A critical survey of a dedicated craniofacial surgery outpatient's clinic within a public health service structure.

The management of craniofacial conditions, especially in the setting of a large general hospital, is ideally achieved by a focused team in a multidisciplinary clinic. The purpose of this article was to present the design, modus operandi and outcomes of a newly formed dedicated craniofacial multidisciplinary outpatients' clinic at the first year of operation endpoint within a public healthcare structure.

Cholesterol embolization syndrome following thrombolysis during acute myocardial infarction.

BACKGROUND: Cholesterol embolization syndrome (CES) is the result of atherosclerotic plaque erosion and subsequent dislodgement of cholesterol crystals from the core of the plaque to the peripheral arteries. The source of emboli is usually located in the aorta, whereas the most commonly affected organs are the skin and the kidneys. CASE REPORT: The case of a 69-year-old male with cyanotic painful discoloration of his toes following thrombolysis for acute myocardial infarction 1 month previously is presented. Both transesophageal echocardiography and magnetic resonance aortography showed a diffuse ulcerated atherosclerotic plaque in the course of descending thoracic aorta, while a skin biopsy of the cyanotic toes revealed cholesterol crystals in the lumen of the small diameter arteries. CONCLUSION: Cholesterol embolizations from the aorta are difficult to treat and may end in renal failure. Since treatment options are limited without proven efficacy, increased awareness by the clinicians is needed.

[Magnetic resonance spectroscopy for inflammatory brain diseases]. / Magnetresonanzspektroskopie bei entzündlichen Hirnerkrankungen.

Magnetic resonance spectroscopy (MRS) is a non-invasive method for investigation of cerebral metabolite concentrations in various pathologic conditions. The clinical use of MRS for intracranial disorders is well established. In this review the characteristic MRS findings for the most important inflammatory brain diseases will be discussed.

[MR spectroscopy in brain tumors]. / MR-spektroskopie bei Hirntumoren.

MRT allows the anatomical visualization of intracerebral space-occupying lesions, and when magnetic resonance spectroscopy (MRS) is used in routine clinical practice it can give more information and be helpful in the diagnosis of such lesions. In MRS with long echo times for nerve tissue there are five metabolites that are particularly significant: N-acetyl aspartate (NAA), creatine, choline, lactate, and lipids. NAA levels are lowered in the presence of intracerebral tumors. Creatine is lowered in situations of hypermetabolic metabolism and elevated in hypometabolic conditions, but remains constant in many pathologic states and can be used as a reliable reference value. With malignant tumors there are usually elevated choline concentrations, reflecting increased membrane synthesis and a higher cell turnover. The lactate level rises following a switch in metabolism from aerobic to anaerobic glycolysis, and this is frequently observed in the presence of malignant tumors. The occurrence of lipid peaks in a tumor spectrum suggests the presence of tissue necroses or metastases. There are typical constellations that are seen on MRS for individual tumors, which are discussed in detail in the present paper.