Radiologische Diagnostik und Intervention bei malignen Gallenwegstumoren

This article gives a review of the current value of radiological diagnostics and interventions for malignant stenoses of the bile pathways. Malignant stenoses are mostly caused by cholangiocellular carcinoma, Klatskin’s tumor, gall bladder carcinoma or pancreatic carcinoma. Percutaneous biliary drainage and stent positioning generally for generally incurable patients (curative approach only possible in 10–20%) is an uncomplicated procedure for an experienced surgical radiologist and is technically very successful with a success rate of 95–100% (for puncture, recanalization and stent positioning). This approach is indicated when a transpapillary endoscopic access is not possible, as for example following previous operative interventions or very hard hilar obstructions. Nowadays the morbidity and mortality are comparable to endoscopy due to the technical improvements in percutaneous interventions.     

Effects of cross-sex hormones on cerebral activation during language and mental rotation: An fMRI study in transsexuals.

Androgens and estrogens affect the performance on certain cognitive tests, particularly those measuring verbal fluency and mental rotation. Their effects on cognition have frequently been attributed to changes in cerebral lateralization. This study tested the impact of a reversal of the sex steroid milieu on cerebral activation and lateralization during verbal and spatial tasks in transsexuals. fMRI scans were obtained from 6 female-to-male and 8 male-to-female transsexuals at baseline and after cross-sex steroid treatment. Activation was measured during language and mental rotation tasks. Language activation increased after sex steroid treatment in both groups (F(1,12) =3.7, p=0.08), and total language activity was correlated to post-treatment estradiol levels (rho=0.54, p=0.05). Lateralization was not affected by the reversal of sex steroid milieus (F(1,12)=1.47, p=0.25). Activation during mental rotation did not increase during treatment (F(1,12)=0.54, p=0.34), but post-treatment testosterone levels correlated to total activation during mental rotation (rho=0.64, p=0.01). Findings suggest that sex steroids may influence cerebral activation, but lateralization remains stable.     

European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of paraproteinaemic demyelinating neuropathies: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society*

Background. Paraprotein‐associated neuropathies have heterogeneous clinical, neurophysiological, neuropathological and haematological features. Objectives. To prepare evidence‐based and consensus guidelines on the clinical management of patients with both a demyelinating neuropathy and a paraprotein (paraproteinaemic demyelinating neuropathy, PDN). Methods. Search of MEDLINE and the Cochrane library, review of evidence and consensus agreement of an expert panel. Recommendations. In the absence of adequate data, evidence based recommendations were not possible but the panel agreed the following good practice points: (1) Patients with PDN should be investigated for a malignant plasma cell dyscrasia. (2) The paraprotein is more likely to be causing the neuropathy if the paraprotein is immunoglobulin (Ig)M, antibodies are present in serum or on biopsy, or the clinical phenotype is chronic distal sensory neuropathy. (3) Patients with IgM PDN usually have predominantly distal and sensory impairment, with prolonged distal motor latencies, and often anti‐myelin associated glycoprotein antibodies. (4) IgM PDN sometimes responds to immune therapies. Their potential benefit should be balanced against their possible side‐effects and the usually slow disease progression. (5) IgG and IgA PDN may be indistinguishable from chronic inflammatory demyelinating polyradiculoneuropathy, clinically, electrophysiologically, and in response to treatment. (6) For POEMS syndrome, local irradiation or resection of an isolated plasmacytoma, or melphalan with or without corticosteroids, should be considered, with haemato‐oncology advice.     

Placental permeability for morphine-3-beta-D-glucuronide in the guinea pig

The fetal Vd and the PS of the major metabolite of morphine, M3G, were studied in pregnant guinea pigs during the last half of gestation. Fetal Vd was determined to be 0.334 ml/g of fetal plus placental weight and did not vary as the gestation progressed. The mean +/- s.e. PS for M3G was 3.7 +/- 0.3 X 10(-5) ml/sec/g and was independent of anaesthesia. This value was consistent with previous studies of other hydrophilic compounds, indicating that diffusion governs the placental passage of M3G. The PS value increased with increasing fetal weight which was consistent with structural changes in the guinea pig placenta as fetal age progresses in late gestation.     

