Anwendung der optischen Kohärenztomographie (OCT) bei der Darstellung von Urothelerkrankungen der Harnblase

PURPOSE: The technique of optical coherence tomography (OCT) has significantly improved over the last few years. This new diagnostic procedure allows imaging of tissue structure of the bladder wall during cystoscopy with high resolution. MATERIALS AND METHODS: The penetration depth of OCT is limited to 2.5 mm. The resolution is approximately 15 microm. Fifty patients with different clinical conditions of the bladder were examined. Altogether 488 OCT images were generated. RESULTS: OCT of normal bladder mucosa clearly shows a differentiation between urothelium, lamina propria, and smooth muscle. Cystitis and metaplasia are characterized by blurring of the laminated structure and thickening of the epithelial layer. In malignant areas there is complete loss of the regular layered tissue structure. CONCLUSION: OCT improves the diagnosis of flat lesions of the urothelium. It has the potential for facilitating intraoperative staging of malignant areas in the bladder.     

Prostatakarzinom (PC) – eine organspezifische Neoplasie aus der Sicht der Pathologie

The organ- and tumour-related specific characteristics of prostate carcinoma (PC) are presented in an overview under various aspects. It is the key for understanding pathological changes, including PC, to consider the subdivision of the prostate into anatomically and functionally distinguishable zones, especially the transitional zone (TZ) and the peripheral zone (PZ). The pseudoneoplastic hyperplasia of the TZ, combined with inflammatory consequences and age-related changes, forms a differential diagnostic challenge to both clinico-radiological diagnosis and macroscopic and microscopic examination. High-degree prostatic intra-epithelial neoplasia (PIN III) and atypical adenomatous hyperplasia (AAH) are presented as precursor lesions of PC with varying significance and assessment. Moreover, there are discussed the following characteristic features of PC: localisation types, focality, volume, progression, double-graduation according to Gleason, tumour stage, and prognosis. The most important prognosis factors of PC (category I) include the categories of the TNM system, such as stage, surgical marginal situation, degree and also the preoperative PSA level as a (poor) substitute for the tumour volume. Potential prognosis parameters (category II) show the tumour volume and the DNS ploidy, while there continues to exist a large number of non-established parameters (category III). The prognostic validity of the pathological examinations depends, on the one hand, on the tissue extent (needle biopsy, transurethral resection (TURP), so-called simple prostatectomy, radical prostatectomy (RPE)) and the prostate zones covered. On the other hand, the prognostic certainty also depends on the tumour-adequate macroscopic and microscopic assessment of an RPE that can only be a partial or complete handling in transversal large-area sections.     

Konzept der operativen Fallanalyse (OFA) bei Tötungsdelikten aus Sicht der Rechtsmedizin

The goal of operative case analysis is to provide supportive references to the investigating police unit, in particular in cases of unsolved homicides and sexually motivated crimes. The concept of operative case analysis has its roots in FBI profiling. Since the 1990s the Federal Criminal Police Office and its Research Unit on Criminology and Criminal Investigation has developed its own suitable strategy. The methodical approach is characterized by a broadly formulated interdisciplinary cooperation including criminological, sociological, and psychological work methods. All steps toward the development of a case profile undergo a plausibility check. Increasingly, crime profiling is linked to computerized database systems. According to the phased actions of criminal acts, the investigations are performed as sequential analysis. Within the concept of objective hermeneutics, forensic medical reports play an important role, with supplementary findings bearing great significance for characterizing the offender. Against the background of third persons using investigative reports and autopsy protocols, the guidelines of the DGRM for forensic autopsy should be followed strictly. "Case analytical" thinking can be helpful for the interpretation of violence patterns or different kinds of evidence.     

