Nach längeren zahnärztlichen Eingriffen unter Lokalanästhesie tritt nicht selten eine Kieferklemme auf. Ein sekundärer Muskelfaserriss als Komplikation im weiteren Verlauf ist nach unserem Wissen bisher nicht beschrieben.

Heart failure occurred in a 50-year-old woman as a result of calcified haemangiomatosis of the liver with a high shunt volume. In the subsequent years there were several bleedings from peptic ulcers. Ultrasonography revealed an increase in liver size and the previously diagnosed calcification. 14 years later the patient was again hospitalized because of increasing weakness and stress dyspnoea; the haemoglobin level was 5.5 g/dl. In addition to the florid gastric and duodenal ulcers, angiodysplasias were for the first time demonstrated in the stomach, duodenum and sigmoid colon, as were telangiectasias in the face and echo-dense round foci in the spleen. After transfusion of red cell concentrates and healing of the peptic ulcers under a 14-day treatment with omeprazole (20 mg two times daily by mouth) and amoxycillin (750 mg three times daily by mouth) the haemoglobin level increased at first (10 g/dl), then tarry stools were once again noted. The condition stabilized after laser coagulation of all accessible gastrointestinal angiodysplasias. The isolated calcified hepatic haemangiomatosis, diagnosed 14 years previously, is most likely a rare variant of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease).

BACKGROUND/AIMS:Elevated levels of serum markers of extracellular matrix, i.e., the amino-terminal procollagen-III-peptide, hyaluronic acid and laminin are found in various diseases. The study aims to examine a panel of these parameters in patients with acute pancreatitis and correlate them with the course and severity of the disease.METHODOLOGY:We prospectively examined the time-course of procollagen-III-peptide, hyaluronic acid and laminin in 24 consecutive patients with acute necrotizing (n = 13) or edematous (n = 11) pancreatitis. Patients with chronic pancreatitis with (n = 10) or without (n = 17) acute pain, and 6 patients in complete remission after an episode of acute pancreatitis as well as healthy individuals served as controls. In addition, serum levels of collagen VI and undulin were followed in 10 and 9 patients with acute necrotizing pancreatitis, respectively.RESULTS:The serum concentrations of procollagen-III-peptide, hyaluronic acid and laminin were significantly higher at the onset of acute necrotizing pancreatitis compared to edematous pancreatitis and the controls. They returned to almost normal levels during the course of the disease when the patient recovered, but remained elevated in patients with a lethal course. Laminin allowed us to discriminate between patients with necrotizing pancreatitis from all other forms of pancreatitis on admission (specificity 82%, sensitivity 92%, PPV 86%, NPV 90%). Collagen type VI levels were 2-3-fold higher in sera of patients with acute pancreatitis than in healthy controls, whereas the results for undulin were inconclusive.CONCLUSIONS:Since markers of matrix metabolism (especially laminin) are differently elevated in acute necrotizing versus edematous pancreatitis, we suggest that they might be used as parameters for the outcome.

The objective of this prospective study was to evaluate the accuracy of color Doppler imaging in comparison to phlebography in diagnosing phlebothrombosis. Five hundred and twenty-six phlebographies (reference method) were compared with 526 color Doppler sonographic examinations. Thrombosis diagnosed with color Doppler imaging showed a sensitivity of 98.0% (400 of 408). In 91.6% (482 of 526) of all examinations the extent of the thrombosis diagnosed with phlebography could also be seen with color Doppler imaging. When the clinical situation is unclear, color Doppler imaging should precede phlebography. Only when findings with ultrasonography are questionable should phlebography definitely be considered.

A 24-year-old patient presented with severe back pain in the lumbar and sacral regions and septic temperatures up to 40 degrees C. Lasègue's sign was bilaterally positive. An enhanced cell count was seen in the CSF (1877 cells/microliters, erythrocytes 1024/microliters). Total protein concentration was 4440 mg/dl. The patient also suffered from granulocytic pleocytosis. X-ray as well as scintigrams revealed inflammation of the presacral soft parts involving the os sacrum and bone marrow. Treatment with doxycycline (200 mg/d), fosfomycin (5 g/d), netilmicin (400 mg/d) and ofloxacin (200 mg/d) succeeded in curing the meningitis, whereas the presacral phlegmon persisted. Endoscopic examination showed a rod-shaped foreign body in the rectum that had penetrated deeply into the mucosa and required deformation and removal by laser. The plastic rod of 10 cm length was probably a liquorice stick. The patient denied introducing it per anum; he suspected having swallowed it while drunk. The inflammation subsided rapidly after removal of the foreign body.

