Belastungsabhängige Segmentstabilität im Funktions-MRT bei Nachwuchsathleten mit Spondylolisthesis mit und ohne Rückenschmerzen

BackgroundSegmental spinal instability is assumed to be a source of low back pain in adolescent athletes (AA). It is unclear, if imaging techniques allow for differentiation of load-dependent segment stability in AA with spondylolisthesis in dependence of pain.Material and MethodsTwenty-two AA (14.1±1.6 years, 164±9 cm, 59±13 kg) with spondylolisthesis L5/S1 were included. Following an orthopedic examination with history of pain (in everyday life [PE]; during sports [PS]) functional MRI was performed (1. Upright-loaded; 2. Supine-unloaded). Anterior translation [mm], lordosis angle [°] and „lumbar disc degeneration-Index (LDDG [1–5]) were determined within MRI. Absolute values and differences (loaded - unloaded condition) are shown by the factor pain (α=0.05).ResultsEight AA reported PE, 10 PS and 10 AA were pain-free (PF). Lordosis angle and anterior translation were higher during loaded condition (60±10° to 46±11; 7.2±2.0mm° to 5.8±1.9 mm). AA with pain showed loaded/unloaded smaller differences of lordosis angles (PE/NP: 13.8±6.3°/14.9±4.6; PS/PF: 13.3±5.1/15.1±5.1; p>0.05) and higher differences of anterior translation (PE: 1.7±1.3 mm/1.2±1.3; PS: 2.2±1.3/0.7±0.8; p=0.002) compared to PF. LDDG was higher for AA with PS than in PF (PS/PF: Median 2 (1.25;3)/ 3.5 (2;4)).ConclusionsAA with spondylolisthesis and PS show lower lordosis and higher segmental anterior translation as well as disc degeneration. Low back pain during sports in AA with spondylolisthesis might be seen as a predictor for higher segmental spinal instability.Level of evidence2 (Cohort study)     

Prävalenz und klinische Bedeutung computertomographisch gesicherter idiopathischer Stammganglienverkalkungen

With increasing CT examinations of the cerebrum, the discovery of basal ganglia calcification becomes more frequent. In order to correlate these calcifications to the symptoms believed to be accompanied with Fahr's disease 2318 cranial CT scans were examined. There was an overall incidence of basal ganglia calcification of 12.5%. The most frequent location was the globus pallidus (96.4%). In the examined population there was no correlation found between the calcifications and symptoms having been described with striopallidentate calcifications.     

Vergleichende Untersuchungen über zeitabhängige Veränderungen im Eiweißspektrum von Vital- und Leichenblut mit der Celluloseacetatfolien-(CAF)-Elektrophorese

Zusammenfassung In systematischen Untersuchungen wird gezeigt, daß es mit zunehmender Hämolyse im Vital- und Leichenblut in der Elektrophorese auf Celluloseacetatfolien (CAF) zu einem Extragradienten im ₂-Globulinbereich kommt, der die relativen Verhältnisse im Elektropherogramm beeinflußt. Bei starker Hämolyse tritt eine Verschmelzung der ₂- und -Globulinbanden auf. Um eine diagnostische Beurteilung am Leichenblut mit der Elektrophorese durchzuführen, muß deshalb in erster Linie der Hämolysegrad berücksichtigt werden. Die durch Hämolyse bestimmten Veränderungen im elektrophoretischen Muster sind mit der Liegezeit am ehesten korreliert, wobei jedoch der Aussagewert bezüglich forensischer Zeitstellungen gering ist.     

Degenerative und altersbedingte Veränderungen an der Wirbelsäule

Degenerative alterations of the spine occur in an individual-specific manner with increasing age. This is not only dependent on external factors, such as hard physical labor over many years but can also be genetically influenced as demonstrated in recent studies. The spinal cord is well-protected within the spinal canal but can be impaired by degenerative alterations of the intervertebral discs and functional spinal segments. Depositions or narrowing of nerve structures can cause lasting pain or focal neurological deficits, such as paralysis or sensitivity disorders. These complaints can slowly develop over years, e.g. by a gradually increasing bony narrowing of the spinal canal (spinal canal stenosis) or can occur suddenly, e.g. an acute herniated disc. However, low back pain is much more common and occurs in approximately 80?% of people sometime during their lifetime. It is necessary to recognize the normal age-related anatomical alterations in magnetic resonance imaging (MRI), particularly for intervertebral discs in order to interpret these correctly. Knowledge of the spectrum of the various age-related degenerative processes which can occur in intervertebral discs and vertebral bodies is necessary to be able to differentiate them from pathological alterations. This is important because therapy decisions are often made as a direct result of MRI.     