Phylloid Pigmentary Pattern with Mosaic Trisomy 13

Abstract: In most patients with hypomelanosis of Ito, the hypopigmentation is characterized by narrow bands following the lines of Blaschko. We report a 13-year-old severely retarded girl with leaf-shaped patches of hypopigmentation on the back together with short stature, scoliosis, facial dysmorphism, and asymmetrical leg length. The cytogenetic examination of both lymphocytes and fibroblasts demonstrated a mosaicism of 46,XX/47,XX,+13. This result was confirmed by in situ hybridization using a chromosome 13-specific library in interphase cells. The pigmentary disturbance of our patient was similar to the phylloid pattern (type 3) of the classification of pigmentary patterns postulated by Happle. This type has been described in four patients so far, along with additional anomalies and a chromosomal mosaisicm in two patients.     

Spiral-CT-Angiographie von Stenosen der A. cerebri media

Zusammenfassung Die nichtinvasive Diagnostik von Stenosen der A. cerebri media (ACM) erfolgt mittels transkraniellem Doppler (TCD) und Magnetresonanzangiographie (MRA). Da die kurze Untersuchungszeit der Spiral-CT-Angiographie (CTA) ein schnelles Notfallmanagement von Patienten mit akuter Verschlu?symptomatik erlaubt, wurde die Nachweisbarkeit von Lumeneinengungen der ACM an 23 in MRA und TCD gesicherten Stenosen untersucht. Für die CTA wurde eine bolusgetriggerte Injektion von 70 ml KM mit 40 ml NaCl-Bolus, eine Detektorbreite von 1 mm, ein pitch von 1,5 und ein Rekonstruktionsintervall von 1 mm eingesetzt. Die Darstellung des Angiogramms erfolgte als MIP und als MPVR. Gegenüber MRA und TCD wurden durch die CTA 14 Stenosen gleich und 9 Stenosen niedriger klassifiziert. Eine übersch?tzung des Stenosegrades durch die CTA kam nicht vor. Bei gleichwertiger Stenoseklassifikation zeigte die MPVR gegenüber der MIP eine bessere Abbildungsqualit?t. Die Ergebnisse sprechen dafür, da? mit der CTA mittel- und hochgradige Stenosen der ACM sicher und schnell erfa?t werden k?nnen. Eingegangen am 2. Juli 1996 Angenommen am 4. Juli 1996     

Color Doppler sonography of focal gastrointestinal lesions: initial clinical experience.

Graded compression color Doppler sonography was used to evaluate gastrointestinal blood flow in 20 normal fasting subjects and 32 patients with focal gastrointestinal lesions. Imaging was optimized for color sensitivity using a 5 MHz linear array transducer. Criteria were established for normal mural blood flow based on findings in normal controls. Two reviewers blinded to the final diagnosis compared patterns of mural vascularity in normal and abnormal patients. Increased mural blood flow was demonstrated in all 32 patients with gastrointestinal inflammatory disorders and in seven of nine patients with neoplasms. No mural flow was demonstrated in four patients with small bowel infarction. The greatest overall degree of flow was noted in patients with Crohn's disease and cytomegalovirus colitis. Flow in tumors was variable, ranging from strikingly increased flow in a giant villoglandular polyp to absent flow in a metastasis from lung carcinoma. Our preliminary experience suggests that the presence of considerable overlap in the color Doppler patterns of mural blood flow in inflammatory and neoplastic lesions. Color Doppler sonography alone without spectral waveform analysis may not distinguish focal inflammatory from neoplastic disorders of the gastrointestinal tract reliably. However, this technique potentially may be useful in diagnosing small bowel ischemia when thickened segments of small bowel are identified with absent flow.