Extradural hematomas: Measurement of size by volume summation on CT scanning

Summary The method of volume summation (V = T(A₁ + A₂...A_n ) was used to measure the size of extradural hematomas. The accuracy was tested on six different artificial silicone hematomas and the mean difference was-2.7 ml, SD 3.7 ml. The reproducibility was tested on CT scans of clinical hematomas, SD was 2.1 ml. An empirical formula for volume estimation then found: 0.5xheightxlengthxdepth was moderately reliable, while midline shift and vesselfree space were poor indicators of size. In conclusion, the volume summation with manual outlining was found to be highly accurate, but the problems of CT smoothing, spectral shift artifact, partial volume effect and separation of the hematoma from other structures must be considered.     

Computed-tomography of bilateral isodense chronic subdural hematomas

Summary While unilateral chronic isodense subdural hematomas as a result of indirect signs of a space-occupying lesion are easily recognizable on computed tomography (CT) and clearly diagnosed on the angiogram, bilateral chronic isodense subdural hematomas may cause considerable difficulty. In two cases with CT false negative findings we observed, retrospectively, significant small cellae mediae and also the main part of the anterior horns sharply pointed and approaching one another. Three further cases showed the same ventricular configuration, which we called hare's ears sign. This sign together with clinical data is always suspicious of chronic bilateral isodense subdural hematomas and carotid angiography is indicated. Other possible signs are: subtle midline shift if the size of the hematoma varies, changed formation of density of brain tissue, non-appearance of cerebral sulci especially in elderly patients, and eventually the visualization of a membrane after intrevenous injection of contrast material.     

Hemorrhage associated with “bone crisis” in Gaucher's disease identified by magnetic resonance imaging

Children suffering from Gaucher's disease were examined by magnetic resonance imaging (MRI) during a characteristic episode of bone crisis. An unexpectedly high intramedullary as well as subperiosteal signal was observed on both the T1 and T2-weighted sequences in 5 patients, suggesting a subacute hemorrhage or hematoma. It is conceivable that such a painful hemorrhage is an important component of the bone crisis phenomenon. Furthermore, in these cases this is a specific sign which may enable differentiation of bone crises from other types of bone pain associated with Gaucher's disease.     

Short-stop-munition

Zusammenfassung Immer wieder wird Munition zur Verteidigung unter Hinweis auf ihre weniger-tödliche bis nicht-tödliche Wirkung angeboten. Die Praxis zeigt jedoch, daß von diesen Munitionstypen entgegen den oft verharmlosenden Angaben der Hersteller sehr wohl eine konkrete Gefahr ausgeht. Einerseits können daraus schwerwiegende Folgen resultieren, andererseits kann als Einlassung vor Gericht die Vorhersehbarkeit solcher Folgen begrundet in Frage gestellt werden. Unter diesem Aspekt werden eine spezielle Schrotmunition für Revolver des Typs Speer 38/357 Shot Shells des Herstellers CCI, die Patrone Short-Stop der Fa. MB Associates in San Ramon (Kalifornien) and mit eigenem Fallbeispiel eine Munition vom Schock-Defense-Typ der Fa. Rauchalles in Offenburg vergleichend hinsichtlich Aufbau und Wirkung besprochen. Sonderdruckanfragen an: W.Eisenmenger     

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.     

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.     

A pragmatic approach to metal artifact reduction in CT: merging of metal artifact reduced images

The purpose of this study was to improve metal artifact reduction (MAR) in X-ray computed tomography (CT) by the combination of two artifact reduction methods. The presented method constitutes an image-based weighted superposition of images processed with two known methods for MAR: linear interpolation of reprojected metal traces (LI) and multi-dimensional adaptive filtering of the raw data (MAF). Two weighting concepts were realized that take into account mean distances of image points from metal objects or additional directional components. Artifact reduction on patient data from the jaw and the hip region shows that although the application of only one of the MAR algorithms can already improve image quality, these methods have specific drawbacks. While MAF does not correct corrupted CT values, LI often introduces secondary artifacts. The corrective impact of the merging algorithm is almost always superior to the application of only one of the methods. The results obtained with directional weighting are equal to or in many cases better than those of the distance weighting scheme. Merging combines the advantages of two fundamentally different approaches to artifact reduction and can improve the quality of images that are affected by metal artifacts.Symbols LI linear interpolation algorithm - MAF multi-dimensional adaptive filtering algorithm - MAR metal artifact reduction - f(x, y) object function at (x, y) - F(), F() normalized filter function in the direction of the coordinates and - I primary X-ray intensity - I₀ transmitted X-ray intensity - N_D number of detectors per detector row - p attenuation - p(,), p(,) projection data (fan and parallel geometry) - p_th lower threshold of the attenuation of adaptive filtering - p_max maximum value of the attenuation of adaptive filtering - (x, y) image point - projection angle in fan geometry - angle within the fan relative to the central ray - , , z, , minimum functions for adaptive filtering - projection angle in parallel geometry - orthogonal distance of a ray to the center of rotation in parallel geometry     

