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  • Electronic Resource  (193)
  • 2015-2019
  • 2000-2004  (193)
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  • Electronic Resource  (193)
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  • 1
    Electronic Resource
    Electronic Resource
    Usefulness of magnetic resonance imaging for diagnosing deep anorectal abscesses (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. S2 
    Details
    ISSN: 1530-0358
    Keywords: MRI ; Ischiorectal abscess ; Pelvirectal abscess
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: We evaluated the usefulness of magnetic resonance imaging for the preoperative diagnosis of deep anorectal abscesses. METHODS: Subjects were 21 patients with deep anorectal abscesses. Deep anorectal abscesses were classified into two types, ischiorectal and pelvirectal, according to their location. Patients were also classified into a single abscess group, which showed either an ischiorectal or pelvirectal abscess, and a double abscess group, which showed both ischiorectal and pelvirectal abscesses. The final diagnosis was made from surgical findings, and the types of deep anorectal abscesses determined by digital examination and magnetic resonance imaging were compared. RESULTS: Sensitivity of ischiorectal abscesses (20 lesions) with digital examination and magnetic resonance imaging was 75 and 95 percent, respectively, and that of pelvirectal abscesses (10 lesions) with digital examination and magnetic resonance imaging was 60 and 70 percent, respectively. Sensitivity of the magnetic resonance imaging was significantly higher than that of digital examination in ischiorectal abscesses. Diagnostic accuracy of digital examination and magnetic resonance imaging were both 83 percent in the single abscess group (12 patients), whereas in the double abscess group (9 patients) it was 22 and 78 percent, respectively. The rate of accurate diagnosis of magnetic resonance imaging compared with digital examination in the double abscess group was significantly higher than that in the single abscess group. CONCLUSION: Magnetic resonance imaging was useful for diagnosing and differentiating ischiorectal and pelvirectal abscesses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237218
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  • 2
    Electronic Resource
    Electronic Resource
    Efficient backward selection ofk-space samples in MRI on a hexagonal grid (2000)
    Springer
    Circuits, systems and signal processing 19 (2000), S. 267-278 
    Details
    ISSN: 1531-5878
    Keywords: MRI ; spectroscopic imaging ; sample selection ; k-space ; hexagonal sampling ; reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Electrical Engineering, Measurement and Control Technology
    Notes: Abstract Certain types of magnetic resonance imaging (MRI) such as magnetic resonance spectroscopic imaging and three-dimensional (3D) MRI require a great deal of time to acquire the image data. The acquisition time can be reduced if the image has a limited region of support, such as when imaging the brain or a cross section of the chest. Hexagonal sampling of the spatial frequency-domain (k-space) yields a 13.4% sampling density reduction compared to rectangular sampling of thek-space for images with a circular region of support (ROS) without incurring spatial aliasing in the reconstructed image. However, certain nonuniform sampling patterns are more efficient than hexagonal sampling for the same ROS. Sequential backward selection (SBS) has been used in previous work to optimize a nonuniform set ofk-space samples selected from a rectangular grid. To reduce the selection time, we present SBS of samples from a hexagonal grid. A Smith normal decomposition is used to transform the nonrectangular 2D discrete Fourier transform to a standard rectangular 2D fast Fourier transform so that the spatial-domain samples are represented directly on a rectangular grid without interpolation. The hexagonal grid allows the SBS algorithm to begin with a smaller set of candidate samples so that fewer samples have to be eliminated. Simulation results show that a significantly reduced selection time can be achieved with the proposed method in comparison with SBS on a rectangular grid.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01200888
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  • 3
    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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  • 4
    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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  • 5
    Electronic Resource
    Electronic Resource
    Bildgebende Diagnostik des Schultergelenks (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 249-254 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Schultergelenk ; Basisdiagnostik ; Röntgendiagnostik ; Sonographie ; Computertomographie ; Kernspintomographie ; Arthrographie ; Keywords ; Shoulder joint ; Basic diagnosis ; X-rays ; Sonography ; Computed tomography ; MRI ; Arthrography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: It is its ball-and-socket anatomy that makes the shoulder joint the most flexible of all human joints. This high degree of freedom of movement means, however, on the one hand that early degenerative damage is likely to occur as a result of sports and occupational strains and on the other that it is particularly vulnerable to injuries. Diagnostic radiology from two different perspectives is the basic diagnostic procedure for unexplained shoulder pain and for shoulder injuries. Dislocating osseous injuries or luxations can be detected most precisely or assessed most reliably during follow-up by this means. Intra-articular findings and alterations to the soft tissues (degenerative, traumatic) can be delineated by sonography, computed tomography and magnetic resonance imaging, albeit with differing degrees of reliability and specificity. Sonography is generally available, but not reliably standardized. Computed tomography is the method of choice for diagnosis of osseous and joint injuries. Over the last 10 years magnetic resonance imaging (MRI) has improved in sensitivity and specificity with technical progress (coils, sequences, reconstruction modalities) and has therefore moved into the focus of clinical interest.
    Notes: Das Schultergelenk ist infolge seiner anatomischen Ausbildung als Kugelgelenk das beweglichste Gelenk des menschlichen Körpers. Die sich hieraus ergebenden Bewegungsmöglichkeiten bedingen einerseits bereits frühzeitig degenerative Schädigungen infolge beruflicher oder sportlicher Belastungen und andererseits eine besondere ¶Angriffsfläche für Verletzungen. Die Basisdiagnostik sowohl des unklaren Schulterschmerzes als auch verletzungsbedingter Schädigungen am Schultergelenk ist die Röntgendiagnostik in 2 Ebenen. Dislozierende ossäre Verletzungen bzw. Luxationen sind hiermit treffsicher nachzuweisen bzw. in der Verlaufskontrolle zu beurteilen. Intraartikuläre Befunde und Weichteilveränderungen (degenerativ, traumatisch) sind hingegen mit den Schnittbildverfahren der Sonographie, Computertomographie und Kernspintomographie mit unterschiedlicher Treffsicherheit und Spezifität nachzuweisen. Die klassische Gelenkarthrographie hingegen tritt gegenüber diesen Verfahren deutlich in ihrer Bedeutung zurück. Die Sonographie ist ein ubiquitär verfügbares, jedoch wenig standardisiertes Verfahren. Die Reproduzierbarkeit der Befunde ist fraglich. Die Computertomographie stellt die Methode der Wahl bei der Diagnostik von okkulten ossären bzw. Gelenkverletzungen dar. Die Methode ist breit verfügbar und mit vertretbarem Aufwand durchzuführen. In den letzten 10 Jahren hat die Kernspintomographie infolge der technischen Weiterentwicklung (Spulen, Sequenzen, Rekonstruktionsmöglichkeiten usw.) an Sensitivität und Spezifität gewonnen. In der Summe aller klinischen Fragestellungen stellt sie neben der Basisdiagnostik derzeit die effektivste Untersuchungsmethode des Schultergelenks dar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100399900176
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  • 6
    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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  • 7
    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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  • 8
    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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  • 9
    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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  • 10
    Electronic Resource
    Electronic Resource
    Die MRT zur Beurteilung von Schußverletzungen (2000)
    Springer
    Rechtsmedizin 10 (2000), S. 90-95 
    Details
    ISSN: 1434-5196
    Keywords: Schlüsselwörter Geschosse ; Verletzungen ; MRT ; Beurteilung ; Dokumentation ; Keywords Projectiles ; Injuries ; MRI ; Assessment ; Documentation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: For the assessment of gunshot injuries, conventional X-ray examination, ultrasound and CT examinations are commonly used imaging techniques. With the exception of some authors, there is agreement that projectiles indicate a contraindication for MRI because of artificial imaging side-effects and the potential of secondary dislocation due to ferromagnetism. MRI testing was carried out on 56 projectiles for ferromagnetism and imaging quality in vitro and in pig carcasses with a 0.2 T and a 1.5T-MRI scanner. The image quality was compared to that of a CT scan. Projectiles with ferromagnetic properties can easily be distinguished from non-ferromagnetic ones by pretesting the motion of an projectile of the same type within the magnetic field of the MR scanner. When ferromagnetic projectiles were excluded, MRI yielded the more precise images compared to other imaging techniques. Projectile localization and associated soft tissue injuries were visualized without artifacts in all cases. When ferromagnetism is excluded MRI gives an excellent imaging procedure for the assessment and documentation of gunshot injuries. Therefore this imaging procedure may be also useful for medico-legal investigations.
    Notes: Zur Beurteilung des Ausmaßes von Schußverletzungen und zur Lokalisationsdiagnostik werden allgemein konventionelle Röntgenübersichtsaufnahmen sowie die Sonographie und die Computertomographie angewendet. Mit Ausnahme weniger Autoren wird generell davon ausgegangen, daß Projektile aufgrund der Generierung von Artefakten in der Bildgebung und der Gefahr einer sekundären Fremdkörperdislokation, bedingt durch den Ferromagnetismus, nicht mit der MRT beurteilt werden dürfen. 56 verschiedene Projektile wurden nach entsprechender Vortestung bezüglich ihrer Ferromagnetizität mit je einem 0,2-T- und 1,5-T-MRT-Gerät in vitro und anschließend in Schweinekadavern untersucht. Die Bildqualität wurde mit denen von CT-Bildern verglichen. Die ferromagnetischen Eigenschaften der Projektile können leicht beurteilt werden, indem man Vergleichsgeschosse desselben Typs in das Magnetfeld des MRT-Gerätes legt. Nach Ausschluß der Ferromagnetizität übertrifft die MRT alle anderen bildgebenden Verfahren. In allen Fällen gelang eine exakte Projektillokalisation sowie eine überlegene Darstellung der Weichteilverletzungen. Aufgrund der Ergebnisse ist die MRT, nach Ausschluß von ferromagnetischen Fremdkörpern, ein exzellentes Verfahren zur Beurteilung und Dokumentation von Schußverletzungen. Abhängig von den Fragestellungen kann dieses bildgebende Verfahren auch in der Rechtsmedizin eingesetzt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001940000044
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  • 11
    Electronic Resource
    Electronic Resource
    Position und Beweglichkeit des Discus articularis nach operativer Versorgung diakapitulärer und hoher Kiefergelenkluxationsfrakturen (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. 111-117 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Kiefergelenkfrakturen ; Kernspintomographie ; Achsiographie ; Diskusmobilität ; Diskusposition ; Key words TMJ fractures ; MRI ; Axiography ; Disc mobility ; Disc position
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Magnetic resonance imaging (MRI) assessment of traumatized temporomandibular joints (TMJ) usually focuses on disc position, defining regular joint function by normal, excentric or displaced disc position. So far, there are only few reports regarding disc position after open reduction of diacapitular or high condylar fractures of the TMJ with dislocation. The aim of the present study was to evaluate the role of the disc as regards postoperative functional outcome by electronic axiographic recordings of condylar movements and MRI, displacement of the disc and lesions of TMJ soft tissues being frequent in this type of mandibular fractures. A total of 30 subjects with 37 condylar fractures in whom osteosynthesis was performed using a preauricular approach were imaged postoperatively (mean 24 months) with a 1.5-Tesla MRI system to determine, (a) the position of the disc, (b) the range of mobility of the disc and (c) condylar mobility in closed and open mouth position, comparing fractured sides (FS) vs nonfractured sides (NFS). Linear movements between the two jaw positions in the sagittal plane were measured by superimposing transparencies. The results indicate: (1) more than 70% of the discs (FS) were found to be in normal position; there was no disc displacement without reduction. However, these data stood in contrast to severe limitations of the axiographic tracings as presented by almost 30% of the subjects. (2) Significant correlations were found between fixed (α = 0.05) or highly immobilized (α = 0.01) discs and axiographic limitations, suggesting disc mobility to be a valuable parameter for assessment of the postoperative functional outcome.