Konzept der operativen Fallanalyse (OFA) bei T?tungsdelikten aus Sicht der Rechtsmedizin

Die operative Fallanalyse hat das Ziel, insbesondere bei ungeklärten Tötungsverbrechen und sexuellen Gewaltdelikten ermittlungsunterstützende Hinweise zu erarbeiten. Das Konzept des BKA hat seine Wurzeln im FBI-Profiling; in den 90er Jahren wurde durch die OFA-Einheit des Bundeskriminalamtes eine eigenständige Strategie der Fallanalyse entwickelt. Das methodische Vorgehen ist durch einen weitgefassten interdisziplinären Ansatz unter Einbeziehung kriminologischer, sozialwissenschaftlicher und psychologischer Arbeitsmethoden gekennzeichnet. Alle Schritte bis zur Entwicklung eines Fallprofils werden einer Plausibilitätskontrolle unterzogen. Die Fallanalysen werden zunehmend durch Informationen aus Datenbanksystemen begleitet.Ihrem phasenhaften Ablauf entsprechend werden die Tathandlungen einer sequenziellen Analyse unterzogen. Im Konzept der objektiven Hermeneutik der Fallanalyse spielt dabei das rechtsmedizinische Untersuchungsergebnis eine wichtige Rolle, wobei der Nebenbefund für die Charakterisierung des Täters von großer Bedeutung sein kann. Vor dem Hintergrund der Verwendung rechtsmedizinischer Befunde durch Dritte sollten die Leitlinien der DGRM zur rechtsmedizinischen Leichenöffnung strikt beachtet werden. "Fallanalytisches Denken" kann bei der Interpretation von Verletzungsmustern oder Spuren verschiedenster Herkunft hilfreich sein.     

Erste Erfahrungen mit der Mehrzeilendetektorspiral-CT in der Diagnostik der Arteriosklerose der Koronargefäße

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

Zuverlässigkeit der Filterstreifenmethode bei der Gm-Bestimmung (Ergebnis eines Blindversuches zwischen zwei Untersuchern)

Ohne Zusammenfassung     

Der Einfluß der Reduktion der Bestrahlungsdosis auf die Inzidenz der radiogenen Pneumonitis, Lungenfibrose und Perikarditis nach Mediastinalbestrahlung bei der Behandlung der Lymphogranulomatose

Background

The amount of radiation dose applied in the treatment of Hodgkin’s disease is associated with the incidence of complications including radiation-induced pneumonitis, lung fibrosis and pericarditis. Therefore, from the beginning of 1986, we have started to apply a radiation therapy approach with reduced doses in order to minimize complications while maintaining effective treatment.

Patients and Method

From 1983 through 1992 141 patients suffering from Hodgkin’s, disease were included in the present study. All of them were treated by radiation of mediastinum. In 126 cases polychemotherapy was applied before radiation. From 1986 we used a reduced radiation dose in cases that were treated by radiation alone (affected nodal regions with 40 Gy instead of 45 Gy and unaffected nodal regions with 36 Gy instead of 40 Gy) as well as after application of chemotherapy (affected nodal regions 36 Gy instead of 40 Gy and unaffected nodal regions with 30 Gy instead of 36 Gy). Ninety-five patients were treated according to the new therapy protocol. Forty-six patients had been treated with the higher dosages and served as the historical control group. Radiation therapy included Co-60, 15-MV and 9-MV photons, and 15-MeV and 9-MeV electrons. Serial thoracic X-ray controls were performed. CT scans, echocardiographic and electrocardiographic investigations were added in selected cases.

Results

During the period from 1983 to 1992, we diagnosed radiation-induced pneumonitis in 31% of the patients who underwent radiation therapy of the mediastinum. In addition, 16% demonstrated lung fibrosis and 10% pericarditis. After implementation of the reduced radiation dosages, the incidence of pneumonitis decreased from 35% to 24% (nearly significant in the 5% range), lung fibrosis from 24% to 12% (p<0.05) and pericarditis from 26% to 2% (p<0.01). The efficacy of treatment remained unaffected by the new therapy approach as has been demonstrated for cumulative survival data and recurrence-free intervals.

Conclusions

Reduction of radiation dose in patients with Hodgkin’s disease who undergo mediastinal radiation leads to a decrease in the incidence of radiation-induced complications (pneumonitis, lung fibrosis, pericarditis) whereas treatment efficacy remains unchanged.     

