erlaubt sie mittlerweile, aufgrund der Verkürzung der Messzeiten, auch Veränderungen der Kortikalis abzubilden. Bei bestimmten Fragestellungen, wie z. B. Veränderungen des Knochenmetabolismus, ermöglichen differenzierte nuklearmedizinische Verfahren eine abbildungsunterstützte Funktionsanalyse.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014549
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  • 12
    Electronic Resource
    Electronic Resource
    Characterization of Wue-1, a novel monoclonal antibody that stimulates the growth of plasmacytoma cell lines (2000)
    Springer
    Virchows Archiv 437 (2000), S. 372-379 
    Details
    ISSN: 1432-2307
    Keywords: Keywords Monoclonal antibody ; Lymphoma ; Myeloma ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A new monoclonal antibody, Wue-1, which specifically recognizes normal and malignant plasma cells, is characterized. Biochemical studies showed that monoclonal antibodies (mAbs) recognize a protein of 94 kDa. Using triple-staining flow cytometry and double-labeling immunohistochemical techniques, two populations of plasma cells, i.e. lymphoplasmocytoid plasma cells located in the germinal center of lymphoid organs and reticular plasma cells at the paracortex or medullary cords of secondary lymphoid tissues, were distinguished. Wue-1 is expressed when B-cell markers become lost and secretory activity with plasma cell morphology appears. Cell surface markers were identified on normal plasma cells and compared with their malignant counterpart in vivo. Terminal plasma–cellular differentiation of malignant low- and high-grade B-cell lymphoma and anaplastic plasmacytoma, otherwise difficult to identify with conventional B-cell markers on tissue sections or fluorescence-activated cell sorter analyses, were detectable by Wue-1. In cell culture, Wue-1 enhanced the proliferation of myeloma cell lines but not normal plasma cells in a dose-dependent manner. Since Wue-1-induced proliferation was increased by interleukin (IL)-6, Wue-1 recognizes a so far unidentified antigen with functional properties. Therefore, Wue-1 represents a useful new tool for therapy and for the in vivo and in vitro studying of B-cell lymphomas and the mechanisms of B-cell differentiation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280000258
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  • 13
    Electronic Resource
    Electronic Resource
    Radiologic anatomy of the spinal dorsal horn at the cervical level (anatomic-MRI correlations) (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 81-88 
    Details
    ISSN: 1279-8517
    Keywords: Spinal cord ; Dorsal horn ; Magnetic resonance imaging ; Radiologic anatomy ; Dorsal root entry zone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The spinal dorsal horn is known for its important functional role in the field of transmission and modulation of sensory afferents. Because of this, the dorsal horn represents a target for numerous analgesic and antispastic procedures. Thus, it would be interesting to develop imaging dedicated to this spinal structure. The purpose of this study was to investigate the radiologic anatomy of the cervical dorsal horn by magnetic resonance imaging (MRI) (1.5T). The first step consisted in the validation of the anatomic information provided by MRI on 5 human cadavers. A spin-echo sequence (T2, 2000/45) enabled the demonstration of good correlations between histologic sections and axial MRI slices performed at the corresponding cervical levels. The second step was the 〈〈in vivo〈〈 exploration of 20 subjects, aiming at the development of a gradient echo sequence (T2*) with a conventional MRI unit, compatible with a routine clinical examination. The dorsal horn was clearly identified in 77% of the axial slices performed (n = 300). The angle between the dorsal horn axis and the sagittal plane was measured as from 25.5˚ at C2 to 40˚ at C8 segments. The results of this anatomico-radiologic study of the cervical dorsal horn suggest that preoperative MRI could be useful to design the surgical approach to this structure, as performed during cervical microsurgical drezotomy (DREZ = dorsal root entry zone) for the treatment of selected cases of chronic pain or disabling spasticity in the upper limbs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0081-8
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  • 14
    Electronic Resource
    Electronic Resource
    Pneumocolography and virtual colonoscopy: its clinical place and development (2000)
    Springer
    Techniques in coloproctology 4 (2000), S. 129-131 
    Details
    ISSN: 1128-045X
    Keywords: Key words Colonscopy ; CT scanning ; Magnetic resonance imaging ; Virtual colonoscopy ; Pneumocolography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Colonoscopy is an invasive technique, frequently incomplete and often poorly tolerated in elderly patients. New, less invasive modalities are being developed to diagnose moderate-sized adenomatous polyps and colorectal caners which involve pneumo- or hydrocolography with high-resolution surface imaging, either by CT or MR scanning. This approach has recently been supplemented by complex image post-processing to provide a form of virtual colonoscopy which takes account of projected colonic direction and which can map for mucosal anomalies. It remains to be seen how sensitive these newer techniques are and whether defined algorithms for colonic representation can be agreed upon which will prove both accurate and cost-effective both in symptomatic and screening populations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101510070002
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  • 15
    Electronic Resource
    Electronic Resource
    Is there a brainstem generator of chronic daily headache? (2000)
    Springer
    The journal of headache and pain 1 (2000), S. 67-71 
    Details
    ISSN: 1129-2377
    Keywords: Key words Chronic daily headache ; Migraine ; Magnetic resonance imaging ; Red nucleus ; Substantia nigra ; Image processing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using BOLD-fMRI we have previously documented activation of the red nucleus (RN) and substantia nigra (SN) during spontaneously and visually activated migraine headache. These observations prompted us to study brainstem function in chronic daily headache patients using high-resolution magnetic resonance imaging (MRI) techniques. Seventeen chronic daily headache (CDH) patients, ten episodic migraine (EM) patients and fifteen controls (N) were imaged with a 3 tesla MRI system. For each subject, the relaxation rates R2, R2* and R2' were obtained for RN and SN. There was a significant decrease in R2' and R2* values for RN and SN in CDH compared to N and EM groups (p 〈 0.05), but no significant difference between the N and EM groups. A decrease in R2' and R2* indicates reduced deoxyhemoglobin and hence persistent activation of the RN and SN in CDH patients most likely secondary to ongoing headache at the time of study. The imaging data provide objective evidence of disturbed central nervous system function in CDH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101940070045
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  • 16
    Electronic Resource
    Electronic Resource
    Subependymoma of the lateral ventricles (2000)
    Springer
    Neurosurgical review 23 (2000), S. 98-103 
    Details
    ISSN: 1437-2320
    Keywords: Key words Computed tomography ; Magnetic resonance imaging ; Lateral ventricle ; Subependymoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Four subependymomas of the lateral ventricle were reviewed with regard to clinical presentation, neuroimaging features, treatment, histopathological features, and long-term follow-up. There were two male and two female patients ranging in age from 27 to 60 years (mean 48.3 years). While two patients presented with symptoms and signs of raised intracranial pressure, two others were found incidentally during neuroimaging investigations to have intraventricular tumors. Neuroimaging characteristics of these tumors included no paraventricular extension, iso- or hypodensity with minimal enhancement on computerized tomography (CT), or iso- or hypointensity on T1-weighted and hyperintensity on T2-weighted magnetic resonance images (MRI). The usual finding on MRI was of no or scarce contrast enhancement, but one case showed heterogeneous enhancement. Three patients underwent total resection of the tumor and one underwent partial resection. No patients received postoperative radiation therapy. All patients have been doing well 4.8 to 15.4 years (mean 8.8 years), after surgery. Although there are no absolutely specific features to distinguish these tumors from other intraventricular tumors preoperatively, subependymoma should be kept in mind for differential diagnosis, as this tumor may safely be removed without sacrificing contiguous normal tissue and with good long-term results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101430050008
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  • 17
    Electronic Resource
    Electronic Resource
    Preoperative staging of rectal cancer (2000)
    Springer
    International journal of colorectal disease 15 (2000), S. 9-20 
    Details
    ISSN: 1432-1262
    Keywords: Keywords Rectal cancer staging ; Computed tomography ; Endorectal sonography ; Magnetic resonance imaging ; Systematic review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  With the widespread introduction of preoperative radiotherapy for rectal cancer and the development of transanal endoscopic microsurgery for selected early lesions, preoperative radiological staging of these tumours has taken on increasing importance. This study is a systematic review to evaluate computed tomography (CT), endorectal sonography (ES) and magnetic resonance imaging (MRI) as preoperative staging modalities in rectal cancer. A Medline-based search identifying studies using CT, ES, or MRI in preoperative staging of rectal cancer between 1980 and 1998 was undertaken. The list of papers was supplemented by extensive cross-checking of citation lists. Studies were included if they met predetermined criteria. Data from the accepted studies were entered into pooled tables comparing radiological and pathological staging results for each modality both in determining bowel wall penetration and involvement of lymph nodes. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were determined for the pooled results. Eighty-three studies from 78 papers including 4897 patients met the inclusion criteria. In determining the wall penetration of the tumour the values for sensitivity for CT, ES, MRI and MRI with endorectal coil were 78%, 93%, 86% and 89%; for specificity 63%, 78%, 77% and 79%; and for accuracy 73%, 87%, 82% and 84%, respectively. In determining the nodal involvement by tumour the sensitivity values for CT, ES, MRI and MRI with endorectal coil 52%, 71%, 65% and 82%; for specificity 78%, 76%, 80% and 83%; and for accuracy 66%, 74%, 74% and 82%, respectively. MRI with an endorectal coil is the single investigation that most accurately predicts pathological stage in rectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050002
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  • 18
    Electronic Resource
    Electronic Resource
    Tibiale Torsionsfehler (2000)
    Springer
    Der Orthopäde 29 (2000), S. 802-807 
    Details
    ISSN: 1433-0431
    Keywords: Schlüsselwörter Unterschenkel ; Torsion ; Tibiatorsion ; Untersuchung ; Therapie ; Kind ; Adoleszente ; Bein ; Entwicklung ; Osteotomie ; Keywords Tibia ; Torsion ; Adolescence ; Child ; Osteotomy ; Diagnosis ; Therapy ; Developmental ; Leg
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Tibial torsion defects are usually not clinically evident and, hence, are often overlooked. Clinical examination and CT scan have proved to be the best ways of measuring static tibial torsion, whereas dynamic measurements are usually performed in the clinic and the “gait laboratory.” Only few studies have determined there to be a connection between a torsion defect in the lower leg and expected pathological conditions of the knee and ankle joints. However, patellofemoral instability, Osgood-Schlatter disease, osteochondrosis dissecans are increasingly being found in cases of increased external tibial torsion and arthrosis in reduced torsion. Although spontaneous correction may occur in certain cases, in others the only way to correct the condition is by employing physiologic torsion. Conservative treatment methods such as bandages or ortheses have been shown to not have any effect on torsion; thus, surgical treatment is the only successful way to correct a pathologic angle of rotation of the tibia. For this, supramalleolar osteotomy with fixation using Kirscher wires and plaster or an external fixator are the most common treatments.
    Notes: Zusammenfassung Tibiale Torsionsfehler sind meistens klinisch nicht sehr evident und werden deshalb häufig übersehen. Zur Messung der statischen Tibiatorsion hat sich am besten die klinische Untersuchung und das CT bewährt, während für die dynamische Messung die Klinik und das Ganglabor zum Einsatz kommen. Es gibt nur wenige Studien, die einen Zusammenhang zwischen einem Torsionsfehler des Unterschenkels (US) und zu erwartenden Pathologien des Knie- und Sprunggelenks nachweisen. Immerhin wurden vermehrt patellofemorale Instabilitäten, Morbus Osgood-Schlatter, Osteochondrosis dissecans bei erhöhter Tibiaaußentorsion und Arthrose bei veminderter Torsion nachgewiesen. Während die Korrektur nach Frakturen in gewissen Fällen spontan erfolgen kann, ist bei andern Ursachen keine Korrektur außer der physiologischen Torsion zu erwarten. Konservative Maßnahmen wie Bandagen oder Orthesen haben nachgewiesenerrmaßen keinen Effekt auf die Torsion, sodass bei pathologischem Drehwinkel der Tibia nur die operative Korrektur zum Erfolg führt. Diese wird meistens in Form einer supramlleolären Osteotomie mit Fixation durch Kirscher-Drähte und Gips oder durch einen Fixateur externe durchgeführt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001320050529
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  • 19
    Electronic Resource
    Electronic Resource
    Kraniomandibuläre Dysfunktion Eine Standortbestimmung (2000)
    Springer
    Manuelle Medizin 38 (2000), S. 335-341 
    Details
    ISSN: 1433-0466
    Keywords: Schlüsselwörter Kiefergelenk ; Kraniomandibuläre Dysfunktion (CMD) ; Kraniozervikale Dysfunktion (CCE) ; Kraniosakrale Dysfunktion (CSD) ; Diagnostik ; Therapie ; Keywords Temporomandibular joint ; Craniomandibular disorder ; Craniocervical disorder ; Craniosacral disorder ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Evaluating the current understanding of craniomandibular disorders means attempting to discern structures among the dysfunctions of this functional disturbance rather than recording the multitude of different forms. Most dentists understand the functioning and dysfunctions of the craniomandibular system (CMS) while most orthopedists have knowledge in the functioning and dysfunctions of the craniocervical systems (CCS), and some are well trained in the disturbances of the craniosacral system (CSS). In clinical practice, however, the specific data and the structural and functional connections are not provided by associative connections. Therefore the figure at the end of the article will help those lacking substantial experience to keep in view the variety of disorders, recognize the inner structure of the dysfunction, consult with colleagues, and begin effective therapeutic procedures.
    Notes: Zusammenfassung Eine bewertende Standortbestimmung zum Thema kraniomandibuläre Dysfunktion vorzunehmen bedeutet nicht, dass versucht wird, die facettenreichen vielgestaltigen Formen von Funktionsstörungen vollständig nachzuzeichnen, sondern vielmehr, das Krankheitsbild – anhand vereinfachter Denkmodelle – durchgängig zu strukturieren. Die meisten Zahnärzte haben Kenntisse über die Funktionen und Dysfunktionen des kraniomandibulären Systems (CMS). Dagegen kennen sich die meisten Orthopäden und Physiotherapeuten gut mit den Funktionen und Dysfunktionen des kraniozervikalen Systems (CCS) aus, etliche auch mit dem kraniosakralen System (CSS). Es sind aber eher die Einzeldaten, die strukturellen und funktionellen Zusammenhänge, die oft nicht durch Assoziationsketten strukturiert sind. Eine tabellarische Übersicht soll deshalb dem noch nicht so Erfahrenen helfen, den Überblick zu behalten und die innere Struktur der Funktionsstörungen zu erkennen, Kollegen gezielt hinzuziehen und die Therapie sinnvoll einzuleiten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003370070005
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  • 20
    Electronic Resource
    Electronic Resource
    Tufted Angioma Fallbeschreibung und Besprechung der aktuellen Therapieoptionen (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 475-478 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Tufted Angioma ; Büschelartiges Hämangiom ; Kutane Tumoren ; Therapie ; Key words Tufted angioma ; Hemangioma ; Cutaneous tumor ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Case report: A 16-month-old girl was admitted with a 6-month history of multiple redishblue plaques on the right abdomen. These proved to have increased in size and number daturing a 1.5-year follow-up. Histologically (including histochemistry and electron microscopy), these skin changes were classified as tufted angioma. Tufted angioma is a rare, often multiple benign tumor. Half of the tumors reported develop in children 5 years and younger. The exclusion of malignant tumors (leukemia, lymphoma, neuroblastoma) is important. A punch biopsy is not very traumatic. A subsequent histological examination is highly sensitive and specific. Therapy: There are a few active therapeutic options with rather severel side effects.
    Notes: Zusammenfassung Fallbericht: Bei einem Mädchen im Alter von 16 Monaten traten seit einem halben Jahr am rechten Abdomen multiple, disseminierte rötliche bis bläulich-bräunliche infiltrierte Plaques auf, die innerhalb des 1,5-jährigen Beobachtungszeitraums weiter an Größe und Anzahl zunahmen. Mittels konventioneller Histologie, Immunhistologie und Elektronenmikroskopie sicherten wird die Diagnose eines Tufted Angioma. Das Tufted Angioma ist ein sehr seltener, häufig multipel vorkommender Tumor gutartigen Charakters. Die Hälfte der berichteten Tumoren entwickelte sich innerhalb der ersten 5 Lebensjahre. Deshalb ist der differenzialdiagnostische Ausschluss eines malignen Geschehens (Leukämie, Lymphome, Neuroblastom) von außerordentlicher Bedeutung. Hierzu ist eine Stanzbiopsie ideal geeignet, da sie einfach durchführbar und nur gering traumatisch ist. Die nachfolgende Histologie hat eine hohe Sensitivität und Spezifität. Therapie: Die aktiven therapeutischen Möglichkeiten müssen eher als eingeschränkt und nebenwirkungsreich gewertet werden. Eine spontane Rückbildung ist möglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050578
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  • 21
    Electronic Resource
    Electronic Resource
    Okuläres vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 113-120 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Okuläres vernarbendes Pemphigoid ; Therapie ; Komplikationen ; Glaukom ; Key words Ocular cicatricial pemphigoid ; Therapy ; Complications ; Glaucoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cicatricial pemphigoid (CP) is a rare autoimmune disease characterized by subepidermal blistering and progressive cicatrization affecting the skin and mucosa. Ocular involvement occurs in approximately 70% of the patients. Methods: The course of the disease, complications and putative risk factors in patients with ocular cicatricial pemphigoid (OCP) treated at the Departments of Ophthalmology and Dermatology were analyzed retrospectively from 1986 to 1998. Results: Eighteen of 28 patients (64%) with CP demonstrated ocular involvement. The mean age of patients with OCP was 73 years; 61% were female. At the time of referral to our hospital, all patients had reached advanced stage III (83%) or IV (17%) of OCP. In 38% of patients vision was already reduced to 〈20/200 at first presentation. Twenty-eight percent of patients additionally suffered from glaucoma. Two patients exhibited life-threatening extraocular manifestations of CP (larynx stricture, esophagus stricture). Conjunctival or mucosal biopsies were performed in 15 patients with OCP and showed typical immunodeposits at the basement membrane zone in 12/15 patients. Therapy with dapsone (12 patients), oral steroids (11 patients), azathioprine (5 patients), cyclophosphamide (4 patients), colchicine (2 patients) and methotrexate (1 patient) was used concomitantly or consecutively. Complications of OCP including entropion, recurrent epithelial erosions, corneal ulcers, keratitis, and corneal perforations required multiple surgical interventions such as entropion surgery (8 patients), tarsorrhaphy (3 patients), mucous membrane grafting (1 patient), amniotic membrane transplantation (1 patient), tectonic keratoplasty (1 patient), keratoprosthesis (1 patient) and enucleation (1 patient). Despite control of the inflammatory process, further visual loss occurred in 53% of eyes. Reading visual acuity could only be maintained in 35% of eyes. Discussion: Early diagnosis and therapy can prevent ocular complications of OCP. This study indicates that advanced stages of the disease often result in irreversible visual loss despite institution of immunosuppressive therapy. Whether or not the high association of OCP with glaucoma and/or anti-glaucomatous treatment in our patients represents part of the underlying disease process or plays a role in the pathogenesis of OCP must still be clarified.
