373 Patientinnen wurden nach brusterhaltender Operation zur Radiotherapie vorgestellt. In einer Planungs-Computertomographie zeigte sich bei 97 Patientinnen das Vorliegen eines größeren Gewebedefektes (Serom/Hämatom) von über 2 Zentimetern Durchmesser. Es sollte das kosmetische Ergebnis dieser Patientinnen evaluiert und der Einfluß der Serome hierauf erhoben werden. Das Durchschnittsalter betrug 59 Jahre. Eine Quadrantenresektion wurde bei 17,5 Prozent, eine Segmentresektion bei 27,8 Prozent und eine Tumorexzision bei 54,6 Prozent der Patientinnen durchgeführt. Die Strahlentherapie umfaßte die Restbrust mit einer Dosis von 50 Gy bei einer Einzeldosis von 2 Gy am Linearbeschleuniger (6 MeV-Photonen). Anschließend erfolgte eine Dosisaufsättigung der ehemaligen Tumorregion mit Elektronen und 10 Gy Gesamtdosis. Eine gesonderte Beurteilung und Dokumentation der Nebenwirkungen der Therapie und des kosmetischen Befundes erfolgte bei 51 Patientinnen. An akuten Nebenwirkungen waren bei allen Patientinnen Hautreaktionen (Grad 1 bis 3) zu verzeichnen. Als Spätnebenwirkungen war es bei 82,3 Prozent der Patientinnen zu Narbenindurationen gekommen. An der Haut wurde bei 51 Prozent der Untersuchten eine vermehrte Pigmentierung, bei 68,6 Prozent eine Atrophie und bei nur 11 Prozent Teleangiektasien festgestellt. Eine subkutane Fibrose zeigten 56,9 Prozent der Patientinnen. In 78,4 Prozent der Fälle mußte eine Asymmetrie der Mammae dokumentiert werden. Bei 41,2 Prozent der Frauen ließ sich ein Lymphödem nachweisen und 72,5 Prozent gaben eine Sensibilitätsstörung an. Das kosmetische Gesamtergebnis, im 5-Punkte-score dokumentiert, war zu 19,6 Prozent „sehr gut” (score 1) und zu 33,3 Prozent „gut” (score 2). 37,3 Prozent zeigten „befriedigende” (score 3) und 9,8 Prozent „schlechte” (score 4) Befunde. „Sehr schlechte” (score 5) Ergebnisse wurden nicht gesehen. Insgesamt entsprachen die kosmetischen Ergebnisse der untersuchten Gruppe von Serom- und Hämatompatientinnen nicht den Literaturangaben anderer Gesamtkollektive. Wir schlußfolgern daraus, daß postoperative Serome und Hämatome einen negativen Einfluß auf die aus der Behandlung resultierende Gesamtkosmetik haben und deren Zahl und Ausmaß zukünftig weiter reduziert werden müssen. There were 373 patients irradiated after breast conserving carcinoma treatment. A planning computed tomography revealed in 97 of these patients seromas and tissue defects exceeding 2 cm in diameter. The cosmetic results in those patients and the impact of seromas herein had to be evaluated. Mean age was 59 years. A quadrant resection was performed in 17,5 percent of the patients, a segmental resection in 27,8 percent and a tumour excision in 54,6 percent. Radiation therapy was applied with the linear accelerator and 6 MeV photons up to a total dose in the residual breast of 50 Gy followed by a boost dose to the former tumour bed of 10 Gy. A distinct evaluation and documentation of therapy related side effects and the resulting cosmesis was done in 51 patients. In all the examined seroma patients there were moderate acute skin reactions grade 1 to 3. As late effects in 82,3 percent scar indurations were noticed. At the skin 51 percent showed enhanced pigmentation, 68,6 percent atrophia and only 11 percent teleangiectasia. Subcutaneous fibrosis occurred in 56,9 percent of the patients, 78,4 percent of the women had breast asymmetries. In 41,2 percent there were a lymphedema subcutaneously, in 72,5 percent impaired sensibility. The overall cosmetic result documented with a 5 point score was “very good” (score 1) in 19,6 percent and “good” (score 2) in 33,3 percent, 37,3 percent were “satisfactory” (score 3) and 9,8 percent “bad” (score 4) respectively. No “very bad” results (score 5) were seen. The cosmetic results in the examined group of seroma and hematoma patients were inferior to those reported in the literature. We conclude that postoperative seroma and hematoma have an adverse effect on the resulting cosmesis and that their frequency and extent have to be reduced in future by the responsible surgeons.