Veränderungen in den Haarwurzeln faulender und exhumierter Leichen

Ohne Zusammenfassung     

Sonographie synovialer und erosiver entzündlicher Veränderungen

High-frequency sonography enables excellent detection of early erosions and synovial proliferations. Power Doppler sonography (PDUS) allows for an improved characterization of articular and peritendinous augmented volume, because detection of hypervascularity correlates with inflammatory activity and further is helpful in differentiation from effusion and inactive pannus. The use of contrast media improves the sensitivity of vascularity detection, because they allow for a delineation of vessels at the microvascular level. This is of increased interest, as the development of new therapeutic options targeting the microvascular level calls for earlier diagnosis and optimal assessment of disease activity. Because of good availability, cost effectiveness, and patient acceptance, sonography facilitates early diagnosis of synovial proliferations and erosions as well as therapy follow-up.     

Benigne und maligne Veränderungen der Innenohr- und Kleinhirnbrückenwinkelregion

Tumorous lesions in the region of the inner ear and cerebellopontine angle are very rare and can be classified into benign and malignant disease forms. This contribution presents and explains the CT and MRI characteristics of these tumors.High-resolution computed tomography (HRCT) in the axial projection is applied for evaluation in the high-resolution bone window. The coronary slices can be reconstructed from the axial datasets or in individual cases examined in the coronary plane.HRCT excellently demonstrates osseous lesions and in individual cases - e.g., exostoses - it can simply suffice to perform HRCT of the temporal bone, while HRCT is also excellent for detecting osseous lesions to determine whether the tumor is benign or malignant.MRI, on the other hand, excellently shows the extent of tumor spread because of its superb soft tissue contrast. Consequently, HRCT and MRI images of the inner ear and cerebellopontine angle provide meaningful information for visualization and classification of tumorous lesions. The two methods should not be considered as competing but rather as complementary and among other aspects exert considerable influence on the therapeutic approach.     

Kongenitale und benigne Veränderungen mit Bezug zum Pharynx

DEVELOPMENT: The first part of this article is supposed to present a brief overview on the development of tissues and structures related to the pharynx, as far as they provide a better understanding of the most congenital lesions in this area of the body. BENIGN LESIONS: The second part of this article focuses on benign lesions originating in the pharynx or in neighbouring structures. Functional pharynx abnormalities are beyond the scope of this paper.     

Zur Tragzeit von Prädiabetikerinnen und Diabetikerinnen

Ohne Zusammenfassung     

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.     

Bilaterales Mammakarzinom und Lokalrezidiv: Prävalenz von BRCA-1- und BRCA-2-Genmutationen an einem unselektionierten Kollektiv

BACKGROUND: Mutations of the BRCA 1/BRCA 2 genes strongly predispose towards the development of contralateral breast cancer. We therefore investigated a hospital-based series of patients with bilateral breast cancer and a comparison group of patients with unilateral breast cancer, pairwise matched by age and family history, for mutations of the BRCA 1/BRCA 2 genes. PATIENTS AND METHODS: Between 1995 and 2000 genomic DNA from blood samples of 75 patients with bilateral breast cancer, who received postoperative radiotherapy, was analyzed for mutations of all coding regions and flanking intron sequences of the BRCA 1/BRCA 2 genes by single strand conformation polymorphism analysis (SSCP) and sequencing of aberrant findings. The results were compared to 75 unilateral breast cancer patients who were screened for common mutations in the BRCA 1 and BRCA 2 genes. Treatment results of patients with bilateral disease were analyzed with regard to a possible carriership of a BRCA 1/BRCA 2 gene mutation. RESULTS: Five distinct frameshift deletions (one in BRCA 1, four in BRCA 2) were identified in six patients with bilateral breast cancer. Three of six carriers developed local relapse, whereas this was the case in only nine of 69 non-carriers. After radiotherapy local relapse occurred in five patients (five of 126 irradiated breasts or chest walls). Three of these patients (60%) were carriers of a pathogenic BRCA 1/BRCA 2 mutation. In the comparison group of patients with unilateral breast cancer three pathogenic BRCA 1 mutations were identified. CONCLUSIONS: We failed to confirm an increased prevalence of BRCA 1/BRCA 2 mutations in our hospital-based series of patients with bilateral breast cancer. However, local relapse, especially when occurring after radiotherapy, may be predictive for an underlying pathogenic BRCA 1 and BRCA 2 gene mutation in patients with bilateral breast cancer.     

Asbestverursachte Veränderungen am Thorax

Asbestos fibers can lead to pulmonary fibrosis, thickening of the pleura and malignancies. These pathologic changes are possible rather than determinate and depend on the type of asbestos fiber, length of exposure to fibers and individual factors. In Germany asbestos fibers were widely used until 1993. Worldwide, there is currently no general ban on the use of asbestos. The leading cause of asbestos-related diseases is occupational exposure. Due to a long latency period the appearance of such diseases may be delayed for more than 40 years so that the final number of cases has not yet been reached. Occupationally-derived asbestos-related diseases of the thorax are asbestosis, asbestos-related benign pleurisy and malignant pleural mesothelioma. Bronchial carcinoma can also be caused by asbestos exposure. For proof of occupational exposure, radiologists are required to report the presence of characteristic findings. The detection, in particular by chest X-ray and high resolution computed tomography (HRCT), requires high quality images and standardized evaluation. The standardized ILO classification and the semi-quantitative HRCT coding are medical findings on which statutory registration criteria are based.