MR-Charakterisierung der Zusammensetzung hämatopoetischen Knochenmarks Befunde bei generalisierten Neoplasien und Monitoring der Therapie

PURPOSE: Methodological work was performed in the field of magnetic resonance imaging (MRI) and spectroscopy (MRS) in order to develop suitable tools for non-invasive characterization of hematopoietic bone marrow. The methods were applied for the assessment of normal values in healthy persons and to examine patients with generalized hematological diseases or to monitor effects of therapies influencing the composition of bone marrow. METHODS: Besides standard techniques of MRI as T1- or T2-weighted methods, chemical shift techniques for selective visualization of water or lipid components were applied. The method of magnetization transfer (MT) contrast was used with the intention to differentiate between multiple water containing tissue compartments (intra- vs. extracellular space). A further approach was the determination of the magnetic field distribution within spongy bone marrow. Besides investigations in healthy volunteers, prospective clinical studies were carried out in patients suffering from acute leukemia during their initial treatment and in patients who underwent high-dose therapy with following peripheral blood stem cell transplantation (PBSCT). RESULTS: Especially MR techniques for selective imaging of water of fat signals and proton spectroscopy yielded a high sensitivity to primarily pathological or therapeutically induced changes of hematopoietic bone marrow. Application of MT allowed an improved differentiation of the tissue compartments under PBSCT, which might result in temporary edema. Storage of hemosiderin in bone marrow after blood transfusions and simultaneous hematopoietic insufficiency could be revealed by methods sensitive to magnetic field inhomogeneities. CONCLUSIONS: Methods of MRI and MRS allow to non-invasively characterize hematopoietic bone marrow in the course of hematological diseases and during therapy. Marked changes in the composition of hematological bone marrow are detectable for extensive marrow areas. The prognostic relevance of the findings has to be evaluated in future follow-up studies.     

Dynamische kontrastverstärkte MRT zur Beurteilung der Knochenmarksmikrozirkulation bei malignen hämatologischen Erkrankungen vor und während einer Thalidomidtherapie

Purpose. The aim of the study was to measure microcirculation parameters by dynamic contrast-enhanced MRI (d-MRI) and to evaluate the anti-angiogentic effects during treatment with thalidomide in different hematologic malignancies. Methods. In 20 healthy normal persons, 20 patients with myelodysplastic syndromes (MDS), 10 patients with multiple myeloma (MM) and 10 with myelofibrosis (MF) a fast gradient echo sequence (Turbo fast low angle shot 2D) with a pump controlled bolus infusion of gadolinium-DTPA was performed before and in 18 of these after beginning (average of 4,3 months) of a thalidomide therapy. Two pharmacokinetic parameters – the amplitude and exchange-rate-constant – were calculated and a statistical comparison of these values between healthy persons and patients as well as a correlation with the clinical course was executed. Results. Compared with the normal controls the patients showed a higher amplitude (normal persons 14.4±5.2, MDS 24.8±8.1, MF 35.9±4.3, MM 23.4±3.6) and exchange-rate-constant (normal persons 0.124±0.042, MDS 0.136±0.036, MF 0.144±0.068, MM 0.131±0.034). In the d-MRI-follow-up examinations a significant (p<0.005) reduction of the amplitude and exchange rate constant values was evident in 14 of 18 patients undergoing a thalidomide therapy. Clinically all of these patients showed a therapy responding with complete or partial diseases remission. Conclusions. In patients with hematologic malignancies significantly higher d-MRI-microcirculation parameters of the lumbar spine can be demonstrated than in normal persons. During anti-angiogenetic treatment with thalidomide a decrease of these values was observed in case of a responding to therapy.     

Tumoren und tumorähnliche Erkrankungen

Tumors and tumor-like lesions are rare diseases in the paranasal sinuses.There is a great variety of histological types, but only a small number of morphological patterns on imaging. Histology is an important point in therapeutic planning. In most cases it is obtained by sampling, which is not as difficult in the sinonasal area as in other regions of the body. The main task of imaging is an exact estimation of the extent and spread of a lesion. This article discusses the possibilities and limitations of CT and MRI in the assessment of the dignity and spread of paranasal tumors and tumor-like lesions in consideration of necessary therapeutic information. Additionally, an overview of features on imaging of different paranasal tumors and tumor-like lesions is given.     