In a prospective study the reliability of colour-coded duplexsonography (CCDS) and phlebography in the diagnosis of deep leg and pelvic vein thrombosis was compared. In 82 consecutive in- or out-patients (42 men, 40 women; mean age 53 [19-86] years) with clinically suspected leg or pelvic vein thrombosis the results of 275 phlebographies (reference method) and 275 CCDS were compared on admission and during follow-up. The two methods were performed less than 6 hours apart. In the diagnosis of thrombosis the sensitivity of CCDS was 99 %, specificity 80 %. In 88 % of all tests, the different thrombosis levels, as diagnosed by phlebography, were also demonstrated by CCDS. - These data indicate that, if the clinical picture of suspected deep leg or pelvic vein thrombosis is unclear, CCDS should be done first. Phlebography should be performed only if the results of the former are inconclusive.

Both, 99mTc DTPA perfusion scintigraphy and color-coded duplex sonography are reliable methods to quantitatively and qualitatively assess kidney transplant perfusion. In this case, minimal perfusion could be detected in a kidney allograft with marked vascular rejection by the scintigraphic analogous scan, whereas color-coded duplex sonography failed.

A 24-year-old patient presented with severe back pain in the lumbar and sacral regions and septic temperatures up to 40-degrees-C. Lasegue's sign was bilaterally positive. An enhanced cell count was seen in the CSF (1877 cells/mul, erythrocytes 1024/mul). Total protein concentration was 4440 mg/dl. The patient also suffered from granulocytic pleocytosis. X-ray as well as scintigrams revealed inflammation of the presacral soft parts involving the os sacrum and bone marrow. Treatment with doxycyclin (200 mg/d), fosfomycin (5 g/d), netilmicin (400 mg/d) and ofloxacin (200 mg/d) succeeded in curing the meningitis, whereas the presacral phlegmon persisted. Endoscopic examination showed a rod-shaped foreign body in the rectum that had penetrated deeply into the mucosa and required deformation and removal by laser. The plastic rod of 10 cm length was probably a liquorice stick. The patient denied introducing it per anum; he suspected having swallowed it while drunk. The inflammation subsided rapidly after removal of the foreign body.

Bei Schädeltraumen, insbesondere bei frontobasalen Frakturen, soll der Optikuskanal in ca. 3,5% der Fälle mit involviert sein. Spätschäden des Sehnervs durch Kallus- oder Narbenbildung mit konsekutivem Virusverlust sind ebenfalls beschrieben. In solchen Fällen ergibt sich die Indikation zur Dekompression des N. opticus, wobei sich unter allen möglichen operativen Zugangswegen der endoskopisch-transphenoidale Zugang bewährt hat. Weitere Indikationen zur Optikusdekompression sind neben Traumen Einengungen des Kanals durch raumfordernde Prozesse wie Osteome, Meningeome etc. sowie einige ophthalmologische und neurologische Fragestellungen.

In a prospective study the reliability of colour-coded duplex-sonography (CCDS) and phlebography in the diagnosis of deep leg and pelvic vein thrombosis was compared. In 82 consecutive in- or out-patients (42 men, 40 women; mean age 53 [19-86] years) with clinically suspected leg or pelvic vein thrombosis the results of 275 phlebographies (reference method) and 275 CCDS were compared on admission and during follow-up. The two methods were performed less than 6 hours apart. In the diagnosis of thrombosis the sensitivity of CCDS was 99%, specificity 80%. In 88% of all tests, the different thrombosis levels, as diagnosed by phlebography, were also demonstrated by CCDS. These data indicate that, if the clinical picture of suspected deep leg or pelvic vein thrombosis is unclear, CCDS should be done first. Phlebography should be performed only if the results of the former are inconclusive.

Für verschiedene Funktionsstörungen seitens des Nervus vestibulocochlearis scheint ein enger Kontakt zwischen der Arteria cerebellaris inferior anterior (AICA) und dem Nerven verantwortlich zu sein. Eine flußkompensierte 3D-Gradientenechosequenz (MR-Angiographie) ermöglicht die gleichzeitige Darstellung nervaler und vaskulärer Strukturen ohne die Gabe von Kontrastmittel.

Vertigo, sensorineural hearing loss and tinnitus are common symptoms in clinical otology. After exclusion of an acoustic neuroma in patients with sensorineural hearing loss and vestibular dysfunction, a vascular malformation can be responsible for pulsatile tinnitus. The two cases now reported with pulsatile tinnitus involved a dural arteriovenous malformation and a diverticulum of the jugular bulb and were diagnosed by non-invasive MR angiography. The techniques of diagnostic imaging using MR tomography, MR angiography, high-resolution computed tomography and digital subtraction angiography are demonstrated in the two cases presented.