Extramedullary localizations at diagnosis or during the course of multiple myeloma are rare. We report on a 70 year old patient, presenting multiple hypoechoic liver lesions during an ultrasound examination. The following contrast-enhanced computed tomography demonstrated hypodense liver lesions with slight contrast enhancement and hyperdense polypoid masses in the wall of the gall bladder as well as a small pericostal tumor. A punch biopsy of the liver and immunohistochemical studies confirmed the diagnosis of extramedullary multiple myeloma. In a follow-up CT five weeks later the liver lesions and the pericostal tumor clearly showed progress, the masses in the gall bladder had developed into a concentric wall-thickening. Additionally, polypoid contrast-enhancing masses in the gastric wall became apparent as well as a hypodense lesion in the spleen. Radiologists should be aware that multiple myeloma can on rare occasions present as hypodense nodules in the liver or new masses in other organs in CT. Because of the morphologic similarity to metastatic disease, a biopsy may be necessary for definitive diagnosis.
Dural arterio-venous fistulas are rare lesions. Traumatic dural AV-fistulas in particular, are very rare complications of head and neck trauma.
Der Begriff „von Meyenburg Komplex” (VMK) bezeichnet Gallengangshamartome und stellt einen seltenen, primär gutartigen Zufallsbefund in der Leberbildgebung dar. Wir berichten über einen 61 jährigen Mann, der sich 14 Jahre nach Remission eines Morbus Hodgkin zur routinemäßigen Nachsorgeuntersuchung vorstellte. Die durchgeführte Computertomographie zeigte multiple hypodense Leberläsionen, sodass zunächst ein Leberbefall durch die einstige Grunderkrankung vermutet wurde. Ein Vergleich mit alten Voraufnahmen zeigte jedoch eine Befundkonstanz und es wurden multiple Gallengangshamartome im Sinne eines VMK diagnostiziert.
Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83ms per heart-phase. In this study, the clinical performance of this new method is evaluated.
Die initiale computertomographische Stadieneinteilung von 2Patienten mit hilusnahen Bronchialkarzinomen erschien zweifelhaft. Vor definitiver Festlegung des Behandlungsschemas wurde deshalb jeweils eine retrospektiv EKG-gegatete Mehrschicht-Spiral-Computertomografie mit optimierten Untersuchungsparametern durchgeführt. Hierdurch musste ein einem Fall ein zunächst angenommenes irresektables T4 Tumorstadium mit Mediastinalinfiltration in ein T2-Stadium herabgestuft werden. Im zweiten Fall konnte die bereits vermutete Infiltration des linken Herzvorhofes gesichert werden. In bestimmten Situationen scheint eine EKG-gegatete Computertomographie mit optimierten Untersuchungsparametern ein genaueres Staging von hilusnahen Bronchialkarzinomen mit entsprechendem Einfluss auf das therapeutische Prozedere zu erlauben.
Magnetresonanztomographie (MRT) im aufrechten Stand „en pointe“ unter voller Belastung ist die Methode der Wahl zum Studium der funktionellen Anatomie des Spitzentanzes und damit verbundener tanzmedizinischer Fragestellungen.
Trotz der Überlegenheit der Magnetresonanztomographie in der Bildgebung akuter cerebraler Ischämie ist die Computertomographie (CT) nach wie vor die am häufigsten angewandte Methode in der akuten Schlaganfalldiagnostik.
INTRODUCTION:There were 373 patients irradiated after breast conserving carcinoma treatment. A planning computed tomography revealed in 97 of these patients seromas and tissue defects exceeding 2cm in diameter. The cosmetic results in those patients and the impact of seromas herein had to be evaluated.PATIENTS AND METHODS:Mean age was 59 years. A quadrant resection was performed in 17.5 percent of the patients, a segmental resection in 27.8 percent and a tumour excision in 54.6 percent. Radiation therapy was applied with the Linear accelerator and 6 MeV photons up to a total dose in the residual breast of 50 Gy followed by a boost dose to the former tumour bed of 10 Gy. A distinct evaluation and documentation of therapy related side effects and the resulting cosmesis was done in 51 patients.RESULTS:In all the examined seroma patients there were moderate acute skin reactions grade 1 to 3. As late effects in 82.3 percent scar indurations were noticed. At the skin 51 percent showed enhanced pigmentation, 68.6 percent atrophia and only 11 percent teleangiectasia. Subcutaneous fibrosis occurred in 56,9 percent of the patients, 78.4 percent of the women had breast asymmetries. In 41.2 percent there were a lymphedema subcutaneously, in 72.5 percent impaired sensibility. The overall cosmetic result documented with a 5 point score was "very good" (score 1) in 19.6 percent and "good" (score 2) in 33.3 percent, 37.3 percent were "satisfactory" (score 3) and 9.8 percent "bad" (score 4) respectively. No "very bad" results (score 5) were seen.CONCLUSIONS:The cosmetic results in the examined group of seroma and hematoma patients were inferior to those reported in the literature. We conclude that postoperative seroma and hematoma have an adverse effect on the resulting cosmesis and that their frequency and extent have to be reduced in future by the responsible surgeons.
