Ossification and pseudoepiphysis formation in the “nonepiphyseal” end of bones of the hands and feet

Metacarpals, metatarsals, and phalanges were studied to assess the developmental morphology of secondary ossification in the nonepiphyseal ends of these bones as well as the formation of the pseudoepiphysis as an epiphyseal ossification variant. Both direct ossification extension from the metaphysis into the epiphysis and pseudoepiphysis formation preceded, and continued to be more mature than, formation and expansion of the classic epiphyseal (secondary) ossification center at the opposite end of each specific bone. Direct metaphyseal to epiphyseal ossification usually started centrally and expanded hemispherically, replacing both physeal and epiphyseal cartilage simultaneously. In contrast, when remnants of physis were retained, while juxtaposed epiphyseal cartilage was replaced, a pseudoepiphysis formed. There were three basic patterns of pseudoepiphysis formation. First, a central osseous bridge extended from the metaphysis across the physis into the epiphysis and subsequently expanded to create a mushroom-like osseous structure. In the second pattern a peripheral osseous bridge formed, creating either an osseous ring or an eccentric bridge between the metaphysis and the epiphysis. In the third pattern, multiple bridging occurred. In each situation the associated remnant physis lacked typical cell columns and was incapable of significantly contributing to the postnatal longitudinal growth of the involved bone. Pseudoepiphyses were well formed by 4–5 years and coalesced with the rest of the bone months of years before skeletal maturation was attained at the opposite epiphyseal end, which ossified in the typical pattern (i.e., formation of a secondary center de novo completely within the cartilaginous epiphysis). This process may also affect the development and appearance of ossification within the longitudinal epiphyseal bracket (delta phalanx).     

Symptomatic vertebral hemangiomas: a report of four cases

Neural compression complicating vertebral hemangioma is associated with: (1) compression fracture, (2) hematoma, (3) epidural extension of tumor, and/or (4) bony expansion or ballooning. Four cases of symptomatic vertebral hemangioma are presented. Discussion includes imaging modalities, preoperative embolization, and surgical approach.     

Die besonderen konstruktionsmerkmale des japanischen „Tan-to“-(Messers) als Kriterien für dessen Gefährlichkeit

Zusammenfassung Es wird auf die besondere Klingenform japanischer Blankwaffen und auf die Neuentwicklung eines Verwandlungs-Tan-to verwiesen. Bei letzterem läßt sich die Klinge in der Handgriffmitte um 90° drehen und arretieren, eine ideale Fixierung dieses Messers durch Faustschluß am Quergriff. Durch diese Bedingungen ist eine hohe Verletzungsgefährdung mit tödlichem Ausgang gegeben. Diese seit kurzer Zeit im Handel erhältlichen Messer sollten nach § 37 Waff G umgehend als verbotene Gegenstände definiert werden.     

“Top of the basilar” syndrome: A comparison of clinical and MR findings

Summary Among 100 patients with an infarction of the brain reported on MR and clinically confirmed there were 4 with widespread lesions of the temporal and occipital lobes, thalamus, midbrain, pons and cerebellum, all supplied by arteries originating around the top of the basilar artery. Clinically these patients presented the top of the basilar syndrome, which is caused by a disturbance in circulation at the top of the basilar artery. Which brain areas are involved may be deduced theoretically from the vascular anatomy. These lesions can, we believe, be clearly detected using MR, because of its sensitivity to ischaemic disturbances and in the posterior fossa. We report our 4 patients here to illustrate the clinical presentation and MR findings of the top of the basilar syndrome.     

Cerebral angiographic findings in thromboangiitis obliterans

Transient ischemic attacks (TIAs) or ischemic stroke may complicate thromboangiitis obliterans (TAO). However, there has been debate regarding the mechanism of ischemic stroke in TAO. We report the case of a patient with TAO who developed repeated TIAs. An angiogram showed multiple alternative areas of arterial occlusions in the distal segments of both middle cerebral arteries. Extensive collateral vessels around the occluded segment were also observed, which resembled the tree root or corkscrew vessels described in the peripheral arteries in TAO. Our patient illustrates that cerebral manifestations of TAO may occur with vascular changes that are identical with those encountered in the limb arteries in TAO.     

