Stellenwert der MR-Tomographie bei traumatischen Patellaluxationen

PURPOSE To describe the MR imaging findings in patients with lateral patellar dislocation. MATERIAL AND METHODS The MRIs of 31 patients with patellar dislocation were evaluated retrospectively. Arthroscopic surgery was performed in 23 cases. RESULTS Hemarthrosis was found in 30/31, contusions of the lateral femoral condyle in 30/31 and of the medial patellar facet in 26/31 cases. Injury of the medial patellar retinaculum was seen in 28/31 cases. Osteochondral fractures were found in 18 patients; compared to arthroscopy there were one false-positive and 5 false-negative findings concerning loose cartilage bodies. In 7 cases, patellar dislocation was not suspected before MR imaging. CONCLUSIO…

Verlaufskontrolle des Morbus Crohn: Kann die Hydro-MRT die fraktionierte Magen-Darm-Passage ersetzen?

PURPOSE: To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease. METHOD: 22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations. RESULTS: In the upper gastrointestinal tract, the follow-through exam…

Gadolinium-DTPA (Magnevist®) als Kontrastmittel für die arterielle DSA

16 DSA investigations using intra-arterial Gd-DTPA were performed on 12 patients. The contrast medium was administered either as a 0.5 molar gadolinium solution (commercially available) or diluted with distilled water to a 0.2-0.4 molar gadolinium solution. The injection was made either by pressure injector or by hand. The aortic arch, abdominal aorta and pelvic and lower limb arteries were examined. 14 of the 16 procedures were diagnostically adequate, but compared with iodinated contrast materials, contrast was less marked. There were no cardiovascular, neurological or allergic side effects. Three patients suffered a feeling of heat and one patient had mild pain during the injection. Even…

Pembrolizumab-induzierter Lichen planus pemphigoides bei einem Patienten mit metastasiertem Melanom

Pulmonale Manifestationen bei HIV-Patienten: Rolle von Thoraxübersicht, CT und HRCT

Aim To determine the prevalence of pulmonary changes on chest radiographs and computed tomography (CT/HRCT) in HIV patients and their relation to pulmonary symptoms. Material and method 64 HIV patients were examined prospectively. 15 had no respiratory symptoms (group I), 30 had non-specific respiratory symptoms (group II), 19 complained of dyspnoea (group III). Chest radiographs and CT were performed within a week. In patients with positive findings, bronchoscopy was carried out with bacteriological and histological examinations. Results In group 1, 13% of chest radiographs and 40% of CTs showed infiltrative changes. In group II, the figures were 27% and 57% respectively. In group III, abn…

CT after enucleation of renal cell carcinoma.

Computed tomography (CT) was performed in 28 patients 2 weeks to 120 months after enucleation of renal cell carcinoma. The postoperative defect could be exactly localized in all patients. A wedge-shaped (N = 11) or concave (N = 9) morphology was typical. No dependence between morphology of the defect and localization or size of the tumor or the operative technique was observed. The defects were smaller (1.9 cm) than the original prominent tumors (3.6 cm). Defect size was dependent on the operative technique: closure by suture of the renal capsule in smaller defects or by fat flap in larger ones. Postoperative hematomas or delayed perfusion in the adjacent parenchyma were seen in five patien…

Die dynamische 31-Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Einfluß von Geschlecht und Alter auf spektroskopische Parameter

PURPOSE 31P-MRS is used to assess the influence of sex und age on quadriceps muscle metabolism before and after exercise. MATERIALS AND METHODS 32 healthy volunteers (15 women, 17 men, mean age: 38 +/- 17 yrs.) were examined by dynamic phosphorus-31 (31P) magnetic resonance spectroscopy (MRS). In the magnet, the quadriceps muscle was stressed by an isometric und an isotonic form of exercise until exhaustion, respectively. RESULTS Resting conditions: With increasing subjects' age, the ratio beta-adenosine triphosphate/total phosphate decreased (r = -0.37; p = 0.02). With increasing subjects' age, the ratios inorganic phosphate/phosphocreatine (r = 0.79; p = 5 x 10(-8), phosphomonoester/beta-…

The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy

Charcot-neuro-osteoarthropathy with its severe destruction of bones remains a challenge for physicians and surgeons. The aim of the study was to characterise a patient population treated in a specialised foot care centre who underwent surgical treatment for their diabetic foot syndrome. Special attention was paid to patients who suffered from Charcot-neuro-osteoarthropathy and the impact of Syme amputation if amputation of the foot was inevitable. A total of 121 patients with diabetic foot syndrome and ulcerations underwent an interdisciplinary strategy for diagnostic and therapeutic procedures including MRI and surgical interventions. If peripheral arterial vessel disease was present, reva…

Perineal Excision of a Large Angiomyxoma in a Young Woman Following Magnetic Resonance and Angiographic Imaging

Abstract Background. Aggressive angiomyxomas are rare, arise from connective tissue of the perineum or the lower pelvis, and affect predominantly young women. Case. We describe an unusual case of aggressive angiomyxoma in which the perineal approach was possible owing to MRI scanning and selective angiography indications. Conclusion. In cases of large aggressive angiomyxomas these diagnostic procedures should make it possible to decide which operative route might be best for the patient.

