Psychosen im Rahmen der Grippeepidemie 1957/58

Zusammenfassung Es werden Beobachtungen an 13 Fällen von Grippepsychosen, die während der Grippeepidemie in Tirol in den Monaten Oktober bis November 1957 auftraten, beschrieben. Auf Grund der dabei erhaltenen Ergebnisse wird angenommen, daß im Gegensatz zu vielen früheren Publikationen die Grippe nicht nur Psychosen vom akuten exogenen Reaktionstyp verursachen kann, sondern auch echte Psychosen schizophrener Art auszulösen vermag. Die Auslösung endogener Depressionen trat ebenfalls im Gegensatz zu früheren Beobachtungen bei weitem zurück. Die Erfahrungen von gesonderten Bildern und Verlaufsformen postgrippöser und grippöser Art konnten bestätigt werden. Bei beiden Formen überwogen außerdem jeweils andere Altersstufen und bestimmte Körperbautypen. Die postgrippalen Formen waren von wesentlich längerer Verlaufsdauer. Ausgang und Verlauf zeigten einige typische Merkmale. Die postgrippalen Formen sprachen sämtliche auf Elektroschocktherapie allein nicht an und erforderten längere Insulinkuren.     

Aufnahmetechnik und Untersuchungsprotokolle beim pädiatrischen Notfall

Paediatric emergencies demand a quick and efficient radiological investigation with special attention to specific adjustments related to patient age and radiation protection. Imaging modalities are improving rapidly and enable to diagnose childhood diseases and injuries more quickly, accurately and safely. This article provides an overview of imaging techniques adjusted to the age of the child and an overview of imaging strategies of common paediatric emergencies. Optimising the imaging parameters (digital radiography, different screen-film systems, exposure specifications) allows for substantial reduction of radiation dose. Spiral- and multislice-CT reduce scan time and enable a considerable reduction of radiation exposure if scanning parameters (pitch setting, tube current) are properly adjusted. MRI is still mainly used for neurological or spinal emergencies despite the advent of fast imaging sequences. The radiologist's task is to select an appropriate imaging strategy according to expected differential diagnosis and to adjust the imaging techniques to the individual patient.     

A retrospectively ECG-gated multislice spiral CT scan and reconstruction technique with suppression of heart pulsation artifacts for cardio-thoracic imaging with extended volume coverage

A method for cardio-thoracic multislice spiral CT imaging with ECG gating for suppression of heart pulsation artifacts is introduced. The proposed technique offers extended volume coverage compared with standard ECG-gated spiral scan and reconstruction approaches for cardiac applications: Thin-slice data of the entire thorax can be acquired within one breath-hold period using a four-slice CT system. The extended volume coverage is enabled by a modified approach for ECG-gated image reconstruction. For a CT system with 0.5-s gantry rotation time, images are reconstructed with 250-ms image temporal resolution. Instead of selecting scan data acquired in exactly the same phase of the cardiac cycle for each image as in standard ECG-gated reconstruction techniques, the patient's ECG signal is used to omit scan data acquired during the systolic phase of highest cardiac motion. With this approach cardiac pulsation artifacts in CT studies of the aorta, of paracardiac lung segments, and of coronary bypass grafts can be effectively reduced.     

200 Sentinel lymph node biopsies without axillary lymph node dissection -- no axillary recurrences after a 3-year follow-up

The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V) and technetium 99m-labelled albumin (Nanocoll). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLN-negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.     

Skeletal applications for flat-panel versus storage-phosphor radiography: effect of exposure on detection of low-contrast details

PURPOSE: To compare exposure requirements for similar detection performance with flat-panel detectors and the most recent generation of storage-phosphor plates in the simulated scatter of typical skeletal radiographic examinations. MATERIALS AND METHODS: A contrast-detail test object was covered with varying thicknesses of acrylic to simulate skeletal exposure conditions in the wrist, knee, and pelvis. Three series were obtained with increasing thicknesses of a simulated soft-tissue layer (5, 10, and 20 cm) and increasing tube voltage (50, 70, and 90 kVp). A fourth series was obtained with exposure conditions adapted to the phantom instructions (75 kVp). Images were acquired with a flat-panel detector (cesium iodide scintillator) and storage-phosphor plates at five exposure levels (speed class range, 100-1,600). Five readers evaluated 84 images to determine the threshold contrast of 12 lesion diameters (range, 0.25-11.1 mm). Statistical significance of differences between the two digital systems was assessed with two-way analysis of variance. RESULTS: A linear relationship was found between the number of detected lesions and the logarithm of exposure (R(2) > 0.98 for all series). On average, the flat-panel system required 45% less exposure than did the phosphor plates when 20-cm-thick acrylic was superimposed on the test object. Differences in exposure requirements were smaller with decreasing thicknesses of simulated soft-tissue layers and lower tube voltages (39% at 10 cm and 70 kVp, and 17% at 5 cm and 50 kVp). All differences were statistically significant. CONCLUSION: Flat-panel radiography provides improved contrast detectability and a potential for exposure reduction compared with those with storage-phosphor radiography. The best performance was achieved with conditions comparable to those for radiography of the trunk and lowest for conditions that simulate radiography of the extremities.     