    Notes: Zusammenfassung Bei diakapitulären Frakturen bzw. hohen Kollumluxationsfrakturen mit Beziehung zum Lig. laterale sind Verlagerungen des Diskus häufig und werden nach konservativer Therapie mit einer Häufigkeit zwischen 50 und 100% angegeben. Informationen über die Diskusposition nach operativer Versorgung dieser Frakturgruppen liegen bisher nicht vor. Ziel der vorliegenden Studie war es, die Bedeutung von Position und Mobilität des Diskus für das postoperative funktionelle Ergebnis dieser Frakturgruppen zu klären. Die Objektivierung der operativen Ergebnisse bei 30 Patienten mit 37 über einen präaurikulären Zugang versorgten Gelenkfrakturen erfolgte mittels elektronischer Achsiographie und Kernspintomographie (1,5-T-System), im Mittel 24 Monate postoperativ. Erhoben wurden die Position und der Bewegungsumfang des Diskus bzw. des Kondylus im Seitenvergleich. Die linearen Bewegungen zwischen mundoffener und -geschlossener Position wurden durch Folienüberlagerung korrespondierender sagittaler MRT-Schichten ermittelt. Die Ergebnisse zeigten zum einen, dass 〉 70% der Disci auf der Frakturseite orthotop (Position A) lagen und keine fixierten anterioren Dislokationen (C) auftraten. Die achsiographischen Befunde zeigten in Diskrepanz dazu bei immerhin 30% der versorgten Gelenke höhergradige Limitationen der Exkursionsbahnen. Zum anderen bestehen signifikante Zusammenhänge zwischen fixierten (α = 0,05) bzw. hochgradig immobilisierten (α = 0,01) Disken und achsiographisch erfassten Limitationen der Translationsbewegung. Im Gegensatz zu bisherigen Studien sollten nach der operativen Versorgung von Gelenkfrakturen nicht nur die (statische) Diskusposition, sondern in erster Linie die Diskusmobilität als Parameter für das funktionelle Ergebnis berücksichtigt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060050181
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  • 12
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    Electronic Resource
    Vergleichende Untersuchung sagittaler und koronaler MRT mit histologischen Diskus- und Kiefergelenkpräparaten zur Prüfung einer Identität von anteriorer Diskusdislokation und anterioren Kapselbindegeweben (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. 285-291 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Kiefergelenk-MRT ; Diskusdislokation ; Kiefergelenkhistologie ; Keywords Temporomandibular joint (TMJ) ; MRI ; Anterior disk dislocation ; TMJ histology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Problem. Anterior dislocation of the articular disk of the temporomandibular joint (TMJ) found by MRI tomography often presents a problem. It may persist in MRI despite improvement of articular symptoms and even be found in healthy persons free of any symptoms. Can this be explained by the similarity in structure of the anterior connective tissue of the disk and capsule and their pathological changes? Is a second coronal plane required for MRI investigation? Material and methods. The preauricular regions of 72 patients of the TMJ clinic were examined by oblique-sagittal and oblique-coronal MRI. A Siemens-Vision MRI was used. It was also possible to prepare 10 articular disks of the TMJ with anterior capsular tissue as well as 20 complete TMJs of adults from autopsy material. Sagittal, transversal, and horizontal serial sections were examined histologically. Results. In 49 of the 72 cases examined, an anterior dislocation without reduction found in the sagittal MRI was not confirmed in the oblique-coronal MRI. In the sagittal MRI it was possible to differentiate three, in the coronal MRI six typical forms of magnetic resonance signals, which are represented in figures. They are compared with anatomical and histological connective tissue findings adjacent to the TMJ. The structural similarity of the disk and anterior capsular tissue of the TMJ is demonstrated. The close connection of the disk and connective tissue surrounding the TMJ makes differentiation of MRI findings difficult especially following regressive and adaptive reactions. Conclusions. In MRI, anterior capsular tissue is able to simulate dislocation of the disk. Pathological tissue reactions may alter the MRI signal and lead to the wrong diagnosis of dislocation of the disk. Diagnosis of an anterior disk dislocation cannot be established solely on the basis of oblique-sagittal MRI findings.
    Notes: Zusammenfassung Fragestellung. Der Befund anteriore Diskusdislokation im sagittalen MRT beinhaltet 2 ungeklärte Probleme. Trotz Rückbildung einer Gelenksymptomatik können anteriore Diskusdislokationen im MRT unverändert bestehen, sie wurden sogar bei gesunden Probanden beschrieben. Ist die Ursache in der feingeweblichen Ähnlichkeit der anterioren Diskus- und Kapselbindegewebe und in deren pathologischen Strukturänderungen zu suchen? Kann auf die Befundung in der 2. koronalen Ebene verzichtet werden? Material und Methode. Die präartikulären Regionen im schräg-sagittalen und im schräg-koronalen MRT von 72 Patienten aus der Kiefergelenkspezialsprechstunde wurden befundet. Die Untersuchungen erfolgten mit dem Siemens-Vision-MRT. Bei unselektierten Sektionen konnten 10 Disci articulares mit dem anterioren Kapselgewebe sowie 20 Kiefergelenkpräparate Erwachsener präpariert werden. Sagittale, transversale und horizontale Serienschnitte wurden histologisch untersucht. Ergebnisse. Bei 49 von 72 ausgewählten Fällen gab es für eine anteriore Diskusdislokation ohne Reduktion im sagittalen MRT keine Bestätigung im schräg-koronalen MRT. Es konnten in den sagittalen MRT 3, in den koronalen MRT 6 sich wiederholende Signalformen differenziert werden. Sie sind skizziert. Ihre Zuordnung zu gelenkumgebenden Bindegeweben erfolgte mittels Vergleich dieser Signalformen mit den anatomischen und histologischen Kiefergelenkpräparaten. Die feingewebliche Ähnlichkeit des Discus articularis mit dem anterioren Kapselbindegewebe wird aufgezeigt. Seine enge Verbindung mit den gelenkumgebenden Bindegeweben erschwert die Differenzierung im MRT insbesondere beim Vorliegen regressiver und adaptiver Reaktionen. Schlussfolgerung. Das anteriore Kapselgewebe kann eine Diskusdislokation im MRT vortäuschen. Pathologische Gewebereaktionen ändern das MRT-Signal und tragen dazu bei, falsch-positive Befunde zur Diskusdislokation entstehen zu lassen. Schräg-sagittale MRT sind für die Diagnosefindung „anteriore Diskusdislokation mit und ohne Reposition“ nicht ausreichend.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010789
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  • 13
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    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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  • 14
    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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  • 15
    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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  • 16
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    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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  • 17
    Electronic Resource
    Electronic Resource
    Gliomatosis cerebri Zwei Fallberichte mit atypischer klinischer und neuroradiologischer Befundkonstellation (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 481-484 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Gliomatosis cerebri ; MRT-Diagnose ; Enzephalitis ; Key words Gliomatosis cerebri ; MRI ; Diagnosis ; Encephalitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The diagnosis of the rare disease Gliomatosis cerebri requires the correlation of clinical, radiological, and pathological findings. We report on two patients with intravitally diagnosed gliomatosis cerebri. Due to the unusually high malignancy of the tumor cells, diagnosis was complicated by atypical findings such as gadolinium enhancement in MRI and raised intracranial pressure. The clinical course, differential diagnosis, and literature are summarized briefly.
    Notes: Zusammenfassung Die Diagnose der seltenen Gliomatosis cerebri kann nur in Zusammenschau von klinischen, radiologischen und histopathologischen Befunden gestellt werden. Im vorliegenden Artikel berichten wir über 2 Patienten, bei denen intra vitam nach stereotaktischer Hirnbiopsie die Diagnose Gliomatosis cerebri gesichert wurde. Da in beiden Fällen für Gliomatosis cerebri ungewöhnlich hochgradig entdifferenzierte Tumorzellen vorlagen, wurde die Diagnosefindung durch atypische Befunde wie Kontrastmittelaufnahme im MRT und klinische Zeichen der intrakraniellen Drucksteigerung erschwert. Klinischer Verlauf, Differentialdiagnosen und Literatur werden kurz dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050611
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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
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    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
    Hallervorden-Spatz-Krankheit Befundkonstellation am nigrostriatalen System (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 660-665 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Hallervorden-Spatz-Krankheit ; Parkinsonsyndrom ; MRT ; 123J-β-CIT ; 123J-IBZM ; Keywords Hallervorden-Spatz Disease ; Parkinson's syndrome ; MRI ; 123I-β-CIT ; 123I-IBZM
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Hallervorden-Spatz disease (HSD), a rare extrapyramidal motor illness, is usually only confirmed after death. In vivo diagnosis has relied hitherto on the combination of typical magnetic resonance imaging (MRI) findings (the “eye of the tiger” sign) and heterogeneous clinical symptoms of movement disorder which have been regarded as almost pathognomonic. We report on the diagnostic contribution of 123J-β-CIT single photon emission computed tomography (SPECT) and 123J-IBZM SPECT in akinetic-rigid Parkinson's syndrome occurring in a case of HSD. In contrast to Parkinson's disease and multisystem atrophies, the results of both tests were normal. This constellation of findings shows that the degeneration lies primarily outside the nigrostriatal system, supporting arguments for the nosologic distinction of HSD from other extrapyramidal illnesses.