Computertomographie der Nieren nach Tumorenukleation

Two weeks to 120 months after enucleation of renal tumours the postoperative defects were correctly localized by renal computed tomography in 34 patients. Typical defect morphology was either wedge-shaped or concave. No dependence on tumour localization, tumour size, operative technique or a certain surgeon was observed. The cortical defects were smaller (mean 2.0 cm) than the original, prominent tumours (mean 3.4 cm). In small defects without tension suture of the capsule is sufficient, leading to minor defects. Larger defects were closed with a retroperitoneal or free peritoneal fat flap resulting in larger residual defects. In case of intra- or postoperative bleeding, CT could demonstrat…

Pembrolizumab-induced lichen planus pemphigoides in a patient with metastatic melanoma

Serum S100B levels correlate with clinical benefit in a metastatic melanoma patient treated by CTLA-4 blockade: a case report.

<b><i>Background:</i></b> Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an immunoregulatory molecule expressed by activated T cells. In patients with metastatic melanoma, anti-CTLA-4 antibody therapy with ipilimumab achieves durable cancer regression in approximately 10-15% of patients. In the face of complex and sometimes delayed tumor response patterns, prognostic and predictive biomarkers are needed to monitor therapy outcomes and to identify early potential long-term survivors who might also benefit from therapy re-induction. <b><i>Case Report:</i></b> The clinical case of a 49-year-old male patient with metastatic melanoma and u…

Magnetresonanztomographie (MRT) der Leber und des Gehirns bei hämatologisch-onkologischen Patienten mit Fieber unbekannter Ursache

PURPOSE To examine the advantage of liver and brain MRI in clinically anomalous haematological patients with fever of unknown origin. MATERIAL AND METHODS Twenty liver MRI (T2-TSE, T2-HASTE, T1-FLASH +/- Gd dynamic) and 16 brain MRI (T2-TSE, FLAIR, T1-TSE +/- Gd) were performed searching for a focus of fever with a suspected organ system. Comparison with clinical follow-up. RESULTS A focus was detected in 11/20 liver MRI. Candidiasis (n = 3), mycobacteriosis (n = 2), relapse of haematological disease (n = 3), graft versus host disease (n = 1), non-clarified (n02). The remaining 9 cases with normal MRI were not suspicious of infectious hepatic disease during follow-up. In brain MRI, 3/16 sho…

Die dynamische31Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Therapiebedingte Veränderungen bei arterieller Verschlußkrankheit

PURPOSE: The present investigation aimed at examining changes in muscle metabolism caused by treatment of arterial occlusive disease, using dynamic 31-phosphorus methods. METHOD: 32 patients with arterial occlusive disease were examined in a 1.5 T apparatus with a 6 cm surface coil before and after treatment. The metabolic changes in the quadriceps muscles were visualised during a 36 s phosphorus spectrum during rest, exercise (isometric and isotonic) and during a period of recovery. RESULTS: Vascular therapy resulted in a significant increase in the duration of both types of exercise during dynamic phosphorus spectroscopy (isometric exercise: 282 s against 199 s: p = 0.002, isotonic exerci…

Die interdisziplin�re Therapie des diabetischen Fu�syndroms

Noch immer werden in Deutschland 28.000 Amputationen/Jahr bei Patienten mit diabetischem Fussyndrom (DFS) durchgefuhrt.Bei gleichzeitig haufig vorhandener ischamischer und osteomyelitischer Komponente fuhrt ein operatives Vorgehen in der Regel zu Wundheilungsstorungen,Nachamputationen und oft auch Extremitatenverlust.Die Ergebnisse eines interdisziplinaren Therapieregimes werden evaluiert und im Literaturvergleich bewertet. Nach Diagnostik hinsichtlich des Vorliegens einer Polyneuropathie,Osteomyelitis und vor allen Dingen einer pAVK hat nach Infektkontrolle die primare distale Bypasschirurgie hochste Prioritat, ihr Erfolg ist richtungsweisend fur den weiteren Verlauf der Erkrankung.Die spa…

Die dynamische31Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Metabolische Veränderungen unter zwei verschiedenen Belastungsformen

PURPOSE The aim of the present investigation was to examine the metabolism of the quadriceps muscles of normal young individuals using dynamic 31phosphorus magnetic resonance spectroscopy. METHODS 22 normal individuals were examined in a 1.5T-MRT using a 6 cm surface coil. The metabolic changes in the quadriceps muscle as shown by the phosphorus spectrum were evaluated during rest, exercise (isometric and isotonic exercise) and during a 36-second period of recovery. RESULTS The Pi/PCr quotient rose from its resting value of 0.11 +/- 0.02 following exercise to a maximum of 0.83 +/- 0.47 (isometric) or 1.40 +/- 0.59 (isotonic) (difference p = 0.0001). Half-time recovery of Pi/PCr was 35 +/- 1…