    Notes: Zusammenfassung Das vernarbende Pemphigoid (cicatricial pemphigoid, CP) ist eine seltene, mit subepidermaler Blasenbildung und Vernarbung einhergehende Autoimmunerkrankung, die sich an Haut und Schleimhaut manifestiert. Eine Augenbeteiligung liegt bei etwa 70% der Patienten vor. Methode: Retrospektiv wurden Krankheitsverlauf, klinische Komplikationen und mögliche Risikofaktoren von Patienten der Augen- und Hautklinik mit vernarbendem Pemphigoid von 1986–1998 untersucht. Ergebnisse: 18/28 Patienten (64%) mit CP hatten eine okuläre Beteiligung. Das Durchschnittsalter der Patienten mit okulärem vernarbendem Pemphigoid betrug 73 Jahre, 61% der Patienten waren weiblich. Bereits bei Erstvorstellung in unserer Klinik bestand bei allen Patienten ein Krankheitsstadium III (83%) oder IV (17%), mit einem Visus 〈0.1 in 38% der Augen. Bei 28% der Patienten wurde zusätzlich ein Glaukom diagnostiziert. Zwei Patienten zeigten eine lebensgefährliche extraokuläre Schleimhautbeteiligung (Larynx- bzw. Ösophagusstriktur). Bei 15 Patienten mit okulärem vernarbendem Pemphigoid wurde eine Bindehaut- bzw. Schleimhautbiopsie aus dem Mund oder Nasen-Rachen-Raum durchgeführt, welche die Verdachtsdiagnose bei 12/15 Patienten immunhistologisch sicherte. Eine Therapie mit Dapson (12 Patienten), oraler Kortikosteroidgabe (11 Patienten), Azathioprin (5 Patienten), Cyclophosphamid (4 Patienten), Colchizin (2 Patienten) und Methotrexat (1 Patient) wurde in Folge oder Kombination eingesetzt. Komplikationen wie Lidfehlstellungen, rezidivierende Epitheldefekte, Hornhautulzera, Keratitiden und Hornhaut-Perforationen erforderten multiple operative Eingriffe wie Entropium-Operation (8 Patienten), Tarsorrhaphie (3 Patienten), Kryoepilation (2 Patienten), Mundschleimhaut-Transplantat (1 Patient), Amniontransplantat (1 Patient), tektonische Keratoplastik (1 Patient), Keratoprothese (1 Patient) und Enukleation (1 Patient). Trotz befriedigender Kontrolle des okulären vernarbenden Pemphigoids kam es bei 53% der Augen zum weiteren Visusabfall. Ein Lesevisus konnte nur in 35% der Augen erhalten werden. Schlußfolgerung: Wahrscheinlich kann die Früherkennung und rechtzeitige Behandlung des okulären vernarbenden Pemphigoids okuläre Komplikationen verhindern. Diese Studie zeigt, daß trotz immunsuppressiver Therapie in Spätstadien häufig ein irreversibler Visusverlust resultiert. Es bleibt zu untersuchen, ob die auffällig hohe Assoziation von okulärem vernarbendem Pemphigoid zu Glaukom bzw. antiglaukomatöser Therapie in unserem Patientenkollektiv als Folge der Grunderkrankung oder als pathogenetischer Faktor zu werten ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050021
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  • 22
    Electronic Resource
    Electronic Resource
    Mikroangiographische Darstellung der Gefäßversorgung des medialen Kollateralbandes am Kniegelenk (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 208-214 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Kniegelenkverletzung ; Mediales Kollateralband ; Ruptur ; Gefäßversorgung ; Therapie ; Key words Knee injury ; Medial collateral ligament ; Rupture ; Vascularization ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Because the vascularization of ligaments is an important factor in ligament healing we wanted to examine the vascularization status of the medial collateral ligament of the knee. The type of vascularization was examined by mikroangiographie of 21 postmortem preparations. We could observe a vascularization from the proximal end of the ligament by one or two major vessels in all cases. These vessels were mostly localized in the ventral third of the ligament. From the proximal to the distal part of the ligament we found a decreasing density of blood vessels. We could not observe vessel free ligament areas. Due to this vascularization status we would advise the differentiation of two ligament areas respecting the following therapy. Because of the good vascularization in the proximal part of the ligament we can accept good conditions concerning complete healing after a non-operative treatment and an operative therapy by suture or refixation. In the case of interligamentous and distal ruptures operative reconstruction by sutures often is difficult and a conservative therapy leads to a high rate of poor results. Therefore we advise fibrin bonding in these ligament areas if a surgical procedure is indicated because of the high risk of vessel strangulation after suture.
    Notes: Zusammenfassung Da die Durchblutungsverhältnisse bei Bandrupturen einen wesentlichen Parameter insbesondere bezüglich der Erfolgsaussichten einer chirurgischen Versorgung darstellen, sollte in der vorliegenden Arbeit die Vaskularisation des Knieinnenbandes dargestellt werden. Die spezielle Durchblutungssituation wurde mittels Mikroangiographie an 21 Leichenpräparaten untersucht. Es zeigte sich dabei eine Versorgung von proximal durch 1 oder 2 Hauptgefäßstämme, die bevorzugt in den ventralen Bandanteilen verliefen. Die Gefäßdichte nahm von proximal nach distal sowie von ventral nach dorsal ab. Gefäßfreie Bandabschnitte waren nicht nachweisbar. Aufgrund des proximalen Versorgungstyps kann im proximalen Bandanteil im Vergleich zum distalen Abschnitt mit günstigeren Heilungsvoraussetzungen sowohl nach operativer als auch nach konservativer Therapie gerechnet werden. Dies entspricht den klinischen Erfahrungen. Prognostisch ungünstiger einzustufen sind interligamentäre und distale Bandverletzungen, die insbesondere nach konservativer Behandlung h6auml;ufig unbefriedigende Resultate zeigen. Angesichts der geringeren Vaskularisation der distalen Bandanteile würden wir hier die Bandrekonstruktion mittels Fibrinklebung empfehlen, die eine atraumatische Wiederherstellung ohne die Gefahr der nahtbedingten Gefäßstrangulation erlaubt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050524
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  • 23
    Electronic Resource
    Electronic Resource
    Diagnostik und Therapie von Pseudotumoren der Orbita (2000)
    Springer
    HNO 48 (2000), S. 665-670 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Pseudotumor orbitae ; Histopathologie ; Therapie ; Rhinochirurgische Zugänge ; Keywords Pseudotumor orbitae ; Histopathology ; Therapy ; Rhinosurgical approaches
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that can be divided histopathologically into three basic types: granulomatous, lymphoid, and sclerosing. Between 1995 and 1998, 12 patients with pseudotumor orbitae were treated in the ENT Department of the University of Saarland. Histopathological examination showed granulomatous type of pseudotumor in six, lymphoid in three, and sclerosing in three patients. In seven cases the pseudotumor orbitae were medially located and in four cases laterally. In one patient nearly all orbital structures were infiltrated. Diagnostic biopsy was taken endonasally in six cases, via medial orbitotomy in two cases, and via lateral orbitotomy in four cases. Due to their good delimitation lymphoid and sclerosing tumors were extracted completely during diagnostic biopsy and patients were free of complaints after a few weeks. The six patients with granulomatous pseudotumor were treated primarily with steroids after the diagnosis had been definitely confirmed by histology. In three of those six cases a second course of steroid therapy had to be given, with positive results in two cases. Follow-up was between 6 and 28 months (mean 16 months). There were no postoperative complications. The clinical and radiographic presentation of the pseudotumors can vary greatly. Therefore, the differential diagnosis of specific infections or neoplasms can only be established through diagnostic biopsy. Different rhinosurgical approaches provide clear biopsy results and in some cases the pseudotumor is even completely removed.
    Notes: Zusammenfassung Der Pseudotumor der Orbita ist ein unspezifischer entzündlicher Prozess dessen Genese unbekannt ist und der histologisch in 3 Gruppen unterteilt wird: der granulomatöse, lymphoide und sklerosierende Typ. Zwischen 1995 und 1998 haben wir 12 Patienten mit einem Pseudotumor der Orbita behandelt. Es handelte sich dabei um Fälle vom granulomatösen (n=6), lymphoiden (n=3) und sklerosierenden (n=3) Typ. Bei 7 Patienten war der Pseudotumor im medialen Bereich der Orbita und in 4 Fällen im lateralen Bereich lokalisiert. Bei einer Patientin lag eine diffuse Infiltration annähernd aller orbitalen Strukturen vor. Die Probebiopsie wurde in 6 Fällen endonasal, in 2 Fällen über eine mediale Orbitotomie und bei 4 Patienten über eine laterale Orbitotomie durchgeführt. Die gut abgrenzbaren lymphoiden (n=3) und sklerosierenden (n=3) Pseudotumoren konnten im Rahmen der Probebiopsie komplett entfernt werden, so dass die Patienten nach wenigen Wochen beschwerdefrei waren. Bei den 6 Patienten mit einem granulomatösen Pseudotumor wurde nach der definitiven Histologie eine primäre Kortikosteroidtherapie durchgeführt. In 3 der 6 Fälle kam es dadurch zu einem Rückgang der Beschwerden mit kompletter Ausheilung. Bei den restlichen 3 Patienten war eine erneute Kortisontherapie erforderlich wobei diese nur in 2 Fällen erfolgreich war. Der Nachbeobachtungszeitraum betrug 6–28 (Mittel 16) Monate. Postoperative Komplikationen traten nicht auf. Die klinische Symptomatik und die radiologische Darstellung der Pseudotumoren kann sehr variabel sein, so dass nur durch eine Probebiopsie eine genaue Differenzierung von spezifischen Infektionen und malignen Raumforderungen möglich ist. Die rhinochirurgischen Zugänge erlauben eine sichere Biopsie und in einigen Fällen auch eine komplette Entfernung des Pseudotumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050636
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  • 24
    Electronic Resource
    Electronic Resource
    Hydroa vacciniformis Klinik, Differenzialdiagnosen und therapeutische Möglichkeiten der seltenen Photodermatose am Beispiel einer Kasuistik (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 895-899 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hydroa vacciniformis ; Klinik ; Differenzialdiagnosen ; Verlauf ; Therapie ; Keywords Hydroa vacciniformis ; Clinical features ; Differential diagnoses ; Course ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Case report. This case of a 6 year old boy presents hydroa vacciniformis, a rare skin disease in children which may also affect the eyes and is caused by UVA exposure. It presents as hemorrhagic small blisters in sun exposed areas that heal with a tendency to scarring, usually with recurrent onset at the beginning of the sunny season until adult age. Differential diagnosis. As possible differential diagnoses polymorphic light eruption, erythropoetic protoporphyria and photodermatitis due to external or systemic photosensitizers must be excluded. In rare cases congenital erythropoetic porphyria, hepatic erythropoetic porphyria, Epstein-Barr virus infection, lymphomatoid papulosis and angiocentric cutaneous T-cell lymphoma may cause the clinical symptoms of hydroa vacciniformis. Therapy. Appropriate therapy consists in protection of skin and eyes against direct and indirect UV radiation, especially UVA-radiation.
    Notes: Zusammenfassung Fallbericht. Anhand der Kasuistik eines 6-jährigen Jungen wird die Hydroa vacciniformis, eine seltene, durch UVA-Exposition ausgelöste Dermatose mit möglicher Augenbeteiligung bei Kindern, vorgestellt. In lichtexponierten Bereichen treten zu Beginn der lichtreichen Jahreszeit rezidivierend bis zum Erwachsenenalter akut zahlreiche hämorrhagische Bläschen auf, die narbig abheilen. Differenzialdiagnose. Differenzialdiagnostisch müssen eine polymorphe Lichtdermatose, eine erythropoetische Protophorphyrie und eine Photodermatose durch exogene bzw. systemische Photosensibilisatoren ausgeschlossen werden. In seltenen Fällen können eine Porphyria erythropoetica congenita, eine hepatoerythropoetische Porphyrie, eine Infektion durch Epstein-Barr-Virus, eine lymphomatoide Papulose und ein angiozentrisches kutanes T-Zell-Lymphom klinisch ähnliche Symptome verursachen. Therapie. Die effektive Therapie besteht im Schutz vor direkter und indirekter UV-Exposition für Haut und Augen, insbesondere im UVA-Bereich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050666
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  • 25
    Electronic Resource
    Electronic Resource
    Büschelartiges Hämangiom (“tufted angioma”) des Unterarms Fallbericht und Literaturübersicht (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 832-836 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hämangiom ; Büschelartiges Hämangiom ; Diagnostik ; Therapie ; Keywords Haemangioma ; Tufted angioma ; Vascular lesion ; Diagnostic ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Tufted angioma represents a benign vascular lesion of the skin. The knowledge of this distinctive entity is important in distinction of clinically more aggressive and malignant neoplasms respectively. Case report. We report a 8-months-old girl who developed a deep seated tufted haemangioma on her right forearm. Sonography and MRI showed a good vascularized tumor with interseptal spreading. Histological examination of the incisional biopsy revealed a cellular capillary haemangioma with morphological features of rare tufted haemangioma. Discussion. Characteristic morphological features of tufted haemangioma allow accurate diagnosis and differential diagnosis to clinically more aggressive and malignant neoplasms of skin and soft tissues, wheras radiological methods are rather unspecific and do not distinguish reliably between these vascular lesions. It is of special clinical importance that tufted haemangioma represents an enlarging but biologically benign vascular neoplasm.
    Notes: Zusammenfassung Hintergrund: Das büschelartige Hämangiom (“tufted angioma”) ist ein benigner vaskulärer Tumor der Haut, dessen Kenntnis in der Differenzialdiagnose zu aggressiveren und malignen Tumoren wichtig ist. Fallbericht. Es wird über ein 8 Monate altes Mädchen mit diesem Tumor im Unterarmbereich berichtet. Sonographie und Magnetresonanztomographie zeigten einen gut vaskularisierten Weichgewebetumor, bei dem aufgrund interseptaler Ausbreitung ein maligner Prozess nicht ausgeschlossen werden konnte. Die Histologie der Inzisionsbiopsie ergab ein zellreiches kapillares Hämangiom, dessen morphologische Veränderungen eine Einordnung als ein seltenes büschelartiges Hämangiom erlaubten. Diskussion. Eine Abgrenzung des büschelartigen Hämangioms gegenüber aggressiveren und malignen vaskulären Läsionen der Haut ist aufgrund des typischen histologischen Bilds möglich, während eine Differenzierung mit Hilfe bildgebender Verfahren nicht gelingt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050651
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  • 26
    Electronic Resource
    Electronic Resource
    Rezidivierende paraneoplastische Zerebellopathie und limbische Enzephalitis Fallbericht bei einer Patientin mit Mammakarzinom (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 295-298 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Paraneoplastische zerebelläre Degeneration ; Opsoklonus-Myoklonus-Syndrom ; Limbische Enzephalitis ; Therapie ; Prognose ; Key words Paraneoplastic cerebellar degeneration ; Opsoclonus-myoclonus syndrome ; Limbic encephalitis ; Therapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Paraneoplastic neurological syndromes are rare diseases that occur in relation to cancer. Supporting the hypothesis of an autoimmune mechanism, specific antineuronal antibodies have sometimes been detected. The current possibilities for treatment are limited. A female patient, aged 57, suffering from a breast cancer, developed a severe paraneoplastic cerebellar syndrome and limbic encephalitis within a few weeks. It is possible that the impressive partial remission that occurred during the ensuing 6 months was not due to therapy. Although the patient was still bound to a wheelchair, discharge from hospital was possible because she was still able to perform daily tasks by herself. A recurrence of the cerebellar symptoms with mild alterations of mental status occurred 2 months later but again showed a good remission.
    Notes: Zusammenfassung Paraneoplastische neurologische Syndrome sind seltene Erkrankungen in Assoziation mit einem Tumor, die bei vermutetem Autoimmunmechanismus mit antineuronalen Antikörpern einhergehen können und deren Verlauf therapeutisch nur bedingt beeinflussbar ist. Berichtet wird von einer 57-jährigen Patientin mit Mammakarzinom, die in engem zeitlichen Rahmen sowohl eine schwere paraneoplastische Zerebellopathie als auch eine limbische Enzephalitis entwickelte. In unklarem Zusammenhang zur Therapie kam es innerhalb von 6 Monaten zu einer vergleichsweisen guten Rückbildung beider Syndrome, so dass zwar noch eine partielle Rollstuhlpflichtigkeit bestand, bei weitgehender Selbständigkeit aber eine Entlassung nach Hause möglich war. Ein Rezidiv 2 Monate später mit im Vordergrund stehender zerebellärer Symptomatik verlief ebenfalls günstig.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050560
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  • 27
    Electronic Resource
    Electronic Resource
    Die isolierte Zungenbeinfraktur (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 996-998 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Zungenbeinfraktur ; Diagnostik ; Therapie ; Keywords Hyoid bone fracture ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We present a rare case of isolated hyoid bone fracture caused by direct trauma. We will describe the mechanism of injury, how to find diagnosis and our treatment.