    Notes: Zusammenfassung Die Diagnose der Hallervorden-Spatz-Krankheit (HSD), einer seltenen extrapyramidal-motorischen Erkrankung, konnte gewöhnlich erst postmortal gesichert werden. Bislang galt der typische MRT-Befund mit dem “Tigerauge-Zeichen” in Kombination mit der heterogen klinischen Symptomatik von Bewegungsstörungen als nahezu pathognomonisch und diente zur Diagnosestellung zu Lebzeiten. In der vorliegenden Kasuistik soll der diagnostische Beitrag von 123J-β-CIT und 123J-IBZM-SPECT bei einem akinetisch-rigiden Parkinsonsyndrom im Rahmen einer HSD dargestellt werden. Für beide Untersuchungen wurden im Gegensatz zum M. Parkinson und Multisystematrophien Normalbefunde gefunden. Diese Befundkonstellation zeigt einerseits, dass die Degeneration primär außerhalb des nigrostriatalen Systems liegt, und andererseits unterstützt sie die Diskussion der nosologischen Abgrenzung der HSD von anderen extrapyramidalen Erkrankungen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050643
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  • 22
    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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  • 23
    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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  • 24
    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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  • 25
    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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  • 26
    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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  • 27
    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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  • 28
    Electronic Resource
    Electronic Resource
    Diffusionsgewichtetes MRT bei Creutzfeldt-Jakob-Patienten (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 91-95 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Creutzfeldt-Jakob-Krankheit ; Diagnostik ; Diffussionswichtung ; MRT ; Bildgebung ; Übertragbare spongiforme Enzephalopathien ; Key words Creutzfeldt-Jakob disease ; Diagnosis ; Diffusion-weighted image ; MRI ; Brain images ; Transmissible spongiform encephalopathies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Today the diagnosis of Creutzfeldt-Jakob disease (CJD) is proven only postmortem or by evidence of neuropathology. During the patient's lifetime EEG recordings or cerebrospinal fluid analysis may support the diagnosis. In most cases, T2-MRI scans show hyperintensities of the basal ganglia. A new imaging technique called diffusion-weighted MRI (DWI) has recently been established. The sensitivity of DWI was evaluated in five patients suspected of CJD. All five cases showed hyperintense signal changes in the basal ganglia on DWI sequences. These findings were more pronounced in DWI than in T2, FLAIR, or PD-weighted images. Thus, DWI seems to be the most sensitive sequence for detecting changes in patients with suspected CJD. Moreover, its short scanning time ensures that fewer artifacts occur, especially in the case of myoclonus.
    Notes: Zusammenfassung Die sichere Diagnose der Creutzfeldt-Jakob-Krankheit kann nur bioptisch oder autoptisch durch Untersuchung von Hirngewebe gestellt werden. Die klinische Verdachtsdiagnose erhärten können technische und laborchemische Untersuchungen; hierzu gehört neben dem EEG die Surrogatmarkerbestimmung im Liquor. Nachdem sich bei der Mehrzahl der Patienten Veränderungen der Basalganglien gezeigt haben, gehört das MRT zu den bildgebenden Verfahren, die bei Verdacht auf CJD eingesetzt werden können. Inzwischen ist die Diffusionswichtung (DWI) in die neuroradiologische Diagnostik eingeführt worden. DWI-gewichtete MRTs bei 5 CJD-Patienten wurden von uns untersucht. Alle 5 Fälle zeigten im DWI-MRT signalintense Veränderungen der Stammganglien. Diese Veränderungen waren jeweils deutlicher als in der T2, Flair- oder Protonenwichtung. Das DWI-MRT halten wir für sensitiver zum Nachweis kortikaler und basaler Veränderungen bei CJD-Patienten im Vergleich zu Standardsequenzen. Durch die kurze Untersuchungszeit können besonders bei den häufig vorhandenen Myoklonien andere Wichtungen aufgrund von Bewegungsartefakten oftmals nicht in der gewünschten Qualität durchgeführt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150070001
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  • 29
    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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  • 30
    Electronic Resource
    Electronic Resource
    Treffsicherheit der Magnetresonanztomographie zum Nachweis von Meniskusrissen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 1079-1085 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Knie ; MRT ; Arthroskopie ; Meniskus ; Key words Knee ; MRI ; Arthroscopy ; Meniscus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In order to assure diagnostic accuracy, 172 knee joints were examined prospectively by MRI. After MRI, all knee joints were examined by arthroscopy. Tears of the medial meniscus were found in 102 patients, the lateral meniscus showed a tear in 29 cases. Assuming that arthroscopy represents the golden standard of diagnostic measure concerning the knee joint, it can be stated that false-positive MRI findings on the medial and lateral meniscus were diagnosed in three cases and false-negative MRI findings were diagnosed for two knee joints regarding the medial meniscus and four times regarding the lateral meniscus. For the medial meniscus a sensitivity of 98%, a specificity of 96%, an accuracy of 94%, and the positive and negative value of prediction were calculated at 97% each. Regarding the lateral meniscus, a sensitivity of 85%, a specificity of 98%, an accuracy of 92%, a positive predictive value of 88%, and a negative predictive value of 85% were found. Under the prerequisite that the MRI is carried out correctly and assessed by an experienced radiologist, the accuracy of the MRI for meniscus diagnosis is almost equivalent to the one by arthroscopy. Under these conditions, MRI can be recommended when no safe and sufficient clinical diagnosis can be made. The rate of unnecessary arthroscopies with a pure diagnostic purpose can be lowered significantly by means of MRI.
    Notes: Zusammenfassung Zur Überprüfung der diagnostischen Treffsicherheit wurden prospektiv 172 Kniegelenke mittels Magnetresonanztomographie (MRT) untersucht. Nach der MRT erfolgte bei allen Kniegelenken die arthroskopische Überprüfung der bildgebenden Diagnose. Rissbildungen des Innenmeniskus fanden sich bei 102 Patienten, am Außenmeniskus wurde 29-mal ein Riss befundet. Unter der Annahme, dass die Arthroskopie der “golden standard” diagnostischer Maßnahmen am Kniegelenk darstellt, ergab sich, dass falsch-positive MRT-Befunde am Innen- und Außenmeniskus in jeweils 3 Fällen und falsch-negative MRT-Befunde am Innenmenikus bei 2 Kniegelenken und am Außenmeniskus 4-mal erhoben wurden. Für den Innenmeniskus wurde eine Sensitivität von 98%, eine Spezifität von 96%, eine Genauigkeit von 94% und der positive bzw. negative Vorhersagewert mit jeweils 97% errechnet. Bezüglich des Außenmeniskus ließ sich eine Sensitivität von 85%, eine Spezifität von 98%, eine Genauigkeit von 92%, ein positiver Vorhersagewert von 88% und ein negativer Vorhersagewert von 85% ermitteln. Unter der Voraussetzung, dass die MRT korrekt durchgeführt und von einem erfahrenen Radiologen befundet wird, ergibt sich eine annähernd gleichwertige Treffsicherheit der MRT für die Meniskusdiagnostik wie mit der Arthroskopie. Die MRT kann daher unter diesen Voraussetzungen zur Anwendung empfohlen werden, wenn klinisch keine ausreichend sichere Diagnose zu stellen ist. Die Rate unnötiger rein diagnostischer Arthroskopien kann durch die MRT entscheidend gesenkt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050672
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  • 31
    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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  • 32
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    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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  • 33
    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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  • 34
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    Electronic Resource
    Die Kufs-Erkrankung Seltene Ursache einer früh beginnenden Demenz (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 411-415 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Kufs ; Neuronale Zeroidlipofuszinose ; Demenz ; PET ; MRT ; Key words Kufs disease ; Neuronal ceroid lipofuscinosis ; Dementia ; PET ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The case of a 35-year-old man with progressive dementia from the age of 17 is presented. Clinical examination showed mild extrapyramidal and cerebellar signs and rare myoclonus. Neuropsychological evaluation disclosed severe cognitive deficits. Magnetic resonance imaging (MRI) revealed moderate generalized atrophy with abnormal iron deposition in the basal ganglia. Positron emission tomography (PET) with 18-fluorodeoxyglucose (18-FDG) demonstrated clear temporoparietal hypermetabolism. The clinical symptoms and course are typical for the rare adult type of neuronal ceroid lipofusconoses (Kufs' disease). The diagnosis is supported by the electron microscope detection of an abnormal accumulation of lipid vacuoles and lipofuscin in the eccrine sweat glands and the rectal ganglia cells.
    Notes: Zusammenfassung Berichtet wird der Fall eines 35-jährigen Patienten mit langsam progredienter Demenz seit dem 18. Lebensjahr. Zum Zeitpunkt der Untersuchung fielen klinisch eine leichtgradige extrapyramidale und zerebelläre Symptomatik sowie seltene Myoklonien auf, während die neuropsychologische Testung ausgeprägte kognitive Defizite ergab. Die kraniale Magnetresonanztomographie zeigte eine mäßige globale Atrophie und eine abnorme Eisenablagerung in den Basalganglien. In der Positronenemissionstomographie mit 18-FDG war ein deutlicher temporoparietaler Hypometabolismus erkennbar. Klinik und Verlauf sind typisch für die seltene adulte Variante der neuronalen Zeroidlipofuszinosen (Kufs-Typ). Diese Diagnose wird gestützt durch den elektronenmiroskopischen Nachweis abnormer Akkumulationen von Fettvakuolen und Lipofuszinablagerungen in den ekkrinen Schweißdrüsen der Haut und in den rektalen Ganglienzellen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050577
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  • 35
    Electronic Resource
    Electronic Resource
    Verlaufsbeobachtung nach enteraler Manganintoxikation Klinische, laborchemische und neuroradiologische Befunde (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 416-419 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Manganintoxikation ; Parkinsonismus ; MRT ; Verlaufskontrolle ; L-Dopa-Therapie ; Key words Manganese intoxication ; Parkinsonism ; MRI ; Follow-up study ; L-dopa treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Manganese intoxication is an unusual, severe form of intoxication. This report deals with a patient now 80 years old who accidentally ingested a solution of potassium permanganate for a period of at least 4 weeks 14 years ago. Since then, the patient suffers from a mild parkinsonian syndrome and distally accentuated polyneuropathies. Psychiatric disorders, especially demential or depressive symptoms, were not observed. Manganese analysis of his hair still shows a clear increase in manganese concentration. The MRI of his brain showed no pathological changes, in particular none of those often described with symmetric signal elevation in T1 in the area of the basal ganglia. In this study, we present clinical, laboratory, and neuroradiological findings. Unusual in this case with a short exposition is the long duration and clinical improvement without L-dopa treatment.