Über Erfahrungen mit der Bestimmungstechnik und der forensischen Brauchbarkeit der Haptoglobintypen nach Smithies

Ohne Zusammenfassung     

Indikationen und ergebnisse der HDR-afterloading-therapie bei erkrankungen der haut und schleimhaut mit standardisierten oberflächenapplikatoren (Leipzig-Applikator)

BACKGROUND: In our department we have developed a standardized applicator for HDR brachytherapy of surface lesions, the so called Leipzig-applicator. We have used this method since September 1987, initially with a Decatron remote afterloading machine, but more recently from November 1990 with a microSelectron-HDR. We report about our experience of 10 years. PATIENTS AND METHOD: Since 1987 we treated 520 patients in 3,026 fractions with this method. In most of the cases we irradiated tumors of the skin of the face, but we also treated tumors of the mouth, of the tongue, of the perianal region and the external genitalia. The histological types were in most of the cases squamous cell carcinomas and basal cell carcinomas, but we also treated tumors like Kaposi-sarcomas, melanomas and skin manifestations of lymphomas and solid organ tumors. We also irradiated benign lesions like keloids after excision. We use single doses between 5 and 10 Gy once to twice a week. The isodose distribution was depending of the tissue infiltration of the tumor. The total dose was 30 to 40 Gy. RESULTS: In 91% of the cases we obtained a complete remission of the tumor, in 6% a partial remission. Recurrences appeared in 8% of the patients. In most cases the reason of the recurrence was a lower brachytherapy dose because of a prior radiotherapy. We didn't observe any severe late radiation reaction. CONCLUSION: We consider that our series of patients treated with HDR brachytherapy and a range of standardized applicators demonstrates that this is a successful method of treating surface lesions.     

Behandlung der arteriosklerotischen Erkrankung der A. carotis

In order to find the most suitable therapy concept for patients with severe stenosis of the carotid bifurcation (>70%), knowledge on the currently available treatment methods is necessary. In addition to carotid endarterectomy, medication therapy and stent angioplasty are also available. The outcome after stent angioplasty must be considered under the aspects of rapid technical development and increasing experience. Results of studies are still only of limited value with respect to the development of protection systems, flexible guiding catheters, low profile and more visible stents and balloons as well as using thrombocyte aggregation.     

Zur Frage der postmortalen Farbveränderungen der Haare

Zusammenfassung Wie die vorliegenden Versuchsergebnisse aufzeigen, dürfte es sich bei den postmortalen Veränderungen der Haarfarbe im wesentlichen um zwei verschiedene Vorgänge handeln, die getrennt für sich oder auch gleichzeitig ablaufen können. Einmal ist der Angriffspunkt das Haarpigment, welches durch Oxydationsvorgänge über die rote Stufe bis zur völligen Zerstörung abgebaut werden kann. Zum anderen können Nitrierungs- und anschließende Alkalisierungsvorgänge zu einer Umwandlung des Keratins, insbesondere seines Bausteines Tyrosin, und damit zu einer Farbänderung (graugelb bis fuchsigrot) führen.Diese Reaktionsabläufe sind nicht allein an flüssige oder feuchte Medien gebunden, sondern können auch bei Einwirkung von Gasen (NO₂ und NH₃) auftreten.Hervorgehoben werden darf nach den vorliegenden Untersuchungs-ergebnissen, daß nicht nur pigmentierte Haare, sondern auch graue (pigmentarme) und weiße, ja selbst Albino-Haare (pigmentlose) die fuchsigrote Farbe annehmen können.Von der jeweiligen Redoxlage unter dem Fäulnis- und Verwesungsprozeß wird es abhängen, ob Haare einen graugelblichen oder fuchsroten Farbton annehmen. Wenn O.Schmidt nach seinen Untersuchungen mit Farbstoffindikatoren ausführt, daß die Entfärbung des Farbstoffes ein Maß für das herrschende Potential ist, so kann nach vorliegenden Untersuchungsergebnissen ergänzend gesagt werden, daß auch die Bildung neuer Farbstoffe von der jeweiligen Redoxlage abhängt.Vortrag gelegentlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in Bonn (Oktober 1953).     

Mustererkennung im hochauflösenden Computertomogramm (HRCT) der Lunge

The pulmonary interstitium is divided into different compartments, with the secondary pulmonary lobule representing the smallest subunit surrounded by connective tissue. Identification of the lobular architecture is a prerequisite for categorizing the broad spectrum of pulmonary interstitial diseases into distinct patterns. High-resolution computed tomography (HRCT) patterns comprise reticular and nodular opacities, ground-glass opacities, and consolidation. Air trapping and emphysema are associated with decreased pulmonary attenuation. The features of these patterns are derived from the anatomic basis and are linked with typical differential diagnoses, although the nonspecificity of the different patterns should be kept in mind. A main objective is to focus on mixed patterns.     