Arterial spasm as a finding intimately associated with the onset of vascular headache

Summary A patient with migraine headaches of the cluster variant type is presented in whom vasospasm of the middle cerebral artery, the anterior cerebral artery and the internal carotid artery triggered a pain episode identical in character and severity to the headaches which had led to her investigation. Vasospasm associated with the painful phase of headache in this case conflicts with the more accepted theory that the pain phase of a vascular headache is related to vasodilatation of cerebral or extracerebral vessels. The literature is reviewed.     

MRI in aqueduct compression and obstructive hydrocephalus due to an ectatic basilar artery

We describe a patient with an ectatic basilar artery in whom MRI showed marked indentation of the floor of the third ventricle and backward displacement of the midbrain, probably causing aqueduct stenosis. It appeared likely that the associated hydrocephalus was due not only to any water-hammer effect, but also to occlusion of the aqueduct.     

Cerebrovascular doppler examination and cerebral angiography-alternative or complementary?

Summary Obstructions in the extracranial cerebral arteries can be detected noninvasively by directional Doppler ultrasound technique using indirect and direct criteria. The indirect criteria are based on measurement of flow in the common carotid and in the terminal branches of the ophthalmic artery before and after the common carotid artery and branches of the external carotid artery are compressed. With the direct criteria, internal and external carotid artery are differentiated by diastolic flow, and local inhomogeneities of flow (turbulence) are detected. Flow in the vertebral artery is picked up transorally in the oropharynx. The Doppler examination was used in 2230 patients of whom 436 underwent angiography. The results of Doppler and angiography correlated in more than 90% of the cases.     

MR imaging of intracranial vertebral artery occlusion

Summary Magnetic resonance (MR) images of nine patients with intracranial vertebral artery occlusion (five proved, four presumed) have been reviewed. In two of nine, both vertebral arteries were occluded and in five of the nine, the basilar artery was also blocked. All occluded arteries showed absence of flow void and were clearly demonstrated as mildly hypo-mildly hyperintense structures to brainstem parenchyma on the T1-weighted images. In two of five patients with basilar artery occlusion, retrograde filling of the distal basilar artery was detected. Thus, MR imaging, in particular the T1-weighted image, is a pertinent diagnostic modality for evaluating intracranial vertebral artery occlusion. Angiography does not seem to be required for confirmation.     

Locations of cerebral infarctions in tuberculous meningitis

Summary The locations of cerebral infarctions were studied in 14 patients with tuberculous meningitis (TBM) and 173 patients with noninflammatory ischemic stroke (IS). In patients with TBM, 75% of infarctions occurred in the TB zone supplied by medial striate and thalamoperforating arteries; only 11% occurred in the IS zone supplied by lateral striate, anterior choroidal and thalamogeniculate arteries. In patients with IS 29% of infarctions occurred in the IS zone, 29% in the subcortical white matter, and 24% in (or involving) the cerebral cortex. Only 11% occurred in the TB zone. Bilaterally symmetrical infarctions of the TB zone were common with TMB (71%) but rare with IS (5%).Presented at the 14th Scientific Meeting of the Neurological Society, R.O.C., held in Taiwan, 20–21 April 1990     

The “dense artery sign” — major cerebral artery thromboembolism demonstrated by computed tomography

Summary A 4 years review of high resolution thin slice (3–5 mm) computed tomography performed within 24 h after cerebral infarction revealed increased density in a major cerebral artery segment in 28 patients. Arteries affected were the vertebral and basilar artery in 6 and 8 patients, the sphenoid course of the middle cerebral artery in 13 cases and the extracranial internal carotid artery in 1 patient. In 35.7% of cases the so called dense artery sign provided earliest evidence of the ensuing infarction documented by CT controls in most patients. Angiography carried out in 8 patients, density caculations in the course of the affected vessel and resolution of the increased density on subsequent CT examinations suggest thrombembolism as the most likely etiology. In the clinical setting of acute stroke increased artery density encompassing the entire vessel diameter may serve as an early indicator of major cerebral artery occlusion and prompt angiographic investigation of a lesion potentially amenable to lysis.     