    Notes: Zusammenfassung Wir berichten über den seltenen Fall einer isolierten Zungenbeinfraktur bei einem Jugendlichen durch ein direktes Trauma. Erörtert werden Unfallmechanismus sowie Diagnostik und Therapie.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050658
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  • 28
    Electronic Resource
    Electronic Resource
    Der vergrößerte ventrikuläre Sacculus beim Larynxkarzinom – ein erhöhtes tumorchirurgisches Risiko (2000)
    Springer
    HNO 48 (2000), S. 689-692 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Larynxkarzinom ; Sacculus laryngis ; Therapie ; Keywords Laryngeal carcinoma ; Sacculus laryngis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The case of a 60-year-old female patient with a supraglottic larynx carcinoma (T3N2CM0) and bilateral enlargement of the laryngeal sacculus is presented. On one side, the sacculus opened atypically into the left vestibular fold. The sacculus is a physiologic part of the roof of Morgagni's ventricle, the size of which can vary greatly. These canal-like structures can be the point of origin of cysts, laryngoceles, mucoceles, and pyoceles. Laryngoceles are present in about 5% of larynx carcinomas; their cause is not precisely known. Frequently, a computer tomogram suggests the coincidence of larynx carcinoma and laryngoceles or a large laryngeal sacculus. In oral panendoscopy, these ventricular distensions are difficult to detect even using 70° rigid endoscopes. A planned supraglottic partial resection must take into account early tumor growth along the preformed canals in the preepiglottic space. In this patient, a laryngectomy was performed due to the bilateral involvement of the vocal process and the anterior commissure.
    Notes: Zusammenfassung Es wird der Fall einer 60-jährigen Patientin mit einem supraglottischen Larynxkarzinoms (T3 N2c M0) und beidseitiger Vergrößerung des Sacculus laryngis vorgestellt. Einseitig mündete der Sacculus untypisch auf der linken Taschenfalte. Der Sacculus laryngis ist eine physiologische Ausstülpung des Daches des Morgagni-Ventrikels, dessen Größe sehr variieren kann. Diese gangartigen Strukturen können Ausgangsort von Zysten, Laryngozelen, Mukozelen und von Pyozelen sein. In ca 5% von Larynxkarzinomen liegen Laryngozelen vor, wobei der disponierende Faktor nicht genau bekannt ist. Oftmals ist der Verdacht der Koinzidenz von Larynxkarzinom und Laryngozele oder großem Sacculus laryngis in der Computertomographie zu stellen. In der Panendoskopie sind diese Erweiterungen der Ventrikel auch mit starren Winkeloptiken schwer zu sehen. Bei geplanter supraglottischer Teilresektion muss man an ein frühes Tumorwachstum entlang der präformierten Gänge in den präepiglottischen Raum denken. Bei der Patientin wurde bei beidseitiger Beteiligung der Processus vocales und der vorderen Kommissur eine Laryngektomie durchgeführt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050640
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  • 29
    Electronic Resource
    Electronic Resource
    Stellenwert von Hydrodistension und Blasentraining (2000)
    Springer
    Der Urologe 39 (2000), S. 539-541 
    Details
    ISSN: 1433-0563
    Keywords: Schlüsselwörter Interstitielle Zystitis ; Blasendehnung ; Hydrodistension ; Blasentraining ; Keywords Interstitial cystitis ; Bladder distension ; Bladder training ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Although hydrodistension of the bladder is generally considered standard therapy for interstitial cystitis, scientific data are largely lacking. With the mechanism of action unknown, prospective studies non-existent and the therapeutic effect at best very short-lived, hydrodistension cannot be regarded as a therapeutic standard concept with scientifically validated efficacy. The value of behavioral therapy and bladder training is equally unclear; success can only be anticipated in the very rare subset of patients without pain.
    Notes: Zusammenfassung Obwohl die Hydrodistension der Harnblase ein häufig angewendetes Konzept in der Behandlung der intestitiellen Zystitis (IC) darstellt, ist die wissenschaftliche Datenlage zur therapeutischen Blasendehnung spärlich. Bei ungeklärtem Wirkungsmechanismus, fehlenden prospektiven und kontrollierten Studien und bestenfalls kurzfristiger Effektivität kann die Hydrodistension nicht als therapeutisches Standardkonzept mit wissenschaftlich nachgewiesenem Behandlungserfolg angesehen werden und besitzt eher den Stellenwert eines Heilversuchs. Die Wertigkeit von Blasentraining oder ähnlichen Miktonsverhaltensmodifikationen bei der IC bleibt ebenfalls unklar, ein gewisser Effekt kann allenfalls für die vergleichsweise kleine Untergruppe von IC-Patienten ohne Schmerzkomponente erwartet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001200050405
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  • 30
    Electronic Resource
    Electronic Resource
    Optionen einer kausalen Therapie der männlichen Infertilität (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 104-112 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Männliche Infertilität ; Therapie ; Medikamente ; Spermatogenese ; Oligozoospermie ; Asthenozoospermie ; Key words Male infertility ; Therapy ; Drugs ; Spermatogenesis ; Oligozoospermia ; Asthenozoospermia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Causal treatment regimens of proven effectiveness in controlled studies are only available for cases of male infertility resulting from hypogonadotropic hypogonadism. Drug treatment of retrograde ejaculation is also effective but has so far not been tested in double-blind, placebo-controlled randomized studies. The results of immunosuppressive therapy in cases of immunological male infertility are still controversial . In addition, antiphlogistic and antibiotic treatment of chronic male genital tract infections has not been shown to improve male fertility. Inconsistent results have been obtained with empirical therapy – e.g., with kallikein, tamoxifen, clomiphene, pentoxifylline, mast cell blockers, testolacton, vitamin E, captopril, alpha receptor blockers, glutathione, indometacin, interferon alpha, growth hormone, zinc salts, ketoprofen, mesterone or testosterone undecanoate – or the studies performed are not sufficient to allow a final judgement. Recent studies have indicated a possible impairment of sperm function by pure FSH, while GnrH and FSH have no influence on spermatogenesis in normogonadotropic men.
    Notes: Zusammenfassung Kausale medikamentöse Therapieregime mit in kontrollierten Studien zweifelsfrei nachgewiesener Wirksamkeit stehen nur bei männlicher Infertilität als Folge des hypogonadotropen Hypogonadismus zu Verfügung. Eine medikamentöse Therapie der retrograden Ejakulation ist ebenfalls effektiv, wurde aber bisher nicht durch doppelblinde, placebokontrollierte, randomisierte Studien ü,berprü,ft. Auch immunsuppressive Therapien bei Nachweis von Spermatozoenantikörpern werden bezüglich ihrer klinischen Wirksamkeit uneinheitlich bewertet. Gleiches trifft auf die Gabe von Antibiotika bei chronisch-entzündlichen Veränderungen oder asymptomatischen Infektionen des Urogenitaltraktes zu. Im Gegensatz dazu sind die Angaben bei empirischer Therapie mit z. B. Kallikrein, Tamoxifen, Clomiphen, Pentoxifyllin, Mastzellblockern, Testolakton, Vitamin E, Captopril, α-Rezeptorenblockern, Glutathion, Indometacin, Interferon-α, Wachtumshormon, Zinksalzen, Ketoprofen, Mesterolon oder Testosteronundecanoat entweder widersprüchlich oder die vorgelegten Studien reichen für eine abschließende Bewertung noch nicht aus. Neuere Studien weisen möglicherweise auf eine Beeinflussung von Spermatozoenfunktionen durch pures FSH hin. Dahingegen haben GnRH und FSH bei normogonadotropen Männern keinen Einfluss auf die Spermatogenese.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001290050018
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    Electronic Resource
    Electronic Resource
    Der benigne tenosynoviale Riesenzelltumor im Bereich des oberen Sprunggelenks Seltene Differentialdiagnose eines Weichteiltumors am Fuß (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 479-481 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Riesenzelltumor ; Sprunggelenk ; Differentialdiagnose ; Therapie ; Keywords Giant cell tumor ; Ankle joint ; Differentialdiagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The giant cell synovialoma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovialoma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.
    Notes: Zusammenfassung Bei dem tenosynovialen Riesenzelltumor handelt es sich um eine benigne Neoplasie, die klassischerweise im Bereich der Finger zu finden ist. Dort geht sie in der Regel von Sehnenscheiden aus, seltener aus der Synovialis hervor. Gerade bei den seltenen und atypischen Lokalisationen kann die differentialdiagnostische Abgrenzung gegenüber Lipomen, Ganglien oder malignen Weichteiltumoren schwierig sein. Es wird über einen 21jährigen Patienten mit einem Riesenzellsynovialom im Bereich des linken Innenknöchels berichtet. Die klinischen, radiologischen und pathologisch-anatomischen Befunde werden dokumentiert. Der Tumor wurde in toto reseziert, andere Herde konnten nicht gefunden werden. Die Problematik der richtigen diagnostischen Einordnung wird dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050569
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  • 32
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    Electronic Resource
    Progressive posthämorrhagische Ventrikelerweiterung des Frühgeborenen Inzidenz, Prognose und Therapie (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 1072-1077 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Posthämorrhagische Ventrikelerweiterung ; Frühgeborene ; Therapie ; Keywords Posthemorrhagic ; Hydrocephalus ; Preterm ; Infant ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background. 35% of preterm infants with intraventricular hemorrhage develop ventricular dilatation. The posthemorrhagic ventricular dilatation can persist, be transient or be progressive. Finally 1–2% of all very low birthweight (VLBW 〈1500 g) infants require shunt placement for the treatment of the posthemorrhagic hydrocephalus. Outcome. The neurodevelopmental outcome is extremely poor in children surviving progressive posthemorrhagic ventricular dilatation. Therapy. There are no uniform guidelines for the treatment of preterm infants with progressive posthemorrhagic ventricular dilatation. Randomised multicenter trials demonstrated, that inhibition of cerebrospinal fluid production with acetazolamide and furosemide or early cerebrospinal fluid tapping did not reduce the need for shunt placement and may worsen the outcome or can be associated with adverse side-effects. Preterm infants with posthemorrhagic ventricular dilatation should be treated by standard therapy with uniform guidelines for cerebrospinal fluid tapping and shunt placement.
    Notes: Zusammenfassung Hintergrund. 35% der Frühgeborenen entwickeln nach einer intraventrikulären Blutung eine Ventrikelerweiterung. Die posthämorrhagische Ventrikelerweiterung kann persistieren, transient oder progressiv sein. Letztlich entwickeln 1–2% der Frühgeborenen mit einem Geburtsgewicht 〈1500 g einen shuntpflichtigen posthämorrhagischen Hydrozephalus. Prognose. Die Prognose von Frühgeborenen mit progressiver posthämorrhagischer Ventrikelerweiterung ist hinsichtlich Mortalität und neurologischer Morbidität noch sehr ungünstig. Therapie. Bisher gibt es keine einheitlichen Therapierichtlinien für Frühgeborene mit progressiver posthämorrhagischer Ventrikelerweiterung. Multizenterstudien zeigten, dass die medikamentöse Hemmung der Liquorproduktion mit Azetazolamid und Lasix oder frühzeitige serielle Liquorpunktionen die Shuntpflichtigkeit nicht vermindern und den Verlauf und die Prognose sogar ungünstig beeinflussen. Die Erkenntnisse aus diesen Studien mahnen zur Vorsicht. Frühgeborene mit posthämorrhagischer Ventrikelerweiterung sollten außerhalb von Studien möglichst konservativ und zurückhaltend mit einheitlichen Kriterien für Liquorpunktion und Shuntimplantation behandelt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050696
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  • 33
    Electronic Resource
    Electronic Resource
    Therapie des Kleinwuchses mit Wachstumshormon Entwicklungen 10 Jahre nach der Einführung von rekombinantem Wachstumshormon (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 746-761 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Wachstumshormon ; Kleinwuchs ; Therapie ; Demographie ; Pharmakoepidemiologie ; KIGS [Kabi] Pharmacia & Upjohn International Growth Study) ; Key words Growth hormone ; Short stature ; Therapy ; Demography ; Pharmaco-epidemiology ; KIGS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Recombinant growth hormone (rGH) therapy in the treatment of children with short stature was introduced 10 years ago, and experience has shown that progress in implementing this mode of therapy depends increasingly on analyses of large pharmaco-epidemiological studies. These studies prove that the diagnosis of growth hormone deficiency, whatever the cause or pathogenetic form, is the most frequent indication for GH therapy. The remaining problems are timely and precise diagnosis, and the best possible and individual therapy aiming at the projected height and taking safety and costs into account. We are closer to solving these problems today than ever before. Apart from this, the use of GH in treating short stature in Turner syndrome and renal insufficiency has led to its acceptance as a suitable therapy for these patients. Height improvement in a number of other growth disorders is, in certain cases, also possible through GH therapy. In the light of current experience, GH therapy can thus be attempted on a rational basis in individual cases. This form of treatment clearly holds wider possibilities and its implementation is likely to go beyond short stature in the future.
    Notes: Zusammenfassung 10 Jahre nach der Einführung von rekombinantem Wachstumshormon (WH) in die Therapie kleinwüchsiger Kinder werden unsere Erfahrungen zunehmend auch durch Analyse umfangreicher pharmako-epidemiologischer Beobachtungen geprägt. Wachstumshormonmangel: Diese zeigen, daß der Wachstumshormonmangel in seinen unterschiedlichen Ursachen und pathogenetischen Erscheinungsformen nach wie vor die häufigste Indikation für WH darstellt. Die Probleme bestehen weiterhin in der rechtzeitigen und rationellen Diagnostik und in der Optimierung und Individualisierung der Therapie zum Erreichen der Wachstumsziele unter ökonomischen Gesichtspunkten und bei gleichzeitiger therapeutischer Sicherheit. Diese Probleme sind für den WH-Mangel heute lösbar. Weitere Indikationen: Ferner zeigt sich, daß auch der Kleinwuchs beim Ullrich-Turner-Syndrom und bei der Niereninsuffizienz, für welche WH zugelassen ist, erfolgreich behandelt werden kann. Bei einer Vielzahl anderer Wachstumsstörungen ist die Möglichkeit zur Größenverbesserung im Einzelfall gegeben. Vor dem Hintergrund heutiger Erfahrungen kann ein individueller Heilversuch so auf eine rationale Basis gestellt werden. Zukunftsperspektiven: In Zukunft wird das breite Wirkpotential von Wachstumshormon über die Indikation des Kleinwuchses hinaus ausgeschöpft werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050633
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    Electronic Resource
    Tarsaltunnelsyndrom (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 341-343 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Tarsaltunnelsyndrom ; Ätiologie ; Trauma ; Diagnose ; Therapie ; Keywords ; Tarsal tunnel syndrome ; Aetiology ; Trauma ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In this paper we describe the tarsal tunnel syndrome with reference to our own experience in 10 cases and the literature. Compared with the numerous injuries involving the ankle and foot, the diagnosis of tarsal tunnel syndrome is rare. In the case of a painful foot of unknown aetiology, the differential diagnosis should therefore include tarsal tunnel syndrome. Our presentation discusses the aetiology and pathology of the tarsal tunnel syndrome, and particularly that caused by trauma. We also describe an effective therapeutic approach based on surgical decompression.
    Notes: Anhand der Literatur und eigenen Erfahrungen von 10 Operationen wird das Tarsaltunnelsyndrom dargestellt. Gemessen an der Vielzahl der Traumen im Sprunggelenk- und Fersenbeinbereich wird die Diagnose selten gestellt. Bei unklaren Fußschmerzen sollte daher differenzialdiagnostisch ein Tarsaltunnelsyndrom in Erwägung gezogen werden. Es wird auf die Ätiologie, die Pathologie sowie auf den Zusammenhang zu Traumen eingegangen und die effektive Therapie durch operative Dekompression beschrieben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390000310
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  • 35
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    Electronic Resource
    Schultergelenknahe Oberarmfrakturen einschließlich Endoprothetik (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S180 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Humeruskopffraktur ; Diagnostik ; Therapie ; Keywords Fracture of the head of the humerus ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Fractures of the head of the humerus present a challenge both at the stages of diagnosis and treatment. Fortunately, 70–80% ¶of all fractures of the humeral head can be treated conservatively because they are not dislocated. When dislocation is present detailed understanding of the morphology of such fractures and purposeful application of internal fixation techniques are essential for the achievement of good shoulder function. Every step of the treatment is aimed at stability of the joint with its components as close as possible to their original anatomical positions. This can generally be managed with minimally invasive approaches and/or with the bone fragments preserved. We regard depression fractures of the humeral head (〉 45%) in active, older patients –¶who are frequently affected – as a primary indication for a shoulder replacement. Four-fragment fractures with displacement of the head fragment in an older, physically active patient can also occasionally be an indication for primary joint replacement. Both for conservatively treated and for operatively treated fractures of the humeral head a customized schedule of follow-up treatment should be applied, to avoid the precipitation of secondary frozen shoulder by too-passive behaviour. On the other hand, neither should the follow-up treatment programme lead to a secondary dislocation. For restoration of the function it is therefore absolutely essential that the trauma surgeon monitor the treatments applied.
