Primäre ziliare Dyskinesie

Primary ciliary dyskinesia (PCD) is an autosomal recessive disease characterized by abnormal ciliary motion and impaired mucociliary clearance. The prevalence of PCD is approximately 1:20,000 live births. Since cilia are common in many organs of the body, there is a wide variety of clinical manifestations in patients with PCD. Due to an extensive genetic heterogeneity the course of the disease varies largely, but with increasing age, the clinical symptoms are dominated by repeated respiratory infections and ultimately respiratory insufficiency. In the presence of situs inversus, which is observed in 50% of affected individuals, the diagnosis is easy, In cases of doubt, analyses of the kinetics and infrastructure of the cilia are necessary. The treatment of PCD is symptomatic. With optimal medical and physiotherapeutic management, the prognosis quoad vitam is good and life expectancy is nearly normal.     

The traumatic dural sinus injury — a clinical study

Summary In a period of 13 years 978 cases of severe head injuries were operated on in our clinic. An analysis of the medical reports includes injuries of the superficial dural sinus (39 cases=4%): among these injuries of the anterior and central part of the superior sagittal sinus (66 per cent), injuries of the transverse sinus (18 per cent), injuries of the posterior part of the superior sagittal sinus (8 per cent), and combined injuries of different dural sinuses (8 per cent).Clinical data, i.e. the causes of accident, radiological examination results, intracranial lesions, operation technqiues and outcome are analysed and discussed. The analysis of cases with dural sinus injuries shows a high mortality rate (total mortality rate: 16 patients=41%; intra-operative mortality rate: 8 patients=20%).     

Fingerfrakturen

Fractures of the phalanges and the metacarpus are among the most common injuries of the upper extremity, accounting for approximately 10% of all fractures. They are not uncommonly dismissed as trivial trauma, so that the primary treatment is often inadequate. One fourth of all stiff fingers are attributable to a fracture, and in 50% of the cases, the fractures are the result of work-related accidents. This article aims to give an overview of the different types of fracture and their current treatment options (nonsurgical/surgical); special attention is also given to the specific features of phalangeal fracture treatment.     

Eight-channel transmit/receive body MRI coil at 3T.

Multichannel transmit magnetic resonance imaging (MR) systems have the potential to compensate for signal-intensity variations occurring at higher field strengths due to wave propagation effects in tissue. Methods such as RF shimming and local excitation in combination with parallel transmission can be applied to compensate for these effects. Moreover, parallel transmission can be applied to ease the excitation of arbitrarily shaped magnetization patterns. The implementation of these methods adds new requirements in terms of MRI hardware. This article describes the design of a decoupled eight-element transmit/receive body coil for 3T. The setup of the coil is explained, starting with standard single-channel resonators. Special focus is placed on the decoupling of the elements to obtain independent RF resonators. After a brief discussion of the underlying theory, the properties and limitations of the coil are outlined. Finally, the functionality and capabilities of the coil are demonstrated using RF measurements as well as MRI sequences.     

Aktuelles medizinrechtliches Schrifttum, Richtlinien und Empfehlungen

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National survey on the management of primary hyperparathyroidism by Swiss endocrinologists

Background From the endocrine surgeon’s perspective, it is important to know how endocrinologists manage patients with primary hyperparathyroidism (pHPT). The aim of this survey was to evaluate the preoperative diagnostic workup and referral pattern for parathyroidectomy by Swiss endocrinologists. Materials and methods The survey was conducted by mailing a questionnaire to all members of the Swiss Society for Endocrinology and Diabetes in spring 2005. Results The questionnaire was sent back by 68 of 124 endocrinologists (55%). The median annual case volume of patients with pHPT was 6 (range 1–50). The mean fraction of these patients referred for surgery was 59 ± 24%. This fraction was significantly higher in the German-speaking part of Switzerland than in the French-speaking part (67 ± 21% vs 51 ± 27%). When considering surgery for asymptomatic pHPT, 62% of the endocrinologists rely routinely on the recommendations of the NIH consensus conference and 86% on the subsequent guidelines of the workshop in 2002. Sixty-seven percent of the endocrinologists routinely perform localization studies before possible referral for surgical exploration. Typically, they consisted of an ultrasonography of the neck (93%) and a ^99mTc-MIBI scintigraphy (80%). The impact of the availability of a minimally invasive surgical procedure on the number of patients referred for surgery seems to be considerable. Sixty-one percent of the participants would expand the indication for surgery if the operation could be done by a limited surgical approach. Conclusions In a relevant fraction of patients with pHPT, endocrinologists still do not regard curative therapy as mandatory. Surprisingly, there are significant cultural differences concerning referral patterns to surgery between the German-speaking and the French-speaking parts of Switzerland. Minimally invasive procedures seem to lower the threshold for referral for surgical therapy. This work was presented at the 2nd Biennial Congress of the ESES, May 2006, Krakow, Poland.     

Rechtsprechung aktuell

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