    Notes: Zusammenfassung Eine Manganintoxikation ist eine ungewöhnliche, schwere Intoxikationsform. Wir berichten über einen jetzt 80-jährigen Patienten, der vor 14 Jahren über die Dauer von mindestens 4 Wochen versehentlich Kaliumpermanganat eingenommen hatte. Der Patient leidet weiterhin unter einem leichten Parkinsonsyndrom und einer distal betonten Polyneuropathie. Psychiatrische St¨rungen, insbesondere ein dementielles oder depressives Symptom, fanden sich nicht mehr. Die Mangananalysen der Haare zeigen auch jetzt noch deutlich erhöhte Konzentrationen. Das MRT des Gehirns erbrachte keinen pathologischen Befund, insbesondere keine häufig bei Manganintoxikationen beschriebenen Veränderungen mit symmetrischen Signalanhebungen in T1-Wichtung im Bereich der Basalganglien (Globus pallidus). In einer aktuellen Untersuchung werden klinische, laborchemische sowie neuroradiologische Ergebnisse vorgestellt. Die Besonderheit des Falles erklärt sich aus einer kurzen Expositionsdauer mit einer langen Verlaufszeit und klinischer Befundbesserung ohne L-Dopa-Behandlung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050578
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  • 36
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    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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  • 37
    Electronic Resource
    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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  • 38
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    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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  • 39
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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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  • 40
    Electronic Resource
    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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  • 41
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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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  • 42
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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
    A rare case of bilateral small cell carcinoma of the ovary diagnosed during pregnancy (2000)
    Springer
    International journal of clinical oncology 5 (2000), S. 200-203 
    Details
    ISSN: 1437-7772
    Keywords: Key words Small cell carcinoma of the ovary ; Pregnancy Paclitaxel ; MRI ; Facial palsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Small cell carcinoma of the ovary (SCCO) is a highly aggressive malignancy that affects young females. The disease is fatal in nearly all patients with disease categorized as higher than stage IA. A 30-year-old Japanese woman was diagnosed, while pregnant, as having bilateral small cell carcinoma, pulmonary type, a rare finding. She received three courses of JP chemotherapy (carboplatin, 525 mg; cisplatin, 120 mg) and three courses of PVP chemotherapy (peplomycin, 30 mg; vinblastin, 12 mg; cisplatin, 120 mg). Computed tomography scans were taken during and after the period in which she received chemotherapy showed growing multiple metastatic tumors and massive ascites. Third-line chemotherapy with paclitaxel (225 mg) was then initiated. Although the lymphadenopathy and massive ascites were alleviated, bone marrow suppression intervened. The patient died 18 months after being diagnosed. To our knowledge, this is third reported case of SCCO to be diagnosed during pregnancy, and the first reported case of bilateral disease diagnosed during pregnancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012039
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  • 44
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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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  • 45
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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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  • 46
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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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  • 47
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    Electronic Resource
    Predicting microscopic extrauterine spread of endometrial carcinoma with MRI to support less invasive therapy (2000)
    Springer
    International journal of clinical oncology 5 (2000), S. 158-163 
    Details
    ISSN: 1437-7772
    Keywords: Key words Endometrial carcinoma ; MRI ; Diagnosis ; Minimally invasive therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Magnetic resonance imaging (MRI) provides precise staging of endometrial carcinoma. However, we have sometimes experienced patients with microscopic extrauterine extension in whom MRI showed the disease as being limited to the uterus. We studied indirect MRI signs for microscopic extrauterine spread of endometrial carcinoma which outwardly seemed to be limited to within the uterus. Methods. MRI studies and the clinical records of 100 patients with surgically proven endometrial carcinoma were retrospectively reviewed. We evaluated: (1) MRI staging, (2) tumor growing at the orifices of the fallopian tube in the uterine fundus, (3) hydrosalpinx, and (4) ascites, in each MRI study. Results. Surgical specimens showed that 12 of the 100 patients had extrauterine spread, with 1 patient showing both ovarian extension and omental metastasis; there ovarian extension in 3, extension to the fallopian tubes in 3, omental metastasis in 1, and positive peritoneal cytology in 4. Tumor growing at the orifices of the fallopian tubes with deep myometrial invasion showed higher accuracy for predicting microscopic intrauterine spread (82.0%) although it was not significantly different from the accuracy of deep myometrial invasion anywhere within the uterus (75.0%). However, tumor growing at the orifices of the fallopian tubes in a patients with stage Ia disease showed a high negative predictive value (89.7%). Hydrosalpinx had the highest specificity (98.9%) and accuracy (88.0%); however, it did not seem to be practical because it was observed in only 2 patients. Ascites in postmenopausal patients showed higher specificity (93.5%), although it was not considered to be useful in the premenopausal patients. Conclusion. Tumor extension at the orifices of the fallopian tubes in patients with stage Ia disease, and ascites in postmenopausal patients on MRI seemed to be predictive factors for microscopic extrauterine spread.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012031
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  • 48
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    Electronic Resource
    Subchondral insufficiency fracture of the femoral head and medial femoral condyle (2000)
    Springer
    Skeletal radiology 29 (2000), S. 40-44 
    Details
    ISSN: 1432-2161
    Keywords: Key words Subchondral insufficiency fracture ; Femoral head ; Medial femoral condyle ; Osteonecrosis ; MRI ; X-ray
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050007
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  • 49
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    Electronic Resource
    Cystic fibrous dysplasia mimicking giant cell tumor: MRI appearance (2000)
    Springer
    Skeletal radiology 29 (2000), S. 45-48 
    Details
    ISSN: 1432-2161
    Keywords: Key words Cystic fibrous dysplasia ; Giant cell tumor ; Femur ; X-ray ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report the case of a 43-year-old man who presented with an osteolytic and expansive lesion in the left distal femur mimicking a giant cell tumor. Magnetic resonance imaging (MRI) showed that most of the lesion was cystic, and histological examination revealed fibrous dysplasia with marked cystic degeneration. Radiographic findings of cystic fibrous dysplasia in the end of a long bone may be similar to those of a giant cell tumor, and a biopsy is essential for the final diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050008
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  • 50
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    Electronic Resource
    Primary hemangiopericytoma of the tibia: MR and angiographic correlation (2000)
    Springer
    Skeletal radiology 29 (2000), S. 49-53 
    Details
    ISSN: 1432-2161
    Keywords: Key words Hemangiopericytoma ; Tibia ; MRI ; Angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The Magnetic Resonance Imaging (MRI) appearances of primary osseous hemangiopericytoma (HPC) have been rarely described. We report on a 46-year-old Chinese man with primary osseous HPC of the right tibia. The characteristic vascular distribution of this tumor, presenting with a ”spoke-wheel” appearance on MR images and with angiographic correlation, is described. Although not pathognomonic, this MR appearance may be an important finding in suggesting the diagnosis of osseous HPC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050009
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  • 51
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    Electronic Resource
    Diffusion-weighted imaging of the musculoskeletal system in humans (2000)
    Springer
    Skeletal radiology 29 (2000), S. 555-562 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Diffusion ; MRI ; Skeletal system ; Spine ; neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This article reviews the principles of diffusion-weighted imaging (DWI) and recent results in DWI of the musculoskeletal system. The potential of DWI in the diagnosis of pathology of the musculoskeletal system is discussed. DWI is a relatively new MR imaging technique that has already been established in neuroradiology, especially in the early detection of brain ischemia. The random motion of water protons on a molecular basis can be measured with DWI. To date DWI of the abdomen and of the musculoskeletal system has only been employed in scientific studies, but first results indicate that it may also be beneficial in these fields. Different diffusion characteristics have been found in normal tissues such as muscle, fat and bone marrow. Also, pathologic entities such as neoplasms, post-therapeutic soft tissue changes and inflammatory processes can be differentiated. Normal muscle shows significantly higher diffusion values than subcutaneous fat and bone marrow, due to a higher mobility of water protons within muscle. Soft tissue tumors exhibit a significantly lower diffusion value compared with post-therapeutic soft tissue changes and inflammatory processes. Necrotic tumor tissue can be distinguished from viable tumor due to significantly higher diffusion of water protons within necrotic tissue.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000243
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  • 52
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    Electronic Resource
    Bone marrow response in treated patients with Gaucher disease: evaluation by T1-weighted magnetic resonance images and correlation with reduction in liver and spleen volume (2000)
    Springer
    Skeletal radiology 29 (2000), S. 563-571 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Gaucher disease ; MRI ; Enzyme replacement therapy ; Liver ; Spleen ; Bone marrow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose. To determine whether T1-weighted magnetic resonance (MR) images can demonstrate response in the marrow of patients with type 1 Gaucher disease treated with enzyme replacement therapy (ERT) and to determine whether a relationship exists between liver and spleen volume reductions and visible marrow changes. Patients. Forty-two patients with type 1 Gaucher disease were evaluated on at least two occasions. Thirty-two patients received ERT. Of these patients, 15 had a baseline examination prior to the initiation of ERT. The remaining 10 patients did not receive ERT. Design. T1-weighted and gradient recalled echo (GRE) coronal images of the femurs and hips were obtained. Concurrently, liver and spleen volumes were determined using contiguous breath-hold axial gradient-echo images. T1-weighted images of the hips and femurs were evaluated to determine change or lack of change in the yellow marrow. Results. Of the 32 patients receiving ERT, 14 (44%) demonstrated increased signal on T1-weighted images suggesting an increase in the amount of yellow marrow. If only the 15 patients with a baseline examination were considered, the response rate to ERT was 67%. Using Student’s t-test a highly significant correlation (P〈0.005) was found between marrow response and reduction in liver and spleen volume. Conclusions. Marrow changes in patients receiving ERT can be detected by T1-weighted images. This response correlated with reductions in visceral volumes (P〈0.0005).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000276
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  • 53