    Notes: Zusammenfassung Humeruskopffrakturen stellen eine Herausforderung an die Diagnostik und die Therapie dar. Glücklicherweise können 70–80% davon konservativ behandelt werden, da sie nicht disloziert sind. Im Fall der Dislokation sind ein differenziertes Verständnis der Frakturmorphologie und der zielgerichtete Einsatz osteosynthetischer Techniken unabdingbare Voraussetzung einer guten Schulterfunktion. Ziel jedweder Behandlungsmaßnahme ist das Erreichen einer stabilen Situation in möglichst anatomiegerechter Position. Dies kann überwiegend mit minimalinvasiven Zugängen bzw. unter Schonung der Knochenfragmente erreicht werden. Besonders im Fall der Humeruskopfimpressionsfrakturen (〉 45%) beim häufig betroffenen älteren, aktiven Patienten sehen wir eine primäre Indikation zur Schulterendoprothese. Ebenso stellen die 4-Fragment-Frakturen mit Verschiebung des Kopffragments bei älteren, biologisch aktiven Patienten eine gelegentliche Indikation zum primären Gelenkersatz dar. Sowohl für die konservativ als auch für die operativ behandelten Humeruskopffrakturen sollte ein differenziertes Nachbehandlungsschema Anwendung finden, um nicht durch zu passives Verhalten eine sekundäre Schultersteife zu initiieren. Auf der anderen Seite sollte ein Nachbehandlungsprogramm auch nicht zur sekundären Dislokation führen. Die unfallchirurgische Kontrolle der Behandlungsmaßnahmen ist daher zwingende Voraussetzung einer bestmöglichen Wiederherstellung der Funktion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014884
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    Electronic Resource
    Arbeitsunfall und psychische Gesundheitsschäden (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S450 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Psychisches Trauma ; Psychische Störungen ; Versicherungsschutz ; Kausalität ; Heilverfahrenssteuerung ; Therapie ; Begutachtung ; Keywords Psychological trauma ; Psychological disorders ; Insurance cover ; Legal causality ; Case management ; Therapy ; Expert reviewing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Accident insurance agencies are confronted with an increasing number of cases in which psychological damage occurs immediately at the time of the traumatic events, or in their aftermath. This article reviews the stipulations governing insurance cover and benefits and the legal principles of causality issues in the case of psychological traumas and disorders resulting from such incidents. Insurance agencies face special challenges for case mangagement, since there are no well-established procedures for physicians and hospitals to follow in such cases. Irrespective of the often difficult causality and liability issues, immediate therapy should be given absolute priority. More attention should be paid to psychological damage, with the aims of improving methods of medical rehabilitation and establishing guidelines for expert review in such cases.
    Notes: Zusammenfassung Die Unfallversicherungsträger sind mit einer zunehmenden Zahl von Fällen konfrontiert, bei denen psychische Gesundheitsschäden unmittelbar bei dem Unfallereignis auftreten oder sich nachfolgend entwickeln. Der Beitrag gibt einen Überblick über Grundsätze des Versicherungsschutzes und Kausalitätsfragen bei psychischen Traumen und psychischen Störungen als Folge eines Versicherungsfalls. Für die Unfallversicherungsträger ergeben sich besondere Anforderungen an die Steuerung des Heilverfahrens, da nicht auf das für organische Verletzungen etablierte System besonderer Heilverfahrensarten, wie z. B. das Durchgangsarztverfahren, zurückgegriffen werden kann. Unter allen Umständen hat die Therapie unbedingten Vorrang, unabhängig von der kausalrechtlichen Fragestellung nach dem zuständigen Leistungsträger. Psychischen Gesundheitsschäden ist vermehrt Aufmerksamkeit zu schenken mit dem Ziel, geeignete Maßnahmen der medizinischen Rehabilitation weiterzuentwickeln und Konventionen für die Begutachtung zu schaffen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014969
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    Electronic Resource
    Frakturen und Luxationen am proximalen Unterarm (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S194 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Fraktur ; Luxation ; Radiusköpfchen ; Olekranon ; Processus coronoideus ; Behandlung ; Keywords Fracture ; Dislocation ; Radial head ; Olecranon ; Coronoid process ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Because of its central location, the elbow joint is considered the most important joint within the upper extremity from the viewpoint of function. Trauma to osseous and ligamentous structures of the proximal forearm confronts trauma surgeons and orthopedic specialists with numerous diagnostic and therapeutic challenges. Conditions following elbow trauma are often accompanied by chronic pain and diminished range of motion, leading to functional deficits of the entire arm. There is now practically no doubt that primary osteosynthesis, anatomical joint reconstruction and early onset of functional treatment are essential for a good ¶final outcome. With our expanding knowledge of the anatomical and biomechanical condtions in the proximal lower arm in the last few decades the basic principles of therapy have also changed, and current standards of treatment for proximal forearm trauma are presented in this paper with reference to the relevant literature.
    Notes: Zusammenfassung Das Ellbogengelenk ist aufgrund seiner zentralen Lage aus funktionellen Gesichtspunkten als das bedeutendste Gelenk der oberen Extremität anzusehen. Knöcherne und ligamentäre Verletzungen im Bereich des proximalen Unterarms konfrontieren den behandelnden Arzt mit einer Anzahl von diagnostischen und therapeutischen Problemen. Posttraumatische Zustände am Ellbogengelenk, die mit chronischer Schmerzsymtomatik und Bewegungseinschränkungen einhergehen, mindern zwangsläufig die Gebrauchsfähigkeit des gesamten Arms. Es besteht heute kaum noch ein Zweifel daran, dass in der Mehrzahl der Fälle eine primäre definitive osteosynthetische Versorgung mit exakter Rekonstruktion der Gelenkfläche für ein befriedigendes Resultat ebenso unverzichtbar ist wie ein frühzeitiger Beginn physiotherapeutischer Übungsmaßnahmen. Mit zunehmendem Verständnis der anatomischen und biomechanischen Besonderheiten des proximalen Unterarms vollzog sich in den letzten Dekaden ein entscheidender Wandel der therapeutischen Grundsätze, deren aktueller Stand in der vorliegenden Arbeit unter Berücksichtigung der relevanten Literatur vorgestellt wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014886
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    Electronic Resource
    Chemokines: new target molecules in renal diseases (2000)
    Springer
    Clinical and experimental nephrology 4 (2000), S. 273-280 
    Details
    ISSN: 1437-7799
    Keywords: Key words Chemokine ; Chemokine receptor ; Kidney ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The presence of leukocytes in the diseased kidneys is a hallmark of almost any kind of renal disease. Activated leukocytes are implicated in playing a crucial role in the pathogenesis of renal diseases. Recent investigations of the pathophysiological roles of chemokines and their cognate receptors have shed light on the detailed molecular mechanisms of leukocyte trafficking and activation in the diseased kidneys. This study summarizes findings that: (1) chemokine/chemokine receptor systems may be essentially involved in the pathogenesis of phase-specific renal disorders, (2) the measurement of urinary levels of chemokines may be clinically useful for monitoring different disease phases and activities in human renal diseases, and (3) interventions in chemokine/chemokine receptor systems may have potential as particular immunotherapeutic strategies to combat specific phases of renal diseases. Further investigations of anti-chemokine therapies for renal diseases will be required before clinical application is feasible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101570070001
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  • 39
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    Electronic Resource
    Peutz-Jeghers syndrome: is family screening needed? (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 437-439 
    Details
    ISSN: 1437-9813
    Keywords: Key words Peutz-Jeghers syndrome ; Intestinal polyposis ; Intussusception ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a 7-year-old boy, a small-bowel polyp was found intraoperatively as a lead point of an intussusception. Histologically, a hamartoma was found and the clinical work-up revealed Peutz-Jeghers syndrome (PJS). Additionally, all four asymptomatic siblings showed intestinal polyposis. All children in a family with PJS should be properly investigated. In case of an intussusception with a polyp in a critical location, a surgical procedure should follow.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003839900296
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  • 40
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    Electronic Resource
    Anti-retroviral treatment in Nigeria: a review (2000)
    Springer
    Journal of infection and chemotherapy 6 (2000), S. 196-199 
    Details
    ISSN: 1437-7780
    Keywords: Key words Anti-retroviral ; Therapy ; Nigeria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Research studies in Nigeria have been done primarily in the areas of epidemiology, clinical practice, virology, and laboratory diagnosis. Therapy for infection with human immunodeficiency virus (HIV) types 1 and 2 has largely focussed on the treatment of the HIV disease (AIDS) rather than the infection. Therefore, opportunistic infections such as tuberculosis, diarrhea, Herpes zoster, and other skin conditions, and tumors (Kaposi's sarcoma) are essentially the targets for therapy. Two reasons are responsible for the dearth of data on anti-retroviral therapy in Nigeria: there was scepticism about zidovudine, the first anti-retroviral drug to be developed, because of its toxicity, and the subsequent reluctance of the Federal Government to allow it into the country. The other reason was the prohibitive cost, making it impossible for patients to afford. That notwithstanding, there have been several uncoordinated and unpublished clinical trials by hospitals in the private sector, as expected, without firm laboratory monitoring or back-up. This review discusses such attempts and the claims of traditional medicine practitioners, as well as pilot studies on private patients with the combination therapy of zidovudine and lamivudine, which agents were allowed into the country in the late 1990s. The patients showed appreciable rises in their CD4 counts, an indirect way of monitoring viral load. This finding was corroborated with results of clinical wellbeing, indicating that they benefitted from the administration of zidovudine and lamivudine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101560070002
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    Electronic Resource
    Macrodystrophia lipomatosa with associated fibrolipomatous hamartoma of the median nerve (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 216-218 
    Details
    ISSN: 1437-9813
    Keywords: Key words Macrodystrophia lipomatosa ; Fibrolipomatous hamartoma ; Magnetic resonance imaging ; Median nerve
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Macrodystrophia lipomatosa (MDL) is a rare disease typically causing localized gigantism and is often associated with a fibrolipomatous hamartoma (FH) of the median or plantar nerve. A previously unreported case of MDL with associated FH of the median nerve is presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050728
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    Electronic Resource
    Imaging of plant-thorn synovitis (2000)
    Springer
    Skeletal radiology 29 (2000), S. 605-608 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Plant-thorn synovitis ; Monoarticular arthritis ; Elbow ; Magnetic resonance imaging ; Ultrasound ; Power Doppler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe a case of plant-thorn synovitis of the elbow resulting from a thorn injury. This caused recurrent pain and swelling of the elbow over a 3-month period. A magnetic resonance imaging examination was initially requested to exclude septic arthritis, and demonstrated a joint effusion, synovitis, and a 2-cm linear opacity embedded in the synovium. Ultrasound was performed prior to surgery to confirm these findings and provide accurate localization of the thorn fragment, later removed at surgery. To our knowledge this is the first example of this condition that has been confirmed by radiological imaging prior to surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000244
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  • 43
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    Electronic Resource
    Effect of low back posture on the morphology of the spinal canal (2000)
    Springer
    Skeletal radiology 29 (2000), S. 217-223 
    Details
    ISSN: 1432-2161
    Keywords: Key words Spinal canal ; Low back posture ; Morphologic change ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To define the possible mechanism of posture-dependent symptoms of spinal stenosis by measuring the effect of low back posture on morphologic changes of the intervertebral discs and spinal canal in healthy young people. Design.Twenty healthy young volunteers underwent magnetic resonance imaging while supine with their spine in neutral, flexed, extended, and right and left rotational positions. The axial MR images at the middle of the intervertebral discs of L3–4 and L4–5 were analyzed to measure the difference in the size and shape of the intervertebral discs and spinal canal in each posture. Results.  Extension or rotation decreased the sagittal diameters and cross-sectional areas of the dural sac and spinal canal and increased the thickness of the ligamentum flavum, whereas flexion had the opposite effects. The gap between the convex posterior disc margin and the anterior margin of the facet joint on each side, represented as the subarticular sagittal diameter, increased with flexion and decreased with extension or rotation. The direction of rotation did not result in asymmetry of the subarticular sagittal diameter, but right rotation caused thickening of the right ligamentum flavum, and vice versa. The shape and dimensions of the disc did not change significantly according to the positions of the low back. Conclusions.With extension or rotation, the thickness of the ligamentum flavum increased and the posterior margin of the intervertebral disc was approximated to the facet joint without any change in shape and size of the disc. These phenomena result in a decrease in the size of the spinal canal and dural sac in extension or rotation postures in young healthy people without disc degeneration, and may explain the posture-dependent symptom of spinal stenosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050596
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    Complete rupture of the distal semimembranosus tendon with secondary hamstring muscles atrophy: MR findings in two cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 362-364 
    Details
    ISSN: 1432-2161
    Keywords: Key words Hamstring muscles ; Semimenbranosus ; Tear ; mass ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Complete rupture of the hamstring muscles is a rare injury. The proximal musculo-tendinous junction is the most frequent site of rupture. We present two cases of complete rupture of the distal semimenbranosus tendon, which clinically presented as soft-tissue masses. MR imaging permitted the correct diagnosis. There has been only one other such case reported.
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    URL: http://dx.doi.org/10.1007/s002560000216
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  • 45
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    Electronic Resource
    Solid aneurysmal bone cyst in the humerus (2000)
    Springer
    Skeletal radiology 29 (2000), S. 470-473 
    Details
    ISSN: 1432-2161
    Keywords: Key words Aneurysmal bone cyst ; Humerus ; Giant cell reparative granuloma ; Pathological fracture ; Radiography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a 69-year-old woman with a solid variant of aneurysmal bone cyst (solid ABC) in the left humerus with a pathological fracture. Radiographically, the lesion exhibited a relatively well-defined osteolytic lesion in the diaphysis of the left humerus. On magnetic resonance (MR) imaging, the medullary lesion exhibited a homogeneous signal intensity isointense with surrounding normal muscles on the T1-weighted images and a mixture of low and high signal intensity on the T2-weighted images. Contrast-enhanced T1-weighted images revealed diffuse enhancement of the entire lesion. The pathological study showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells in a collagenous matrix. Abundant osteoid formation in the matrix was observed, but the cells were devoid of nuclear atypia. Aneurysmal cystic cavities were absent. A review of the English literature found 22 cases of solid ABC of the long bones.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000236
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  • 46
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    Electronic Resource
    Juxta-articular hemangioma of long bone (2000)
    Springer
    Skeletal radiology 29 (2000), S. 535-537 
    Details
    ISSN: 1432-2161
    Keywords: Key words Computed tomography ; Intraosseous hemangioma ; Magnetic resonance imaging ; Epiphysis equivalent ; Tibia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a rare case of an intraosseous hemangioma involving the proximal tibia in a 70-year-old man. Radiographically, the lesion was a well-defined osteolytic lesion with marginal sclerosis. The CT images demonstrated a well-defined osteolytic lesion with partial cortical breakthrough. T1-weighted MR images showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000256
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  • 47
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    Electronic Resource
    Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation (2000)
    Springer
    Skeletal radiology 29 (2000), S. 402-408 
    Details
    ISSN: 1432-2161
    Keywords: Key words Soft tissue ; Magnetic resonance imaging ; Sparganosis ; Sparganosis ; magnetic resonance imaging ; Sparganosis ; ultrasonography ; Parasitic infection ; Sparganum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To document the imaging characteristics of subcutaneous and musculoskeletal sparganosis. Design and patients. Ten patients with musculoskeletal sparganosis were examined, with a variety of imaging modalities including MRI (n=6), ultrasonography (n=8), plain radiography (n=7) and CT (n=1). Pathologic correlation was carried out in all cases. Results. Nine lesions involved soft tissues, of which seven were in the thigh, two in the trunk and one involved a vertebral body. The majority of the lesions in soft tissue were confined to the subcutaneous layer but two extended deep into underlying muscles. Sonography revealed low-echoic serpiginous tubular tracts (8/8), and an intraluminal echogenic structure (4/8). MRI revealed multiple serpiginous tubular tracts and peripheral rim enhancement. Two patients showed perilesional soft tissue edema. Pathologically, the lesion consisted of a larva surrounded by three layers of inflammation: an inner epithelioid granulomatous cell layer, middle chronic inflammatory cell layers, and an outer fibrous layer. Conclusion. The study suggests that if serpiginous tubular tracts are seen at imaging studies, musculoskeletal sparganosis should be included in the differential diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000206
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  • 48
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    Electronic Resource
    Pectoralis major muscle and tendon tears: diagnosis and grading using magnetic resonance imaging (2000)
    Springer
    Skeletal radiology 29 (2000), S. 305-313 
    Details
    ISSN: 1432-2161
    Keywords: Key words Pectoralis major muscle ; Magnetic resonance imaging ; Tendons ; injuries ; Tendons ; magnetic resonance imaging ; Muscles ; injuries ; Muscles ; magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To assess the accuracy and utility of magnetic resonance (MR) imaging in the detection and grading of pectoralis major muscle and tendon tears. Design and patients. A retrospective review was carried out of 10 patients referred for MR imaging for suspected pectoralis muscle injury and possible operative therapy. The pectoralis muscle and tendon were imaged using thin (3–4 mm) axial sections with a variety of sequences combined for anatomical delineation (T1-weighted SE or PD SE) and fluid detection (T2-weighted SE, T2-weighted FSE with fat suppression, or STIR). Surgical correlation was available in six patients. Clinical follow-up was available in four patients treated by nonoperative therapy. Results. MR imaging identified five complete tears, four partial tears and one normal tendon. One complete and one partial tear were at the myotendinous junction. The remaining seven injuries were at the enthesis. Surgical correlation consisted of five complete tears and one partial tear. One complete and one partial tear were at the myotendinous junction with the remaining four complete tears at the enthesis. The MR interpretation and surgical findings were in agreement in all six cases. All four patients treated with nonoperative therapy demonstrated improvement at a clinical follow-up examination, with restoration of function and strength consistent with a healed prior partial injury. Conclusion. MR imaging is accurate and useful in detecting and grading tears involving the pectoralis major muscle and tendon, facilitating the identification of patients with complete tears who are candidates for operative therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000199
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  • 49
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    Imaging in isolated sacral tuberculosis: a review of 15 cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 392-396 
    Details
    ISSN: 1432-2161
    Keywords: Key words Sacral ; Tuberculosis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To review imaging studies of isolated involvement of the sacrum due to tuberculosis and determine the role of imaging in the diagnosis and management of these patients. Design and patients. A retrospective analysis of 15 cases of isolated sacral tuberculosis imaged with MR imaging was performed. The CT images were also reviewed where available, and the various lesion characteristics were identified. We also reviewed the medical records in an attempt to determine the impact of the imaging studies on the management of these patients. Results. Fifteen patients (5 male, 10 female) presented with symptoms of 3–15 months’ duration. Chronic localized backache with muscle spasm was the commonest presenting symptom; discharging sinuses with abscess formation was found in six patients, five of whom were children. MR imaging of the sacrum revealed a hypointense marrow signal on T1-weighted images and hyperintense signal on T2-weighted images in 14 of 15 patients, the S2 vertebra being always involved. CT revealed osteolytic changes in the sacrum in all the five patients in whom CT was performed. All patients showed marked clinical improvement within 1 year of anti-tuberculous chemotherapy. Conclusion. Isolated tuberculosis of the sacrum is uncommon but should be suspected in patients presenting with chronic low backache or children with discharging sinuses/abscesses and showing sacral destruction on CT or MR imaging. MR imaging can identify cases and enables early institution of anti- tuberculous chemotherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000229
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    Juxtacortical chondromyxoid fibroma arising in an apophysis (2000)
    Springer
    Skeletal radiology 29 (2000), S. 466-469 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bone neoplasm ; Chondromyxoid fibroma ; Femur ; Apophysis ; Radiography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We present a rare case of juxtacortical chondromyxoid fibroma arising in the lesser trochanter of the right femur which corresponds to an apophysis. Radiography showed a well-defined expansive lesion with a sclerotic margin measuring 5×3.5 cm in diameter in the lesser trochanter. On spin echo T1-weighted images, the lesion revealed low signal intensity similar to muscle. On spin echo T2-weighted images, the lesion revealed high heterogeneous signal intensity, which after gadolinium injection showed heterogeneous enhancement. The inner margin of the cortex was intact and adjacent bone marrow was of normal signal intensity. The outer margin of the lesion was also clearly defined and extension into adjacent soft tissue beyond the exophytic cortical outgrowth was not evident.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000245
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    Familial occurrence of glenoid dysplasia: report of two cases in two consecutive generations (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 349-351 
    Details
    ISSN: 1434-3916
    Keywords: Key words Glenoid dysplasia ; Magnetic resonance imaging ; Multidirectional shoulder dislocation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Glenoid dysplasia is a rare abnormality of the shoulder. We report glenoid dysplasia in two consecutive generations: a boy and his father. Both suffered recurrent shoulder dislocations, and radiological examination revealed bilateral glenoid dysplasia. Our cases confirm dominant inheritance of this osseous malformation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050481
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    Kraniofaziale Fehlbildungen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S068 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Kraniofaziale Fehlbildungen ; Deformationen des Hirn- und Gesichtsschädels ; Therapie ; Frontoorbitales Advancement ; Key words ; Craniofacial malformations ; Craniofacial skull deformations ; Therapy ; Frontoorbital advancement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Most craniofacial malformations result from a premature fusion of skull sutures. Depending on the scope of the sutures affected, the results are more or less distinct deformations of the facial and cranial skull with substantial negative effects on functional as well as esthetic aspects. The etiopathology is still unclear. Various therapies have been developed over the past 100 years. However, Tessier’s technique of fronto-orbital advancement has been an important milestone in the treatment of these malformations. Numerous adjustments have since perfected this operational technique. It is now possible to treat practically all skull malformations with the surgical techniques available today. At the same time, these techniques have also aided the advancements in tumor surgery and traumatology.