The von Meyenburg complex (VMC) describes bile duct hamartomas and presents a rare, benign incidental finding in liver imaging. We report on a 61-year-old man, who was referred for a follow up study 14 years after remission of Hodgkin's disease. Computed tomography (CT) revealed multiple hypodense lesions throughout the liver, primary suggesting recurrent Hodgkin's disease. Previous CT-examinations, which were obtained at a later date, showed those Lesions in identical distribution and morphology over the years, leading to diagnosis of multiple bile duct hamartomas (VMC). Making imaging-based diagnosis of VMC including ultrasound, CT and magnetic resonance imaging is a challenging task for the radiologist. Based on literature research findings, the impact of different modalities in the diagnostic work-up of VMC is discussed.
Die Mehrheit fokaler Nierenläsionen wird zufällig bei Sonographie, Magnetresonanztomographie und Computertomographie entdeckt. Sonographisch unklare Läsionen werden mittels MRT oder CT weiter abgeklärt, wobei der Radiologe die Frage beantworten muss, ob ein chirurgisches Vorgehen erforderlich ist oder nicht, und ob eine Verlaufskontrolle der Läsion zu erfolgen hat. Bewährt hat es sich, dazu die Läsionen zunächst in solide versus zystische Nierenläsionen einzuteilen. Für zystische Veränderungen sollte die Klassifikation nach Bosniak genutzt werden, insbesondere auch die neu eingeführte Kategorie IIF mit nachfolgenden follow-up. Bei soliden Nierenläsionen sollten zunächst nicht-operationspflichtige Veränderungen ausgeschlossen werden wie Niereninfarkte, fokale Nephritiden (fokale Entzündungen) bzw. Lymphome. Zur weiteren Differenzierung ist die Suche nach Fett innerhalb der Läsion essentiell, um Angiomyolipome von anderen soliden Neoplasien zu differenzieren. Obwohl sich die Spezifität von CT und MRT in den letzten Jahren nicht wesentlich erhöht hat und daher eine Differenzierung zwischen den übrigen soliden Neoplasien weiterhin schwierig oder unmöglich ist, kann mit diesem Vorgehen dennoch in den meisten Fällen eine richtige therapeutische Entscheidung gefällt werden.
La alopecia androgénica o patrón de caída del pelo masculino es una caída del pelo mediada por dihidrotestosterona, la forma activa de la testosterona.Actualmente solo existen dos tratamientos aprobados por la FDA para su uso en la alopecia androgénica, minoxidil y finasteride, unidos a un tercer tratamiento reconocido por la FDA, el láser de baja frecuencia.Existen otros tratamientos que también se utilizan para la alopecia androgénica, pero que no presentan los mismos datos de eficacia que los tratamientos comentados previamente. Entre ellos se encuentra el uso del plasma rico en plaquetas y, en el caso de la alopecia androgénica femenina, anticonceptivos orales y antiandrógenos. Se utilizan también en la práctica clínica complejos vitamínicos y con aminoácidos que, si bien no han demostrado eficacia en ensayos, podrían aumentar en algunos casos el grosor del pelo.Androgenic alopecia or the pattern of masculine hair loss is an loss mediated by dihydrotestosterone, the active form of testosterone.There are currently only two FDA-approved treatments for androgenic alopecia, minoxidil and finasteride, together with a third FDA-recognised treatment, low frequency laser.Although there are other treatments which are also used to treat androgenic alopecia, they are not associated with the same level of efficacy as the above-mentioned treatments. They include the use of platelet-rich plasma and, in the case of female androgenic alopecia, oral contraceptives and anti-androgens. Vitamin complexes with amino acids are also used in clinical practice which, although they have not been proven to be effective in trials, may in some cases increase the thickness of the hair.