The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome

Abstract A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period was tested. The value of the score in predicting neurodevelopmental outcome at 1 y of age was assessed. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. In addition to the hypoxic ischaemic encephalopathy score all but two infants had at least one cranial ultrasound examination. Thirty-five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, four who died before 6 months of age and one infant who was hospitalized at the time of the 12 month assessment. Twenty-three (58%) of the infants were normal and 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. The hypoxic ischaemic encephalopathy score was highly predictive for outcome. The best correlation with outcome was the peak score; a peak score of 15 or higher had a positive predictive value of 92% and a negative predictive value of 82% for abnormal outcome, with a sensitivity and specificity of 71% and 96%, respectively. For the clinician working in areas where sophisticated technology is unavailable this scoring system will be useful for assessment of infants with hypoxic ischaemic encephalopathy and for prognosis of neurodevelopmental outcome.     

A review of open biopsy for mediastinal masses

Objective: To review the recent experience with biopsied mediastinal lesions in children and to assess the impact of recent advances in imaging and surgical techniques on diagnosis. Methodology: The clinical and radiological features of 55 patients who had mediastinal biopsies at The Royal Alexandra Hospital For Children (RAHC) over 15 years were reviewed. Results: Fifty-five patients presented to RAHC between 1978 and 1993 with lesions of the mediastinum requiring biopsy of that site. Thirty-one of the 55 (56%) lesions were malignant. Neurogenic tumours were the most common (40%). In order of frequency the following lesions were found: neuroblastoma (15), teratoma (eight), non- Hodgkin's lymphoma (NHL; eight), enteric cyst/duplication (five), ganglioneuroma (five), bronchogenic cyst (three), ganglioneuroblastoma (two), lymphangioma (two), abscess (two), Hodgkin's lymphoma (HL; two), oesophageal granuloma (one), Langerhan's cell histiocytosis (one), congenital fibromatosis (one). Eighty-two per cent of neurogenic tumours were located in the posterior mediastinum, while 75% of teratomas and 100% lymphoid tumours were located anteriorly. Symptoms were generally unhelpful in establishing a specific diagnosis and in 27% of cases the lesions were discovered incidentally. Physical signs, such as thoracic inlet obstruction and neurological findings, were helpful clinically in localizing lesions within the mediastinum. Chest radiography enabled lesions to be subdivided within the mediastinum. This localization, in combination with the age at presentation, predicted the tissue diagnosis. Computerized tomography (CT) and magnetic resonance imaging (MRI) further defined the lesion and demonstrated involvement of adjacent structures. Histology, however, was essential to distinguish benign from malignant lesions. Conclusions: The clinical presentation of mediastinal masses is often non-specific or incidental. Despite recent advances in imaging technology and biopsy techniques, full histological examination is required to exclude malignancy.     

Prolonged survival in a nasopharyngeal carcinoma patient with multiple metastases: a case report and review of the literature

Nasopharyngeal carcinoma is a common cancer in South East Asia. In the early stages, radiotherapy alone may achieve sustained control, but once metastasis occurs, it becomes an incurable disease with limited survival time. We report a case of nasopharyngeal carcinoma, initial stage T4N0M0, diagnosed in 1985 in a patient aged 36 years who received 70 Gy radiotherapy to the head and neck region. In 1988, relapse occurred with multiple lung metastases. The patient received many chemotherapy regimens with a very good response, including near complete remission with the first treatment regimen of cisplatin, 5-fluorouracil and leucovorin for lung metastases, and with the fifth chemotherapy regimen of ifosfamide as a single agent. After ifosfamide treatment, there was residual fibrotic change in the lung and complete disappearance, lasting for almost a year, of the liver and bone lesions. The patient eventually died in July 1995 due to progressive disease. Prolonged survival after mainly thoracic metastasis is possible in patients with nasopharyngeal carcinoma, especially if the tumor is chemo-responsive.      

子宫腔纱条填塞术在控制剖宫产出血中的应用

子宫腔纱条填塞术在控制剖宫产出血中的应用胡娅莉周重宛金溶溶罗月娥李文玉产后出血是剖宫产最常见的并发症。我科自１９８９年始应用宫腔纱条填塞控制剖宫产术中严重子宫出血，取得满意效果，报告如下。一、临床资料１．一般情况：１９８９年１月～１９９６年１２月本院...     

Synthesis of keratin proteins during maturation of cultured human keratinocytes

We have examined the synthesis of keratin and total protein during cellular maturation in cultured oral and epidermal keratinocytes. Keratinocytes were separated on the basis of maturational age on gradients of Ficoll 400. Analysis of selected gradient fractions revealed that during maturation in culture the amount of protein/cell increases from 100 to 900 pg and the apparent rate of protein synthesis increases about two-fold. However, the proportion of protein that is keratin remains constant throughout this process. The major keratin proteins (58K, 56K, and 46K) are synthesized at the same relative rates throughout maturation in vitro. Therefore, during terminal differentiation in culture, the keratinocyte forms an expanding cell in which the rate of protein synthesis increases while the relative proportion of keratin proteins and nonkeratin proteins remain the same.