[Coronary angiography and change in antioxidative status]. / Koronarangiographie und Veränderung des antioxidativen Status.

PATIENTS AND METHODS: In a prospective study in 53 patients with stable angina pectoris symptoms the antioxidant status (glutathione peroxidase, glutathione, superoxid dismutase, malondialdehyde and selenium in serum and whole blood) was determined before and 4 to 6 hours after coronary angiography. According to the results of the coronary angiography the patients were classified in a group with "severe" (n = 16) and another with "moderate" coronary alterations. RESULTS: In both groups there was a significant reduction of selenium in serum and whole blood. The enzymes glutathione peroxidase and superoxide dismutase as well as glutathione and malondialdehyde changed only slightly. CONCLUSION: These results can be the cause of an increase of the formation of free radicals during coronary reperfusion (PTCA, implantation of stents in the group with "severe" coronary alterations) but could also be seen as a sign of formation of radicals by the method itself (in patients with "moderate" coronary alterations). Further investigations are indicated. Furthermore the amelioration of the antioxidant status of the organism by scavenger substances (vitamins A, B, C and selenium) should be discussed.

[Experimental and clinical studies on the relevance of proton spin tomography in patients with coxarthrosis]. / Experimentelle und klinische Untersuchungen zur Bedeutung der Kernspintomographie bei Patienten mit Coxarthrose.

We examined 2 in formalin fixed hip specimens from a corpse, 27 patients with coxarthrosis and 3 healthy young volunteers with MRT concerning the illustration of the hip joint and pathological changes by coxarthrosis. Specimen of the femoral head after endoprosthetic operation could be achieved in 18 cases for comparison with MRT. All pathological alterations as cartilage alterations, sclerosis, cysts, effusion, edema, fibrosis were figured with high sensitivity. Cartilage was figured much better by gradient echo sequence with short echo time than by spin echo sequence. Gradient echo sequence made it possible to figure and quantify thinning of cartilage with high sensitivity. Both sequences showed artefacts because of the chemical shift in the area of the cartilage-bone boundary, which impaired especially the judgement of cartilage by spin echo sequence. Gradient echo sequence allowed because of the phase-contrast effect the distinction of hematopoietic and fatty bone marrow and possibly the delineation of bone marrow edema.

MR mammographic localization. Work in progress.

The authors present phantom test results for a stereotaxic device that may permit simple, rapid, and accurate needle biopsy and localization of breast lesions detected at contrast material-enhanced magnetic resonance (MR) mammography. The mechanical accuracy of this prototype MR breast localizer is approximately plus or minus 3.5 mm at 5 cm.

Identification of the 408 valine to methionine mutation in the low density lipoprotein receptor in a German family with familial hypercholesterolemia.

Familial hypercholesterolemia (FH) is caused by different mutations in the gene encoding the low density lipoprotein receptor (LDLR). In Caucasian patients, at least three single point mutations have been identified causing FH. The asparagine206 to glutamine, and valine408 to methionine mutations were originally described in Afrikaners and recently identified in Dutch FH patients. The proline664 to leucine mutations was previously identified in an FH homozygote of Asian Indian origin and later identified in patients from London. Any of these mutations can be identified using direct amplification of genomic DNA by the polymerase chain reaction (PCR) and restriction enzyme digestion of PCR products. In this study, 100 unrelated German FH patients were screened for these three mutations. The valine408 to methionine mutation was identified in one individual and subsequently in the hypercholesterolemic child of the proband. Haplotype analysis with 7 restriction fragment length polymorphisms (RFLPs) revealed that the mutant allele carried the same haplotype as the previously described patients in South Africa and the Netherlands. Our finding supports the previous assumption of the European origin of the mutation.

Identification of a 76-year-old patient with compound heterozygous familial hypercholesterolemia by haplotype analysis of the LDL receptor gene.