    Notes: Zusammenfassung Kraniofaziale Fehlbildungen entstehen überwiegend durch die vorzeitige Verknöcherung von Schädelnähten. Je nach Nahtbefall resultieren daraus mehr oder weniger ausgeprägte Deformationen des Hirn- und Gesichtsschädels, die sowohl zu einer funktionellen als auch zu einer ästhetischen Beeinträchtigung führen. Die Ätiopathogenese ist noch weitgehend ungeklärt. In den vergangenen 100 Jahren wurden verschiedene Therapieansätze entwickelt, wobei Tessier mit der Technik des frontoorbitalen Advancements der entscheidende Fortschritt gelang. Aufbauend auf dieser Operationstechnik wurden bis heute zahlreiche Verbesserungen eingebracht. Mit den heutigen Operationstechniken ist es möglich, praktisch alle Schädelfehlbildungen zu therapieren. Gleichzeitig konnten durch diese Techniken auch Fortschritte in der Tumorchirurgie und der Traumatologie erzielt werden.
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    Gefäß- und Nervenmalformationen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S076 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Gefäßmalformation ; Nervenmalformation ; Neurofibromatose ; Hämangiom ; Therapie ; Key words ; Vascular malformation ; Neural malformation ; Neurofibromatosis ; Hemangioma ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The presentation of vascular and neural malformations in an understandable terminology permits accurate diagnosis, proper treatment, individualized prognosis, and also stimulates studies of pathogenesis. The descriptive classification includes: NF 1 and NF 2; hemangiomas, low- and high-flow vascular malformations, combined malformations, and hypertrophy; and syndromes such as, Parkes Weber, Klippel-Trénaunay, Maffuci’s, and multiple dysplasia syndromes. Lymphatic malformations are abnormalities of lymphatic development. The list of treatment includes surgical and nonsurgical treatment. Not all vascular malformations can be successfully treated. Coping with NF is a challenge for both, affected individuals and health care professionals. NF is often associated with a myriad of anomalies that present a lot of problems for plastic surgery. In certain cases watchful waiting seems justified but not in cases of severe problems, giant growth, and local complications.
    Notes: Zusammenfassung Die Frage der Terminologie ist im Zusammenhang mit vaskulären und nervalen Malformationen besonders wichtig. Dies gilt nicht nur im Hinblick auf die Wahl des richtigen Therapieverfahrens, sondern auch im Hinblick auf die individuell ausgerichtete Prognose und natürlich auch zur Beantwortung der die Pathogenese betreffenden Fragen. Es ist klar, dass bei Besprechung der Neurofibromatose zunächst an die NF 1 und NF 2 gedacht wird, die Hämangiome werden entsprechend ihrer Durchblutung und auch im Hinblick auf die Kombination mit den so ¶genannten Hypertrophiesyndromen, die später im Text genannt werden, eingeteilt. Dass die Bezeichnung Lymphangiom impliziert, es handle sich um einen Tumor, mag nicht ganz richtig sein, da anscheinend die für Tumoren üblichen Mitosen vermisst werden. Interessant ist das therapeutische Spektrum und dies gilt für alle Malformationen der Gefäße und Nerven, aber ganz besonders natürlich für die Neurofibromatose und die Hämangiome. Mit der NF konfrontiert zu sein, bedeutet für den Patienten und das ärztliche Personal eine lebenslange Herausforderung, darüber hinaus ist die NF häufig mit einer Unzahl von Einzelproblemen vergesellschaftet, die für die plastische Chirurgie z. T. schwere oder nicht zu lösende Probleme darstellen. Die große Zahl an Therapievorschlägen zeigt, dass die Gefäßmalformationen zum einen sehr unterschiedliche Probleme zeigen, und zum anderen, dass es kaum ein Therapieverfahren gibt, welches keinen Wunsch offen lässt. Wichtig ist der Hinweis, dass schnell wachsende Hämangiome durchaus im Anfangsstadium entfernt werden sollten, zuwartende Haltung ist in bestimmten Fällen gerechtfertigt, aber nicht, wenn sich schwere Probleme, Riesenwachstum und lokale Komplikationen einstellen.
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    Tumorchirurgie (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S142 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Tumoren im Kopf-Hals-Bereich ; Therapie ; DÖSAK-Richtlinien ; Key words ; Tumors in the head and neck area ; Therapy ; DÖSAK guidelines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Surgery is still the primary therapeutic approach in treatment of tumors in the head and neck area, dating back to the early nineteenth century. More than 150 years ago, hemimaxillectomies and mandibular resections as well as hemiglossectomies were already performed by leading surgeons. The block principle we are now following dates back to Crile, who also established the principle of cervical lymph node dissection. Ablative oncologic surgery has always been closely linked with plastic and reconstructive surgery, rendering radical surgical interventions possible without disfiguring patients. The development of facial reconstructive surgery proceeded in stages, in the first instance as secondary reconstruction using tube pedicled flaps. The change to the concept of primary reconstruction occurred via arterialized skin flaps and myocutaneous flaps to the widely accepted and performed free tissue transfer. Free bone grafting, inaugurated earlier and still representing the majority of bone grafting, has been supplemented for certain reconstructive purposes by free vascularized bone transfer from various donor sites. Although the five-year-survival rate of carcinoma of the oral cavity has remained unchanged in the past 30 years, distinctive improvements in tumor surgery can be recorded. This is primarily based on improved diagnostics such as modern imaging techniques and the refinement of surgical techniques. The DÖSAK has worked out distinctive guidelines for effective ablative oncologic surgery. Surgical approaches offering wide exposure and carrying low morbidity play a decisive role in radical resections. For this reason, midfacial degloving offers an essential improvement for the resection of midface tumors, especially from an aesthetic point of view. Tumors situated deep behind the viscerocranium at the skull base can be clearly exposed either through a lateral approach following a temporary osteotomy of the mandibular ramus or a transmandibular, transmaxillar, or transfacial approach with minimal morbidity. Concerning the concept of neck dissection, radical techniques are more and more abandoned in favor of a more conservative procedure. Actual inquiries concerning present surgical procedures as to the surgical strategy in “No-neck” or marginal and segmental resection in mandibular adherent carcinomas demand scientific clarification.
    Notes: Zusammenfassung Im Zentrum der Behandlung von Tumoren im Kopf-Hals-Bereich steht immer noch die Chirurgie, deren Ansätze weit in das 19. Jahrhundert zurückreichen. Schon vor weit über 150 Jahren wurden durch wegweisende Chirurgen Halbseitenresektionen des Ober- und Unterkiefers sowie der Zunge durchgeführt. Das heute von uns verfolgte Blockprinzip geht auf Crile zurück, der auch die Prinzipien der Halslymphknotenausräumung festschrieb. Eng verknüpft mit der Tumorchirurgie war stets die plastische und rekonstruktive Chirurgie, die radikalchirurgische Eingriffe ohne Entstellung der Patienten erst ermöglichte. Die Entwicklung der wiederherstellenden Gesichtschirurgie verlief in Phasen, zunächst als sekundäre Rekonstruktion mittels Rundstiellappen. Der Wandel zur primären Wiederherstellung vollzog sich über arterialisierte Hautfettlappen und die Myokutanlappen bis zum heute aktuellen mikrovaskulär anastomosierten Gewebetransfer. Die schon früh inaugurierte und heute noch praktizierte freie Knochentransplantation wurde für spezielle Indikationen durch den mikrochirurgischen Knochentransfer aus verschiedenen Spenderregionen ergänzt. Obwohl die 5-Jahres-Überlebensraten für das Mundhöhlenkarzinom in den letzten ¶30 Jahren stagnieren, sind heute doch deutliche Fortschritte in der Tumorchirurgie zu verzeichnen. Diese beruhen zunächst auf einer verbesserten Diagnostik durch die modernen bildgebenden Verfahren und die Weiterentwicklung der Operationsverfahren. Für eine erfolgreiche Tumorchirurgie hat der DÖSAK klare Richtlinien erarbeitet. Für eine radikale Tumorresektion spielen übersichtliche und wenig destruierende Zugangswege eine entscheidende Rolle. So brachte für die Tumoren des Oberkiefers das Midfacial degloving eine wesentliche Verbesserung, insbesondere auch aus ästhetischer Sicht. Versteckt hinter dem Gesichtsschädel liegende Tumoren an der Schädelbasis lassen sich entweder über einen lateralen Zugang nach temporärer Osteotomie des Unterkieferasts oder transmandibulär, transmaxillär oder transfazial übersichtlich ohne Destruktionen darstellen. Bezüglich der Halslymphknotenausräumung ist eine Abkehr vom radikalen zum konservativen Vorgehen zu verzeichnen. Derzeit aktuelle chirurgische Fragen, wie das operative Vorgehen beim „N 0 -Hals“ oder Kastenresektion bzw. Kontinuitätsresektion des Unterkiefers bei der Mandibula adhärenten Karzinomen, bedürfen einer wissenschaftlichen Klärung.
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    Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis – an evaluation of 59 cases (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 245-251 
    Details
    ISSN: 1434-3916
    Keywords: Key words Spondylodiscitis ; Magnetic resonance imaging ; Computed tomography ; Diagnostic algorithm ; Therapeutic algorithm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fifty-nine patients with spondylodiscitis (SD) of the thoracic and/or lumbar spine were followed-up clinically and radiologically [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] over a mean time of 2.2 years (1–6.5 years). All patients without abscess formation (n = 35) were treated conservatively. Out of the group with abscess formation (n = 24) 6 patients were also treated conservatively, 11 were drained under CT control and 7 were operated. At time of diagnosis, “signs of florid inflammation” were seen in 60% of the roentgenograms, in 93% of the CTs and in all of the MRIs. The sensitivity to differentiate between SD with and without abscess formation was 85% by MRI and 69% by CT. “Signs of regressive inflammation” and “signs of increasing osseous consolidation”, essential facts for starting remobilization, could first be seen using CT 6 weeks after onset of therapy. Using MRI these signs were seen with a considerable delay at 12 weeks. Clinically, only 3 of the 59 analyzed patients developed recurrent SD. In conclusion, MRI is the radiological method of choice for establishing the diagnosis of SD, in particular with regard to differentiating between cases with and without abscess formations. In contrast, CT is superior for performing success control after treatment. Therapeutically, conservative, minimal-invasive and operative procedures are not rival but rather complementary.
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    Gliomas of the optic nerve: histological, immunohistochemical (MIB-1 and p53), and MRI analysis (2000)
    Springer
    Acta neuropathologica 99 (2000), S. 563-570 
    Details
    ISSN: 1432-0533
    Keywords: Key words Ki-67 labeling index ; Magnetic resonance imaging ; Optic nerve glioma ; p53 ; Pilocytic ¶astrocytoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gliomas of the optic nerve, although typically of pilocytic (WHO grade I) histology, can present within the spectrum of astrocytic neoplasia including glioblastoma (WHO grade IV). In certain cases, histologic features alone make the distinction between pilocytic and diffuse astrocytomas difficult. We reviewed 22 cases of optic nerve gliomas, 19 of which were pilocytic astrocytomas (PA), and 3 of which were diffuse, non-pilocytic astrocytomas. The cases were evaluated for their clinical course, radiographic appearance, histologic grade, and proliferation indices as detected by MIB-1 (Ki-67) and p53 antibodies. Of the 19 PA, 14 showed no tumor growth by magnetic resonance imaging, and had Ki-67 and p53 labeling indices (LI) of 〈 1%. The other 5 PA exhibited aggressive behavior manifest by marked diffuse infiltrative tumor growth causing death in 2 patients, 1 of whom was diagnosed with neurofibromatosis type 1 (immunoperoxidase and radiographs not available), and marked local growth with an average time to growth of 39.3 months, a Ki-67 LI of 2–3%, and a p53 LI of 〈 1% in three others. Three of the five aggressive PA histologically demonstrated a finely reticulated pattern, a pattern that appears as an exaggeration or expansion of the normal neuroglia of the optic nerve, and may simulate a diffuse low-grade astrocytoma. Two demonstrated the coarsely reticulated pattern, with the biphasic and microcystic pattern typical of PA. Three diffuse astrocytomas (2 anaplastic astrocytomas and 1 glioblastoma) originated clinically and radiographically from the optic nerve, and revealed a Ki-67 LI of 2–12%, a p53 LI of 2–8%, and an average time to growth of 8 months. We conclude that the majority of PA of the optic nerve are non-aggressive, stabilize radiographically, and have Ki-67 and p53 LI 〈 1%. However, a subpopulation of PA has a propensity for aggressive behavior, and are identified by a Ki-67 LI of 2–3% and a p53 LI of 〈 1%. Diffuse astrocytomas have both Ki-67 and p53 LI 〉 2%. Thus, in cases of aggressive optic nerve tumors in which the histologic review of biopsy material cannot confidently confirm the diagnosis of pilocytic or diffuse fibrillary glioma, a p53 LI of 〉 1% appears to favor the diagnosis of diffuse astrocytoma.
