Sport bei Hüftgelenkserkrankungen im Kindes- und Jugendalter

Children and adolescents suffering from hip disorders are often compromised in their physical activity and sports. The typical hip diseases in this age group are hip dysplasia, Perthes disease, Slipped Capital Femoral Epiphysis and transient synovitis of the hip. On the one hand athletic overuse can provoke hip symptoms and on the other hand sports activities need to be restricted in ongoing or past hip diseases. It is important to follow patients until growth arrest to recognize and possibly treat secondary hip deformities and early osteoarthritis.     

Hämangiome und vaskuläre Malformationen im Kopf- und Halsbereich

Zusammenfassung Die Behandlung von Kindern und jugendlichen Patienten mit vaskulären Anomalien im Kopf- und Halsbereich erfordert die interdisziplinäre Zusammenarbeit von Pädiatern, Mund-, Kiefer- und Gesichtschirurgen, Dermatologen und Radiologen.Grundlage der gemeinsamen Therapieentscheidung ist eine international anerkannte Klassifikation vaskulärer Anomalien. Danach werden Hämangiome als proliferierende Neubildungen von vaskulären Malformationen als anlagebedingte Fehlbildungen unterschieden. Nach Hämodynamik und Gefäßbett teilen wir letztere in langsam durchströmte kapilläre, lymphatische oder venöse Malformationen und in rasch durchflossene arteriovenöse Malformationen ein.In dieser Arbeit wird ein Algorithmus zur klinischen und bildgebenden Diagnostik vaskulärer Anomalien vorgestellt. Die Indikationen zur Behandlung werden diskutiert und die Therapieoptionen erläutert.     

Endovaskuläre Interventionen beim Polytrauma

Clinical issue

In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding.

Standard treatment/treatment innovations

Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting.

Diagnostic work-up

In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible.

Performance

Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time.

Achievements

Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods.

Practical recommendations

In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access.     

Interdisziplinäre Zusammenarbeit im Schockraummanagement

Accidents do not only cause human harm but also tremendous costs. Prevention of injuries and improvement of management has reduced the mortality in trauma during recent years. Because time is an important factor in treatment of severely injured patients, the initial clinical treatment is the key in the management of these patients. Appropriate equipment and personnel are necessary to provide an efficient management of trauma patients. A strategy focused on life-threatening injuries and simultaneous diagnostic and therapeutic procedures are critical in the "golden hour of shock".     

Plötzliche Todesfälle im Wasser,insbesondere beim Baden und Sportschwimmen

Ohne ZusammenfassungVorgetragen auf der 18. Tagung der Dtsch. Ges. gerichtl. Med., Heidelberg, September 1929.     

Zur bedeutung bronchiolitischer und peribronchiolitischer Veränderungen beim plötzlichen Tode im Säuglingsalter

Zusammenfassung An Hand eines größeren Obduktions- und histologischen Materials von Feten, Neugeborenen und Säuglingen wurden die postmortalen von vital-entzündlichen Veränderungen am Bronchiolensystem abgegrenzt. Eine eigentliche Bronchiolitis ist keine Ursache plötzlichen Todes im Säuglingsalter. Dagegen finden sich in vielen Fällen bei anscheinend primär extrapulmonal erkrankten und dann plötzlich verstorbenen Säuglingen sowohl perivasculäre Infiltrate der Bronchiolenwand, als auch (meist gleichzeitig) multifokal angeordnete, vermutlich durch diabronchiolären Reiz entstandene, parabronchioläre Infiltrate im Parenchym bei intaktem Bronchiolus, die vielleicht Ausgangsstadien nicht mehr zu voller Entwicklung gelangter bronchopneumonischer Herde darstellen. Die Gesamtheit dieser Veränderungen wird zwar in dem vorliegenden Material als höchstens sekundär todesursächlich oder überhaupt agonal aufgefaßt, bietet aber eine Stütze der Annahme einer hämatogenen Genese der Säuglingspneumonie über die Bronchiolargefäße bzw. die endobronchiale Infektion des Lungengewebes ohne Bronchiolitis. Für die forensische Praxis ist der sekundäre Charakter aller dieser Befunde zu beachten.     