Three-dimensional display of myocardial perfusion detection of ischemic lesions using a new image subtraction method

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new distance-subtraction method: after suitable centering of the axial slices, 3D distance-shaded images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of distance-shaded images is decisive for a correct diagnosis.     

Einige gerichtsmedizinische und kriminalistische Bemerkungen über Verletzungen durch Kleinkaliberwaffen

Zusammenfassung Aus der Gesamtanalyse von erzielten Ergebnissen der durchgeführten Untersuchungen geht hervor, da die Kleinkaliberpistole Pavliek eine gefährliche Schuwaffe ist, die sogar bei gröeren Schuentfernungen schwere Körperschädigungen oder den Tod des Menschen herbeiführen kann. Man darf dies vor allem auf die beträchtliche Durchschlagskraft und auf die starke Deformationsfähigkeit des Geschosse im menschlichen Körper zurückführen.Im deutlich fetthaltigen Schmutzring gibt es unabhängig von der Schuweite immer feine Pulverkörnchen, worauf man besonders bei chemischen Proben achtgeben mu.Charakteristische Nahschuzeichen entstehen bei Verwendung dieser Waffe nur bei verhältnismäig kleinen Schuabständen. Diese hängen nur im geringen Grade von der benutzten Waffe ab, ändern sich aber beträchtlich bei der Anwendung verschiedener Munitionsarten. In einzelnen Expertisen soll man also nicht nur verdächtige Exemplare der Waffe prüfen, sondern dabei vor allem genau dieselbe Munitionsart verwenden.Man darf es nicht ableugnen, da trotz immer fortwachsender Entwicklung und Besserung der kriminaltechnischen Untersuchungen, die vorgeführten einfachen Untersuchungsmethoden immer noch am Platze sind und ihre beträchtliche Bedeutung sowohl in laufenden gerichtsmedizinischen Expertisen wie auch in wissenschaftlichen Arbeiten über die Wirkungen der modernen Schuwaffen besitzen.     

Das Problem der a-priori-Wahrscheinlichkeit bei Verwendung der Essen-Möller-Formel zur Berechnung der Vaterschaftswahrscheinlichkeit

Zusammenfassung Die Annahme der a-priori-Wahrscheinlichkeit, daß Nichtväter und wahre Väter gleichhäufig zur Begutachtung gelangen, wird an Hand von 408 Aktenfällen bestätigt.Die Berechnung der Vaterschaftswahrscheinlichkeit bietet, insbesondere bei Mehrverkehrsfällen, wertvolle Hinweise für die Vaterschaft oder Nichtvaterschaft eines Probanden, Hinweise, die durch die Angabe der Vaterschaftsausschlußchance aufgrund der Mutter-Kind-Konstellation nicht erbracht werden können. Auf Beziehungen zwischen der Vaterschaftsausschlußchance und der Vaterschaftswahrscheinlichkeit wird hingewiesen.

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The assumption of prior probability computing the plausibility of paternity by the Essen-Möller equation and its problem

Summary Among objectivists the assumption of firsthand probability, that non-fathers and true-fathers are being given an opinion on with equal frequency, yields to a rejection in calculating the probability of fatherhood according to Essen-Möller. By means of 408 cases it is shown, that this assumption does meet the actual situation. Non-fathers and true-fathers are observed equally frequent. Calculation of fatherhood probability renders a valuable reference to paternity or nonpaternity of a subject in cases of multiple intercourses. These references cannot be brought on by the statement of the exclusion chance of fatherhood based on the mother-child-constellation. The relationship between the exclusion chance and the probability of fatherhood is pointed out.