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    URL: http://dx.doi.org/10.1007/s004010051161
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    Das akute Rechtsherzversagen Ätiologie – Pathophysiologie – Diagnostik – Therapie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 788-809 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Rechtsherzfunktion ; Störung ; Ätiologie ; Pathophysiologie Diagnostik ; Therapie ; Keywords Impaired right ventricular function ; RV failure ; Diagnosis ; Monitoring ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Impaired right ventricular (RV) function may be caused by pulmonary hypertension or myocardial ischemia. It is characterized by a dilation of the RV, which is followed by an increase of wall tension and O2-consumption and a decrease of RV ejection fraction (RV ‘dysfunction’). If a drop of arterial pressure occurs this my precipitate RV failure and shock (RV ‘insufficiency’). Diagnosis of RV failure and monitoring of RV function is difficult. Sometimes, even a severe impairment of RV function goes undetected or is misinterpreted. Patients in the operating room or on intensive care units seem to be especially prone to RV dysfunction and failure. Since a causative therapy often is not readily available, adequate symptomatic therapy is of utmost importance. Four basic principles have to be considered: 1) Optimizing preload: The failing RV requires adequate filling for preservation of stroke volume. On the other hand, overdistension of the RV may result in RV ischemia, thereby further deteriorating RV function Hence, volume loading is important, but requires continuous monitoring. 2) Maintenance of aortic pressure: Vasopressors are indicated if there is a critical drop of coronary perfusion pressure. Norepinephrine presently is the drug of choice for this purpose. 3) Reduction of RV afterload: Whereas intravenous vasodilators are limited in their efficacy in dilating pulmonary vessels due to systemic side effects, inhaled vasodilators result in selective pulmonary vasodilation and may improve RV function. 4) Increase of RV contractility: In RV failure and shock, norepinephrine and epinephrine are the drugs of choice. Inodilators are well suited for reducing pulmonary vascular resistance due to their positive inotropic and vasodilating effects. Since systemic vasodilation may occur, these drugs must only be used in hemodynamically stable patients.
    Notes: Zusammenfassung Eine Störung der Rechtsherzfunktion entsteht meist als Folge einer pulmonalen Hypertension, seltener bei primärer Myokardischämie. Sie ist gekennzeichnet durch eine Dilatation des rechten Ventrikels mit Anstieg von Wandspannung und Sauerstoffverbrauch bei reduzierter Ejektionsfraktion (“Dysfunktion”). Kommt es zum Abfall von arteriellem Druck und koronarem Perfusionsdruck, kann dies ein Rechtsherzversagen mit Schock auslösen (“Insuffizienz”). Diagnostik und Monitoring des rechten Ventrikels sind schwierig. Selbst eine schwere Beeinträchtigung der rechtsventrikulären Pumpfunktion bleibt daher häufig unbemerkt oder wird fehlgedeutet. Patienten in der perioperativen Phase und auf Intensivstationen scheinen besonders häufig von dem Krankheitsbild betroffen zu sein. Da eine kausale Therapie des akuten Rechtsherzversagens nur selten möglich ist, kommt der symptomatischen Therapie besondere Bedeutung zu. Sie stützt sich auf vier Prinzipien: 1) Optimierung der Vorlast: Der insuffiziente rechte Ventrikel benötigt zur Aufrechterhaltung seines Schlagvolumens ein gute Füllung. Andererseits kann eine Überdehnung des rechten Ventrikels eine Myokardischämie induzieren und seine Funktion weiter verschlechtern. Eine adäquate Volumentherapie ist daher essenziell, muss jedoch unter engmaschigem hämodynamischem Monitoring erfolgen. 2) Aufrechterhaltung des Aortendrucks: Bei kritischem Abfall des arteriellen Drucks ist die Gabe von Vasopressoren indiziert, um den rechtskoronaren Perfusionsdruck zu erhöhen. Noradrenalin gilt derzeit wegen seiner zusätzlich positiv inotropen Wirkung als Mittel der Wahl. 3) Verminderung der rechtsventrikulären Nachlast: Während sich intravenöse Vasodilatatoren wegen systemischer Nebenwirkungen nur bedingt zur Therapie der pulmonalen Hypertension eignen, dilatieren inhalierte Vasodilatatoren die pulmonale Strombahn selektiv und verbessern so die Pumpfunktion des rechten Ventrikels. 4) Steigerung der rechtsventrikulären Kontraktilität: Mittel der Wahl bei Dekompensation und Schock sind Noradrenalin und Adrenalin. Inodilatatoren weisen neben einer positiv inotropen auch eine pulmonal vasodilatierende Wirkung auf und eignen sich daher ebenfalls zur Therapie der rechtsventrikulären Dysfunktion. Sie sollten jedoch wegen der damit verbundenen systemischen Vasodilatation nur bei kreislaufstabilen Patienten eingesetzt werden.
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    URL: http://dx.doi.org/10.1007/s001010070052
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    Erworbene Hemmkörperhämophilie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 34-42 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter ; Erworbene Hemmkörperhämophilie ; spontane Faktor-VIII-Inhibitoren ; spontane Faktor-IX-Inhibitoren ; Diagnose ; Therapie ; Key words ; Acquired haemophilia ; Spontaneous factor VIII inhibitors ; Spontaneous factor IX inhibitors ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Although autoantibodies against factor VIII or factor IX are a rare phenomenon, they are associated with a high risk of bleeding and high mortality. The condition, termed ac- quired haemophilia, occurs equally in both sexes and is most frequent in higher age groups. Patients typically present with severe bleedings in muscles and skin. In contrast to patients with congenital haemophilia and inhibitors, joint bleedings are very rare. In approximately half of all cases an associated disease state can be identified as the cause of autoantibody formation. An immediate and comprehensive diagnosis is essential for a rapid initiation of therapy. Equally important are a careful diagnostic differentiation between congenital and acquired factor deficiencies and the exclusion of non-specific inhibitors, which increase the occurrence of thrombolic events. The inhibitor titre, quantified using the Bethesda assay, is an important criterion for selecting the appropriate therapy. A wide range of treatment options is now available for the management of bleedings in patients with acquired haemophilia, namely porcine factor VIII, recombinant factor VIIa, prothrombin complex concentrates, and immunoadsorptions. In addition, immunosuppressive therapies are used to achieve permanent reduction or elimination of inhibitors.
    Notes: Zusammenfassung Autoantikörper gegen Faktor VIII oder Faktor IX sind ein zwar seltenes, aber mit hohem Blutungsrisiko und hoher Letalität verbundenes Phänomen. Diese als erworbene Hemmkörperhämophilie bezeichnete Erkrankung kommt bei beiden Geschlechtern gleich häufig vor und tritt gehäuft im hohen Lebensalter auf. Die Patienten fallen klinisch v. a. durch schwere Blutungen in Muskeln und Haut auf, wogegen Gelenkeinblutungen – im Gegensatz zur angeborenen Hämophilie mit Hemmkörpern – sehr selten auftreten. In etwa der Hälfte der Fälle kann eine assoziierte Grunderkrankung als Auslöser der Autoantikörperbildung identifiziert werden. Eine rasche und umfassende Diagnostik ist entscheidend für einen schnellen Therapiebeginn. Ebenso bedeutend ist eine sorgfältige differentialdiagnostische Abgrenzung gegen einen angeborenen oder erworbenen Faktorenmangel sowie der Ausschluß unspezifischer Inhibitoren, die vermehrt zu Thrombosen führen können. Wichtig für die Auswahl der geeigneten Therapieform ist der Inhibitortiter, gemessen im Bethesda-Assay. Für die Blutstillungstherapie steht heute mit porcinem Faktor VIII, rekombinantem Faktor VIIa, Prothrombinkomplexpräparaten und Immunadsorptionen ein breites Spektrum an Möglichkeiten zur Verfügung. Für eine dauerhafte Reduktion bzw. Elimination der Autoantikörper finden immunsuppressive Therapien Anwendung.
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    URL: http://dx.doi.org/10.1007/s001010050007
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    Schädelhirntrauma und zerebrale Hypoxie Diagnostik – Monitoring – Therapie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 332-339 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Schädelhirntrauma ; zerebrale Hypoxie ; Diagnose ; Therapie ; Key words Brain damage ; Cerebral hypoxie ; Diagnosis ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The main reason for posttraumatic secondary brain damage is cerebral hypoxia. Both, severity and duration of hypoxia are crucial in determining wether irreversible cerebral infarction will occur or not. For the clinical routine, the diagnosis of hypoxia is indirectly made by low CPP, low jugularvenous oxygen saturation (SjO2) or low tissue PO2. To minimize misleading false negative SjO2, the CT-Approach for the side of monitorig and calculation of arterial-jugularvenous lactate content for detection of anaerobic metabolism is recommended. Targeted treatment of hypoxia according to the underlying cause is mandatory. Primary goal is to increase cellular oxygen delivery by correction of low arterial oxygen content and elevation of regional CBF. Within the autoregulatory range decreasing CPP causes vasodilation and increasing CPP vasoconstriction with increasing or decreasing cerebral blood volume respectively. Initially elevation of the lower autoregulatory threshold often requires CPP 70 mmHg. Targeted treatment of intracranial hypertension must avoid decreasing CPP. In the early postrautmatic phase prevention of cerebral hypoxia relies on management of CBF by means of CPP and cerebral vascular resistance. Thereafter targeted treatment of intracranial hypertension caused by cerebral edema and hypervolemia are increasingly important.
    Notes: Zusammenfassung Hauptursache der sekundären Hirnschädigung ist die zerebrale Hypoxie. Abhängig von Schweregrad und Dauer entsteht eine irreversible Hirngewebsschädigung. Zur Diagnose der Hypoxie dient unter klinischen Bedingungen die kontinuierliche Messung des zerebralen Perfusionsdrucks (CPP) in Verbindung mit der zerebrovenösen O2-Sättigung (SjO2) oder der O2-Partialdruckmessung im Hirngewebe. Zur Minimierung von SjO2-Fehlinterpretationen sollte nach CT-Approach punktiert und ein anaerober Hirnstoffwechsel durch Bestimmung der arterio-jugularvenösen Laktatkonzentrationsdifferenz (avDL) ausgeschlossen werden. Die Therapie der zerebralen Hypoxie sollte kausal erfolgen. Normalisierung des arteriellen O2-Gehalts und Steigerung der Hirndurchblutung (CBF) haben Prioritöt. Bei intakter Autoregulation der CBF wird ein CPP-Abfall durch Vasodilatation mit Zunahme des zerebralen Blutvolumens und ein CPP-Anstieg durch Vasokonstriktion mit Abnahme des CBV kompensiert. Die häufige posttraumatische Rechtsverschiebung der unteren Autoregulationsschwelle erfordert in der Initialphase mit dem höchsten Hypoxierisiko CPP-Werte 70 mmHg. Die Therapie des ICP 〉 20 mmHg erfolgt CPP-orientiert. Eine ICP-Senkung zu Lasten des CPP ist zu vermeiden. Initial nach SHT hat die individuelle Optimierung der CBF durch Sicherstellung eines adäquaten CPP und zerebrovaskulären Gefäßwiderstandes (CVR) Priorität. Nachfolgend gewinnen durch SjO2 und avDL- oder Gewebe-PO2-Messung kontrollierte Maßnahmen zur Modulation von CVR und CBV sowie die Hirnödemtherapie zunehmend an Bedeutung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050838
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    Acute myelofibrosis: multifocal bone marrow infiltration detected by scintigraphy and magnetic resonance imaging (2000)
    Springer
    Annals of hematology 79 (2000), S. 275-278 
    Details
    ISSN: 1432-0584
    Keywords: Key words Acute myelofibrosis ; Acute megakaryoblastic leukemia ; Scintigraphy ; Magnetic resonance imaging ; Interferon gamma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Acute myelofibrosis is a rare, malignant hematological disorder of unknown etiology with an inevitably fatal outcome. Here we present the study of a 63-year-old Caucasian man with acute onset of pancytopenia. Repeated bone marrow biopsies showed dense fibrosis and hypoplastic hematopoiesis raising various differential diagnoses of malignant and nonmalignant conditions. Bone marrow scintigraphy and magnetic resonance imaging (MRI) showed areas suggesting neoplastic infiltration, mainly in both femurs and tibias. Histological examination of a surgical biopsy of the left tibia revealed acute megakaryoblastic leukemia. As the patient refused polychemotherapy, therapy with interferon gamma was initiated but discontinued prematurely because of intolerable side effects. The presented case therefore suggests that the combination of bone marrow scintigraphy and MRI is a valuable diagnostic tool in patients presenting with myelofibrosis of unknown origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050593
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    Therapy of B-cell lymphomas with monoclonal antibodies and radioimmunoconjugates: the Seattle experience (2000)
    Springer
    Annals of hematology 79 (2000), S. 175-182 
    Details
    ISSN: 1432-0584
    Keywords: Monoclonal antibody ; Radioimmunotherapy ; Lymphoma ; Therapy ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050576
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  • 62
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    Functional organization of the human masseter muscle (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 181-190 
    Details
    ISSN: 1279-8517
    Keywords: Masseter muscle ; Architecture ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors carried out an anatomic and magnetic resonance imaging study of the architecture of the elevator muscles of the mandible in 169 cadavers. The aim of this study was to define the architectural organization of the human masseter muscle, temporalis and pterygoid muscles. Layered dissections and anatomic sections in different spatial planes showed that the masseter muscle exhibited a typical pennate structure consisting of a succession of alternating musculoaponeurotic layers. The muscle had three well-differentiated parts the superficial, intermediate and deep masseter muscles. The same pattern was constantly found 1) for the superficial masseter, two alternate musculoaponeurotic layers oriented at 60∘ in relation to the plane of occlusion, 2) for the intermediate masseter, a single musculo-aponeurotic layer oriented at 90∘ in relation to the occlusal plane, 3) for the deep masseter, three musculoaponeurotic layers whose general orientation was at 90∘ for the bounding layers and 110∘ for the intermediate layer. The MRI study confirmed the reality of this architectural arrangement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0181-5
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  • 63
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    Therapie des Lichen sclerosus et atrophicus vulvae mit dem CO2-Silk-touch-Laser (2000)
    Springer
    Der Hautarzt 51 (2000), S. 502-504 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Lichen sclerosus et atrophicus ; Therapie ; CO2 Laser ; Keywords Lichen sclerosus et atrophicus ; Therapy ; Carbon dioxide laser
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract A 50 year old woman with distinct lichen sclerosus et atrophicus was suffering from severe genital itching, dyspareunia and increasing urinary burning. Therapy attempts with topical glucosteroids and estrogens had been without effort. Treatment with CO2 laser in silk touch mode under insufflation anesthesia to an improvement of her skin lesions and a nearly complete remission of her symptoms.