In a large family with clinical characteristics of heterozygous familial hypercholesterolemia (FH) seven restriction fragment length polymorphisms (RFLP) were used to determine low-density-lipoprotein receptor (LDLR) gene haplotypes. Following the inheritance of the LDL receptor genes characterized by their seven RFLP haplotypes, two different alleles were found to cosegregate with elevated cholesterol levels within this family. In a 76-year-old man both alleles identified as defective were present, thus classifying this individual as heterozygous compound for FH. In five heterozygous family members one allele was associated with 38% higher cholesterol levels when compared to the other mutant allele in two heterozygous family members. Cosegregation of hypercholesterolemia with the apolipoprotein B (apoB) gene and apolipoprotein E (apoE) gene was excluded by genotyping all individuals for the apoB XbaI RFLP and apoE polymorphisms. These findings are consistent with variable phenotypic expression of the mutant LDLR gene alleles.

[Nuclear magnetic resonance tomography of meniscus lesions]. / Kernspintomographie von Meniskusläsionen.

In magnetic resonance imaging (MR) the use of suitable surface coils combined with high resolution makes it possible to obtain differentiated information on the condition of the menisci. In particular, the course and extent of cracks, degenerative changes, and the attachment zones of the menisci can be assessed. This paper describes MR and clinical findings in 58 patients and compares them with those in seven healthy subjects.

[Meniscus imaging in MR tomography using surface coils. Anatomy, areas of degeneration, laceration formation]. / Meniskusdarstellung in der MR-Tomographie mit Oberflächenspulen. Anatomie, Degenerationszonen, Rissbildungen.

High resolution MR imaging using surface coils and thin-section techniques provides specific information when evaluating meniscal diseases. Extension and localisation of meniscal tears can be demonstrated as well as meniscal attachment areas. Diagnosis of degenerative changes is possible. We examined 7 healthy volunteers and 58 patients with suspected knee injuries. This study was done to discuss the use of MRI in the evaluation of meniscal diseases.

Angiography of histopathologic variants of synovial sarcoma.

Synovial sarcomas are rare soft tissue tumors which histopathologically can be divided into monophasic, biphasic and mixed variants. As part of a protocol for intra-arterial chemotherapy 12 patients with biopsy proven synovial sarcoma underwent angiography. The angiograms on these patients were reviewed to determine whether synovial sarcomas and their variants demonstrated a characteristic angiographic appearance. Synovial sarcomas appeared angiographically as soft tissue masses which showed a fine network of tumor vessels with an inhomogeneous capillary blush. Their degree of vascularity varied according to their histopathology. Monophasic synovial sarcomas demonstrated in general a higher degree of neovascularity than the biphasic form. This finding was also suggested by histopathologic analysis of the vessels in the tumor. Although angiography did not show a distinctive vascular pattern it may be useful to evaluate tumor size and vascularity.

Multiple endocrine neoplasia type I. A case report.

A case of multiple endocrine neoplasia (Men) consisting of an unusual combination of an insulin-producing islet cell tumour and an adrenal adenoma is reported. CT clearly demonstrated the adrenal mass whereas the pancreatic lesion remained questionable. Conversely angiography located the pancreatic tumour but the adrenal findings were subtle.

[Computerized tomography in endocrine ophthalmopathy with malignant exophthalmos]. / Computertomographie bei endokriner Ophthalmopathie mit malignem Exophthalmus.

CT scanning was done in 16 patients with deterioration of sight in endocrine ophthalmopathy. The assessment involved muscular changes and density of retrobulbar fat. Evaluation of muscular changes was staged. In addition, exophthalmus was graded and evaluated by staging. More than two thirds of patients showed pronounced muscular thickening whereas the remaining patients showed few or no muscular changes. Likewise, in a number of patients exophthalmus could hardly be demonstrated according to Hertel's values. Thus, clinical presentation in a number of patients is relatively mild. Pathophysiologic considerations as to the development of deterioration of sight mainly involve myogenic compression of the optic nerve at its orbital entry. This does not seem to hold true for patients without muscular thickening. In such patients optic nerve affection could be caused by increase of the volume of the fat body.

Radiology and pathology of malignant fibrous histiocytomas of the soft tissues: a report of ten cases.