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    Electronic Resource
    Telangiectatic dedifferentiation of a parosteal osteosarcoma (2000)
    Springer
    Skeletal radiology 29 (2000), S. 597-600 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Parosteal osteosarcoma ; Telangiectatic osteosarcoma ; Dedifferentiation ; Femur ; Radiography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A unique case of parosteal osteosarcoma (POS) of the proximal femur, with areas of telangiectatic dedifferentiation, in a 28-year-old woman is reported. The patient had a 7-week history of pain and swelling in her right thigh. A biopsy diagnosis of POS was established. The patient was treated with two cycles of intra-arterial chemotherapy, followed by limb salvage surgery. Histological examination of the resected specimen showed POS with areas of dedifferentiation composed of high-grade telangiectatic osteosarcoma with associated secondary aneurysmal bone cyst change.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000247
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  • 54
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    Malignant round cell tumours of bone: atypical clinical and imaging features (2000)
    Springer
    Skeletal radiology 29 (2000), S. 646-651 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Ewing sarcoma ; Primitive neuroectodermal tumour ; Radiography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective.To describe the clinical, radiological and MRI features of six atypical cases of histologically proven appendicular Ewing sarcoma/ primitive neuroectodermal tumour (PNET). Design. Retrospective review of case notes and available imaging was carried out. Patients. Six patients (4 male, 2 female; mean age 27years, range 19–44 years), presenting over a 77-month period, were identified from the Bone Tumour Register. All had unusual clinical and imaging features for Ewing sarcoma/PNET. Results and conclusions. Four tumours were centred on the distal femoral metaphysis, one in the proximal tibial metaphysis and one in the distal tibial metaphysis. Plain radiographs were available in four cases and showed minor cortical changes. MRI demonstrated a relatively small, eccentrically located intraosseous component with a large, eccentric extraosseous component. Extension into the epiphysis was seen in three cases and into the adjacent joint in two cases. Intraosseous ”skip” metastases were present in three cases. The clinical and imaging features were atypical for conventional intraosseous Ewing sarcoma/PNET and the exact site of origin (intraosseous, periosteal or soft-tissue) was unclear.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000277
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  • 55
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    Osteoblastoma-like osteosarcoma (2000)
    Springer
    Skeletal radiology 29 (2000), S. 656-659 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Osteoblastoma-like osteosarcoma ; Osteosarcoma ; Aggressive osteoblastoma ; Fibula ; Radiography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report an osteoblastoma-like osteosarcoma in the right proximal fibula in a 22-year-old woman. Radiographs showed an irregular osteolytic lesion from the metaphysis to the epiphysis in the proximal fibula with partial destruction of cortical bone. Tissue from a biopsy indicated a typical osteoblastoma. Curettage and bone graft was performed. One year after the surgery, local recurrence occurred, and a wide excision was performed. Histological examination of the en-bloc surgical specimen revealed the tumor had permeated through the host bony trabeculae, although the nuclear atypia was not marked. Immunohistochemical expression of MIB-1 was detected in 9.0% of cells.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000271
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  • 56
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    Tunneling Schmorl’s nodes in an elderly woman treated for acute lymphoblastic leukemia (2000)
    Springer
    Skeletal radiology 29 (2000), S. 660-663 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Acute lymphoblastic leukemia ; Chemotherapy ; Spine ; Tunneling Schmorl’s nodes ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We present a 70-year-old woman with pre-B acute lymphoblastic leukemia in whom serial imaging studies showed the development of multiple vertebral collapse, and communicating superior and inferior Schmorl’s nodes creating a longitudinal channel (”tunneling” Schmorl’s nodes) through the anterior aspect of T12 to L3 vertebral bodies of her osteoporotic thoracolumbar spine. This was observed after achieving complete remission of the disease and during maintenance therapy. The finding is felt to be secondary to iatrogenic exacerbation of osteoporosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000272
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  • 57
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    Mid-foot reconstruction following involvement of five bones by giant cell tumor (2000)
    Springer
    Skeletal radiology 29 (2000), S. 664-667 
    Details
    ISSN: 1432-2161
    Keywords: Keywords Giant cell tumor ; Multiple mid-foot bones ; Reconstructive surgery ; Radiography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a patient who had giant cell tumor involving multiple bones of the mid-foot. The tumor originated from the navicular bone, but also destroyed the cuboid, and all cuneiform bones. This unusual presentation of giant cell tumor presented a therapeutic challenge for the surgeons. The patient was treated with en bloc resection and the bony defect replaced with a massive iliac crest graft which united within 9 months and has remained stable for 7 years without local recurrence, and with excellent function of the foot.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000274
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  • 58
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    Intraosseous schwannoma of the metacarpal (2000)
    Springer
    Skeletal radiology 29 (2000), S. 224-226 
    Details
    ISSN: 1432-2161
    Keywords: Key words Intraosseous neurilemmoma (schwannoma) ; Primary bone neoplasm ; Metacarpal ; X-ray ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Intraosseous schwannoma (neurilemmoma) is an extremely rare, benign neoplasm, constituting less than 0.2% of primary bone tumors. It infrequently involves the bones of the hand. We present a case of intraosseous neurilemmoma of the metacarpal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050597
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    Hemangioma of bone arising in the ulna: imaging findings with emphasis on MR (2000)
    Springer
    Skeletal radiology 29 (2000), S. 231-234 
    Details
    ISSN: 1432-2161
    Keywords: Key words Hemangioma ; Ulna ; CT ; MRI ; X-ray
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  An 18-year-old woman presented with left elbow joint pain. Radiographs and computed tomographic scan showed a well-defined osteolytic lesion of the left ulna associated with a honeycomb appearance on the radiographs. Magnetic resonance images showed intermediate signal intensity on T1-weighted images and mixed intermediate and high signal intensities on T2-weighted images. Only the periphery of the lesion enhanced with intravenously injected gadolinium-diethylenetriamine pentaacetic acid. The lesion was curetted to avoid pathologic fracture, and a histologic diagnosis of cavernous hemangioma of bone was made. Hemangioma involving the ulna is rare, but should be included in the differential diagnosis of a radiographic osteolytic lesion with a honeycomb appearance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050599
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  • 60
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    Unsuspected metastases presenting as solitary soft tissue lesions: a fourteen-year review (2000)
    Springer
    Skeletal radiology 29 (2000), S. 270-274 
    Details
    ISSN: 1432-2161
    Keywords: Key words Soft tissue neoplasm ; Metastasis ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To describe a series of patients with no known primary malignancy who presented with a solitary unsuspected soft tissue metastasis masquerading as a soft tissue sarcoma, and secondarily to describe the imaging appearance of these lesions. Design. Records of two academic hospitals with active orthopedic oncology services were reviewed for patients meeting the above criteria. Clinical charts were examined, and the imaging appearance of the soft tissue lesions retrospectively reviewed. Patients. Of 1421 patients examined for soft tissue lesions, 11 were found who met the above criteria. Results. Of the 11 patients whose initial presentation was a solitary soft tissue metastasis, eight were found to have a primary lung cancer, two were diagnosed with adenocarcinoma of unknown primary, and adenocarcinoma of the colon was discovered in the remaining patient. Conclusions. The clinical presentation of a solitary soft tissue metastasis without a known primary malignancy is a rare occurrence, with an incidence of approximately 0.8%. Lung cancer is the primary neoplasm in a high percentage of these cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050606
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  • 61
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    Angiomyolipoma arising in the thigh (2000)
    Springer
    Skeletal radiology 29 (2000), S. 293-297 
    Details
    ISSN: 1432-2161
    Keywords: Key words Angiomyolipoma (AML) ; Soft tissue ; Thigh ; MRI ; CT ; Angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A 41-year-old man presented with an asymptomatic mass in the right medial thigh. Magnetic resonance imaging (MRI) revealed a well-demarcated, 10-cm mass in the right adductor muscles. The margins of the mass exhibited high signal intensity and the rest showed low or iso signal intensity on T1-weighted MR images. However, the high signal intensity was decreased on T2-weighted images with fat suppression. The central part of the tumor was of inhomogeneous high signal intensity on T2-weighted images; after Gd-DTPA injection it enhanced inhomogeneously on T1-weighted images with fat suppression. On dynamic computed tomography (CT) in the arterial phase, there were strongly enhancing spotty areas in the tumor. At surgery, a yellow-whitish tumor was resected and a pathological diagnosis of angiomyolipoma (AML) in the thigh was made.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050612
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  • 62
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    Bilateral metachronous periosteal tibial amyloid tumors (2000)
    Springer
    Skeletal radiology 29 (2000), S. 346-348 
    Details
    ISSN: 1432-2161
    Keywords: Key words Amyloid tumor ; Tibia ; Periosteum ; Bilateral ; MRI ; Bilateral metachronous periosteal tibial amyloid tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Localized primary periosteal amyloid tumors are extremely rare. A case of bilateral tibial amyloid tumor is presented. A 62-year-old woman initially presented with a painful mass in the anterior aspect of the right leg. There was no evidence of underlying systemic disease, including chronic infection or malignancy. Based on the results of resistance with Congo red staining to treatment with potassium permanganate and positivity for kappa light chain, we classified this particular case as AL-type amyloidosis. The patient noticed a swelling in the opposite leg 2 years later. The second tumor was also an AL-type amyloidoma. Amyloid tumors are generally solitary. This is the first case of bilateral periosteal amyloid tumors of the AL-type occurring in the tibiae.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000215
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  • 63
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    Sonographic evaluation of digital annular pulley tears (2000)
    Springer
    Skeletal radiology 29 (2000), S. 387-391 
    Details
    ISSN: 1432-2161
    Keywords: Key words Trauma ; Hand ; Sonography ; Ultrasound ; Annular pulleys ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To evaluate the sonographic (US) appearance of digital annular pulley (DAP) tears in high-level rock climbers. Design and patients. We performed a retrospective analysis of the US examinations of 16 high-level rock climbers with clinical signs of DAP lesions. MRI and surgical evaluation were performed in five and three patients respectively. The normal US and MRI appearances of DAP were evaluated in 40 and three normal fingers respectively. Results. Nine of 16 patients presented a DAP tear. In eight subjects (seven with complete tears involving the fourth finger and one the fifth finger), US diagnosis was based on the indirect sign of volar bowstringing of the flexor tendons. Injured pulleys were not appreciated by US. Tears concerned the A2 and A3 in six patients and the A3 and A4 in two patients. A2 pulley thickening and hypoechogenicity compatible with a partial tear was demonstrated in one patient. MRI and surgical data correlated well with the US findings. Four patients had tenosynovitis of the flexor tendons but no evidence of pulley disruption. US examinations of three patients were normal. In the healthy subjects US demonstrated DAP in 16 of 40 digits. Conclusion. US can diagnose DAP tears and correlates with the MRI and surgical data. Because of its low cost and non-invasiveness we suggest US as the first imaging modality in the evaluation of injuries of the digital pulley.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000226