    Notes: Zusammenfassung Wir berichten über eine 50jährige Frau mit einem ausgeprägten Lichen sclerosus et atrophicus vulvae. Die Patientin litt unter stärkstem genitalen Pruritus, einer Dyspareunie und zunehmenden, brennenden Schmerzen beim Wasserlassen. Therapieversuche mit glukokortikosteroid- und östrogenhaltigen Externa erbrachten keine Besserung. Eine Behandlung in Intubationsnarkose mit dem CO2-Laser im Silk-touch-Modus führte zu einer Besserung der Hautveränderungen und zu einer beinahe kompletten Remission der subjektiven Beschwerden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051161
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    Prospective evaluation of late effects after childhood cancer therapy with a follow-up over 9 years (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 750-758 
    Details
    ISSN: 1432-1076
    Keywords: Key words Long-term late effects ; Childhood ; Cancer ; Therapy ; Follow-up examinations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intensive multimodality treatment has led to a remarkable improvement of prognosis in paediatric cancer patients, however, a great number of long-term survivors suffer from considerable tumour- or treatment-related late effects. Between January 1990 and December 1998, 223 consecutive survivors of childhood malignancies entered a prospective follow-up study designed to evaluate the frequency and severity of tumour- and/or therapy-related long-term sequelae. After cessation of therapy and subsequently once a year, all patients underwent a detailed examination programme including physical examination, laboratory tests, abdominal sonography, echocardiography, electrocardiography, electroencephalography, spirometry, audiometry, ophthalmological examination and endocrine stimulation tests. Median follow-up was 5 years (range 0.4 to 9.6 years). A total of 167 patients (75%) had at least one chronic medical problem of whom 80 needed permanent medical support. The organ systems most frequently affected were the nervous system in 39%, the endocrine system in 32%, the ears/eyes in 22%, the kidneys in 17%, and the liver in 12% of the patients. Some late effects (endocrine deficits, hearing loss, tubulopathy) were primarily diagnosed only several years after the end of oncological therapy. Conclusion The results of this study indicate that a considerable number of former paediatric cancer patients suffer from remarkable long-term side-effects. Since life quality is an important parameter of cancer survival, careful follow-up of long-term survivors is mandatory with the aim to reduce or even abrogate possible side-effects at the earliest time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00008340
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    Cortical malformations: a frequent cause of epilepsy in children (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 555-562 
    Details
    ISSN: 1432-1076
    Keywords: Key words Epilepsy ; Cortical malformations ; Migration disorders ; Magnetic resonance imaging ; Brain development
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this review, a simplified scheme for classification of cortical malformations is introduced and illustrated based on the work of Barkovich et al. [8]. Detailed MRI studies identify cortical malformations as a major cause of epilepsy in children. Two aspects that are becoming increasingly important for the paediatrician are emphasised. First, knowledge of the genetic background of cortical malformations is necessary for appropriate genetic counselling. Although the majority of cortical malformations occur sporadically, recent studies have shown a familial pattern in specific epilepsy syndromes associated with cortical malformations. Second, the epilepsy becomes refractory to the common anti-epileptic drugs in many patients with cortical malformations so that epilepsy surgery should be considered. In this respect, the paediatrician can play a pivotal role in referring candidate patients for further specialised assessment. Conclusion The input of the paediatrician will become crucial to link clinical, genetic and neuro-imaging data in children with the great variety of possible cortical malformations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000452
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  • 66
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    Adult care in phenylketonuria and hyperphenylalaninaemia: the relevance of neurological abnormalities (2000)
    Springer
    European journal of pediatrics 159 (2000), S. S114 
    Details
    ISSN: 1432-1076
    Keywords: Key words Dietary therapy ; Magnetic resonance imaging ; Neurology ; Pathology ; Phenylketonuria ; AbbreviationsHPA hyperphenylalaninaemia ; 1H-MRS proton magnetic resonance spectroscopy ; Phe phenylalanine ; PKU phenylketonuria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neurological abnormalities in phenylketonuria were described before dietary treatment became possible. These included tremor, clumsiness, epilepsy, spastic paraparesis and occasionally extrapyramidal features. Neurological deterioration after childhood was recognised. Patients with neurological deterioration described recently have been late diagnosed or intellectually impaired or both. No early diagnosed patient who was well treated and of good intellectual outcome has yet shown neurological deterioration after stopping diet but it may happen. Conclusion The fascinating links between pathology, magnetic resonance imaging appearances, magnetic resonance spectroscopy results and clinical features are not yet clearly understood. Patients must understand the possible risks of stopping diet and make their choice. All patients need help, support and follow-up regardless of the choices they make over continuing diet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014373
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    New insights into the pathogenesis of erythropoietic protoporphyria and their impact on patient care (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 719-725 
    Details
    ISSN: 1432-1076
    Keywords: Key words Erythropoietic protoporphyria ; Ferrochelatase ; Mutation ; Inheritance ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Erythropoietic protoporphyria (EPP, MIM 177000) is an inherited disorder caused by a partial deficiency of ferrochelatase (FECH) which catalyses the chelation of iron into protoporphyrin to form haem. The majority of EPP patients experience solely a painful photosensitivity whereas a small number of them develop liver complications due to the accumulation of excessive amount of protoporphyrin in the liver. EPP is considered to be an autosomal dominant disorder, however, with a low clinical penetrance. To date, a total of 65 different mutations have been identified in the FECH gene of EPP patients. Among the 89 EPP patients who carry a “null allele” mutation which results in the formation of a truncated protein, 18 of them developed EPP-related liver complications. None of the 16 missense mutations identified among 19 patients on the other hand, have been associated with liver disease (P = 0.038). The allelic constellation of an overt patient consists of a mutated FECH allele and a “low expressed” normal allele and that of an asymptomatic carrier, a combination of a mutated and a normally expressed FECH allele. The identification of the “low expressed” allele is facilitated by haplotype analysis using two single nucleotide polymorphisms, −251 A/G in the promoter region and IVS1−23C/T. At the current time when only partially effective therapies are available, the disclosures of both “null allele” and the “low expression” mechanisms will improve patient management. Conclusion While covering the important clinical aspect of erythropoietic protoporphyria, this article emphasises the latest achievements in the molecular genetics of the disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310000494
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  • 68
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    Recurrence of non-Hodgkin's lymphoma isolated to the right masticator and left psoas muscles (2000)
    Springer
    European radiology 10 (2000), S. 841-843 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Lymphoma ; Magnetic resonance imaging ; Skeletal muscle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We present the clinical and magnetic resonance imaging findings of a patient who, following treatment for pancreatic non-Hodgkin's lymphoma (NHL), relapsed with apparently isolated involvement of the right masticator space and left psoas muscles. Non-Hodgkin's lymphoma arising from the masticator space muscles is very rare. In addition, simultaneous lymphomatous involvement of multiple discrete skeletal muscle sites, in the absence of disease elsewhere, has previously only been reported in the limb or limb girdle muscles. Lymphoma should be considered as a cause of isolated enlarged skeletal muscles, even when involving such distant sites.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051015
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  • 69
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    Die Therapie der primären kutanen B-Zell-Lymphome (2000)
    Springer
    Der Hautarzt 51 (2000), S. 19-24 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter ; Kutane B-Zell-Lymphome ; Therapie ; Key words ; Cutaneous B-cell lymphomas ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background and objective: Primary cutaneous B-cell lymphomas (PCBCL) represent a unique type of extranodal B-cell lymphomas. Recently, the „European Organization for Research and Treatment of Cancer (EORTC)–Cutaneous Lymphoma Study Group” classified PCBCL into two major groups: one with low-grade malignancy and excellent prognosis (follicle center cell lymphoma, immunocytoma/marginal zone B-cell lymphoma) and the other with intermediate malignancy and worse prognosis (large B-cell lymphoma of the leg). The clinical course and the prognosis of both groups clearly distinguish them from nodal lymphomas with similar morphological aspects, thus underlying the need for different treatment modalities. Patients/Methods: We investigated retrospectively the therapeutic data from 51 patients with PCBCL (40 lowgrade lymphomas, 11 large B-cell lymphomas). Several treatment modalities were used: total excision, radiotherapy, polychemotherapy, systemic corticosteroids, systemic antibiotics, as well as a variety of combination treatments. Results: Recurrence, dissemination and/or death of the patients were not significantly related to any single treatment modality. Conclusions: In our opinion, the choice of treatment for PCBCL depends on the histologic classification, the number, spread and localization of the infiltrates, and on the general condition of the patient.
    Notes: Zusammenfassung Hintergrund und Fragestellung: Primäre kutane B-Zell-Lymphome (PKBZL) stellen eine eigenständige Krankheitsgruppe lymphoproliferativer Tumoren dar. In der vor kurzem von der „European Organization for Research and Treatment of Cancer (EORTC)-Cutaneous Lymphoma Study Group” publizierten Klassifikation kutaner Lymphome wurden 2 Hauptgruppen der PKBZL beschrieben: Eine mit niedriger Malignität und exzellenter Prognose (Keimzentrumslymphome, Immunozytom/„Marginalzonelymphom”) und eine 2. mit intermediärer Malignität und schlechterer Prognose (großzelliges B-Zell-Lymphom der unteren Extremitäten). Der Verlauf und die unterschiedlichen Prognosen weisen darauf hin, dass es notwendig ist, eine dem klinischen Verhalten entsprechende Therapieform zu wählen. Patienten/Methodik: Wir untersuchten die Verlaufsdaten von 51 Patienten mit PKBZL (40 niedrig maligne PKBZL und 11 großzellige PKBZL) retrospektiv. Als Behandlungsformen kamen Totalexzision, Strahlentherapie, systemische Kortison- und Antibiotikatherapie, Polychemotherapie sowie verschiedene Kombinationstherapien zur Anwendung. Ergebnisse: Das Auftreten von Rezidiven sowie von Lymphknoten- oder Organbeteiligungen stand in keinem signifikanten Zusammenhang mit der gewählten Therapiemodalität. Schlussfolgerungen: Aus der Vielzahl der verwendeten Behandlungsformen ist die Komplexität der Erkrankung an sich und die der Wahl der Therapie ersichtlich. Unserer Meinung nach sollte die Behandlung der PKBZL in Abhängigkeit von der histologischen Klassifikation, der Anzahl, Ausdehnung und Lokalisation der Hautinfiltrate sowie vom Allgemeinzustand des Patienten gewählt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050005
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    Propofol improves recovery from paraquat acute toxicity in vitro and in vivo (2000)
    Springer
    Intensive care medicine 26 (2000), S. 981-987 
    Details
    ISSN: 1432-1238
    Keywords: Key words Superoxide ; Reactive oxygen species ; Propofol ; Herbicide ; Therapy ; Hypnotics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate whether the antioxidative sedatives propofol and thiopental can improve recovery from acute paraquat toxicity in A549 cells and in mice.¶Design: Prospective, controlled, dose-response, in vitro study and prospective, controlled animal study. Setting: A university animal research laboratory.¶Subjects: Established human lung cultured cells and male SPF ICR mice. Interventions: Paraquat-treated (0.2 mM) A549 cells were incubated either with the antioxidative sedatives propofol (0–0.56 mM) or thiopental (0–2.0 mM), or the non-antioxidative sedatives diazepam (0–3.0 mM), midazolam (0–3.0 mM) and ketamine (0–9.0 mM), as well as the antioxidative drugs, trolox (0–2.0 mM), α-tocopherol (0–4.4 mM), antioxidative-processed food (AOB; 0–1.0 mg/ml), superoxide dismutase (SOD; 0 and 3,000 U/ml) and ulinastatin (0 and 50,000 U/ml), for 48 h. Paraquat-treated mice received i. v. injections of 10 mg/kg propofol, 5 mg/kg thiopental, 4.0 mg/kg trolox, 100 mg/kg α-tocopherol, 10 mg/kg AOB or 5,000 U/kg SOD, b. i. d. for 4 days (n = 10 each). Measurements and results: Post-administered propofol and thiopental, as well as the antioxidative drugs, trolox, α-tocopherol and AOB, improved A549 cell survival in vitro. The non-antioxidative sedatives SOD and ulinastatin were not protective. An i. p. injection of 50 mg/kg of paraquat resulted in a survival rate of 40 % in mice at day 6. Propofol, trolox, α-tocopherol and AOB significantly lowered the mortality rate (80 % survival), while thiopental did not.¶Conclusion: Post i. v. injection of propofol is protective against paraquat-induced damage. Propofol can be given during mechanical ventilatory support after paraquat poisoning.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051291
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    MRI demonstration of intracerebral cryptococcal granuloma (2000)
    Springer
    Neuroradiology 42 (2000), S. 30-33 
    Details
    ISSN: 1432-1920
    Keywords: Key words Granuloma cryptococcal ; Magnetic resonance imaging ; Pulse sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report an intracerebral cryptococcal granuloma in a patient who presented with recent memory disturbance and deteriorating mental status followed by temporary loss of consciousness. To our knowledge, this is the first reported case of an intracerebral cryptococcal granuloma examined by a combination of conventional MRI, fluid-attenuated inversion-recovery and diffusion-weighted imaging and in which the surgical specimen was analysed histochemically.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050006
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    MRI of intracranial toxoplasmosis after bone marrow transplantation (2000)
    Springer
    Neuroradiology 42 (2000), S. 14-18 
    Details
    ISSN: 1432-1920
    Keywords: Key words Bone marrow, transplantation ; Toxoplasmosis, cerebral ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Toxoplasma encephalitis was confirmed by biopsy in three patients with bone marrow (BMT) or peripheral blood stem-cell transplantation (PBSCT). All had MRI before antimicrobial therapy. The intensity of contrast enhancement was very variable. One patient had one large, moderately enhancing cerebral lesion and several smaller almost nonenhancing lesions. The second had small nodular and haemorrhagic lesions without any enhancement. The third had late cerebral toxoplasmosis and showed multiple lesions with marked contrast enhancement. The moderate or absent contrast enhancement in the two patients in the early phase of cerebral toxoplasmosis may be related to a poor immunological response, with a low white blood cell count in at least one patient. Both received higher doses of prednisone than the patient with late infection, leading to a reduced inflammatory response. In patients with a low leukocyte count and/or high doses of immunosuppressive therapy, typical contrast enhancement may be absent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050003
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    Cranial MRI in the Nijmegen breakage syndrome (2000)
    Springer
    Neuroradiology 42 (2000), S. 43-47 
    Details
    ISSN: 1432-1920
    Keywords: Key words Nijmegen breakage syndrome ; Anomalies of brain ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We present the results ¶of MRI examinations in ten patients with documented Nijmegen ¶breakage syndrome (NBS), aged 1.75–19 years. T1-, Proton-Density- and T2-weighted spin-echo sequences were performed in three planes. All patients showed microcephaly with decreased size of the frontal lobes and narrow frontal horns. In four patients agenesis of the posterior part of the corpus callosum was found, with colpocephaly and temporal horns dilatation. In one patient callosal hypoplasia was accompanied by abnormal cerebrospinal fluid spaces and wide cerebral cortex, suspicious of pachygyria. Sinusitis was present in all ten patients, as a result of primary immunodeficiency. As in ataxia teleangiectasia and other breakage syndromes, patients with NBS show an inherited susceptibility to malignancy and hypersensitivity to X- and γ-radiation. CT is therefore contraindicated in these patients and MRI should be the method of choice for diagnostic imaging.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050011
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    Dermal sinus with dermoid cyst in the upper cervical spine: case note (2000)
    Springer
    Neuroradiology 42 (2000), S. 51-53 
    Details
    ISSN: 1432-1920
    Keywords: Key words Sinus dermal ; Cyst dermoid ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a 5 year-old girl who had a skin dimple of the back of her upper neck. MRI showed a dermal sinus tract in the upper cervical spine, associated with an intramedullary dermoid cyst at C 2–3, and spina bifida. A laminectomy was performed, the dermoid cyst and the sinus tract were completely removed. This congenital complex is very rare.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050013
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    MRI T-staging of laryngeal tumours: role of contrast medium (2000)
    Springer
    Neuroradiology 42 (2000), S. 66-71 
    Details
    ISSN: 1432-1920
    Keywords: Key words Larynx, tumours ; Magnetic resonance imaging ; Contrast medium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our aim was to evaluate the relative diagnostic accuracy of MRI without contrast medium and MRI before and after contrast medium in the assessment of T-staging of laryngeal tumours. We studied 25 men (mean age 51.8, range 41–61) with laryngeal squamous cell carcinomas, using Spin-echo (SE) T1-weighted and fast SE T2-weighted sequences. The T1-weighted sequences were then repeated after gadolinium-diethylene-triaminepenta-acetic acid (Gd DTPA) 0.1 ml/kg. All patients then underwent biopsy and surgery. Two radiologists independently assessed the anonymised images by filling-out two multiple-choice forms, one for each technique, at a 2 week interval. The forms included a judgement concerning tumour identification and infiltration of the anterior commissure, supraglottic region, arytenoid cartilage, Morgagni's ventricle, paraglottic space, thyroid and cricoid cartilages, thyro-hyo-epiglottic space, vocal cords, subglottic region, and epiglottis. Similar forms were filled out by the surgeon and the pathologist after surgery. The sensitivity, specificity and diagnostic accuracy of MRI were unaffected by the use of contrast medium. Since it did not provide additional staging information, its continued routine use in these cases is not justified.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050017
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    Bilateral thalamic glioma: case report (2000)
    Springer
    Neuroradiology 42 (2000), S. 732-734 
    Details
    ISSN: 1432-1920
    Keywords: Key words Glioma, thalamic, bilateral ; Magnetic resonance imaging ; Magnetic resonance spectroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a 63-year-old man who had a rare bilateral thalamic glioma. He complained of difficulty with calculations and had mental deterioration. T1-weighted images revealed bilateral thalamic swelling with homogeneous low signal and no contrast enhancement. The tumour, showing decrease of N-acetylaspartate and the presence of lactate on magnetic resonance spectroscopy, was diagnosed as an astrocytoma by stereotactic biopsy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000380
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  • 77
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    Electronic Resource
    Primary central nervous system immunocytoma: MRI and spectroscopy (2000)
    Springer
    Neuroradiology 42 (2000), S. 738-741 
    Details
    ISSN: 1432-1920
    Keywords: Key words Lymphoma ; Central nervous system ; Immunocytoma, cerebral ; Magnetic resonance imaging ; Magnetic resonance spectroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report on a young woman with a primary cerebral immunocytoma. Most primary cerebral nervous system lymphomas (PCNSL) are highly malignant undifferentiated B-cell tumours, there are few data on the clinical course, MRI and spectroscopy findings of this rare PCNSL subtype. MRI revealed a radially enhancing tumour with mild perifocal oedema. MR spectroscopy indicated low cell turnover. Slow clinical progression, no significant changes with treatment, and imaging findings were consistent with a low-grade malignant tumour.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000392
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  • 78
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    Electronic Resource
    MRI in tick-borne encephalitis (2000)
    Springer
    Neuroradiology 42 (2000), S. 753-755 
    Details
    ISSN: 1432-1920
    Keywords: Key words Encephalitis, tick-borne ; Magnetic resonance imaging ; Basal ganglia ; Thalamus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The tick-borne encephalitis (TBE) virus gives rise to epidemic encephalitis. Mild forms usually manifest as influenza-like episodes or are clinically silent. MRI is usually normal in TBE. We describe severe TBE in a patient who presented with fever and altered mental status after a tick bite and a specific antibody response to TBE. MRI revealed pronounced signal abnormalities in the basal ganglia and thalamus, without contrast enhancement. These findings coincide well with neuropathological studies of severe nerve cell degeneration with inflammatory cell infiltrates, neuronophagia and reactive astrocytosis in the deep grey matter. We review the literature and discuss the relevant differential diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000396
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  • 79
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    Electronic Resource
    Classification of acquired lesions of the corpus callosum with MRI (2000)
    Springer
    Neuroradiology 42 (2000), S. 795-802 
    Details
    ISSN: 1432-1920
