Studien zur Abklärung der primär krankhaften Veränderungen der unteren Extremitäten

Zusammenfassung Von 193 plötzlich Verstorbenen wurden Häufigkeit, Umfang und Lokalisation der Phlebosklerose der Gliedmaßengefäße untersucht. Das Verfahren nach v. KOSSA bzw. MEYER hatte sich zur makroskopischen Darstellung bewährt.Korrelationen zu verschiedenen Faktoren, insbesondere Lebensalter und morphologisch faßbaren Herzkreislauferkrankungen, werden dargelegt und interpretiert.

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Summary Veins of the limbs of 193 sudden deaths are examined under aspects of frequency, extent and localisation of sclerosis. Macroscopic process of preparation has approved.Correlations to several factors, especially age and affections of heart and arteries, are represented and discussed.

Mit finanzieller Unterstützung des Ministers für Wissenschaft und Forschung des Landes Nordrhein-Westfallen. Forschungsprogramm Prof. Dr. G. DOTZAUER: Grundlagenforschung auf dem Gebiet der Unterschenkelgefäße. Auszugsweise vorgetragen auf der 53. Jahrestagung der Deutschen Gesellschaft für Rechtsmedizin, Göttingen, 1974.     

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.     

Trauma der Halswirbelsäule

Cervical spine injuries are a common occurrence in multi-trauma patients and should be taken into account when planning further clinical management. This review describes in detail upper and lower cervical spine injuries and introduces the sub-axial injury classification (SLIC) that is based on three components: injury morphology, integrity of the discoligamentous complex and the neurologic status of the patient. If the total SLIC score is <3, non-surgical treatment is recommended. If the total is > or =5, operative treatment is indicated as such a score is associated with instability and probably neurologic deficits. The precise diagnosis of the radiologist, which would include the SLIC classification, should facilitate clinical decision-making about further management.     

Veränderungen im visuomotorischen System während der Phase der Äthanolanflutung

Aim

The purpose of the study was to investigate the correlation between the blood alcohol concentration (BAC) and the resulting alcohol-induced alterations of neurophysiological parameters of functional brain imaging.

Material and methods

In this study 14 healthy subjects were investigated before and after forced rapid drinking of alcohol using functional magnetic resonance imaging. In order to evoke brain activity in the visual and motor cortex a visuomotor task was presented. During the measurements taken under alcoholic conditions venous blood samples were collected from the subjects at regular intervals.

Results

In the range between 0.5?‰ and 0.93?‰ no linear dependency between BAC and the blood oxygenation level-dependent (BOLD) signal was observed. The maximum alcohol-induced changes of the BOLD signals were found in the range of 0.7?‰.

Conclusion

The observed correlation between the BAC and the neurophysiological changes can be interpreted as the correlate of the influx phase after forced alcohol drinking.     

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).     

Stellenwert der Galaktographie zur Abklärung pathologischer Sekretion in der komplementären Mammadiagnostik

Purpose

Galactography has been used in cases of pathological discharge for decades. Meanwhile other methods, such as high-resolution ultrasound (US) and magnetic resonance mammography (MRM) have been established for modern multimodal breast imaging. A survey among certified German breast care centers aimed to investigate to what extent galactography is currently used and whether newer techniques in multimodal imaging are preferred.

Materials and methods

An anonymous online survey was carried out nationwide and open to 342 radiology units in certified German breast care centers.

Results

A total of 177 units (52?%) participated in the survey of which 13?% generally do not provide galactography, 33?% conduct a maximum of 5 galactographies per year, 24?% conduct 6–10, 18?% 11–20, 8?% 21–50 and 5?% 51–100. Of the participants 53?% give first priority to US and prefer galactography to MRM in stepwise diagnosis and 32?% prefer MRM to galactography. Only 4?% use galactography initially.

Conclusion

Currently galactography is no longer a mandatory standard and newer methods are preferred. The evidential value of galactography in comparison to other techniques should be established on the basis of the literature. The second part of this paper will deal with this question.     

Zur Morphologie der Essigsäurevergiftung

Zusammenfassung Drei tödlich verlaufene Fälle von Essigsäurevergiftungen gaben uns Anlaß, die sehr unterschiedlichen morphologischen Veränderungen zu untersuchen. Neben lokaler Ätzwirkung fanden sich Parenchymschäden an Leber, Milz und Nieren, deren Genese und Bedeutung diskutiert werden. Eine Abhängigkeit zwischen Giftmenge und Ausmaß der Veränderungen läßt sich nur für lokale Verätzungen erkennen. Die allgemeinen Gewebsstörungen sind sekundäre Folgen der lokalen Schäden. Der Nachweis einer lokalen toxischen Wirkung auf das Parenchym der Organe ist bisher noch nicht erbracht. Schwerere Verätzungen des Tracheobronchialsystems, Verblutungen durch tiefgreifende Magenwandnekrosen sowie ein Nierenversagen sind die lebensbedrohenden Komplikationen.     