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  • 64
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    Chronic post-traumatic osteomyelitis of the lower extremity: comparison of magnetic resonance imaging and combined bone scintigraphy/immunoscintigraphy with radiolabelled monoclonal antigranulocyte antibodies (2000)
    Springer
    Skeletal radiology 29 (2000), S. 378-386 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bones ; infection ; Bones ; radionuclide studies ; MRI ; comparative studies ; Bones ; MRI studies ; MRI ; extremities ; Bones ; immunoscintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. A retrospective study of the validity of combined bone scintigraphy (BS) and immunoscintigraphy (IS) using 99mTc-labelled murine antigranulocyte antibodies (MAB) and magnetic resonance imaging (MRI) in chronic post- traumatic osteomyelitis. Design and patients. The results of MRI and combined BS/IS of 19 lesions in 18 patients (13 men, 5 women; mean age 45 years, range 27–65 years) were independently evaluated by two radiologists and one nuclear medicine physician with regard to bone infection activity and extent. The patient group was a highly selective collection of clinical cases: the average number of operations conducted because of relapsing infection was eight (range 2–27), the average time interval between the last surgical intervention and the present study was 6.5 years (range 3 months to 39 years), and from the first operation was 14 years (range 1.5–42 years). Interobserver agreement on MRI was measured by kappa statistics. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRI and the nuclear medicine studies. Results. For MRI/nuclear medicine, a sensitivity of 100%/77%, a specificity of 60%/50%, an accuracy of 79%/61%, a PPV of 69%/58% and a NPV of 100%/71% were calculated. Four MR examinations were false positives because of postsurgical granulation tissue. A high degree of interobserver agreement was found on MRI (κ=0.88). A low-grade infection was missed on two scintigrams, while four were false positive because of ectopic haematopoietic bone marrow, and in one examination the anatomical distortion resulted in an inaccurate assignment of the uptake leading to false positive findings. Image analysis was frequently hindered by susceptibility artefacts due to residual abrasions of metallic implants after removal of orthopaedic devices (15/18 patients); this led to limited assessment in 17% (3/18 patients). Conclusion. Acute activity in a chronic osteomyelitis can be excluded with high probability if the MRI findings are negative. In the first postoperative year fibrovascular scar cannot be distinguished accurately from reactivated infection on MRI and scintigraphy may improve the accuracy of diagnosis. MRI is more sensitive in low-grade infection during the later course than combined BS/IS. Scintigraphic errors due to ectopic, peripheral, haematopoietic bone marrow can be corrected by MRI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000228
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  • 65
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    Tuberculosis of the sternum and clavicle: imaging findings in 15 patients (2000)
    Springer
    Skeletal radiology 29 (2000), S. 447-453 
    Details
    ISSN: 1432-2161
    Keywords: Key words Tuberculosis ; Sternum ; Clavicle ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To describe the imaging findings in sterno-clavicular tubercular involvement. Design and patients. Fifteen patients with pathologically proven tuberculosis of the sternum and clavicle were retrospectively evaluated. Routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were used in some or all of the patients. Clinical information and imaging features were evaluated in each case. Results. Eight patients had sterno-clavicular joint (SCJ) involvement, five had isolated sternal involvement and two had isolated clavicular involvement. Seven patients were evaluated with only CT, six with only MRI and two with both. There were eight male and seven female patients, varying in age between 16 and 78 years. Fever, swelling and pain were common presenting symptoms. Two patients were HIV positive. Radiographs were positive in only eight patients. Destruction and signal intensity (SI) changes of the sternum and clavicle, destruction of the cartilage, soft tissue changes representing granulation tissue/abscess, displacement of the adjacent structures (vessels, trachea, etc.) and inflammatory changes in the adjacent structures in the form of cellulitis and myositis were common imaging features. Conclusions. All imaging methods can provide complementary information regarding sterno-clavicular tubercular involvement that is helpful for determination of the therapy. MRI is useful in determining the extent of the lesion, particularly marrow involvement and soft tissue extent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000207
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  • 66
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    Diabetic muscle infarction: atypical MR appearance (2000)
    Springer
    Skeletal radiology 29 (2000), S. 477-480 
    Details
    ISSN: 1432-2161
    Keywords: Key words Diabetes mellitus ; Muscle, infarction ; Short T1 ; Hemorrhage ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe a case of diabetic muscle infarction which had atypical features of hyperintensity of the affected muscle on T1-weighted images. Biopsy was performed which revealed diffuse extensive hemorrhage within the infarcted muscle. We believe increased signal intensity on T1-weighted images should suggest hemorrhage within the infarcted muscle.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000246
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  • 67
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    Electronic Resource
    Multimodality imaging assessment of meniscal ossicle (2000)
    Springer
    Skeletal radiology 29 (2000), S. 481-484 
    Details
    ISSN: 1432-2161
    Keywords: Key words Meniscal ossicles ; Ultrasound ; CT-arthrography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A case of meniscal ossicles occurring in the left knee of a 23-year-old woman is presented. Radiographs showed two calcified lesions at the posteromedial aspect of the knee which were interpreted as loose bodies. Sonography, computed tomography arthrography and magnetic resonance imaging showed the fragments within the posterior horn of the medial meniscus permitting a diagnosis of meniscal ossicles. These techniques can detect meniscal ossicles and exclude intra-articular loose bodies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000235
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  • 68
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    MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review (2000)
    Springer
    Skeletal radiology 29 (2000), S. 187-195 
    Details
    ISSN: 1432-2161
    Keywords: Key words Clear cell sarcoma ; Malignant melanoma of soft parts ; MRI ; Magnetic resonance ; Neoplasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To evaluate MR imaging and pathology findings in order to define the characteristic features of clear cell sarcoma of the soft tissues (malignant melanoma of the soft parts). Design and patients. MR examinations of 21 patients with histologically proven clear cell sarcoma of the musculoskeletal system were retrospectively reviewed and assessed for shape, homogeneity, delineation, signal intensities on T1- and T2-weighted images, contrast enhancement, relationship with adjacent fascia or tendon, secondary bone involvement, and intratumoral necrosis. In 19 cases the pathology findings were available for review and for a comparative MR-pathology study. Results. On T1-weighted images, lesions were isointense (n=3), hypointense (n=7) or slightly hyperintense to muscle (n=11). Immunohistochemical examination was performed in 17 patients. All 17 specimens showed positivity for HMB-45 antibody. In nine of 11 lesions with slightly increased signal intensity on T1-weighted images, a correlative MR imaging-pathology study was possible. All nine were positive to HMB-45 antibody. Conclusions. Clear cell sarcoma of the musculoskeletal system often has a benign-looking appearance on MR images. In up to 52% of patients, this lesion with melanocytic differentiation has slightly increased signal intensity on T1-weighted images compared with muscle. As the presence of this relative higher signal intensity on T1-weighted images is rather specific for tumors displaying melanocytic differentiation, radiologists should familiarize themselves with this rare entity and include it in their differential diagnosis when confronted with a well-defined, homogeneous, strongly enhancing mass with slightly higher signal intensity compared with muscle on native T1-weighted images.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050592
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  • 69
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    Erdheim-Chester disease with intramuscular lipogranuloma (2000)
    Springer
    Skeletal radiology 29 (2000), S. 227-230 
    Details
    ISSN: 1432-2161
    Keywords: Key words Erdheim-Chester Disease ; Lipogranuloma ; MRI ; Muscle ; Rectus femoris
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report on a rare manifestation of Erdheim-Chester disease with intramuscular lipogranuloma. The patient was a 66-year-old man who noted a soft tissue mass in the right quadriceps femoris muscle. Radiographs revealed symmetrical osteosclerosis in the diametaphysis of both femora and tibiae. An open biopsy revealed a proliferation of lipid-laden histiocytes in the femoral bone marrow and the quadriceps femoris muscle. To our knowledge, this is the second case of Erdheim-Chester disease involving muscle.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050598
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  • 70
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    MR appearances in a case of femoral ecchinococcosis (2000)
    Springer
    Skeletal radiology 29 (2000), S. 235-238 
    Details
    ISSN: 1432-2161
    Keywords: Key words Femur echinococcosis ; MRI ; echinococcosis ; Hydatid cyst surgery ; Hydatid cyst ; anticestodal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Magnetic resonance (MR) findings of a rare case of osseous echinococcosis with involvement of the femur are described. Attention is drawn to the typical MR appearances and therapeutic management.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050600
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  • 71
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    Congenital transverse deficiency of the tibia and fibula: a report of two cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 243-246 
    Details
    ISSN: 1432-2161
    Keywords: Key words Tibial deficiency ; Fibular deficiency ; Congenital hip dislocation ; Transverse limb deficiency ; X-ray ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report two similar, but unrelated, patients with congenital bilateral partial deficiencies of the tibia and fibula associated with intact feet. In both patients, the tibia and fibula were absent on initial radiographs, while the femur and the tarsal bones were well developed and there was bilateral teratologic dislocation of the hips. Ultrasound and magnetic resonance imaging (MRI) studies suggested the presence of cartilaginous remnants of the tibia and fibula. There were multidirectional instabilities in the knees and ankles. The clinical and radiological features of these cases are distinct from those of congenital longitudinal deficiency of the tibia, in which the fibula is always preserved, and from longitudinal deficiency of the fibula, in which the tibia is present and the foot is usually involved. We suggest that the bilateral partial deficiencies of the tibia and fibula associated with the intact foot and teratologic dislocation of the hips is a single-entity disorder, possibly categorized as an intercalary transverse deficiency of the lower limb.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050602
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  • 72
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    Metastatic bone tumor mimicking spontaneous osteonecrosis of the medial condyle of the femur: misleading appearance on MR imaging (2000)