    Keywords: Key words Corpus callosum ; Ischaemia ; Demyelination ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract MRI has facilitated diagnostic assessment of the corpus callosum. Diagnostic classification of solitary or multiple lesions of the corpus callosum has not attracted much attention, although signal abnormalities are not uncommon. Our aim was to identify characteristic imaging features of lesions frequently encountered in practice. We reviewed the case histories of 59 patients with lesions shown on MRI. The nature of the lesions was based on clinical features and/or long term follow-up (ischaemic 20, Virchow-Robin spaces 3, diffuse axonal injury 7, multiple sclerosis 11, hydrocephalus 5, acute disseminated encephalomyelitis 5, Marchiafava-Bignami disease 4, lymphoma 2, glioblastoma hamartoma each 1). The location in the sagittal plane, the relationship to the borders of the corpus callosum and midline and the size were documented. The 20 ischaemic lesions were asymmetrical but adjacent to the midline; the latter was involved in new or large lesions. Diffuse axonal injury commonly resulted in large lesions, which tended to be asymmetrical; the midline and borders of the corpus callosum were always involved. Lesions in MS were small, at the lower border of the corpus callosum next to the septum pellucidum, and crossed the midline asymmetrically. Acute disseminated encephalomyelitis and the other perivenous inflammatory diseases caused relatively large, asymmetrical lesions. Hydrocephalus resulted in lesions of the upper part of the corpus callosum, and mostly in its posterior two thirds; they were found in the midline. Lesions in Marchiafava-Bignami disease were large, often symmetrically in the midline in the splenium and did not reach the edge of the corpus callosum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000430
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  • 80
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    Neuroradiological history: Sir Joseph Larmor and the basis of MRI physics (2000)
    Springer
    Neuroradiology 42 (2000), S. 852-855 
    Details
    ISSN: 1432-1920
    Keywords: Key words Larmor ; Joseph ; Magnetic resonance imaging ; Neurology history
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The origin of many of the eponymous terms in modern medicine is unknown to many people who utter them daily. As a contribution to understanding the historical background of MRI, we provide a brief account of the life and work of Joseph Larmor, the Irish scientist, whose name is frequently used by chemists, physicists and radiologists alike.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000400
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  • 81
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    Gadolinium-myelocisternography for cerebrospinal fluid rhinorrhoea (2000)
    Springer
    Neuroradiology 42 (2000), S. 874-880 
    Details
    ISSN: 1432-1920
    Keywords: Key words Gadolinium-containing contrast medium ; Myelocisternography ; Cerebrospinal fluid leakage ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Knowledge of the exact site of leakage of cerebrospinal fluid CSF leakage is important for planning surgery. We report our experience with myelocisternography with Gd-DTPA. We decided that intrathecal use of this contrast medium was justified in selected cases when other techniques have failed. After we had given detailed information to four patients with CSF leakage, they underwent five examinations. The images were interpreted by comparing those before and after injection. In all cases the contrast medium arrived at the basal cisterns, giving high contrast against adjacent structures. All patients tolerated the examination without complications or any indication of side effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000485
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  • 82
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    Idiopathic granulomatous hypophysitis: are there reliable, constant radiological and clinical diagnostic criterias? (2000)
    Springer
    Neuroradiology 42 (2000), S. 890-894 
    Details
    ISSN: 1432-1920
    Keywords: Key words Pituitary ; Hypophysitis, granulomatous ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Idiopathic granulomatous hypophysitis is a rare inflammatory disease of unknown aetiology; few cases are reported. We review the clinical presentation and radiological characteristics of these cases and our own experience with three new surgical cases, to determine diagnostic criteria. MRI of three cases revealed sellar lesions extending into the chiasmatic cistern. Their shape varied, from dumbbell to spherical and elliptical. All were isointense with the brain on T1-weighted images and gave heterogeneously high signal on T2-weighted images. Contrast enhancement was homogeneous in one case and heterogeneous in another. The pituitary stalk could not be identified. There was no dural enhancement. The sphenoid sinus mucosa was thickened in two cases and normal in one.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000481
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  • 83
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    A case of ochronosis: MRI of the lumbar spine (2000)
    Springer
    Neuroradiology 42 (2000), S. 905-907 
    Details
    ISSN: 1432-1920
    Keywords: Key words Alkaptonuria ; Ochronosis ; Spine ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We present the MRI features of the lumbar spine in a patient with ochronosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000428
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  • 84
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    Electronic Resource
    Primary malignant lymphoma of the maxillary sinus: CT and MRI (2000)
    Springer
    Neuroradiology 42 (2000), S. 285-289 
    Details
    ISSN: 1432-1920
    Keywords: Key words Lymphoma ; malignant ; Sinus ; maxillary ; Magnetic resonance imaging ; Computed tomography.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed the CT and MRI of seven patients with primary malignant lymphoma of the maxillary sinus to find if there are characteristic imaging findings suggestive of the disease. The images were analysed for appearance, size, signal, internal characteristics, extent of tumour, bone change and lymph node enlargement. In two patients, the tumour first presented with mucosal thickening. In the remaining five, the tumours were an expansile mass 4–6 cm in diameter at the time of detection. Although it was difficult to distinguish tumour from mucosa or obstructed fluid on CT, T2-weighted MRI enabled us to separate tumour from normal mucosa or fluid. In two patients, the tumours were heterogeneous. Calcification and haemorrhage were observed in one patient. Periantral soft-tissue infiltration was always present, even when tumour appeared as slight mucosal thickening. Posterior extension was seen in all patients. Permeative and lytic bone destruction accompanied most cases of periantral soft-tissue infiltration; mixed destruction and sclerosis was also observed. Mucosal thickening with periantral soft-tissue infiltration may suggest malignant lymphoma of the maxillary sinus in its early form. Various types of bone change may accompany the periantral soft-tissue infiltration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050887
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  • 85
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    Electronic Resource
    Hippocampal malrotation with normal corpus callosum: a new entity? (2000)
    Springer
    Neuroradiology 42 (2000), S. 339-345 
    Details
    ISSN: 1432-1920
    Keywords: Key words Brain, development ; Hippocampus ; Magnetic resonance imaging ; Epilepsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among 527 MRI examinations of patients with a suspicion of epilepsy in 5 years, we found 32 cases of hippocampal malrotation (HIMAL). The characteristic features are: incomplete inversion of the hippocampus with and abnormally round shape; unilateral involvement of the whole hippocampus; normal signal intensity and size; blurred internal structure; an abnormal angle of collateral sulcus; abnormal position and size of the fornix; normal size of the temporal lobe; enlargement and particular configuration of the temporal horn, typical of corpus callosum agenesis; and a normal corpus callosum. In 7 cases (22 %) HIMAL occurred together with developmental disorders. It was predominantly seen in men. The clinical features were varied. Based on some MRI features, the presence of developmental disorders, the male predominance, the frequently positive family history, and a review of the literature, we think HIMAL may be the consequence of a mild hemisphere developmental disorder. It is probably not the basic cause of epilepsy in such varied clinical setting, but may be a sign of a developmental disorder and can help in selecting patients for more meticulous investigation. It also may give some new understanding of brain development.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050895
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  • 86
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    Electronic Resource
    MRI of orbital schwannomas (2000)
    Springer
    Neuroradiology 42 (2000), S. 466-468 
    Details
    ISSN: 1432-1920
    Keywords: Key words Orbit ; Schwannoma ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The literature on MRI of orbital schwannomas is limited. The appearances in three patients with an orbital schwannoma were reviewed. A superior orbitotomy through a subfrontal craniotomy revealed a schwannoma in all cases. MRI characteristics of very low signal on T 1-weighted images and homogeneous postcontrast enhancement may be helpful for differentiating schwannomas from other intraconal masses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000296
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  • 87
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    Electronic Resource
    Dural enhancement in pituitary macroadenomas (2000)
    Springer
    Neuroradiology 42 (2000), S. 505-508 
    Details
    ISSN: 1432-1920
    Keywords: Key words Meninges ; Adenoma ; pituitary ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe the normal dural enhancement patterns of the sellar region and determine whether the duramater is affected by pituitary macroadenomas. Dural enhancement appeared to be usually abnormal in 20 patients with pituitary macroadenoma compared with 20 control patients, mainly at the planum sphenoidale and carotid sulcus. However dural changes are subtle and their recognition requires knowledge of the normal enhancement patterns. Dural changes, reported in a variety of inflammatory and infectious dural diseases and after surgery, are not specific and may be also seen in pituitary macroadenomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000346
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  • 88
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    Electronic Resource
    Virtual endoscopy of the inner ear and the auditory canal (2000)
    Springer
    Neuroradiology 42 (2000), S. 543-547 
    Details
    ISSN: 1432-1920
    Keywords: Key words Inner ear ; Virtual endoscopy ; Volume rendering ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the role of virtual endoscopy (VE) in the examination of intracisternal structures and of the inner ear, we studied the anatomy of the labyrinth and internal auditory canal using the original CT slices and VE on the unaffected side in three female and three male patients, age range 3–46 years, with contralateral retrocochlear hearing loss. We also examined seven patients with different pathological findings. VE was performed using an advanced postprocessing program with high- resolution 3D data sets of CT (1–1.5 mm thickness, pitch 1.25) and MRI-CISS-3D (constructive interference in steady state) images of the basal cisterns (1.5 T, slice thickness 0.7–1 mm). VE provides an endoscopic-like view from a given point within the basal cisterns of vessels and nerves (on MRI) or of the structures of the inner ear (on CT). The complex anatomy and pathological changes in the inner ear can be faithfully shown. The main advantage is not basic diagnostic information but demonstration of topographically complex situations, such as the canalicular system of the inner ear, for discussion, preoperative planning and teaching.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000329
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  • 89
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    Electronic Resource
    Rupture of spinal dermoid tumors with spread of fatty droplets in the cerebrospinal fluid pathways (2000)
    Springer
    Neuroradiology 42 (2000), S. 572-579 
    Details
    ISSN: 1432-1920
    Keywords: Key words Dermoid tumor ; spinal ; Syringomyelia ; Fat ; free ; Meningitis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cranial and spinal MRI was carried out at 0.5 or 1.5 T in five patients with spinal dermoid tumours. Free fatty material was appreciated within the normally communicating cerebrospinal fluid pathways in all five cases and in one case fat droplets were also observed within a dilated central canal of the spinal cord. While dissemination of lipid within the subarachnoid space and ventricles is easily understandable, the presence of lipid droplets within the central canal is more difficult to explain, since the central canal is only potential in the adult. When a dermoid tumor is suspected, we recommend MRI of the entire central nervous system, to detect possible leakage of fat from rupture of a cystic portion of the tumour.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000345
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  • 90
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    Electronic Resource
    Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences (2000)
    Springer
    Neuroradiology 42 (2000), S. 602-607 
    Details
    ISSN: 1432-1920
    Keywords: Key words Stroke ; Magnetic resonance imaging ; Pulse sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We evaluated the feasibility and use of diffusion-weighted and fluid-attenuated inversion-recovery pulse sequences performed as an emergency for patients with acute ischaemic stroke. A 5-min MRI session was designed as an emergency diagnostic procedure for patients admitted with suspected acute ischaemic stroke. We reviewed routine clinical implementation of the procedure, and its sensitivity and specificity for acute ischaemic stroke over the first 8 months. We imaged 91 patients (80 min to 48 h following the onset of stroke). Clinical deficit had resolved in less than 3 h in 15 patients, and the remaining 76 were classified as stroke (59) or stroke-like (17) after hospital discharge. Sensitivity of MRI for acute ischaemic stroke was 98 %, specificity 100 %. MRI provided an immediate and accurate picture of the number, site, size and age of ischaemic lesions in stroke and simplified diagnosis in stroke-like episodes. The feasibility and high diagnostic accuracy of emergency MRI in acute stroke strongly support its routine use in a stroke centre.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000356
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  • 91
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    Electronic Resource
    Delayed transient neurologic toxicity due to tacrolimus: CT and MRI (2000)
    Springer
    Neuroradiology 42 (2000), S. 666-668 
    Details
    ISSN: 1432-1920
    Keywords: Key words White matter ; White matter ; Immunosuppressive therapy, complications ; Bone-marrow transplant ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of transient neurologic toxicity secondary to tacrolimus. The clinical and imaging findings are reported and their subsequent regression after interruption of therapy in the patient following a bone-marrow transplant is also described. The etiology of the neurotoxicity and its analogy with other immunosuppressant agents are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000298
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  • 92
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    Electronic Resource
    A residual cystic lesion in acute disseminated encephalomyelitis (2000)
    Springer
    Neuroradiology 42 (2000), S. 682-684 
    Details
    ISSN: 1432-1920
    Keywords: Key words Acute disseminated encephalomyelitis ; Magnetic resonance imaging ; Cyst ; Japanese encephalitis vaccine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of acute disseminated encephalomyelitis (ADEM) with a residual cystic lesion on MRI. This seemed to be induced by Japanese encephalitis vaccination. Despite complete clinical improvement with high-dose steroid therapy, the cystic lesion has persisted for 3 years on MRI. There have been no previous reports of residual cystic lesions in ADEM.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002349900240
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  • 93
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    Electronic Resource
    Unilateral congenital cerebral venous dysgenesis (2000)
    Springer
    Neuroradiology 42 (2000), S. 40-42 
    Details
    ISSN: 1432-1920
    Keywords: Key words Veins, cerebral, anomalies ; Angiography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract I report a 30-year-old woman with congenital cerebral venous dysgenesis with absence of the internal cerebral and basal veins and most of the cortical veins. Unlike the more common bilateral picture, she had involvement only on the left side, which delayed presentation and gave relatively mild symptoms. The embryological mechanism and differential diagnosis of unilateral absence of the internal cerebral, basal and cortical veins are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050010
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  • 94
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    Electronic Resource
    De novo development of presumed cavernomas following resolution of E. Coli subdural empyemas (2000)
    Springer
    Neuroradiology 42 (2000), S. 778-780 
    Details
    ISSN: 1432-1920
    Keywords: Key words Cavernous angioma ; Empyema, subdural ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cavernomas fall within the group of angiographically occult lesions and may be found in up to 4 % of the population [1]. They may occur at any age, and with the advent of MRI incidental cavernomas are increasingly identified. The pathogenesis is uncertain. Familial cases are well recognised with a reported prevalence of 10–15 % [2–3]. The incidence of new lesions has been reported at 0.4 lesions per patient per year in cases with familial cavernomas [4]. Presumed cavernomas have been documented following radiation for malignancy [5–6], and sterotactic cerebral biopsy [7]. There have been no previously documented cases of de novo genesis of cavernomas following bacterial meningitis and subdural empyemas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000397
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  • 95
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    Electronic Resource
    MRI in multiple sclerosis of the spinal cord: evaluation of fast short-tan inversion-recovery and spin-echo sequences (2000)
    Springer
    Neuroradiology 42 (2000), S. 810-813 
    Details
    ISSN: 1432-1920
    Keywords: Key words Multiple sclerosis ; Spinal cord ; Magnetic resonance imaging ; Pulse sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We compared the sensitivity of T2-weighted spin-echo (FSE) and fast short-tau inversion-recovery (fSTIR) sequences in detection of multiple sclerosis of the spinal cord in 100 consecutive patients with clinically confirmed multiple sclerosis (MS); 86 patients underwent also brain MRI. In all, 310 focal lesions were detected on fSTIR and 212 on T2-weighted FSE, spinal cord lesions were seen better on fSTIR images, with a higher contrast between the lesion and the normal spinal cord. In 24 patients in whom cord plaques were shown with both sequences, the cranial study was normal or inconclusive. Assessment of spinal plaques can be particularly important when MRI of the brain is inconclusive, and in there situations fSTIR can be helpful.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000429
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  • 96
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    Tay's syndrome: MRI (2000)
    Springer
    Neuroradiology 42 (2000), S. 849-851 
    Details
    ISSN: 1432-1920
    Keywords: Key words Brittle hair ; Tay's syndrome ; Dysmyelination ; Magnetic resonance imaging ; Magnetic resonance spectroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tay's syndrome is a trichothiodystrophy associated with congenital ichthyosis. We report the findings on MRI and spectroscopy in a young girl with sparse, short, ruffled hair, dry skin and delayed milestones. T2-weighted images showed prominent diffuse confluent increase in signal symmetrically in all the supratentorial white matter. These findings are similar to those in a previously described case, and consistent with dysmyelination. Spectroscopy showed increased myoinositol and decreased choline.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000443
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  • 97
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    Electronic Resource
    Correlation between MRI findings and long-term outcome in patients with severe brain trauma (2000)
    Springer
    Neuroradiology 42 (2000), S. 860-867 
    Details
    ISSN: 1432-1920
    Keywords: Key words Traumatic brain injury ; Magnetic resonance imaging ; Pulse sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our aim was to relate MRI findings in patients with severe traumatic brain injury (TBI) to clinical severity and long-term outcome. We studied 37 patients with severe TBI, who were submitted to clinical assessment for disability and cognition and to MRI 60–90 days after trauma. Clinical assessment was also performed 3, 6 and 12 months later. The number and volume of lesions in various cerebral structures were calculated semiautomatically from FLAIR and fast field-echo images. Possible correlations between total and regional lesion volume and clinical deficits were then investigated. The frontal and temporal lobes were most frequently involved. Total lesion volume on FLAIR images correlated significantly with clinical outcome, whereas that on FFE images did not. Regional analysis showed that FLAIR lesion volume in the corpus callosum correlated significantly with scores on disability and cognition scales at the first clinical assessment. FLAIR lesion volume in the frontal lobes correlated significantly with clinical scores 1 year later.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000447
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  • 98
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    Electronic Resource
    Reversible posterior leukoencephalopathy after combination chemotherapy (2000)
    Springer
    Neuroradiology 42 (2000), S. 895-899 
    Details
    ISSN: 1432-1920
    Keywords: Key words Chemotherapy ; Cytarabine ; Cyclophosphamide ; Adriamycin ; Leukoencephalopathy ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a young woman with Burkitt's lymphoma, treated with intravenous adriamycine and cyclophosphamide and intrathecal cytarabine. She developed a reversible posterior leukoencephalopathy syndrome (RPLS) with typical MRI findings. Diffusion-weighted images during the first days after the onset of symptoms predicted a small irreversible lesion in the frontal lobe, verified on T2-weighted images 1 month later. The patient showed full recovery after high-dose steroid treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000482
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  • 99
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    Electronic Resource
    Subacute sclerosing panencephalitis: brain stem involvement in a peculiar pattern (2000)
    Springer
    Neuroradiology 42 (2000), S. 913-916 
    Details
    ISSN: 1432-1920
    Keywords: Key words Subacute sclerosing panencephalitis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The most common pattern in subacute sclerosing panencephalitis, is in the cerebral hemisphere white matter on T2-weighted images with or without atrophy. Brain-stem lesions are rare. We report brain-stem involvement in two children with subacute sclerosing panencephalitis. A peculiar pattern, with involvement of the pons with extension to both middle cerebellar peduncles and substantia nigra but sparing the pontine tegmentum, is suggested.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000448
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  • 100
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    Electronic Resource
    Invasive aspergillosis presenting as a cavernous sinus mass in immuno competent individuals; report of 3 cases (2000)
    Springer
    Neuroradiology 42 (2000), S. 108-111 
    Details
    ISSN: 1432-1920
    Keywords: Key words Cavernous sinus ; Magnetic resonance imaging ; Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aspergillosis of the cavernous sinus is rare, especially in immuno competent individuals. We report three such cases secondary to paranasal sinus aspergillosis, with imaging findings.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050025
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