[Uveal and iridociliary melanomas in young patients : A retrospective analysis of 57 cases]. / Aderhaut- und Ziliarkörpermelanome bei jungen Patienten : Eine retrospektive Analyse von 57 Fällen.

BACKGROUND: Uveal melanomas (UM) are rare malignancies in young patients. It is unknown if UM in young patients significantly differs from those in older patients concerning tumor size and localization, metastasis and genetics. The aim of this study was to evaluate the clinical course and tumor characteristics in young patients with UM. MATERIAL AND METHODS: All patients with UM below the age of 32 years who had been treated at our hospital were included in the study. Patient age and sex, duration of symptoms, visual impairment, tumor size and location, genetics, therapy, follow-up interventions and tumor-associated deaths were documented. RESULTS: A total of 57 patients (67 % male, mean age 24.7 years) were included in the study with an average symptomatic course of 5 months. Of the patients 8 (14 %) had an initial visual acuity of ≥ 0.9, 16 (28 %) 0.5-0.8, 22 (39 %) 0.05-0.4 and 9 (16 %) < 0.05 (no data for 2 patients, 4 %). After therapy visual acuity was < 0.05 in 54 % and 53 % of the tumors were choroidal UM (70 % juxtapapillary/circumpapillary), whereas 47 % were ciliochoroidal (54 % with iridociliary involvement). The average tumor size was 12.7 ± 3.6 mm with an average prominence of 6.2 ± 3.2 mm. Genetic evaluation (n = 16) revealed disomy 3 in 64 % and 54 % of the patients received radiotherapy with local application of ruthenium 106. In 46 % of cases follow-up interventions were neccessary including 70 % due to radiogenic retinopathy. CONCLUSION: In young patients UM did not show any preferred localization. The majority of genetically evaluated tumors revealed disomy 3 with no significant correlation to tumor location. Independent of tumor size, location and therapy, approximately half of the patients needed follow-up interventions, predominantly due to radiogenic retinopathy.

"Still crazy after all these years"--tuberculosis as an old disease with diverse facets in a thirty-five-year-old male patient.

We report about a thirty-five-year-old male patient with miliary TB as first manifestation of HIV-infection.

[A combined mediastinal and retroperitoneal cystic lymphangioma as a rare cause of recurrent pleural effusion]. / Das kombinierte mediastinale und retroperitoneale zystische Lymphangiom als seltene Ursache rezidivierender Pleuraergüsse.

We report on a 71-year-old female patient with spontaneous unilateral recurrent chylothoraces - at first glance with no apparent cause. After performing CT, MRI, lymphatic scintigraphy, and CT-guided biopsy, we were able to establish the diagnosis of a combined mediastinal and retroperitoneal cystic lymphangioma. Together with a review of the literature concerning cystic lymphangioma, we also discuss possible differential diagnoses of chylothoraces.

Syndrome of inadequate antidiuretic hormone secretion in pulmonary tuberculosis - a therapeutic challenge.

A forty-nine-year-old female patient with pulmonary tuberculosis developed syndrome of inadequate antidiuretic hormone secretion. Consequent restriction of fluid intake as a therapeutic measure was just as ineffective as a medication with tolvaptan which was performed later on. A probable explanation for the inefficacy of the aquaretic drug is an interaction of rifampicine and tolvaptan. This case report gives a short summary of SIADH in pulmonary TB and discusses possible reasons for the difficult antituberculotic treatment in this patient.

[Dispensing with sedation in pediatric MR imaging of the brain: what is feasible?]. / Verzicht auf Sedierungen bei pädiatrischen MRT-Untersuchungen des Kopfes: Was ist machbar?

PURPOSE: Feasibility study to evaluate whether a diagnostic pediatric MRI scan of the brain can be performed without sedation by using BLADE sequences with rotating blade-like k-space covering. MATERIALS AND METHODS: Between 01/09 and 12/10 all children with a planned MRI of the brain were included. After age-dependent preparation of the child the MRI was acquired with a parent closely attending. Pharmacological sedation was only applied when strong motion artifacts occurred. All MRI sequences were independently reviewed by 2 radiologists who ranked image quality on a scale of III (excellent image quality, no motion artefacts), II (motion artefacts but still diagnostic quality), and I (non-diagnostic image quality). RESULTS: 326 children (53 % male, mean age 7.2 ± 4.3 years) were evaluated of whom 247 (76 %) had to be sedated. All infants < 1 year and 84 % of 1-year-old patients, 90 % of 2-year-old, 59 % of 3-year-old, 9 % of 4-year-old children, and 2 % of patients older than 4 years had to be sedated. In total, 2461 MRI sequences (7.6 ± 1.2 per study) including 622 BLADE sequences (25 %) were acquired. Reviewer A rated 2077 sequences (84 %) as III, 318 (13 %) as II, and 66 (3 %) as I, whereas reviewer B rated 2119 sequences (86 %) as III, 308 (13 %) as II, and 34 (1 %) as I. Inter-observer agreement was good to excellent (normal/weighted kappa value for BLADE sequences: 0.88/0.56, for all sequences: 0.92/0.71). CONCLUSION: Age-adjusted preparation and implementation of a pediatric cranial MRI may reduce the need for sedation. BLADE sequences abate motion artefacts thus enabling acquisition of diagnostic images even in young children. In patients older than 3 years, performance of MRI scans without sedation should be considered.

