[Success, satisfaction and improvement of informed consents for computed tomography : A survey among patients and physicians]. / Aufklärungserfolg, Zufriedenheit und Verbesserungsmöglichkeiten bei Computertomographie-Aufklärungen : Eine Befragung von Patienten und Ärzten.

BACKGROUND: Providing informed consent before a computed tomography (CT) is important for the physicians and the patients. A personal interview about the procedure, risks, and possible alternatives is mandatory before a CT examination. METHODS: A survey was carried out on patient satisfaction with regard to the duration and content of informed consents of CT examinations. Physicians were also interviewed about the duration and content of CT informed consents. Another part of the survey dealt with the acceptance of technical innovations, such as information videos or tablets/PCs. RESULTS: A total of 512 patients and 106 physicians took part in the survey. The duration of the informed consent was estimated by the patients to be 4.08 min on average and 4.7 min by the physicians. The most detailed information given by the physicians regards side effects associated with contrast agents. Less information was given on possible diagnostic alternatives and the need for an examination. According to this, about 92% of all patients did not remember having received information about alternative examinations. Furthermore, 88.7% of the patients and 95.3% of the physicians recommended informed consent using interactive videos and animations, and 74% of the patients and 98.8% of the physicians recommended answering questions on tablet/PC. CONCLUSION: Patients estimated the duration of a CT informed consent to be a little bit shorter, although some patients did not remember the content very well. The acceptance of technical innovations was very high among the participants. The use of information videos and tablets/PCs could increase the success of providing informed consent.

[Analysis of documented informed consent forms for computed tomography : Completeness and data quality in four clinics]. / Analyse von dokumentierten Computertomographie-Aufklärungen : Vollständigkeit und Datenqualität in vier Kliniken.

BACKGROUND: Before performing a medical procedure, such as a computed tomography, an obligatory informed consent of the patient and its detailed documentation is necessary. METHODS: A total of 1424 informed consent forms for contrast-enhanced computed tomography from four clinics with different healthcare levels were analyzed. Informed consent forms were evaluated related to completeness, legibility and quality. RESULTS: In all, 1110 (77.9%) informed consent forms were sufficiently completed, 267 patients (18.8%) answered the form incompletely and 47 patients (3.3%) returned it without answering a question. Handwritten comments were found in 1391 (97.7%) cases. Thereof, 1329 (93.3%) were graded as detailed comments and 62 (4.4%) as less detailed comments. These comments were well legible in 675 (47.4%) cases, 558 (39.2%) informed consents showed limited legibility and in 158 (11.1%) more than 50% of the comments were unreadable. Signatures were complete in 1374 (96.5%) informed consent forms. CONCLUSION: The results show a better quality and documentation of informed consent forms for computed tomography obtained by radiology residents compared to radiological specialists. Compared to the radiologists, the non-radiologists performed significantly worse. The establishment of videos and use of digital informed consent forms could provide a possible solution.

[Vena cava cement embolism after percutaneous kyphoplasty. Interventional radiological recovery in metastasized urothelial cancer]. / Intracavaler Zementzapfen nach Kyphoplastie. Interventionell-radiologische Bergung bei metastasiertem Urothelkarzinom.

For patients suffering from vertebral metastases vertebroplasty and kyphoplasty offer two relatively new treatment options for the stabilization of vertebral compression fractures. This can help to reduce the fracture-associated symptoms and can improve the quality of life. Cement extravasation is a specific complication of this therapy. This article reports a case of multiple cement paravasations in the paravertebral veins, the vena cava inferior and peripheral segmental and subsegmental pumonary arteries after kyphoplasty of an extensive pathological vertebral body fracture in a 64-year-old man suffering from metastatic urothelial cancer.

[Experiences with cement leakage after balloon kyphoplasty]. / Erfahrungen mit intravasalen Zementaustritten nach Ballonkyphoplastie.

BACKGROUND: Kyphoplasty is associated with a low incidence of cement leakage and this usually tends to be clinically asymptomatic. However, there is a potential for life-threatening complications from extraspinal leakage resulting in vascular, cardiac and pulmonary embolisms. A total of eight cases of open surgical thrombectomy for cardiopulmonary cement leakage have been published in the current literature to date. Besides the description of a consecutive series with special reference to extraspinal cement leakage this article presents the results after successful endovascular removal of intravenous cement fragments following kyphoplasty in two patients. MATERIALS AND METHODS: In 46 cases following balloon kyphoplasty the number and amount of extraspinal venous cement leakage was retrospectively determined using computed tomography (CT). The number of cement embolisms into the pulmonary venous system was differently revealed for patients showing no extravertebral leakage or leakage only into the external vertebral venous plexus compared to leakage into the major venous vessels, azygos and hemiazygos vein or inferior vena cava. RESULTS: In 8 out of 046 cases (17.4 %) leakage into the external vertebral venous plexus was detected. In 5 out of 8 cases without involvement of the azygos/hemiazygos vein or inferior vena cava no pulmonary cement embolism was detected. In 3 out of 8 cases the inferior vena cava or azygos/hemiazygos vein was reached and additionally asymptomatic peripheral pulmonary cement embolism was induced in these cases. In two cases harboring residual intravasal cement fragments treatment was successful using endovascular extraction techniques. CONCLUSIONS: A computed tomography scan after kyphoplasty is recommended for all cases. If there is involvement of the inferior vena cava or the azygos/hemiazygos vein an additional CT scan of the chest should follow, even in asymptomatic cases. Residual intravasal cement fragments are safely extractable using endovascular techniques.