Genetische Prädisposition und Strahlenempfindlichkeit von Tumoren

Background

Studies on normal tissue radiation sensitivity have demonstrated profound differences of individual sensitivities. A number of genetic syndroms associated with abnormal radiation sensitivity have been discribed. Significant differences have also been detected in persons without known genetic disorders. The question arises as to whether tumors originating from normal tissues with abnormal radiation sensitivity share this abnormal sensitivity and as to whether a general correlation between normal tissue sensitivity and tumor tissue sensitivity can be substantiated.

Methods

Experimental and clinical data derived from own investigations and an extensive review of the literature was used to answer the question.

Results

Experimental studies on normal and tumor tissues of SCID- and C3H-mice demonstrated that the 2.7-fold enhanced radiation sensitivity of SCID normal tissues is also found in SCID tumors. Clinical investigations on cervical carcinoma and breast cancer patients revealed higher local tumor control rates in patients with more pronounced acute side effects. A weak trend towards the same relationship was found in head and neck cancer patients. Case reports on unusually severe acute radiation side effects or unexpected tumor remissions as well as few reports on radiotherapy in ataxia telangiectasia (AT) patients suggest a correlation between normal- and tumor-tissue radiation sensitivity. Studies on fibroblasts and tumor cells from the same patient support this hypothesis in soft tissue sarcoma patients, but do not so for head and neck cancer patients. Tumor cells exhibit a considerably higher variation of radiation sensitivities than normal tissue cells.

Conclusions

Experimental and clinical data are compatible with the hypothesis that normal tissue radiation sensitivity predicts for tumor tissue sensitivity. However, in view of the larger heterogeneity of tumor cell radiation sensitivity as compared to normal tissue radiation sensitivity, the development of a clinically useful predictive test for tumor sensitivity based on normal cell sensitivity appears to be unrealistic.     

Pädiatrische intraspinale Neoplasien

With an overall incidence of 10?% of all central nervous system tumors, spinal tumors are relatively rare in children. The majority of these tumors are astrocytomas and ependymomas (70?%) followed by rare non-glial tumor entities, such as gangliogliomas. They can be differentiated into intramedullary, extramedullary intradural and extramedullary extradural tumors according to their occurrence within the anatomical intraspinal compartments. The clinical presentation is generally unspecific. Longer lasting back pain or a gradually worsening scoliosis are often the first signs of the disease. Neurological deficits, such as gait disturbances and paresis often occur after a time delay. In rare cases increased intracranial pressure has been reported. Knowledge concerning potential organ manifestations, resulting complications and typical radiological presentation, especially in magnetic resonance imaging are mandatory for adequate diagnosis and treatment of affected patients.     

Identifizierungstätigkeit bei Massenunfällen und Katastrophen

The identification of victims in cases of mass disasters is still a great challenge for all concerned. On the one hand an adaptive strategy is necessary for the identification workflow depending on the type of catastrophe and on the other hand high public pressure demands a fast identification process of missing relatives. The international cooperation after the Tsunami in 2004 showed under what conditions successful victim identification can be carried out. This led among other things to intensification of international cooperation at various levels, which is necessary in order to attain basic standards for identification for all participating countries. The identification commission (IDKO) of the Bundeskriminalamt (BKA) has actively participated in this international cooperation in recent years with support from forensic pathology, forensic odontostomatology and forensic molecular genetics. In this article the established standards and training options in the German victim identification process will be reported.     

Alkoholresorption und Alkoholverbrennung bei Schädeltraumen

Ohne ZusammenfassungAuf der 25. Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin am 5. IX. 1936 in Dresden vonG. Jungmichel auszugsweise vorgetragen.     