Though being inferior to magnetic resonance imaging, computed tomography (CT) of the brain is the most frequently applied imaging modality in the diagnostic workup of acute cerebral Ischaemia. We report on a case of a comatose 53-year-old man who was brought to the emergency room after cardiopulmonary resuscitation. The CT of the brain showed a diffuse brain oedema with an explicit hypodense demarcation of all deep nuclei.
Iodinated contrast media are widely used in computed tomography and angiography. Adverse reactions such as contrast-medium induced nephropathy (CIN), anaphylactoid reactions and iodine-induced thyrotoxicosis are associated with intravasal administration of contrast agents. Iodinated contrast agents are generally considered to be safe, but in rare cases they can cause severe life threatening situations. In this review we present an overview about the incidence, pathways, and risk factors of adverse reactions. Simple schemes including hydration protocols for prevention of CIN, medication for prophylaxis of iodine-induced thyrotoxicosis with thyreostatics and anaphylactoid reactions with histamine antagonists and corticosteroids are suggested.
Weight-bearing upright Magnetic resonance imaging (MRI) "en pointe" is the ideal tool for research in the field of functional anatomy of pointe dancing and pointe dancing related medicine.
Dural arterio-venous fistulas are rare lesions. Traumatic dural AV-fistulas in particular, are very rare complications of head and neck trauma. We report on a 59-year old man with a severe facial and head trauma. Initial computed tomography demonstrated a left frontal subdural hematoma, leading to progressive midline shift. Additionally, a complex skull base fracture was present, involving the frontal, temporal and sphenoid bone. A few days after the accident the patient reported a left pulsatile tinnitus. Subsequent selective carotid angiography revealed a high flow dural arterio-venous fistula involving the middle meningeal artery and facial veins. Complete endovascular embolization was performed by a transarterial approach using microparticles and an electrolytically detachable coil resulting in an immediate disappearance of the tinnitus. Remarkably, this case nicely illustrates possible "dangerous" collateral circulation to the ophthalmic artery-a feature that should be kept in mind during endovascular treatment of this entity.
Portal vein thrombosis complicating acute pancreatitis is more often diagnosed today due to the improved imaging techniques (computed tomography, ultrasound, nmr). Nevertheless the outcome of recent portal vein thrombosis is ill-known. We report on the computed tomographic findings and clinical course of portal vein thrombosis in two patients suffering from acute pancreatitis. Both patients showed spontaneous recanalization of the thrombosis.
Equivocal initial CT-based staging in 2 patients with hilar bronchial neoplasms was reassessed with retrospective ECG-gated Multislice-CT and optimized examination parameters prior to definition of treatment. An initially suspected irresectable T4 tumor with mediastinal infiltration was downstaged to T2 in one case, while tumor infiltration into the left atrium could be confirmed in the other case. In doubtful conditions, ECG-gated multislice CT with optimized examination parameters may be helpful for refined staging in patients with hilar bronchial neoplasms, thus possibly influencing treatment strategies.
UNLABELLED:Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83 ms per heart-phase. In this study, the clinical performance of this new method is evaluated.MATERIALS AND METHODS:In fifty patients (33 male, 17 female; age 50 +/- 13 years) with suspected coronary heart disease, CT angiography (slice thickness 0.75 mm, contrast-agent 60-80 ml iomeprol) was performed with a Somatom Definition scanner. Based on the coronary 15-segment-model of the AHA, scores for image quality and lumen reduction were established to enable the observer, to give recommendations for further therapy.RESULTS:Out of 750 possible AHA-segments, 655 were depicted (87.3%). 591 segments (90.2%) were assessed without any limitation of quality, 49 (7.5%) segments showed moderate, and 15 (2.3%) segments severe limitation in image quality. 508 (77.6%) segments were without pathological findings, 92 (14.0%) segments had minimal atherosclerotic lesions, 42 (6.4%) segments suffered from stenoses with lumen reduction less than 70%, and 13 (2.0%) showed significant stenoses of more than 70%. In 31 patients (62%), coronary heart disease was ruled out by CT angiography without any need for further non-invasive or invasive diagnostics. 8 patients (16%) underwent stress-testing for ischemia. In 11 (22%) patients coronary angiography was recommended, and DSCT findings were confirmed in 10 cases. Only one LCx stenosis was overestimated in DSCT.CONCLUSION:Contrast-enhanced DSCT is a powerful tool in diagnosis of coronary heart disease. 98% of coronary segments could be assessed in diagnostic quality, and at least 90% of haemodynamically significant coronary stenoses were detected.