[Analysis of image acquisition, post-processing and documentation in adolescents with spine injuries - comparison before and after referral to a university hospital]. / Bildgebung bei wirbelsäulenverletzten Kindern und jungen Erwachsenen - eine Analyse von Umfeld, Standards und Wiederholungsuntersuchungen bei Patientenverlegungen.

PURPOSE: Systematic evaluation of imaging situation and standards in acute spinal injuries of adolescents. MATERIALS AND METHODS: Retrospective analysis of imaging studies of transferred adolescents with spinal injuries and survey of transferring hospitals (TH) with respect to the availability of modalities and radiological expertise and post-processing and documentation of CT studies were performed. Repetitions of imaging studies and cumulative effective dose (CED) were noted. RESULTS: 33 of 43 patients (77 %) treated in our hospital (MA 17.2 years, 52 % male) and 25 of 32 TH (78 %) were evaluated. 24-hr availability of conventional radiography and CT was present in 96 % and 92 % of TH, whereas MRI was available in only 36 %. In 64 % of TH, imaging expertise was guaranteed by an on-staff radiologist. During off-hours radiological service was provided on an on-call basis in 56 % of TH. Neuroradiologic and pediatric radiology expertise was not available in 44 % and 60 % of TH, respectively. CT imaging including post-processing and documentation matched our standards in 36 % and 32 % of cases. The repetition rate of CT studies was 39 % (CED 116.08 mSv). CONCLUSION: With frequent CT repetitions, two-thirds of re-examined patients revealed a different clinical estimation of trauma severity and insufficient CT quality as possible causes for re-examination. A standardization of initial clinical evaluation and CT imaging could possibly reduce the need for repeat examinations.

[Prognostic pulmonary and thoracic findings in patients with unstable injuries of the thoracic spine]. / Prognostische pulmonale und thorakale Befunde bei Patienten mit instabilen Verletzungen der Brustwirbelsäule.

BACKGROUND: Instable fractures of the thoracic spine imply a substantial trauma to the chest. The aim of this study was to undertake a systematic analysis of the prognostic impact of CT findings of the chest wall, mediastinum, lungs, and pleural space on the mortality rate. METHOD: All multiple injury patients with instable fractures of the thoracic spine and initial CT scans treated in our clinic from April 2004 to May 2007 were eligible. The following variables were evaluated for their prognostic power: injury to the lungs (pneumothorax, effusion, lung contusions/lacerations, atelectasis), mediastinum (vessel dissection/rupture, bleeding, diaphragmatic rupture), chest wall (bruises, soft tissue emphysema, rib fractures), and need for pre-diagnostic tube thoracostomy. The significance level was set to P = 0.05. PATIENTS: Of a total of 33 patients (mean age: 43.5 ± 20.1 years [range 14 - 83 years]; 25-male [76 %]), seven patients (21 %) died with women being significantly more affected (P < 0.001). Mortality rate was not influenced by patient age. RESULTS: Non-survivors displayed significantly higher median lung contusion score values compared to survivors (4.0 [0 - 12] versus 1.0 [0 - 10]; P = 0.016). The following variables revealed a significant association with the mortality rate: chest wall bruises with soft tissue emphysema > 90 ° of the thoracic circumference (sensitivity [SE]: 43 %, specificity [SP]: 100 %, positive predictive value [PPV]: 100 %, negative predictive value [NPV]: 87 %, overall accuracy [OA]: 88 %; P = 0.006), rib fractures (SE: 71 %, SP: 81 %, PPW: 50 %, NPW: 91 %, OA: 79 %; P = 0.016), mediastinal haematoma (SE: 71 %, SP: 77 %, PPW: 45 %, NPW: 91 %, OA: 76 %; P = 0.027), and bilateral pneumothoraces (SE: 29 %, SP: 100 %, PPW: 100 %, NPW: 84 %, OA: 85 %; P = 0.040). CONCLUSION: Multiply injured patients with instable fractures of the thoracic spine display CT findings indicative of non-survival. Image acquisition and interpretation focusing solely on the spine should be avoided to ensure the detection of prognostic injury patterns to the lungs.

[Paraganglioma--a rare cause of mediastinal lesions]. / Das Paragangliom--seltene Ursache einer mediastinalen Raumforderung.

A 73-year-old female patient was admitted to our clinic for further clarification of a suspicious mediastinal lesion. Endosonographically, we performed a fine-needle aspiration biopsy. Clinical and radiological findings as well as cytology hardened the suspicion of a paraganglioma as being the cause of the mediastinal lesion. Finally, this diagnosis was confirmed histologically after complete surgical resection of the lesion. This case report on a mediastinal paraganglioma includes a concise summary of diagnostic procedures and therapeutic options for this rare disease.

Therapeutic mTOR inhibition in autosomal dominant polycystic kidney disease: What is the appropriate serum level?