Eine Methode der Carboxyhämoglobin-Bestimmung

Zusammenfassung Eine modifizierte Methode des Carboxyhämoglobins mit der Anwendung von Mikrodiffusionstechnik wurde beschrieben.Für die wertvollen Anregungen und Hinweise danke ich Herrn Prof. Dr.Shokichi Ueno.     

Degenerative Erkrankungen der Wirbelsäule

GOAL: The aim of this article is to describe rare and often unrecognized causes of spinal pain syndromes. METHOD: Intervertebral disc degeneration frequently appears in early adulthood and can have a symptomatic or asymptomatic course. This article discusses incidence, pathophysiology, imaging, and pain symptomatology involved in the origin of back pain. RESULTS: Anulus tears are often found in asymptomatic individuals but could be implicated in lumbar pain symptomatology in correlation with the provocative discography. Transient disorders can lead to pseudarthrosis of the iliac bone and to degeneration or to a reactive hypermobility with intervertebral disc degeneration in the level above. Modic type 1 erosive osteochondrosis is characterized by bone marrow edema near the hyaline cartilage end plate, which mostly elicits severe pain and results in serious limitations in everyday activities. The most important differential diagnosis is spondylodiscitis. Schmorl's nodes can exhibit considerable surrounding bone marrow edema that can be mistaken for metastases. A combination of MRI and CT should be employed for the diagnostic work-up of fatigue fracture of the interarticular portion, which is often overlooked due to its location. Synovial cysts of the facet joints can lead to radicular symptoms. Insufficiency fracture of the sacrum is frequently mistaken for metastasis due to intense scintigraphic enhancement and its signal behavior in MRI. CT provides instructive information. CONCLUSION: Differential diagnosis should include less common causes such as anulus tears, transient disorders, activated Schmorl's nodes, synovial cysts of the facet joints, fatigue fractures of the interarticular portion of the spine and the sacrum and distinguish from metastases in particular.     

Stellenwert der Galaktographie zur Abklärung pathologischer Sekretion in der komplementären Mammadiagnostik

Background

The survey results of a previous study showed that galactography is now rarely used in Germany and newer methods are applied. The evidential value of galactography should be established and opposed to the evidential value of ultrasound (US) and magnetic resonance mammography (MRM).

Materials and methods

A search was carried out in PubMed and Cochrane involving studies written in English or German. The level of evidence was measured according to the Oxford Centre for Evidence-based Medicine.

Results

A total of 19 studies were included, 14 with results on galactography, 10 on US and 5 on MRM. Almost all studies were retrospective with an evidence assigned to level 3b or lower. The results on the diagnostic values showed a very wide range. Because of very variable numbers of cases and consideration of various pathologies, the studies are only comparable to a limited extent.

Conclusion

Galactography, US and MRM all show a weak level of evidence and no superiority of a particular method can be derived. Therefore, galactography can no longer be considered as a mandatory standard in modern multimodal imaging of the breast. Recommendations for the diagnostic work-up of pathological nipple discharge have to be included in current guidelines and must consider these facts.     

Probleme bei der ärztlichen Leichenschau

Background

In Germany all doctors are committed by law to testify death and to perform an external inspection of the body. Afterwards they have to fill out a death certificate which mainly contains relevant judicial questions and have to be answered by medical doctors. This creates a number of problems.

Resident doctors

The main problem is the conflict of interests between acting as the family doctor on the one hand and as the neutral medical expert on the other. Often the relatives or even the police put pressure on the doctor to certify a natural cause of death. Also the fee for examining the body is considered as being inadequately low.

Clinicians

Doctors in hospitals wish to have clarity concerning what manner of death they have to certify when a patient died during or shortly after a medical intervention. They also like to have a better feedback concerning the results of an autopsy.

Emergency physicians

Because of their close relationship to police officers emergency physicians often feel great pressure of expectation to certify a natural death irrespective of the lack of information concerning the medical history of the deceased.

Police

Police officers often experience that doctors do not perform a good and sufficient external examination of a dead body and in hospitals they often have to face doctors who are not willing to communicate in an adequate way.

Conclusion

The system of testifying death in Germany is in need of reform. The medical education of students and the continuing training of doctors concerning testifying death have to be intensified. Furthermore the autopsy rate in Germany has to be significantly increased to identify the real cause and manner of death.     

Traumatische Schädigung der Aorta

Ohne Zusammenfassung     

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.