    Springer
    Skeletal radiology 29 (2000), S. 286-288 
    Details
    ISSN: 1432-2161
    Keywords: Key words Metastatic bone tumor ; Knee ; Spontaneous osteonecrosis ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a case of a metastatic bone tumor that mimicked spontaneous osteonecrosis of the medial condyle of the femur on magnetic resonance imaging.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050610
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  • 73
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    Chronic ulceration of the leg following extensive scarring due to a snake bite complicated by squamous cell carcinoma (2000)
    Springer
    Skeletal radiology 29 (2000), S. 298-301 
    Details
    ISSN: 1432-2161
    Keywords: Key words Chronic leg ulcers ; Squamous cell carcinoma ; Malignancy ; Snake bite ; X-rays ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Chronic ulcers of the leg are common in Brazil, perhaps more common than in the developed world. We report a case of a chronic ulcer of the leg following extensive scarring due to a bite by a venomous snake, which eventually led to a squamous cell carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050613
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  • 74
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    Collagenous fibroma of the arm: a report of two cases (2000)
    Springer
    Skeletal radiology 29 (2000), S. 417-420 
    Details
    ISSN: 1432-2161
    Keywords: Key words Arm ; Collagenous fibroma ; Desmoplastic fibroblastoma ; Short T2 ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A recently proposed addition to fibrous tumors in soft tissue was first described as desmoplastic fibroblastoma and later renamed collagenous fibroma. This tumor is clinically and morphologically distinct and benign. However, only a few series have been reported, and the clinicopathologic features are not widely recognized. We present two cases of collagenous fibroma of the arm. Both patients presented with an enlarging, well-circumscribed and mobile soft tissue mass. Magnetic resonance imaging showed areas of low signal intensity on both T1- and T2-weighted sequences. Needle aspiration cytology revealed nondiagnostic samples because of the low cellularity of the tumors. Each of the resected tumors was composed of low-cellular spindle- to stellate-shaped cells in a fibrous matrix with clear margination. After the marginal excisions, no recurrences were observed. Clinicians should be aware of this entity to prevent overtreatment, because imaging findings and cytologic features are similar to those of desmoid tumor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000223
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  • 75
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    Electronic Resource
    MRI in inflammatory myopathies (2000)
    Springer
    Skeletal radiology 29 (2000), S. 425-438 
    Details
    ISSN: 1432-2161
    Keywords: Key words Muscles ; MRI ; Myositis ; Muscles ; Abscess ; Dermatomyositis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Inflammatory myopathies encompass a group of acquired muscle disorders caused by infectious agents (bacteria, viruses, fungi and parasitic agents) or autoimmune processes (polymyositis, dermatomyositis and other types). In suspected infection sonography, CT and MRI are all able to show edema and fluid collections in soft tissues and muscles; sonography and CT may help guidance of a needle aspiration to establish a correct diagnosis. By offering better tissue differentiation, MRI appears to be more efficient than sonography and CT in diagnosing and managing autoimmune myopathies. MRI is indeed very sensitive to the presence of water and edema, and appears to be a very good indicator for an early diagnosis of diseases. MRI may also help to evaluate the extent and number of lesions, to guide a biopsy in an area of active disease and finally to follow the evolution under therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000238
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  • 76
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    Intraosseous microcystic meningioma (2000)
    Springer
    Skeletal radiology 29 (2000), S. 354-357 
    Details
    ISSN: 1432-2161
    Keywords: Key words Intraosseous meningioma ; Microcystic meningioma ; Parietal bone ; X ray ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Extradural ectopic meningioma is a rare tumor. We report on an example of microcystic meningioma arising in the skull of an elderly woman. Radiological examination revealed a localized osteolytic lesion in the left parietal bone. At surgery, it was discovered that the tumor was located within the skull without any evidence of extraosseous extension. The light microscopic, immunohistochemical and ultrastructural features were consistent with a microcystic variant of meningioma. To our knowledge, this is the first case of an intraosseous microcystic meningioma, and we believe that this type of meningioma should be considered in the differential diagnoses of myxoid bone tumors of the calvarium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000217
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  • 77
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    Chondro-osseous differentiation in fat tissue tumors: magnetic resonance imaging with pathological correlation (2000)
    Springer
    Skeletal radiology 29 (2000), S. 459-465 
    Details
    ISSN: 1432-2161
    Keywords: Key words Chondrolipoma ; Liposarcoma ; Mesenchymoma ; Cartilage ; Metaplasia ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Chondro-osseous differentiation of three benign or malignant fat tissue tumors – two chondrolipomas and a liposarcoma with cartilaginous metaplasia – was studied with magnetic resonance (MR) imaging and compared with their pathological findings. The results suggest that demarcation of cartilage tisssue can be clearly defined on MR imaging when the size of the cartilaginous area is large. Myxoid matrix, degenerative fat tissue and lipodystrophic change may decrease the delineation of the cartilage tissue.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560000241
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  • 78
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    Shockwave application in calcifying tendinitis of the shoulder – prediction of outcome by imaging (2000)
    Springer
    Archives of orthopaedic and trauma surgery 120 (2000), S. 493-498 
    Details
    ISSN: 1434-3916
    Keywords: Key words Shoulder ; Calcifying tendinitis ; Shock wave ; MRI ; Prediction parameters ; Clinical outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p 〈 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits before ESWA were not associated with the clinical outcome, negative contrast reactions around the deposits (p = 0.0001), synovia (p = 0.0049) and bursae (p 〈 0.01) were associated with improved clinical outcomes. After the total study group was divided into two groups, one with Constant scores ≥ 75% (n = 43) and the other with scores 〈 75% (n = 22), the positive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.95; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.49) and bursae (ppv: 0.86; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020000154
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  • 79
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    Reintitan als Knochenersatzmaterial (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. S504 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter CAD/CAM ; Knochenersatzmaterial ; MRT ; Qualitätskontrolle ; Titan ; Key words Bone substitute material ; CAD/¶CAM ; MRI ; Quality control ; Titanium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Computer-assisted prefabricated skull implants of pure titanium as a bone replacement material have been used in 22 departments since 1994. Our experience with 104 implants includes clinical aspects (indication; tissue quality; surgical technique; patient guidance), but also geometric and material-specific parameters (acquisition, transfer, and evaluation of CT data; construction; manufacturing; cleaning; postoperative use of radiologic techniques). While the clinical aspects are responsibly defined by the respective surgeon, the geometric and material-specific parameters of individual implants have to comply with the laws on medical products. Therefore, the prospective documentation for each implant includes: helical CT acquisition parameters; geometric data of the computer-based skull model and implant; the cleaning procedure; and the individual marking. Medically specified pure titanium is processed by milling only so that neither purity nor structure is impaired. A specially developed milling technique guarantees the fabrication of all constructed elements down to fine details of 50 μm. Considering the necessary radiologic follow-up of defects after tumor surgery, all patients in our hospital undergo postoperative MRI examination, partly with preoperative documentation as an intraindividual control. Such comprehensive documentation and quality assurance is essential for techniques of prefabricated bone substitution. Hand in hand with scientific research and clinical application, these formal criteria have to be elaborated and fulfilled for the respective techniques. The successful determination of specifically adapted MRI sequences goes even one step further: spin-echo sequences minimize inhomogeneities of the magnetic field induced by the titanium implants and enable accurate postoperative documentation and diagnostics especially in the follow-up after tumor surgery.
    Notes: Zusammenfassung Computergestützt vorgefertigte Schädelimplantate aus Reintitan als Knochenersatzmaterial werden seit 1994 in 22 Kliniken eingesetzt. Die Erfahrungen mit 104 Implantaten umfassen klinische (Indikationsstellung; Implantatlager; Operationstechnik; Patientenführung), aber auch geometrische und materialspezifische Aspekte (CT-Datenakquisition, -transfer und -auswertung; Konstruktion; Fertigung; Reinigung; postoperative Einsatzmöglichkeit bildgebender Verfahren). Während die klinischen Aspekte im Verantwortungsbereich ärztlichen Handelns definiert werden, gilt für die geometrischen und materialspezifischen Aspekte bei individuellen Implantaten das Medizinproduktegesetz. Prospektiv werden entsprechend für jedes Implantat die Spiral-CT-Akquisitionsparameter, die Geometriedaten des rechnerinternen Schädelmodells und des Implantats, das Reinigungsverfahren und die individuelle Kennzeichnung dokumentiert. Medizinisch spezifiziertes Reintitan wird ausschließlich durch Fräsung bearbeitet, sodass weder Reinheit noch Gefüge Änderungen erfahren. Eine eigens entwickelte Frästechnik garantiert die Umsetzung aller konstruierter Elemente bis zu einer Feinheit von 50 μm. Im Hinblick auf die bei tumorbedingten Defekten notwendige bildgebende Verlaufskontrolle werden sämtliche Patienten der eigenen Klinik postoperativ mit MRT untersucht, z. T. mit einer präoperativen Darstellung als intraindividuelle Kontrolle. Eine umfassende Dokumentation und Qualitätssicherung ist für Techniken des vorgefertigten Knochenersatzes unabdingbar. Parallel zur forscherischen Entwicklung und ärztlichen Anwendung müssen diese formalen Kriterien für das jeweilige Verfahren bearbeitet und erfüllt werden. Die erfolgreiche Erarbeitung von eigens adaptierten MRT-Sequenzen geht darüber noch hinaus: Spinechosequenzen minimieren die durch die Titanimplantate erzeugten Feldinhomogenitäten und erlauben eine aussagekräftige postoperative Dokumentation und Diagnostik insbesondere nach Tumoroperationen in der Verlaufsbeobachtung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012701
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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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  • 81
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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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014535
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  • 83
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    Stellenwert von Computertomographie und Magnetresonanztomographie bei der Diagnostik von Malignomen der Mundhöhle und des Oropharynx (2000)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 4 (2000), S. 217-221 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter CT ; MRT ; Mundhöhlen- und Oropharynxtumoren ; Diagnose ; Tumorstaging ; Keywords CT ; MRI ; Head and neck tumors ; Diagnosis ; Staging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Problem: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer – some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. Patients: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. Results: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. Conclusion: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.