Primäre Degeneration des ZNS im Alter

Despite further development of new magnetic resonance imaging techniques, e.g., diffusion tensor imaging and 1H magnetic resonance spectroscopy, structural imaging will continue to play a major role in the diagnosis of primary central nervous system degeneration in ageing. Characteristic imaging patterns of multisystem atrophies and primary dementias as well as differential diagnostic features are demonstrated. While such features may have high specificity, their sensitivity is low especially in cross-sectional studies. Longitudinal studies are the optimal method to characterize the dynamic neuroanatomical correlates of the disease. However, according to disease duration and progression, neuroimaging will show increased overlapping and convergence of pathological changes in multisystem atrophy as well as in dementia.     

Tödliche Cardiazolvergiftungen beim Menschen und im Tierversuch

Ohne ZusammenfassungHerrn Prof. Dr.Merkel zu seinem 60. Geburtstage, am 7. VI. 1933, gewidmet.     

Rekonstruktive endovaskuläre Behandlungsverfahren im Bereich der A. subclavia und ihrer Äste

PURPOSE: Principles, methods and results of percutaneous therapy in acute and chronic vascular alterations of the subclavian artery and its branches. MATERIAL AND METHODS: 17 arteries in 15 patients have been treated. The patients suffered from stenoses (n = 6), occlusions (n = 7), aneurysms, (n = 2) or acute hemorrhage (n = 2). The lesions were located in the subclavian artery (n = 8), the axillary artery (n = 4) or the vertebral artery (n = 5). In all cases the procedures were performed via via a transfemoral approach. Balloon angioplasty was employed in 13 cases, in 6 cases bare stents and in 4 cases grafted stents were implanted. In one case additionally local lysis was performed. RESULTS: Primary technical success was achieved in all cases. No catheter complications did occur. In 13 Patients complete follow-up examinations could be performed. The life-threatening acute hemorrhages were stopped without recurrent bleeding. The aneurysms could be completely excluded without endoleaks. In 4 Patients of the stenosis-group re-stenosis occurred and following stent-implantation one occlusion after 6 months was observed. 8 patients are without clinical symptoms since the intervention. CONCLUSION: Stenotic and occlusive vascular alterations as well as aneurysms and the acute hemorrhage in supraaortic arteries can be effectively and safely treated by endovascular techniques using percutaneous groin access.     

Aufnahmetechnik und Untersuchungsprotokolle beim pädiatrischen Notfall

Paediatric emergencies demand a quick and efficient radiological investigation with special attention to specific adjustments related to patient age and radiation protection. Imaging modalities are improving rapidly and enable to diagnose childhood diseases and injuries more quickly, accurately and safely. This article provides an overview of imaging techniques adjusted to the age of the child and an overview of imaging strategies of common paediatric emergencies. Optimising the imaging parameters (digital radiography, different screen-film systems, exposure specifications) allows for substantial reduction of radiation dose. Spiral- and multislice-CT reduce scan time and enable a considerable reduction of radiation exposure if scanning parameters (pitch setting, tube current) are properly adjusted. MRI is still mainly used for neurological or spinal emergencies despite the advent of fast imaging sequences. The radiologist's task is to select an appropriate imaging strategy according to expected differential diagnosis and to adjust the imaging techniques to the individual patient.     

Verletzungen und Überlastungsschäden beim Golf

In 2016 in Rio de Janeiro golf as a new discipline will be part of the Olympic games for the first time. High loads in training and competition can lead to injuries and overuse problems in leisure sport golfers and in high competitive golfers. Low back pain and neck pain occur in 20-30% of all golfers. Tendinopathies and ligament strains of the shoulder, elbow or wrist are very common in the upper extremity. Soft tissue injuries around the hip and overuse syndromes around the knee including meniscal tears and cartilage problems can stop the sporting activity. Golf can be recommended for patients with arthroplasty of the hip or knee joint. Strengthening exercises and proprioceptive training can reduce the risk of injury or overuse.     

Hypophysäre Erscheinungen und ihre gerichtsärztliche Bedeutung

Ohne Zusammenfassung