Malignant fibrous histiocytomas (MFH) are believed to originate from histiocytes and are composed of malignant cells with spindle or round shapes. We evaluated ten MFH of the soft tissues by plain roentgenograms, computed tomography (CT), and angiography and subdivided them into four grades of anaplasia and five predominant histologic variants. The variants of MFH demonstrated different vascular patterns. The extension of the lesions could be determined by CT and angiography. CT is the method of choice in the assessment of size and extent of MFH of the soft tissues. When intra-arterial chemotherapy is indicated the angiograms obtained at each catheter placement may substitute CT in follow-up studies obviating additional diagnostic procedures.

[Computer tomography in drusen of the optic papilla]. / Computertomographie bei Drusenpapillen.

Drusen (astrocytic hamartoma) of the optic nerve are a rare eye disease produced by ocular calcification (inclusions containing calcium) at the optic disc surface. These drusen can lead to eye complaints as they grow bigger; in particular, they can cause loss of vision and can also limit the visual field. Ophthalmologically, they are characterised by an indistinct optic disc and/or ectasia of the optic disc which is sometimes combined with a poorly defined optic disc margin. Differential diagnosis must take into consideration the presence of space-occupying intracranial processes. The final diagnosis can be made via computerised tomography on the basis of a characteristic calcification pattern. Hence, the radiologist must be familiar with the disease pattern and must be able to differentiate this against other types of intraocular calcifications.

[Radiotherapy in endocrine ophthalmopathy--evaluation of 56 cases]. / Strahlentherapie der endokrinen Ophthalmopathie--Auswertung von 56 Fällen.

The authors present the radiotherapeutic results achieved in 56 patients with endocrine ophthalmopathy, 15 out of them with severe, so-called malignant course. All patients were irradiated conventionally with small doses between 3 and 10 Gy at the surface. For this purpose, a deep therapy unit with 250 kV was used. The X-ray irradiation produced an improvement in 62% of the cases; the separate evaluation of cases with malignant course showed an improvement in nine cases. Thus the results produced by this method are as good as those of high doses, the greater possibilities in case of recurrence, however, are to be considered as an advantage. The irradiation should be applied early, and the simultaneous administration of a cortisone preparation is preferred by our team.

[Dose distribution during irradiation of the retrobulbar space--results of measurements on a phantom]. / Die Dosisverteilung bei Bestrahlung des Retrobulbärraumes--Messergebnisse am Phantom.

The transverse dose distribution in case of X-ray and cobalt irradiation of the retrobulbar space was measured in a water phantom. As expected, the crystalline lens receives a smaller dose by cobalt irradiation with lead shielding in front of the eye than by X-irradiation. In case of cobalt irradiation, the dorsal portions lying within the hypophyseal region can only be sufficiently protected by a special block cast by us in a divergent form and surrounding the irradiation field. If X-ray irradiation is performed with a field size of 2 X 4 cm2, the 50% isodose encloses just the complete retrobulbar space. Taking into consideration a second contralateral field, the crystalline lens is exposed to less than 10% of the maximum dose. Thus the doses applied usually in radiotherapy of endocrine ophthalmopathy, i.e. 15 to 20 Gy, lead to an unproblematic crystalline lens exposure of 150 to 200 rad.

[Computer tomography of esthesioneuroblastoma]. / Computertomographie bei Asthesioneuroblastomen.

Aesthesioneuroblastomas are rare malignant nasal tumours of neural origin. Clinical symptoms depend upon the extent of the lesion. Five cases of tomography visualised the tumours as non-homogeneous soft tissue masses in the nasal cavity and the ethmoid cells with a varying infiltration of the adjacent paranasal sinuses. Radical surgery and radiation therapy are recommended. CT should be an integral part of annual follow-up studies.

Angiography in soft tissue sarcomas.

Angiography was performed in 41 patients with histologically proven soft tissue sarcomas that included tumors derived from a variety of cell types and locations. The leiomyosarcomas and sarcomas of uncertain or mixed origin showed extensive neovascularity. Liposarcomas, synovial cell sarcomas, and fibrous histiocytic sarcomas were moderately vascularized. Sarcomas originating from vascular, fibrous, neural, and osseous tissues had variable degrees of vascularity. In nearly all of the cases studied, angiography revealed tumor size, extent, source, and degree of vascularity and helped to determine the degree of malignancy. While angiography does not provide a histologic diagnosis, it plays an important role in patient management when a conservative therapy plan that uses several modalities is followed.