Kernspintomographische Diagnostik benigner und prämaligner abdomineller Tumoren im Kindesalter

PURPOSE: To evaluate the potential of MRI in determining benign and premalignant abdominal tumors in childhood. METHODS: MR images of 93 children with 69 malignant and 24 benign abdominal tumors were analyzed retrospectively without and with knowledge of clinical findings. Based on the final diagnosis, MR findings were surveyed with regard to the correct differential diagnosis and to the differentiation between benign and malignant masses. RESULTS: Analysis of MRI alone revealed relatively low sensitivity of 67% for diagnosis of a benign tumor. The main reason was unspecific morphologic criteria leading to the false-negative diagnosis of a malignant tumor. Together with clinical and laboratory findings, sensitivity could be increased to 92%. The main criterion for differentiation of malignant tumors turned to be out the origin of tumor. Benign tumors could be best differentiated by their internal structure. CONCLUSION: When considering clinical findings in pediatric abdominal tumors, MRI represents a valuable modality for differential diagnosis.     

Tumoren der Schädelbasis

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.     

Chirurgische und pathologischanatomische Befunde bei Verkehrsunfällen

Ohne Zusammenfassung     

Nephrosen bei Transfusionsschäden und exogenen Vergiftungen

Zusammenfassung Die Nierenveränderungen durch viele endo- und exogene Gifte sind mit einer verwirrenden Fülle von Namen belegt, ein Teil der Namen wurde zu einem Schema geordnet. Die verschiedenen Bezeichnungen dürfen nicht dazu verführen, das Gemeinsame dieser Nierenreaktionen zu übersehen. Dies wird dargestellt.Andererscits ist zu erwarten, daß nicht alle Gifte gleichartig wirken, sondern das gemeinsame Grundschema der Reaktionsweise variieren oder durch neue Bilder bereichern. Manche Spuren solcher pathologischer Vorgänge sind nachweisbar, besonders wenn man nach Gefriertrocknung auch wasserlösliche Substanzen erfaßt. Dies wird mit Beispielen belegt von verschiedener Lokalisation der Veränderungen in der Rinde, im Nephron, von verschiedenen morphologischen und histochemischen Veränderungen in der Aktivität von alkalischer und saurer Phosphatase, der Lipase, von Polysacchariden und von dem Nachweis anderer Substanzen, möglicherweise Reaktionsprodukten des Giftes.Für manche Bilder bei der Sublimatvergiftung wird ein Zusammenhang mit der Ablagerung des Giftes in den Tubulusepithelien vermutet. Es bleibt allerdings bei jedem neuen Bild vorerst noch offen, wie weit es für ein bestimmtes Gift spezifisch ist oder durch Reaktionen entsteht, die bei vielen pathologischen Prozessen ablaufen.Vorgetragen am Kongreß der Dtsch. Ges. für gerichtl. u. soz. Med. Marburg 1956.     

Tumoren der hinteren Schädelgrube

Various types of brain tumor can occur in the region of the posterior fossa. Brain metastases in adults are the most common malignancies at this localization. Ependymomas, medulloblastomas and pilocytic astrocytomas occur mostly in children and only rarely in adults. Other tumors that occur in the posterior fossa are meningiomas, schwannomas, hemangioblastomas, brain stem gliomas and epidermoid tumors. Due to the fact that the various tumors of the posterior fossa have different treatment approaches and prognoses, an accurate and specific diagnosis is mandatory. This review discusses the imaging aspects by computed tomography (CT) and magnetic resonance imaging (MRI) of the most frequent tumors of the posterior fossa.     

Fehlerquellen bei der Methämoglobinbestimmung und ihre Ausschaltung

Zusammenfassung Die wichtigste Fehlerquelle bei der Methämoglobin(Hämiglobin)-bestimmung ist die Methämoglobinrückbildung. Sie ist fermentativ bedingt. Durch Hämolyse und Verdünnung des Blutes mit Wasser kann die Rückbildung praktisch vollständig ausgeschaltet werden, ebenso durch Zusatz von Na-Fluorid zum Blut. Bei, längerer Aufbewahrung des Blutes oder der Blutlösung stört die spontane Methämoglobinbildung. Sie kann durch CO-Sättigung eingeschränkt werden.Vorgetragen auf der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin vom 12.–15. Oktober 1960 in Graz.     

Komplikationen nach Tracheotomie und Angiographie bei Schädel-Hirn-Traumen

Ohne Zusammenfassung