Intracapsular implant rupture: MR findings of incomplete shell collapse

The objective of this study was to determine the frequency and significance of the MR findings of incomplete shell collapse for detecting implant rupture in a series of surgically removed breast prostheses. MR images of 86 breast implants in 44 patients were studied retrospectively and correlated with surgical findings at explanation. MR findings included (a) complete shell collapse (linguine sign), 21 implants; (b) incomplete shell collapse (subcapsular line sign, teardrop sign, and keyhole sign), 33 implants; (c) radial folds, 31 implants; and (d) normal, 1 implant. The subcapsular line sign was seen in 26 implants, the teardrop sign was seen in 27 implants, and the keyhole sign was seen in 23 implants. At surgery, 48 implants were found to be ruptured and 38 were intact. The MR findings of ruptured implants showed signs of incomplete collapse in 52% (n = 25), linguine sign in 44% (n = 21), and radial folds in 4% (n = 2). The linguine sign perfectly predicted implant rupture, but sensitivity was low. Findings of incomplete shell collapse improved sensitivity and negative predictive values, and the subcapsular line sign produced a significant incremental increase in predictive ability. MRI signs of incomplete shell collapse were more common than the linguine sign in ruptured implants and are significant contributors to the high sensitivity and negative predictive values of MRI for evaluating implant integrity.     

Problem der Mehrlingsschwangerschaft nach assistierter Reproduktion

In western countries, techniques of assisted reproduction are responsible for the considerable increase in the rate of multiple pregnancies and deliveries in the last two decades. These pregnancies and deliveries are associated with high risks for babies, pregnant women and mothers. Obstetricians and neonatologists are often faced with the problem of extremely premature delivery and growth retardation in such cases. Limiting the number of preembryos for transfer would obviously seem to be the most important strategy for minimizing the multiple pregnancy rate. The specific situation in this area in Europe, especially in Germany, is shown. Experience so far with elective single embryo transfer is described.     

Universitätskinderklinik an der Berliner Charité

This paper is concerned with the history of the University Children’s Hospital at the Berlin Charité. It was founded at the beginning of 1830. The individual directors—Eduard Wolff (1830), Stephan Friedrich Barez (1830–1847), Erbkamm (temporary supervisor, 1847–1849), Hermann Friedrich Ludwig Ebert (1849–1872), Eduard Heinrich Henoch (1872–1893), Otto Heubner (1894–1913), Adalbert Czerny (1913–1932), Georg Bessau (1932–1944), Hans Kleinschmidt (1944–1945), Otto Cammann (1945), Wilhelm Stoeltzner (1945–1947), Karl Klinke (1947–1951), Herbert Brugschs (temporary supervisor, 1951–1952), Friedrich Hartmut Dost (1952–1959), Ferdinand Max Gerhard Otto (temporary supervisor, 1959–1960), Josef Dieckhoff (1960–1972), Peter Großmann (1972–1991)—and their particular emphases in the sectors of teaching and research are presented. Particular attention is paid to the difficult times the hospital went through during the Third Reich and during and after the war. These also impacted heavily on the hospital buildings. In this respect a great deal has changed since the initial makeshift accommodation in one wing of the “Old Charité”, culminating in the present quarters in the Charité’s Virchow Clinic. Since the upturn other far-reaching restructuring measures have been implemented, and the prospect of the new generation of directors in 2010 also leads us to expect innovations in the future.     

Frühdefibrillation in Deutschland

Zusammenfassung Die erfolgreiche Anwendung der automatisierten externen Defibrillation in den USA war der Anlass für eine 1989 veröffentliche Pilotstudie in Berlin. Diese führte zur systematischen Einführung der Frühdefibrillation in Berlin und zu vergleichbaren Konzepten in verschiedenen deutschen Städten. Verschiedene erfolgreiche Studien und die technische Weiterentwicklung von leichteren und preiswerteren Geräten führte zur Ausweitung der Konzepte im Sinne einer Defibrillation durch First Responder oder der Public Access Defibrillation. Doch weiterhin bestehen viele ungelöste Probleme: die Frage nach der effektivsten Schockform und der notwendigen Energiemenge ist ebenso ungelöst wie die Frage der Ausbildungsintensität für die Frühdefibrillation außerhalb des Rettungsdienstes. Diese Fragen sollen in z. T. schon laufenden Studien weiter untersucht werden.     

Indikationen zur Therapie von Stenosen der A. carotis

The annual stroke risk for patients with asymptomatic stenoses of the carotid artery is around 1% in case of <70% stenosis (NASCET criteria) and 2-5% in patients with >70% stenosis. The risk of recurrent ischemic events for patients with symptomatic stenoses is much higher, around 15% during the first year. For more than 10 years, the efficacy of carotid surgery has been proven, and there is growing evidence to support surgery in case of asymptomatic stenosis. Patients with severe stenoses, male or elderly patients, and those with bilateral stenoses benefit more from surgery. Carotid artery stenting has not proven its safety or efficacy. Despite this lack of evidence, the method is used in many centers as an alternative to surgery. Especially symptomatic carotid artery stenosis should be used mainly in the setting of a randomized trial such as SPACE.