[Necrotizing fasciitis. 2011 update]. / Nekrotisierende Fasziitis. Update 2011.

Necrotizing fasciitis belongs to a group of complicated soft tissue infections that can be even life threatening. Despite growing knowledge about its etiology, predictors, and the clinical progression, the mortality remains at a high level with 20%. A relevant reduction can be achieved only by an early diagnosis followed by consistent therapy. The clinical findings in about 75% of the cases are pain out of proportion, edema and tenderness, blisters, and erythema. It is elementary to differentiate a necrotizing or a non-necrotizing soft tissue infection early. In uncertain cases it can be necessary to perform a surgical exploration to confirm the diagnosis. The histopathologic characteristics are the fascial necrosis, vasculitis, thrombosis of perforating veins, the presence of the disease-causing bacteria as well as inflammatory cells like macrophages and polymorphonuclear granulocytes. Secondly, both the cutis and the muscle can be affected. In many cases there is a disproportion of the degree of local and systemic symptoms. Depending on the infectious agents there are two main types: type I is a polymicrobial infection and type II is a more invasive, serious, and fulminant monomicrobial infection mostly caused by group A Streptococcus pyogenes.Invasive, severe forms of streptococcal infections seem to occur more often in recent years. Multimodal and interdisciplinary therapy should be based on radical surgical débridement, systemic antibiotic therapy as well as enhanced intensive care therapy, which is sometimes combined with immunoglobulins (in streptococcal or staphylococcal infections) or hyperbaric oxygen therapy (HBOT, in clostridial infections). For wound care of extensive soft tissue defects vacuum-assisted closure has shown its benefit.

The interventional therapy of varicoceles amongst children, adolescents and young men.

The retrograde sclerotherapy of the internal spermatic vein is a simple and safe method for the treatment of a varicocele. Approximately 5500 patients had so far undergone the interventional therapy in our departments. The methods of retrograde sclerotherapy will be described and alternative methods of treatment will be given in detail. The minor trauma, the low gonad dose and fast implementation coupled with a high success rate show that this method is very safe and efficient. We have, therefore, chosen it as the primary therapy.

Bell's palsy: what is the prognostic value of measurements of signal intensity increases with contrast enhancement on MRI?

Our objective was to assess the prognostic value of measurements of the degree of contrast enhancement of the intratemporal segments of the facial nerve. We prospectively obtained MRI, slice thickness <1 mm of 20 patients with a facial palsy on the first day of inpatient treatment, and measured contrast enhancement of the nerve. The data were compared with compound muscle action potential (CMAP) measurements and the clinical course. Analysis of the initial enabled differentiation of three patients whose palsy was to show no improvement from 17 whose palsy was to resolve as expected. No patient with a poor outcome showed lesser increase in signal in the internal auditory canal, pars tympanica and pars mastoidea than patients who fully recovered. In no patient who had been diagnosed on the basis of the initial MRI as having a "normal" palsy was the amplitude of the (CMAP) reduced to less than 20% that of the normal side. Measurement of contrast enhancement was thus shown to be a prognostic indicator and may provide a basis for a differential treatment of facial palsy.

[The prognostic value of quantified MRI at an early stage of Bell's palsy]. / Der prognostische Wert der dynamischen, kontrastmittelverstärkten Region-of-interest-MRT in der Akutphase der idiopathischen Fazialisparese.

OBJECTIVE: The aim of the study was to assess whether MRI has a prognostic value at an early stage of Bell's palsy. MATERIAL AND METHODS: Prospective, blinded study on 30 patients suffering from Bell's palsy, who came to hospital until the sixth day of illness, to receive high doses steroid therapy. MRI was done on the first day of inpatient treatment as a gradient-echo-sequence with a slice thickness of 0.7 mm before and after i. v. administration of 0.1 mmol GdDTPA/kg weight. The signal intensity increase was evaluated quantitatively by region on interest (ROI). The results were compared to the clinical outcome and the results of electrophysiology. RESULTS: The examinations of all patients could be evaluated. The 3 patients who developed a chronic facial paralysis were detected by MRI on the first day of inpatient treatment. The patients, who showed MR signs for an unfavorable course, had a highly significant pathologic compound muscle action potential (CMAP) as a result of the electrophysiologic measurement. Rather than using complex measurement procedures it is possible to obtain reliable prognostic information from just one measurement within the Internal auditory canal before and after i. v. administration of contrast. CONCLUSION: MRI has a prognostic value at an early stage of the illness. In the clinical setting this measurement is easy to perform, so that it is possible to obtain prognostic information at a stage when causal treatment is still possible.