Early enzyme changes in skin wounds demonstrated by isoelectric focusing in polyacrylamide gel

Summary Esterase patterns in vital skin wound extracts were observed and compared to those seen in normal skin. Employing the relatively simple method of isoelectric focusing in polyacrylamide gel, it was demonstrated that three, consecutively appearing, characteristic changes were visible in the esterase zymograms of vital (pre-mortally) injured skin as compared with skin which was uninjured or post-mortally damaged. One of these characteristics (characteristic a), since it is found only in wound reactions and not in uninjured skin, may represent an enzyme specifically produced during the wound reaction process. All three features normally appeared within 30 min of trauma and the first change within 5 min, even though it had been generally assumed that vital reactions, i.e. wound reactions, could be demonstrated only after a longer period of time. It was possible therefore to determine victim survival time and distinguish between pre- and post-mortal wounds. Also the isoelectric focusing of enzymes apparently gives a more efficient pattern band separation than previous methods.

---

Zusammenfassung Durch isoelektrische Fokussierung der Extrakte aus vital verletzter Haut wurden die -Naphthylacetat-spaltenden Enzyme aufgetrennt und mit gleichartig hergestellten Extrakten unverletzter Haut desselben Menschen verglichen. Es konnten 3 nacheinander auftretende Merkmale im Esterasemuster der verletzten Haut festgestellt werden. Die mit a, b und c bezeichneten Unterschiede im Esterasemuster sind für die frühen Wundreaktionen kennzeichnend. Das Merkmal a ist eine nur in vitalen Hautwunden nachweisbare Esterase-Fraktion, die innerhalb 5 min nach der Wundsetzung auftritt. Die Merkmale b und c erscheinen nach dem Merkmal a innerhalb 30 min nach der Verletzung. Der Nachweis von a, b, c in einer Wunde erlaubt eine Beurteilung der Überlebenszeit und ermöglicht außerdem eine Unterscheidung von vitalen und postmortalen Wunden. Die isoelektrische Fokussierung von Enzymen scheint leistungsfähiger zu sein als die bisher zur Kennzeichnung von Wundenzymen angewandten histoenzymatischen und elektrophoretischen Methoden.

     

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.

---

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.

     

The influence of orthoses on the proprioception of the ankle joint

The ankle joints of 14 healthy volunteers and 16 patients with unstable ankle joints were tested regarding their functional and proprioceptive capabilities. All of them were active athletes. Three tests were used of the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace/Mikros, stirrup-brace/ Aircast, taping) on the proprioceptivity of stable and unstable ankle joints was evaluated. The scores of the singleleg jumping course without any stabilizing device (category standard) ranged between 8.06 and 13.68 (10.65±1.29). In the categories Mikros (9.85±0.99), and Aircast (9.99±1.14) as well as with the tape bandage (10.27±0.81) better scores were achieved. The differences standard vs. Mikros and standard vs. Aircast revealed a significant reduction of the scores with orthoses (P<0.01). The error rate in the single-leg stance test was within the range of 0–16 (5.12±2.85) for the category standard. It was lower for the categories Mikros (3.65±2.65) and Aircast (4.17±2.59). The error rate was highest in the group with a tape bandage (5.79±3.53). The differences standard vs Mikros as well as standard vs. Aircast were significant (P<0.01). There was also a significant difference between these categories regarding injured and not injured ankle joints (P<0.01). The angle-reproduction-test showed higher values for the category standard (2.36°±0.97) in comparison to the categories Mikros (1.46°±0.72), Aircast (1.62°±0.91) and taping (1.84°±0.41). In the category standard the reproduction error was lower testing not injured ankle joints (2.30°±1.04) than testing the group of unstable ankle joints (2.44°±0.81), whereas in all other categories the reproduction error was higher in the group of not injured joints. The differences in all measurements between standard vs. Mikros and standard vs. Aircast were significant (P<0.01). The results of the three tests showed a highly significant difference between injured and not injured ankle joints (P<0.01).     

Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n=88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n=100, group 1), and controls with ESRD but no prior thrombectomy procedures (n=117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n=23), 10% (n=9) and 16% (n=14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p=0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n=49), 10% (n=12) and 4% (n=5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR=1.5), although this failed to reach statistical significance (p=0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension. Patients with ESRD are more likely to have pulmonary hypertension.     

Cerebral ultrasound images in prenatal cytomegalovirus infection

Summary A male newborn with prenatal cytomegalovirus infection was referred for cranial ultrasound. The cranial ultrasound demonstrated areas of increased echogenicity in the thalamic and gray nuclei resembling a branched candlestick. Doppler technique located the branched candlestick along the thalamostriate arteries. This image is particularly interesting because to our knowledge it has never before been described in congenital cytomegalovirus infection, but only in congenital rubella.     

Comparison of iodine-123 labelled 2β-carbomethoxy-3β-(4-iodophenyl)tropane and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane for imaging of the dopamine transporter in the living human brain

Several cocaine congeners are of potential for imaging the dopamine transporter (DAT). Previous studies have shown that iodine-123 labelled 2-carbomethoxy-3-(4-iodophenyl)tropane ([¹²³I]-CIT) is a promising radiotracer for imaging the serotonin (5-HT) and dopamine (DA) transporters in the living human brain with single-photon emission tomography (SPET). [¹²³I]-CIT was found to be not very practical for 1-day DAT imaging protocols since peak DAT uptake occurs later than 8 h. Here we report a pilot comparison of [¹²³I]-CIT and 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ([¹²³I]-CIT FP), using SPET imaging in four healthy male subjects. Peak uptake of [¹²³I]-CIT-FP into the basal ganglia occurred earlier (3–4 h after injection of tracer) than that of [¹²³I]-CIT (>8 h). However, the specific DAT binding of [¹²³I]-CIT-FP in the basal ganglia was somewhat less (0.813±0.047) than that of [¹²³I]-CIT (0.922±0.004). Imaging quality is excellent with both tracers and they are potentially of value for brain imaging in various neuropsychiatric disorders.     

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.     

The “dural tail” adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology

We examined 32 patients with intracranial tumors (17 meningiomas, 8 neuromas, 7 pituitary adenomas) by conventional and dynamic contrast-enhanced MRI. Our aim was to clarify whether the pathological dural contrast enhancement adjacent to meningiomas (the dural tail) is specific to meningiomas and, more important, whether it represents neoplastic dural infiltration or hypervascularization as a tumor accompanying reaction. A dural tail was found in 9 of 17 meningiomas. None of the other extra-axial tumours (neuromas, pituitary adenomas) showed comparable dural enhancement. Dynamic examinations with an ultrafast single slice imaging technique (snapshot-FLASH) after a bolus injection of contrast medium showed a dural tail in seven out of these nine meningiomas, while in two cases the dural tail turned out to be a cortical vein with a characteristic dynamic contrast enhancement pattern. In the dynamic study all seven dural tails were found to have earlier, steeper contrast enhancement than the corresponding tumours. All the tumours and part of the adjacent dura mater in four of the seven meningiomas with dural enhancement were examined histopathologically. In none of these four cases was neoplastic tissue found more than 2 mm away from the main tumour. The results strongly support the suggestion that the dural tail adjacent to meningiomas represents a hypervascular, non-neoplastic dural reaction.     

Dose reduction in subsecond multislice spiral CT examination of children by online tube current modulation

The potential of online tube current modulation in subsecond multislice spiral CT (MSCT) examinations of children to reduce the dose without a loss in image quality is investigated in a controlled patient study. The dose can be reduced for oval patient sectional view without an increase in noise if the tube current is reduced where the patient diameter and, consequently, attenuation are small. We investigated a product version of an online control for tube current in a SOMATOM Sensation 4 (Siemens, Forchheim). We evaluated image quality, noise and dose reduction for examinations with online tube current modulation in 30 MSCT of thorax/abdomen and abdomen and compared mA s for tube current modulation to the mA s in standard weight-adapted children protocols. Image quality was rated as very good, good, diagnostic and poor in a consensus by three radiologists. Noise was assessed in comparison to 24 MSCT examinations without tube current modulation measured as SD in ROIs. The dose was reduced from 26 to 43% (mean 36%), depending on the patients geometry and weight. In general, no loss of image quality was observed. Measured noise showed a decrease up to 26% and an increase up to 36%, although there was no decrease of image quality. Online tube current modulation is now used as a standard in MSCT at our institution. Dose in MSCT examinations of children can be reduced substantially in routine examinations by online tube current modulation without a loss of image quality.     