Magnetresonanztomographie des Kniegelenks mit einem Niederfeldsystem

Ziel der vorliegenden Untersuchung ist die Evaluierung der Niederfeldmagnetresonanztomographie an einem offenen System unter Berucksichtigung des Erfahrungsstands des Untersuchers. In einer prospektiven Studie wurden von August 1995 bis Mai 1997 75 Patienten der Klinik fur Unfallchirurgie der Universitat Mainz mit einem akuten Trauma des Kniegelenks nach klinischer und konventionell-radiologischer Diagnostik magnetresonanztomographisch untersucht und anschliesend diagnostisch und therapeutisch arthroskopiert. Die Auswertung der MRT-Untersuchungen erfolgte hierbei durch 2 unabhangige Untersucher unterschiedlichen Erfahrungsstands ohne Kenntnis der Anamnese bzw. des klinischen Befunds. Sensit…

Radiologische Diagnostik bei Dysphagie und Motilitätsstörungen des Ösophagus

Streßfraktur der Tibia beim Kleinkind. Aussagekraft bildgebender Diagnostik

Successful treatment of adult multisystemic Langerhans cell histiocytosis with psoralen-UV-A, prednisolone, mercaptopurine, and vinblastine.

Background Langerhans cell histiocytosis (LCH) is a rare disease with a peak incidence in childhood. There is limited experience with treatment options for adult patients having multisystemic LCH involvement. We report successful treatment of a 70-year-old woman with adult onset of LCH and multisystem disease (diabetes insipidus centralis, bone marrow infiltration, and lung and skin involvement). Observations A 70-year-old woman with erythematous plaques and papules of the submammary and inguinal skin attended our outpatient clinic and was diagnosed as having LCH. Organ involvement was found in the infundibulum of the pituitary gland, associated with diabetes insipidus centralis, bone marro…

6-18F-Fluoro-l-Dihydroxyphenylalanine Positron Emission Tomography Is Superior to123I-Metaiodobenzyl-Guanidine Scintigraphy in the Detection of Extraadrenal and Hereditary Pheochromocytomas and Paragangliomas: Correlation with Vesicular Monoamine Transporter Expression

Context: Pheochromocytomas (PHEOs) and paragangliomas (PGLs) may be better detected by 18F-fluorodihydroxyphenylalanine-positron emission tomography (FDOPA-PET) than 123I-metaiodobenzyl-guanidine (123-I-MIBG) scintigraphy. Objective: The objective of the study was to correlate functional imaging results with immunohistochemical, molecular-genetic, and biochemical findings. Design and Setting: Thirty consecutive patients with suspected PHEO/PGL presenting at a tertiary referral centre were investigated in a prospective study. Patients: Twenty-five patients had confirmed PHEO/PGL. Thirteen of 25 patients had a hereditary PHEO/PGL syndrome (two multiple endocrine neoplasia II, six succinate de…

Eine Mannitollösung als orales Kontrastmittel in der pelvinen MRT

PURPOSE Improvement of pelvic MRI using peroral administration of an aqueous mannitol solution. METHODS We retrospectively evaluated magnetic resonance examinations of 72 patients with suspected or proven pelvic abnormalities: In 36 patients, no bowel marking was carried out. In further 36 patients, we performed a contrast enhancement of the bowel by oral application of 1000 ml of an aqueous mannitol solution. RESULTS 8/36 (22%) patients suffered from diarrhoea, nausea or meteorism as a result of mannitol application. In group 2, an excellent bowel marking of the small intestine could be obtained in 36/36 (100%) patients. Contrast enhancement of the bowel significantly improved delineation …

Gemcitabine plus sorafenib versus gemcitabine alone in advanced biliary tract cancer: a double-blind placebo-controlled multicentre phase II AIO study with biomarker and serum programme.

Background: Since sorafenib has shown activity in different tumour types and gemcitabine regimens improved the outcome for biliary tract cancer (BTC) patients, we evaluated first-line gemcitabine plus sorafenib in a double-blind phase II study. Patients and methods: 102 unresectable or metastatic BTC patients with histologically proven adenocarcinoma of gallbladder or intrahepatic bile ducts, Eastern Cooperative Oncology Group (ECOG) 0–2 were randomised to gemcitabine (1000 mg/m2 once weekly, first 7-weeks + 1-week rest followed by once 3-weeks + 1-week rest) plus sorafenib (400 mg twice daily) or placebo. Treatment continued until progression or unacceptable toxicity. Tumour samples were p…

Niederfeld-MR-Tomographie des Kniegelenkes: Ergebnisse einer prospektiven, arthroskopisch kontrollierten Studie

PURPOSE To define the diagnostic accuracy of an open low-field MR unit (Magnetom Open, Siemens, Erlangen) in traumatic knee lesions. MATERIALS AND METHODS The MRIs of 150 patients were prospectively evaluated by two independent readers with different experience levels. The study protocol included a proton-density weighted SE-sequence in the sagittal, a T2.-weighted Flash-2D-sequence in the coronal, and a 3D-acquisition (DESS) in the axial plane. 75 patients were treated either conservatively or operatively. RESULTS Based on arthroscopy as the gold standard, the sensitivities, specificities, and diagnostic accuracies for lesions of the medial and lateral meniscus, the anterior cruciate ligam…