     

Problems with the “dural tail” sign

Prominent enhancement of the dura mater, the dural tail adjacent to a peripherally located mass on gadolinium-enhanced MRI has been described as being characteristic of meningiomas. We present a cerebral glioma showing the classical dural tail.     

In vitro experiment and initial clinical experience in angioplasty,in vascular occlusive disease with a new pulsed dye-laser system

The feasibility of using a pulsed dye-laser in angioplasty for detection and disintegration of calcified plaques was studied in vitro. The laser (495 nm wave-length; 2 s pulse duration) was used as the exciting source for laser-induced-fluorescence (LIF) signals. Spectral data in the 520 to 800 nm region of normal artery wall, calcified plaques, and fibro-fatty plaques were analysed with an optical multichannel analyser. Good signal-to-noise ratio and different spectra for different specimens were obtained within only 2 s. Fluorescence analysis can be performed in less than 300 ns and therefore the laser can be controlled before plasma threshold is reached. This can lead to a clinical by useful feedback system in an intelligent laser, which can selectively ablate atherosclerotic tissue. In a parallel step we investigated a pulsed dye-laser device (504 nm; 1.2 s) for in vivo recanalisation of arteries in ischaemic lower limbs. A specially designed 9F or 7F guide wire directed multifibre catheter was used for treatment of 17 patients. The recanalisation technical success was 8/8 (4 occlusions/5 stenoses) in the iliac arteries (IA) and 8/9 (8 occlusions/4 stenoses) in the superficial femoral (SFA) and popliteal arteries (PA). All occlusion lengths were below 10 cm. Three early re-occlusions occured, caused by very bad run-off. There was one clinically insignificant SFA perforation and one groin haematoma. Additional techniques (balloon dilatation, stenting, lysis) were considered necessary in 15/17 patients. Mean ankle-arm-index increased significantly in the 1 week examination in rest from 0.61 to 0.76 (P < 0.05) in IA and from 0.65 to 0.93 (P < 0.01) in SFA. Pulsed dye-laser angioplasty promises to be an effective method for plaque ablation/debulking. Correspondence to: M. Zwaan     

Local Administration of NF-κ B Decoy Oligonucleotides to Prevent Restenosis after Balloon Angioplasty: An Experimental Study in New Zealand White Rabbits

Purpose To evaluate the efficacy of NF- B oligonucleotides (ODN) administered by local administration with the channeled balloon catheter to prevent restenosis after balloon angioplasty in restenotic iliac arteries of New Zealand white rabbits.Materials and Methods In vitro, 8000 rabbit vascular smooth muscle cells (rVSMC) where transfected with a liposomal carrier (TfX50) with 100 ng of decoy and scrambled ODN. Inhibition of proliferation was measured using a MTT assay after 24 hours in comparison to control. In vivo, 22 male New Zealand White rabbits were fed a 1% cholesterol diet and received denudation of both common iliac arteries with a 3 mm balloon catheter to induce an arterial stenosis. Four weeks after stenosis induction, local application of NF- B in two different concentrations (1 g: n=14; 10 g: n=8) was performed randomly on one common iliac artery. Scrambled oligonucleotides without specific binding capacities were injected into the contralateral side. The channeled balloon catheter allows simultaneous balloon dilation (8 atm) of the stenosis and local application of a drug solution (2 atm). Four weeks after local drug delivery the animals were killed and the vessels were excised and computerized morphometric measurements were performed.Results NF- B decoy ODN but not scrambled ODN inhibited proliferation of rVSMC in vitro. Following local ODN application in the animals, no acute vascular complications were seen. NF- B ODN resulted in a statistically non significant reduction of neointimal area compared to the control group. The neointimal area was 0.97 mm² using 1 g NF- B ODN compared to 0.98 mm² in the control group. The higher dose resulted in a neointimal area of 0.97 mm² compared to 1.07mm² at the control side.Conclusions Local drug delivery of NF- B ODN using the channeled balloon catheter could not reduce neointimal hyperplasia in stenostic rabbit iliac arteries. Application modalities have to be improved to enhance the effect of the local application to prevent restenosis after balloon angioplasty.     