Evaluation of knee ligament injuries with the IKDC form

Various scoring systems have been proposed to quantify the disability caused by knee ligament injuries and to evaluate the results of treatment. None of these systems has found worldwide acceptance, mainly because all scoring systems attribute numerical values to factors that are not quantifiable, and then the arbitrary scores are added together for parameters not comparable with each other. For these reasons a group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee (1KDC). A common terminology and an evaluation form was created. This form is the standard form for all publications on results of treatment of knee ligament injuries. It is a concise one-page form. It includes a documentation section, a qualification section and a evaluation section. For evaluation there are four problem areas (subjective assessment, symptoms, range of motion and ligament examination). These are supplemented with four additional areas that are only documented but not included in the evaluation (compartmental findings, donor site pathology, X-ray findings and functional tests). The form can be used pre- and postoperatively and at follow-up. It has been specified that in any publication the minimum follow-up time for shortterm results should be 2 years, for medium-term results 5 years and for long-term results 10 years. The largest part of the sheet is the qualification section. It is called qualification section rather than scoring section because no scores are given. Each parameter is qualified as normal, nearly normal, abnormal or severely abnormal. This qualification is less subjective and emotional than very good, good, fair and poor. No knee and no knee function can be better than normal, and it is rather doubtful whether any knee, once operated on, can ever be normal again. For evaluation, the parameters of the four problem ares subjective assessment, symptoms, range of motion and ligament examination, are qualified for the group qualification. The worst qualification within the group gives the group qualification. The worst group qualification gives the final evaluation. If the knee is abnormal in any of the problem areas, it cannot be a normal knee. For chronic knee conditions there is also the possibility of evaluating the sum of levels of improvement or deterioration of all groups compared with the preoperative evaluation. The committee also recommends that terms describing knee ligament problems should be used according to the definitions of Noyes et al. [32]. The use of the IKDC evaluation form will reveal less favourable results than those evaluated with other current evaluation forms, because a still existing knee problem cannot be hidden with a high numerical score that is added up from other, unrelated parameters. It is to be hoped, however, that the use of this new form will enable us to compare treatment methods in various publications with each other.     

The “Pelvic digit” — An unusual developmental anomaly

Five cases of a rare developmental anomaly involving extraskeletal bone formation are described — four in the pelvis and one arising from the 12th rib. Three of these bony growths, called Pelvic digits had well developed joints or pseudoarticulations. The similarity of this anomaly to posttraumatic myositis ossificans and avulsion injuries of the pelvis (rectus femoris) is pointed out and a differential diagnosis offered.     

Neuroradiologic evaluation of the subdural pathogenesis in infants with small heads

Summary A marginal low density area is often revealed by CT scan in infants with microcephalia. However, it is difficult to assess precisely the main pathologic state of the marginal low density area and also whether such a lesion exists in the subdural-epiarachnoid space or in the subarachnoid space.A carotid antiographic evaluation of cortical vessels in the marginal avascular area was made and suggestive results were obtained.When there is acute subdural effusion or subdural hematoma, cortical arteries in the marginal avascular area will have a straightened and attenuated figure. But when such a pathologic state persists for a long period, it induces secondary cortical atrophy and the subarachnoid space becomes anlarged. The cortical artery appears as if it is flying in the enlarged subarachnoid space because it is detached from the gyrus and the sulcus following the cortical atrophy. This is why we named it the flying artery.Angiographic findings allow more precise interpretation of the marginal low density area in the CT scan.     

DNA extraction from mixtures of body fluid using mild preferential lysis

Summary A modification to the DNA extraction method preferential lysis (Gill et al. 1985) is proposed which can be applied to DNA mixtures of vaginal cells and spermatozoa. In mixtures with a low sperm content the further loss of sperm DNA caused by the extraction can be avoided by using mild preferential lysis. Amplification by PCR (polymerase chain reaction) then yields sufficient DNA to be able to identify both components in the mixture.