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.     

Ausgeprägte intramuskuläre Hämorrhagien vitaler Genese bei letaler suizidaler Strombeibringung

Der Obduktionsbefund intramuskul?rer H?morrhagien ist bei verschiedenen Todesursachen zu erheben. In prim?r unklaren oder zweifelhaften F?llen kann die histologische Untersuchung der betroffenen Skelettmuskulatur Hinweise auf den Entstehungszeitpunkt (antemortal versus postmortal), in einigen F?llen auch auf die Entstehungsart der Muskelblutungen geben. Wir berichten über den Fall eines psychiatrisch erkrankten Elektroingenieurs, welcher sich mittels einer selbst gefertigten Strom führenden Apparatur suizidierte. Autoptisch fanden sich ausgepr?gte intramuskul?re H?morrhagien in den im Stromweg gelegenen Muskelgruppen, deren Entstehungszeitpunkt durch die makromorphologische Befunderhebung allein nicht sicher zu kl?ren war. Die histologische Untersuchung der mit PTAH gef?rbten Skelettmuskulatur zeigte Hyperkontraktionsbanden, einen segmentalen und diskoiden Zerfall der Muskelfasern sowie eine pathologische L?ngsstreifung. Dieses vitale Sch?digungsmuster l?sst den Rückschluss auf eine antemortale Entstehung im Rahmen strominduzierter tetanischer Muskelkontraktionen zu. Zudem lie?en sich histologisch weitere stromassoziierte Organver?nderungen an Haut und Herzmuskulatur nachweisen.      

Facettenblockade, peridurale und periradikuläre Schmerztherapie

More than 80% of vertebrogenic lumbar pain is unspecific and can only be attributed to a specific anatomic structure with difficulty. The pain can emanate from the intervertebral discs, intervertebral and sacroiliac (SI) joints, musculature, and ligaments. In a maximum of 7% of cases, the pain is radicular (4% due to intervertebral discs and 3% caused by stenoses). In 7-15% of cases, the pain's origin is located in the region of the vertebral joints and in up to 15% in the region of the SI joint. Although the overwhelming majority of pain has no clear structural cause, infiltrations of medications and nerve blockades are frequently employed. The efficacy of these procedures has however not been verified in controlled studies with the exception of epidural injection of corticosteroids for radicular pain. Epidural and epiradicular application of corticosteroids appear to be effective for radicular pain, at least on a short-term basis, although controlled studies have yielded controversial results. The difficulty lies partly in the exact placement at the affected root for applying the medication. This is hardly possible with a caudal injection, while with a lumbar peridural injection and periradicular injections it is only possible under X-ray control or even better CT guidance.     

Hämoglobine und andere Hämoproteine

Ohne ZusammenfassungVortrag gelegentlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in München 1952.     

Interdisziplinäre Gesichtsrekonstruktion einer Moorleiche

In 2000 a severely fragmented bog body was uncovered in the “Großes Uchter Moor” (District of Nienburg, Lower Saxony). An interdisciplinary team of forensic scientists, anthropologists, palaeopathologists and archaeologists initiated the reconstruction of the skull and face of this female bog body, named “Moora”. With a newly developed computerized animation based on computed tomographic (CT) findings of individual bones and fragments, the skull was reconstructed digitally and subsequently by using the rapid-prototyping technique.On the basis of this skull model five scientists formed different faces of the bog body using different facial reconstruction techniques. The results are presented two dimensionally.     

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".     

Vaskuläre Rekanalisationstechniken: Nierenarterienstenosen

Decisive for the evaluation for radiological interventional therapy of renal artery stenosis, are the morphologic diagnostic by Duplex sonography, non-invasive cross-sectional angiography and digital subtraction angiography in addition to the anamnesis and clinical constellation. A standardized diagnostic algorithm and an evidence-based indication status contribute just as importantly to improvement of outcome as the implementation of uniform peri-interventional measures and a structured procedure for angiography, percutaneous transluminal renoangioplasty and follow-up. The aim of this article is to provide a practical introduction for the current radiological management of renal artery stenosis.     

Intramuskuläre Applikation von Depotmedikamenten

Drug-loaded microparticles (microspheres) based on poly(lactic-co-glycolic) acid (PLGA) are used for long-term drug release mainly after intramuscular injection. The particles are rarely seen in histological sections from autopsy specimens. The case of a 65-year-old woman who died following a generalized infection and erysipelas is presented where the origin of histologically detected microparticles could only be identified with great difficulty.     

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.     

Primäre Strahlentherapie des Larynxkarzinoms

Purpose

In the treatment of laryngeal carcinoma definitive radiotherapy results in a similar outcome as surgical treatment in the early stages with a lower morbidity rate and good functional results. In fact no randomized studies exist, so far, and the optimal treatment concept for the different stages is not well defined. The following study analyses retrospectively the treatment results and the recurrence data in patients with a squamous cell carcinoma of the larynx treated with definitive radiotherapy.