Ein Beitrag zur Prüfung der LeistungsfÄhigkeit der plastischen Rekonstruktionsmethode der Physiognomie bei der Identifizierung von SchÄdeln

Ohne Zusammenfassung     

Experimentelle Untersuchungen zur Bedeutung der vacuoligen Umwandlung der Leber für die Diagnostik der Kohlenmonoxydvergiftung

Zusammenfassung An 125 männlichen Ratten eines Inzuchtstammes wurde die Frage untersucht, welche diagnostischen Rückschlüsse sich aus der Veränderung der Leber, bezüglich der CO-Vergiftung ziehen lassen. Es wird festgestellt, daß bei der akuten Kohlenmonoxydvergiftung keine Beziehung zwischen CO-Hb-Gehalt und dem Auftreten einer vacuoligen Degeneration besteht. Demgegenüber findet sich eine ausgesprochene Zeitabhängigkeit zwischen der Kohlenmonoxydvergiftung, dem Auftreten der vacuoligen Umwandlung der Leber und dem Eintritt des Todes.     

Aus der forensisch-psychiatrischen Abteilung der Freien Universität Berlin

Ohne Zusammenfassung     

Biochemische MR-Bildgebung der Bandscheibe und Facettengelenke der Wirbelsäule

The limited specificity of standard magnetic resonance imaging (MRI) in patients with low back pain encourages the development of new imaging techniques. Quantitative MR methods have the potential to assess biochemical changes of spinal structures in vivo. Early diagnosis of intervertebral disc and facet joint changes in young to middle aged patients allows the use of a specific therapy and preventative measures. Potential techniques are T2 and T2* mapping, diffusion-weighted imaging, magnetization transfer imaging, T1ρ mapping, sodium imaging and MR spectroscopy. Well designed longitudinal therapy studies, which assess biochemical and clinical parameters, are necessary. High-field MR systems (3 Tesla) are needed for high resolution biochemical MRI and clinically reasonable scan times.     

Anatomie und Normvarianten der Nasennebenhöhlen in der Schnittbildgebung

CT and MRI are the radiological methods of choice in the diagnostics of diseases of the paranasal sinuses. Detailed anatomical knowledge is mandatory for correct image interpretation. Before endonasal surgery the individually variable anatomic situation has to be known. This article describes radiologically relevant anatomical structures and summarizes normal variations.     

Einsatz von G-CSF (Neupogen®) bei multimodalen Therapiekonzepten in der Strahlentherapie

Background

Therapy-induced leucopenias with corresponding consequences repeatedly occur in radiotherapy using combined modalities treatment. In radiotherapy, where G-CSF (granulocyte-colony-stimulating-factor) is not licensed, G-CSF has been used successfully under individual circumstances. These results were confirmed in several studies with small patient groups. The aim of this study was to check former results in a larger patient group, to verify postulated side effects and specially to define a cost-effective schedule in the treatment with G-CSF (Neupogen^®).

Patients and Methods

In this surveillance trial 50, partially previously treated patients with different malignant tumors were treated with G-CSF. According to the probability of a leucocytosis lower than 1000/mm³, G-CSF (Neupogen^®) was already given at leucocyte values lower than 2500/mm³ (500/mm³ bis 2450/mm³). It was administered subcutaneously, every other day, based on body weight until reaching normal leucocyte levels.

Results

In 92% of the patients the increase of leucocytes occurred in the first 24 hours. On average G-CSF was given 4.9 times per patient. Patients without prior therapies or less complex therapies needed less G-CSF applications (3.5 to 5.8 applications). Due to individually varying leucocyte courses the G-CSF therapy was started with leucocyte values between 500/mm³ and 2450/mm³. Patients who were treatet with up to 3 G-CSF applications had higher leucocyte levels than those with 4 or more applications (1620/mm³ to 1250/mm³). Leucopenia related infections, therapy interruptions or break-offs did not occur. Besides light “flu like” symptoms in 14% of the patients, no side effects were observed.

Conclusions

When a decrease of leucocyte values lower than 1000/mm³ is expected, the most cost-effective treatment is given when starting the interventional G-CSF administration already at leucocyte values around 1600/mm³. Leucopenias can be treated effectively, with little side effects and in a cost-effective way when G-CSF is given on time.