Die Durchblutung eines Gewebes ist im wesentlichen von der Druckdifferenz in dem jeweiligen Gefäßsystem abhängig. Nach dem Hagen-Poiseuillschen Gesetz ist das in einem Gefäß herrschende Stromzeitvolumen der vierten Potenz des Radius proportional; d.h. die Verdoppelung des Gefäßdurchmessers bewirkt eine Zunahme des Stromzeitvolumens um den Faktor 16. Die Weite der einzelnen Gefäße wird von dem transmuralen Druck sowie dem Tonus der glatten Muskelzellen in den Gefäßwänden bestimmt. Der Tonus der Muskelzellen wird nerval, humoral, hormonal sowie auch durch lokale metabolische Mechanismen gesteuert. Die Reaktion der Vasa nervorum des N. facialis während der Stimulation mit Neurotransmittern (Noradrenalin, Acetylcholin, Histamin) wollten wir im Tiermodell experimentell bestimmen.

Vertigo, sensorineural hearing loss and tinnitus are common symptoms in clinical otology. After exclusion of an acoustic neuroma in patients with sensorineural hearing loss and vestibular dysfunction, a vascular malformation can be responsible for pulsatile tinnitus. The two cases now reported with pulsatile tinnitus involved a dural arteriovenous malformation and a diverticulum of the jugular bulb and were diagnosed by non-invasive MR angiography. The techniques of diagnostic imaging using MR tomography, MR angiography, high-resolution computed tomography and digital subtraction angiography are demonstrated in the two cases presented.

Heart failure occurred in a 50-year-old woman as a result of calcified haemangiomatosis of the liver with a high shunt volume. In the subsequent years there were several bleedings from peptic ulcers. Ultrasonography revealed an increase in liver size and the previously diagnosed calcification. 14 years later the patient was again hospitalized because of increasing weakness and stress dyspnoea; the haemoglobin level was 5.5 g/dl. In addition to the florid gastric and duodenal ulcers, angiodysplasias were for the first time demonstrated in the stomach, duodenum and sigmoid colon, as were telangiectasias in the face and echo-dense round foci in the spleen. After transfusion of red cell concentrates and healing of the peptic ulcers under a 14-day treatment with omeprazole (20 mg two times daily by mouth) and amoxycillin (750 mg three times daily by mouth) the haemoglobin level increased at first (10 g/dl), then tarry stools were once again noted. The condition stabilized after laser coagulation of all accessible gastrointestinal angiodysplasias. The isolated calcified hepatic haemangiomatosis, diagnosed 14 years previously, is most likely a rare variant of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease).

Heart failure occurred in a 50-year-old woman as a result of calcified haemangiomatosis of the liver with a high shunt volume. In the subsequent years there were several bleedings from peptic ulcers. Ultrasonography revealed an increase in liver size and the previously diagnosed calcification. 14 years later the patient was again hospitalized because of increasing weekness and stress dyspnoea; the haemoglobin level was 5.5 g/dl. In addition to the florid gastric and duodenal ulcers, angiodysplasias were for the first time demonstrated in the stomach, duodenum and sigmoid colon, as were telangiectasias in the face and echo-dense round foci in the spleen. After transfusion of red cell concentrates and healing of the peptic ulcers under a 14-day treatment with omeprazole (20 mg two times daily by mouth) and amoxycillin (750 mg three times daily by mouth) the haemoglobin level increased at first (10 g/dl), then tarry stools were once again noted. The condition stabilized after laser coagulation of all accessible gastrointestinal angiodysplasias. The isolated calcified hepatic haemangiomatosis, diagnosed 14 years previously, is most likely a rare variant of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease).

The interaction between arterial loops and the vestibulocochlear nerve is considered to be responsible for such clinical symptoms as progressive sensorineural hearing loss, tinnitus and vestibular dysfunction. Previously, neurovascular relationships were best demonstrated with invasive Gas-CT-cisternography, although this technique resulted in a low detection rate of 38%. Magnetic resonance angiography offers a non-invasive method for imaging vessel loops in the cerebellopontine angle without contrast medium in more than 90% of cases. A comparison between gas-CT-cisternography and magnetic resonance angiography in 9 patients revealed a superior simultaneous depiction of both anterior inferior cerebellar arteries with magnetic resonance angiography.

The interaction between arterial loops and the vestibulocochlear nerve is considered to be responsible for such clinical symptoms as progressive sensorineural hearing loss, tinnitus and vestibular dysfunction. Previously, neurovascular relationships were best demonstrated with invasive Gas-CT-cisternography, although this technique resulted in a low detection rate of 38%. Magnetic resonance angiography offers a non-invasive method for imaging vessel loops in the cerebellopontine angle without contrast medium in more than 90% of cases. A comparison between gas-CT-cisternography and magnetic resonance angiography in 9 patients revealed a superior simultaneous depiction of both anterior inferior cerebellar arteries with magnetic resonance angiography.