Duplex imaging and incidence of carotid radiation injury after high-dose radiotherapy for tumors of the head and neck

Radiation-induced carotid artery disease following high-dose (greater than 50-Gy) radiotherapy for head and neck cancer may become more common as improved treatment results in longer survival. Duplex ultrasound scans were obtained in 91 consecutive patients to determine whether increased incidence and severity of extracranial carotid disease correlate with prior radiotherapy. Fifty-three patients who underwent radiotherapy an average of 28 months previously and 38 patients who received no radiotherapy were studied. Thirty percent of the irradiated group had lesions of the carotid arteries that were either moderate or severe vs only 6% of the control patients. Five patients were symptomatic; all had undergone radiotherapy. Long-term follow-up with sequential duplex ultrasound examinations is indicated in patients receiving high-dose radiotherapy for head and neck tumors, to detect radiation-induced carotid artery disease and prevent late sequelae.     

Quantification of flow dynamics in congenital heart disease: applications of velocity-encoded cine MR imaging.

Velocity-encoded cine (VEC) magnetic resonance (MR) imaging is a valuable technique for quantitative assessment of flow dynamics in congenital heart disease (CHD). VEC MR imaging has a variety of clinical applications, including the measurement of collateral flow and pressure gradients in coarctation of the aorta, differentiation of blood flow in the left and right pulmonary arteries, quantification of shunts, and evaluation of valvular regurgitation and stenosis. After surgical repair of CHD, VEC MR imaging can be used to monitor conduit blood flow, stenosis, and flow dynamics. There are some pitfalls that can occur in VEC MR imaging. These include potential underestimation of velocity and flow, aliasing, inadequate depiction of very small vessels, and possible errors in pressure gradient measurements. Nevertheless, VEC MR imaging is a valuable tool for preoperative planning and postoperative monitoring in patients with CHD.     

Offene Kolonchirurgie

Open resection of the colon is one of the most frequent abdominal operations, which clearly indicates the great importance of colon carcinomas. The surgical aim is resection of the affected intestinal region and the according lymph drainage region. In this respect, the techniques employed are strictly standardized: right hemicolectomy for right colon carcinoma, transverse resection for right colon carcinoma, left hemicolectomy for descendent colon carcinoma, and sigmoid resection for sigmoid carcinoma. In case of benign underlying disease, the operational method depends largely on the extent to which the intestine is affected and can include anything from simple colotomy and polyp removal to colectomy for toxic megacolon. Elective colon surgery is usually primary, but in emergencies a protective stoma might be necessary. Standardized indication and operational techniques enable low perioperative mortality and complication rates that make open colon resection usually un-problematic even in very old patients.     

Tumormarker thorakaler Neoplasien

Lung carcinomas account for 95–98% of primary pulmonary malignant tumors and are the most frequent cause of death from cancer worldwide. The appropriate use of tumor markers should lead to improved quality of life and to a longer survival for the cancer patient, with a concurrent decrease in healthcare costs. Randomized prospective and large retrospective studies as well as meta-analyses regarding the tumor markers used to date show rather sobering results when it comes to evidence-based outcomes. Still, tumor markers have considerable potential for differential diagnosis and prognosis, and, in addition to morphological diagnostics, they can deliver valuable assistance in staging, control of therapy efficacy, postoperative follow-up, and detection of recurrent disease. However, the use of tumor markers makes sense only if conclusions for the patient’s treatment and care are drawn from the results. The use of CYFRA 21-1, CEA, NSE, ProGRP, and SCCA as primary tumor markers in lung cancer is presented, and their clinical relevance is discussed with regard to national and international recommendations and guidelines.     

Bildgebende Diagnostik des Nierenzellkarzinoms

There is an increasing tendency of incidental detection of renal cell carcinoma (RCC) in imaging studies performed for other purposes. In most instances multi-detector computerized tomography (MDCT) is the current investigation of choice for confirmation of diagnosis and staging of the primary RCC. Exceptional circumstances where alternative imaging modalities, such as magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), would be preferred include contrast medium allergy, functional renal impairment and pregnancy. MRI provides excellent soft tissue contrast facilitating evaluation of tumor composition and characterization of masses. Besides identifying these incidental lesions, diagnostic imaging plays an increasingly more prominent clinical role and supports the need for accurate imaging characterization, particularly in the context of newer therapeutic approaches, such as laparoscopic and nephron-sparing approaches. Staging systems are designed to reflect the modes of spread and are used to stratify treatment options and to assess prognosis and survival characteristics.     

Mobile Augeninnendruckmessung

Goldmann applanation tonometry is still the gold standard of intraocular pressure measurement (IOP) and an essential part in the diagnosis of glaucoma. Applanation tonometry is usually performed on a sitting patient at the slit lamp. However, under certain circumstances it is necessary to measure the IOP outside the office setting. With handheld devices the measuring procedure is brought to bedside and surgery theatres, as well as to patients who are not able to sit behind the slit lamp. The dynamic contour tonometer (DCT) represents a new method of direct IOP measurement. Its physical principle is based on piezo-electronic contour matching tonometry and is claimed to be less dependent on biochemical properties of the cornea. Besides the IOP, the ocular pulse amplitude can also be measured. Until now, the DCT had been available as a slit lamp mounted device. In this report, we present a portable prototype of the device. In comparison with the Perkins tonometer and the TONO-PEN XL, the handheld DCT shows smaller intra- and inter-examiner variability. Additionally, the device offers the unique possibility to display the ocular pulse amplitude while the patient is in a horizontal position.     

Glomerulonephritiden und Schwangerschaft

Diabetic nephropathy, hypertensive kidney injury, and glomerulonephritis are the most common causes of terminal kidney failure. Depending on the form of glomerulonephritis, women in childbearing age also may be affected. Pregnancy’s influence on the disease as well as its effect on the course of pregnancy can be of pivotal importance to both mother and child. Optimal treatment of glomerulonephritis during pregnancy requires the close cooperation of gynecologists and nephrologists. We describe the most important aspects of such treatment concerning risk profiles, diagnosis, and therapy options, paying special attention to pregnancy with concomitant lupus nephritis.