Patients and Method

Two hundreds and eighty-three patients with carcinoma of the larynx were treated with radiation therapy in the department of radiology of the LMU München between September 1971 and June 1986. Twenty-six patients (9.2%) were female and 257 (73.1%) male. The median age was 68.5 years, respectively 70 years. All patients had a histologically confirmed squamous cell carcinoma of the larynx. No true subglottic cases were observed. Forty-one (14.5%) tumors were localized supraglottically, 207 (73.1%) glottically. Thirty-five patients had a T4 tumor with glottic and supraglottic involvement. In 147 patients the histopathological grading was evaluable: 32 tumors were classified as G1, 95 as G2, 15 as G3 and 5 as G4. According to the UICC classification of 1979 25 patients had a carcinoma in situ (Tis), 93 patients had a stage T1, 90 stage T2, 40 stage T3 and 35 stage T4. Two hundreds and thirty-three of 283 (82.3%) had no lymph node involvement. In 50 patients clinically a lymph node involvement was observed. 22 patients had a stage N1, 5 patients stage N2 and 23 patients stage N3. An external beam radiation mostly with cobalt-60 was performed with a mean dose of 61.9 Gy.

Results

The 5-years relapse free survival for the whole group was 61.7%. The probability for “no evidence of disease” (NED) depended on tumor stage and-localisation (glottic tumors: Tis/T1 90.5%; T2 59.4%; T3 39.6%; [5-year NED]; supraglottic tumors: T1 64.2%; T2/3 28.6%; T4/N3 24.7% [3-year NED]). Other signifikant prognostic factors besides T-stage were N-stage (N0 vs. N1–3: 3-year recurrence-free survival 68% vs. 37.2%, p<0.001) and histopathologic grading (G1 vs. G3/4: 3-year recurrence-free survival 74% vs. 37.1%, p<0.01). One hundred and twenty-two (43.1%) patients had a recurrence, which occurred in 75.4% local, in 12.3% locoregional, in 8.2% with distant metastases and 4.1% combined. In 50 patients with a recurrent disease a salvage-therapy was carried out. Thereby 17 patients achieved a complete response.

Conclusion

Even for the here described negatively selected patient group with a high median age and multimorbidity, good local controlrates could be achieved escpecially in early stages with definitive radiation therapy. In more advanced stages even in elderly patients a combined surgical-radiotherapeutic treatment should be performed.     

Zelluläre Mechanismen der Tumorresponse

Diseases caused by cancer have become more common due to an increase in life-expectation, but the probability of reaching an old age with or without a tumor disease is still increasing. According to the statistics of the German Cancer register, at present more than half of cancer patients survive for at least 5 years after cancer has been diagnosed. Many tumors can be cured using innovative neoadjuvant and adjuvant therapy regimes, but the options for palliative therapy have also been improved. This leads to an increasing importance of the evaluation of the tumor response using imaging techniques. Classically, tumor response is measured by imaging using the RECIST (response evaluation criteria in solid tumors) criteria, which define the changes in size of the tumor during therapy. However, there is increasingly more evidence that RECIST as the only measure of tumor response, does not document tumor response for all tumor entities and especially not for many medications known as targeted therapy. This article gives a review of the principles and mode of effect of various therapy regimes as well as the clinical demands on imaging techniques.     

Hypophysäre Erscheinungen und ihre gerichtsärztliche Bedeutung

Ohne Zusammenfassung     

Ewing-Sarkom,fibrogene Tumoren,Riesenzelltumor, Hämangiom des Skeletts

Radiological imaging only reflects the anatomy and its pathological abnormalities. Therefore, the radiologist should be able to recognize the basic features of the pathological anatomy of bone tumors. This can only be learned working closely with a pathologist who is experienced in this field. On the other hand, the pathologist needs from the radiologist their diagnostic assessment with information on size, location, aggressiveness and the existence of a bone tumor’s matrix, of the whole lesion, because he usually only receives a small part for examination in the form of a biopsy. In this article, the features and fundamentals (standards) of radiological–pathological cooperation as the mainstay for a precise diagnosis in bone tumors are outlined. The radiological appearance and the histopathological features behind it are presented for Ewing’s sarcoma, fibrogenic tumors, giant cell tumor, and hemangioma of the bone.     

Über eine primäre Cliradonsucht

Ohne ZusammenfassungVortrag gelegentlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in München 1952.     

Solide pseudopapilläre Tumoren des Pankreas

Solid pseudopapillary tumors of the pancreas (SPTP) are rare tumors of the pancreas with low malignancy potential and a very good prognostic outcome after surgery. They typically occur in young women or adolescents and consist of solid, cystic and cystic-hemorrhagic components.Imaging findings in these tumors are characteristic and include a fibrotic capsule with a clear delineation and exhibit solid and cystic-hemorrhagic signal and density characteristics. Calcifications may be present in the periphery of the tumor. The tumor capsule shows contrast enhancement, the solid components in the periphery enhance in the early phase and gradually and inhomogeneously in late phases. MRI is superior to CT and other imaging modalities for characterization of SPTP. Awareness and knowledge of this tumor entity with an excellent prognosis is crucial to guide the patient towards effective, predominantly organ-sparing surgical treatment.