    Notes: Fragestellung: Die Differenzialindikation von MRT und CT bei der Diagnostik von Malignomen im Kopf-Hals-Bereich wird in der Literatur kontrovers diskutiert. Mit der vorliegenden Studie soll versucht werden, eine eindeutige Auswahl des Verfahrens zu begründen. Patientengut: Bei 165 Patienten mit Tumoren des Oropharynx und der Mundhöhle wurden insgesamt 463 CT- und 197 MRT-Untersuchungen durchgeführt. Ergebnisse: Bei 67% bzw. 60% der Oropharynxtumoren stimmten das CT- bzw. MRT-TNM-Tumorstaging mit der Klinik überein. Bei den Mundhöhlentumoren waren die klinischen TNM-Stadien in 50% bzw. 43% mit den CT- bzw. MRT-Befunden identisch. Beim Lymphknotenstaging war die Fehlerhäufigkeit bei der MRT mit 27% etwas höher als bei der Computertomographie mit 22%. Bei der Beurteilung der zervikalen Lymphknoten war die CT der MRT bezüglich der Sensitivität mit 78% gegenüber 69% überlegen. Schlussfolgerung: Aufgrund der Ergebnisse ergeben sich eindeutige Indikationen zur MRT- und CT-Untersuchung. Das primäre präoperative Screening und die posttherapeutische Nachsorge sollten durch CT beurteilt werden ebenso wie die Lymphknotendiagnostik im Halsbereich. Bei speziellen Fragestellungen, wie z. B. bezüglich der Periost- und Knocheninfiltration, ist die MRT eine ergänzende Untersuchung des 2. Schritts.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060000173
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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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  • 87
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    Electronic Resource
    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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  • 88
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    Electronic Resource
    Study of the variations in length of the anterior cruciate ligament during flexion of the knee: use of a 3D model reconstructed from MRI sections (2000)
    Springer
    Surgical and radiologic anatomy 21 (2000), S. 313-317 
    Details
    ISSN: 1279-8517
    Keywords: Anterior cruciate ligament ; Kinematics ; Knee ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study is to suggest an anatomic study of the modifications of the length of the anterior cruciate ligament (ACL) and its bundles during flexion with the aid of a 3D computerized model of the knee in a living subject. The method of evaluation suggested is a 3D computerized reconstruction based on MRI sections, reproducing the movement of flexion of the knee from 0 to 75°. Twenty-one sections were made for each of the 13 positions of flexion. The reconstruction of Delaunay and the realignment of each position provided a 3D model which allowed monitoring of a bony point during the movement. By knowing the relative displacement of the ligamentous attachments it was possible to define the biometry of the ligament by calculating the length of the bundles of the ACL in each position and to demonstrate the variations in length during the movement. The mean length of the ligament was 3.4 mm. The anteromedial bundle was longer by 30% compared with the other two bundles. During flexion the anteromedial bundle was not much modified (this feature seems to provide a reference position for a ligamentoplasty), the posterolateral bundle became taut after 30°, and the intermediate bundle relaxed from the beginning of movement. Based on the data from the literature, this method allows an anatomic approach to the ACL, bundle by bundle, during flexion movement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-999-0313-5
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  • 89
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    Electronic Resource
    Serial anatomy of the larynx in MRI: MRI-histologic correlations (2000)
    Springer
    Surgical and radiologic anatomy 22 (2000), S. 5-11 
    Details
    ISSN: 1279-8517
    Keywords: Larynx ; MRI ; Histology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The larynx is an organ with a complex anatomic structure. MRI allows the performance of sections in the three planes of space, so that this study of the soft parts of the larynx yields results superior to those of other imaging techniques. Together with laryngoscopy, MRI is most often used in assessing the extension of malignant laryngeal tumors. This assessment is fundamental in choosing the indications for surgery, but the published reports of MRI of the larynx are sometimes discordant. The visualization of certain important anatomic structures such as the conus elasticus is uncertain. Our aim was to study the MRI radio-anatomy of the larynx based on correlations between MRI and histologic sections. Eight anatomic specimens were studied four in the transverse plane, two in the sagittal plane, and two in the frontal plane. The MRI and histologic sections made at the same levels were compared. These comparisons allowed a description of the sectional radio-anatomy of the larynx and an assessment of the reliability and limitations of MRI. All the major anatomic structures could be identified. It was possible to demonstrate the conus elasticus. We were able to visualize the vocal process of the arytenoid cartilage, which has not to our knowledge been previously described in the literature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00276-000-0005-7
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  • 90
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    Electronic Resource
    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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  • 91
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    Electronic Resource
    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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  • 92
    Electronic Resource
    Electronic Resource
    MR imaging following herniography in patients with unclear groin pain (2000)
    Springer
    European radiology 10 (2000), S. 1691-1696 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Herniography ; MRI ; Hernia ; Groin pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aims of the present study were to assess if MRI gives the same diagnostic information as herniography concerning the presence of hernias and reveals other causes of groin pain. The prospective study enrolled 20 patients referred for herniography, 6 women and 14 men, mean age 48 years. After herniography the patients underwent MRI using T1-weighted, fat-suppressed inversion recovery (STIR), and magnetic resonance cholangiopancreaticography (MRCP) pulse sequences. No contrast medium was administered at MRI. Herniography revealed 11 hernias and MRI depicted 8 of these. Magnetic resonance imaging depicted well the anatomy in the groins. In 3 patients where hernias were not revealed, MRI revealed inflammatory changes in the symphysis region as a possible cause of groin pain. The primary diagnostic tool for diagnosing hernias is herniography. If the herniogram is normal, MRI may reveal other causes of groin pain and may also better visualize related structures in the groin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000555
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  • 93
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    Electronic Resource
    Value of (18F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma (2000)
    Springer
    European radiology 10 (2000), S. 761-767 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Ovarian cancer ; Lesion characterization ; Recurrence ; PET ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to compare prospectively the accuracy of whole-body positron emission tomography (PET), CT and MRI in diagnosing primary and recurrent ovarian cancer. Nineteen patients (age range 23–76 years) were recruited with suspicious ovarian lesions at presentation (n = 8) or follow-up for recurrence (n = 11). All patients were scheduled for laparotomy and histological confirmation. Whole-body PET with FDG, contrast-enhanced spiral CT of the abdomen, including the pelvis, and MRI of the entire abdomen were performed. Each imaging study was evaluated separately. Imaging findings were correlated with histopathological diagnosis. The sensitivity, specificity and accuracy for lesion characterization in patients with suspicious ovarian lesions (n = 7) were, respectively: 100, 67 and 86 % for PET; 100, 67 and 86 % for CT; and 100, 100 and 100 % for MRI. For the diagnosis of recurrent disease (n = 10), PET had a sensitivity of 100 %, specificity of 50 % and accuracy of 90 %. The PET technique was the only technique which correctly identified a single transverse colon metastasis. Results for CT were 40, 50 and 43 %, and for MRI 86, 100 and 89 %, respectively. No statistically significant difference was seen. Neither FDG PET nor CT nor MRI can replace surgery in the detection of microscopic peritoneal disease. No statistically significant difference was observed for the investigated imaging modalities with regard to lesion characterization or detection of recurrent disease; thus, the methods are permissible alternatives. The PET technique, however, has the drawback of less accurate spatial assignment of small lesions compared with CT and MRI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051000
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  • 94
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    Electronic Resource
    Uterine endometrial stromal sarcoma located in uterine myometrium: MRI appearance (2000)
    Springer
    European radiology 10 (2000), S. 780-782 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Uterus ; Endometrial stromal sarcoma ; Uterine myometrium ; Uterine leiomyoma ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Two cases of uterine endometrial stromal sarcoma whose main mass was located in uterine myometrium are reported. They mimicked uterine leiomyoma with cystic degeneration or uterine leiomyosarcoma. Endometrial stromal sarcoma should be suggested in the differential diagnosis of mass lesion in uterine myometrium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051004
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  • 95
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    Electronic Resource
    Osteochondroma: MR imaging of tumor-related complications (2000)
    Springer
    European radiology 10 (2000), S. 832-840 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Osteochondroma ; Complications ; Chondrosarcoma ; Bone tumors ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Osteochondromas can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and postoperative recurrence. Magnetic resonance imaging represents the most valuable imaging modality in symptomatic cases, because it can demonstrate typical features of associated soft tissue pathology, which can be differentiated from malignant transformation. Reactive bursae formation presents as an overlying fluid collection with peripheral contrast enhancement. Dislocation, deformation, and signal alterations of adjacent soft tissue structures can be observed in different impingement syndromes caused by osteochondromas. Magnetic resonance imaging provides excellent demonstration of arterial and venous compromise and represents the method of choice in cases with compression of spinal cord, nerve roots, or peripheral nerves, depicting changes in size, position, and signal intensity of the affected neural structures. Malignant transformation as the most worrisome complication occurs in approximately 1 % of solitary and 5–25 % of multiple osteochondromas. Magnetic resonance imaging is the most accurate method in measuring cartilage cap thickness, which represents an important criterion for differentiation of osteochondromas and exostotic (low-grade) chondrosarcomas. Cartilage cap thickness exceeding 2 cm in adults and 3 cm in children should raise the suspicion for malignant transformation. Finally, MR imaging can detect postoperative recurrence by depiction of a recurrent mass presenting typical morphological features of a cartilage-forming lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051014
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  • 96
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    Electronic Resource
    Chronic osteomyelitis of the femur: value of PET imaging (2000)
    Springer
    European radiology 10 (2000), S. 855-858 
    Details
    ISSN: 1432-1084
    Keywords: Key words:18FDG-PET ; Osteomyelitis ; Antigranulocyte antibody scintigraphy ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this report is to discuss FDG-PET as a potentially new imaging tool in the diagnosis of infections of osteosynthetic material. We present a patient with a poly-trauma who developed a chronic osteomyelitis and ostitis after repeated osteosynthesis in a fibular transplant to the left femur. Work up included MRI, antigranulocyte antibody scintigraphy and positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG). Infection of the fibular transplant was demonstrated clearly by PET but not by the other methods. Positron emission tomography may become an important indication in the diagnosis and follow-up of bone infection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051019
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  • 97
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    Electronic Resource
    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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  • 98
    Electronic Resource
    Electronic Resource
    L5 radicular pain related to a cystic lesion of the posterior longitudinal ligament (2000)
    Springer
    European radiology 10 (2000), S. 1812-1814 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Lumbar spine ; Ganglion cyst ; Posterior longitudinal ligament ; Radiculopathy ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A 35-year-old man with a long history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging demonstrated a round lesion situated in the anterior epidural space, with uniform high signal intensity on T2-weighted sequences characteristic of a cystic lesion. During surgery a liquid-containing cyst originating from the posterior longitudinal ligament was punctured and resected. The histologic aspect was that of a ganglion cyst without synovial layers. The radiologic differential diagnoses are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000445
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  • 99
    Electronic Resource
    Electronic Resource
    CT colonography and MR colonography: current status, research directions and comparison (2000)
    Springer
    European radiology 10 (2000), S. 786-801 
    Details
    ISSN: 1432-1084
    Keywords: Key words: CT ; MRI ; Colon ; Colonography ; Virtual colonoscopy ; Colorectal polyp ; Screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. With the introduction of multidetector technology in CT and the moveable table with integrated coil modules in MRI, the concept of multiorgan screening has become realistic. CT colonography and MR colonography are new radiologic techniques that promise to be highly sensitive colorectal screening examinations. This article reviews the current status and research directions in CT colonography and MR colonography, and compares these methods.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051006
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  • 100
    Electronic Resource
    Electronic Resource
    Plain film, CT and MRI sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes (2000)
    Springer
    European radiology 10 (2000), S. 1338-1341 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Eye injuries ; CT ; MRI ; Eye foreign body
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Detection and characterization of intraorbital foreign bodies (IFB) is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to IFB movements when a MRI study is planned. Papers concerning plain film and CT sensibility in IFB detection show controversial results. For this reason we investigated plain film, CT and MRI sensibility in the evaluation of IFB. For an in vitro model, specimens of dry and fresh wood, glass, iron, plastic and graphite were immersed in animal lard and in a 0.9 % sodium chloride plus 3.5 g/dl human serum albumin solution. Specimens of different size and nature where also implanted into enucleated pig eyes. Air bubbles were introduced also. Plain film, CT and MRI investigation were performed. Plain films underestimated intraocular IFB as plastic, fresh or dry wooden IFB were not demonstrated. The CT study was always able to depict and differentiate IFB according to the attenuation values. Severe artefacts prevented demonstration of iron, glass and graphite IFB on MRI, whereas plastic or wooden IFB were always detected. Despite radiographs have been suggested as a prerequisite for MR imaging, because our results showed plain film to underestimate radiolucent IFB, we suggest CT as the modality of choice when IFB has to be ruled out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003309900306
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