Intramural hydatid cysts of pulmonary arteries: CT and MR findings

Involvement of the pulmonary artery by echinococcosis usually occurs due to pulmonary embolization after rupture of the cyst in the right ventricle or, rarely, by dissemenation from a hepatic focus. This paper presents an adult patient with intramural hydatid cysts of the pulmonary arteries, which apparently grew slowly toward the lumina resulting in complete luminal occlusion, enabling sufficient time for development of sufficient perfusion from the bronchial arteries. The condition apparently resulted from embryos of the parasite, which entered the vasa vasorum of the pulmonary arteries, a previously unreported mechanism.     

Large vessel disease in Chinese patients with capsular infarcts and prior ipsilateral transient ischaemia

Summary Carotid angiography was carried out in 21 Chinese patients with acute capsular infarcts; all had had a previous ipsilateral transient ischaemic attack (TIA) or reversible ischaemic neurological deficit (RIND) during the preceding 6 months. Sixteen (group 1) showed lacunar capsular infarcts, and 5 (group 2) either giant lacunae or striatocapsular infarcts. Angiography showed that 81% of group 1 and all group 2 patients had ipsilateral severe stenosis or occlusion of either the M1 segment of the middle cerebral artery or the internal carotid artery. Ten group 1 patients and 3 group 2 patients also had contralateral intra- or extracranial carotid artery stenosis. Apart from hypertension, other risk factors such as hyperfibrinogenaemia, polycythaemia, and low HDL-cholesterol level seem to play a role. Haemorheological abnormalities in the presence of atherostenosis at the orifice of lenticulostriate arteries and/or artery-to-artery embolism might be the cause of infarcts in the majority of the patients. A fifth of patients had recurrent large ipsilateral infarcts. Thus capsular lacunar syndromes with prior ipsilateral TIA or RIND are not as benign as previously thought, and they should indicate more intensive studies including cerebral angiography, and more vigorous therapy.     

The “early filling vein”: Is “early venous filling” in an angiogram really a reliable sign of malignancy?

Summary The case is reported of a 41-year-old man with a meningioma arising from the choroid plexus in the trigonal region of the left lateral ventricle. Carotid angiography revealed that the tumour was surrounded by pathological angiomatous vessels drained by early veins. It is stressed that early venous filling is not a safe sign of malignancy in any tumour.

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Die frühzeitige Venenfüllung: Ist die frühe Vene im Angiogramm tatsächlich ein sicheres Zeichen der Malignität?

Zusammenfassung Fallbeschreibung eines 41-jährigen Patienten mit einem Meningeom, das vom Plexus im Bereich des Trigonum des linken Seitenventrikels ausging. Die Carotisangiographie zeigte, daß der Tumor von pathologischen Gefäßen umgeben war, dabei stellte sich eine frühe Vene dar. Die Untersuchung zeigt, daß diese frühe Vene nicht immer ein sicheres Zeichen der Tumor-Malignität bedeutet.

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L' «Opacification veineuse precoce»: Peut-elle reellement être consideree comme un signe sûr de malignite sur un angiogramme?

Résumé Les auteurs rapportent le cas d'un homme de 41 ans porteur d'un méningiome s'étendant du plexus choroïde à la région trigonale du ventricule latéral gauche. L'angiographie carotidienne démontra que la tumeur était entourée par des vaisseaux angiomateux «pathologiques» drainés par des «veines précoces». Les auteurs insistent sur le fait que l'«opacification veineuse précoce» n'est pas un signe sûr de malignité d'une tumeur.