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease, and sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been shown to significantly retard cyst expansion in animal models. The optimal therapeutic dose of sirolimus is not yet defined. Here, we report the history of a previously unknown ADPKD deceased donor whose kidneys were engrafted in two different recipients. One of the two received an immunosuppressive regimen based on sirolimus for 5 years while the other did not. After transplantation, both patients developed severe transplant cystic disease. Donor DNA sequence identified a new hypomorphic mutation in PKD1. The rate of cyst growth was identical in the two patients regardless of the treatment. While sirolimus treatment reduced the activation of mTOR in peripheral blood mononuclear cells, it failed to prevent mTOR activation in kidney tubular cells, this could account for the inefficiency of treatment on cyst growth. Together, our results suggest that the dose of sirolimus required to inhibit mTOR varies according to the tissue.

Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients.

Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

[Assessment of pedicle screws following dorsal instrumentation of the spine: a comparison of conventional radiographs with multidetector CT]. / Lagebeurteilung transpedikulA currencyrer Schrauben nach dorsaler Spondylodese mittels konventioneller RA paragraph signntgenaufnahmen: ein Vergleich zur Mehrzeilen-Computertomografie.

PURPOSE: To evaluate the performance of conventional radiographs (CR) for the assessment of pedicle screws in comparison with CT including MPR. MATERIALS AND METHODS: Comparison of CR and CT for the evaluation of screw length, extracorporal perforation (grade A: 0 - 2 mm, B: 3 - 4 mm, C: 5 - 6 mm, D: > 6 mm, relevant: grade C and D), screw contact/loosening, and subjective image quality (1: excellent to 4: non-diagnostic). The sensitivity (SE), specificity (SP), positive (PPV) and negative predictive value (NPV), and overall accuracy (OA) were calculated with 4x4 contingency tables. The subjective image quality was evaluated using the Wilcoxon test (p < 0.05). RESULTS: 411 screws were evaluated. The relevant medial perforation was diagnosed with CR/CT in 53(13 %)/ 11(3 %) screws, while the relevant lateral perforation was found in 3(1 %)/ 43(11 %) screws. Pedicle screw contact was diagnosed by CR/CT in 10(2 %)/ 18(4 %) cases and incorrect length was confirmed in 80(20 %)/ 90(22 %) screws. A diagnosis of loosening was established in 10(2 %) screws by CR and in 7(2 %) screws by MDCT. In summary, CR demonstrated SE, SP, PPV, NPV, and OA for the following variables: relevant medial perforation = 64 / 89 / 13 / 99 / 88 %, relevant lateral perforation = 4 / 99 / 67 / 90 / 90 %, screw contact = 11 / 98 / 20 / 96 / 94 %, incorrect screw length = 86 / 58 / 89 / 51 / 81 %, and screw loosening = 71 %/ 99 %/ 50 %/ 100 %/ 98 %. The subjective image quality of CR was significantly lower compared to CT (2.19 A + or - 0.84 and 1.11 A + or - 0.31; p < 0.001). CONCLUSION: CR evaluation of pedicle screws following dorsal instrumentation of the spine demonstrated an OA < or = 90 % for relevant medial and lateral perforation and for incorrect screw length compared to CT. Thus, reliable evaluation of pedicle screws based solely on CR does not seem feasible.

[Structure of the meeting of the german radiological society and scientific discourse pertaining to radiation dose and dose reduction: an analysis of 1998 - 2008]. / Die Struktur des Deutschen Röntgenkongresses und die wissenschaftliche Behandlung der Themen Strahlendosis und Dosisreduktion: eine Analyse der Jahre 1998 - 2008.

PURPOSE: Evaluation of the emphasis of themes pertaining to radiation dose and dose reduction at the Meeting of the German Radiological Society from 1998 - 2008 in comparison to international data. MATERIALS AND METHODS: Retrospective analysis of 9440 abstracts with documentation of study presentation character, type of imaging, and examined body region. Abstracts stating radiation dose or primarily dealing with radiation dose/dose reduction were documented. Results were compared with a Pubmed query. RESULTS: The percentage of purely scientific presentations sank in the observation period from 88 to 66 %. While contributions dealing with MRI sank from 48 to 34 %, those dealing with CT rose from 30 to 34 %. The percentage of abstracts dealing with radiation dose rose from 7 to 10 %, while that of work primarily pertaining to dose/dose reduction grew from 4 to 6 % and 2 to 4 %, respectively. Of all abstracts concerning CT, 15 % touched on radiation dose, while 9 % and 6 % primarily dealt with dose and dose reduction. The respective numbers for cardiac CT, whose relative share of all CT abstracts rose from 3 % in 1998 to 12 % in 2008, were 10 %, 7 %, and 5 %. An online query produced 137,791 publications on CT, and 2 % of these abstracts mentioned radiation dose and 0.5 % mentioned dose reduction. CONCLUSION: The number of presentations dealing with dose at the Meeting of the German Radiological Society has risen with time and is higher than the international number. On the other hand, > 90 % of all presentations and > 85 % of all CT abstracts do not mention radiation dose. In light of increasing public concern relating to radiation exposure, more intensive research of these themes is warranted.