Measuring Ventricular Width on Cranial Computed Tomography: Feasibility of Dose Reduction in a Custom-Made Adult Phantom.

PURPOSE: To estimate feasible dose reduction to reliably measure ventricular width in adults with hydrocephalus in follow-up cranial computed tomography (CCT) using a custom-made phantom. MATERIALS AND METHODS: A gelatine-filled adult calvarium with embedded central fibers of two carrots representing the lateral ventricles was used as a phantom. The phantom was scanned 11 times with two CT scanners (LightSpeed Ultra, GE and Somatom Sensation, Siemens), using tube currents of 380/400, 350, 300, 250, 200, 150 and 100 mA, and tube voltages of 140, 120, 100 and 80 kV. The width of the carrots was measured at four sites in consensus decision of two principle investigators blinded to the scan parameters. Values measured at 380/400 mA and 140 kV served as a reference for the width of the ventricles. Measurements received 1 point if they did not differ more than 0.5 mm from the reference values. A maximum score of 4 could be achieved. RESULTS: The relationship between the correct width measurement of the carrots (lateral ventricles) and the radiation dose can be described by a quadratic regression function. Pixel noise increases and accuracy of measurements decreases with a lower radiation dose. Starting from a tube current of 380/400 mA and a tube voltage of 140 kV, the dose can be reduced by 76 % for LightSpeed Ultra and by 80 % for Somatom Sensation provided that a margin of error of 37.5 % (score = 2.5) for correct width measurement of the carrots is accepted. CONCLUSION: Lowering the radiation dose by up to 48 % for LightSpeed Ultra and by 52 % for Somatom Sensation, compared to the standard protocol (120 kV and 400 mA) still allowed reliable measurements of ventricular widths in this model. KEY POINTS: • There is a quadratic relationship between correct width measurements of lateral ventricles and radiation dose in CT. • Reduction of radiation dose results in increased pixel noise and increased error for correct ventricle width measurement. • Due to a considerable attenuation difference between cerebrospinal fluid and brain parenchyma, a dose reduction for the determination of ventricular size in CT seems feasible and should be performed.

Aceruloplasminaemia: a family with a novel mutation and long-term therapy with deferasirox.

Ceruloplasmin is a member of the multicopper oxidase family that plays a major role in the transport of iron in the body. Aceruloplasminaemia (ACP) is a rare disease and is clinically identified by iron overload in liver, pancreas, brain, and other organs, and by microcytic anaemia. So far, the iron chelator deferasirox was given for therapy only up to 6 months due to side effects. Here, we describe a novel mutation leading to ACP and report for the first time a long-term therapy, that is, 2 years with deferasirox. ACP was diagnosed in 3 siblings using clinical and biochemical characteristics, HFE and ceruloplasmin mutational analysis, liver biopsy, brain-, liver-, and heart-MRI. For iron depletion, a starting dose of deferasirox 7.5 mg/kg/day was increased to 15 mg/kg/day and maintained at 4-7.5 mg/kg/day with a patient follow-up for 2 years. A novel homozygous mutation of the ceruloplasmin gene on chromosome 3 (3q23-q25, exon 12, G708S) was found. Iron was selectively and successfully removed by long-term therapy with deferasirox, as confirmed by follow-up liver biopsies, normalisation of serum ferritin concentrations, and improved glucose metabolism. Unexpectedly, iron depletion ameliorated anaemia. Low-dose deferasirox is an effective and safe long-term treatment option for patients with ACP.

Polyelectrolyte multilayers generated in a microfluidic device with pH gradients direct adhesion and movement of cells.

In this study, multilayers from polyethylene imine, heparin and chitosan are prepared at three different pH values of 5, 7 and 9. Water contact angle and quartz microbalance measurements show that resulting multilayers differ in terms of wetting behaviour, layer mass and mechanical properties. The multilayer is then formed within a gradient generation microfluidic (µFL) device. Polyethylene imine or heparin solutions of pH 5 are introduced into one inlet and the same solutions but at pH 9 into another inlet of the µFL device. The pH gradient established during the multilayer formation can be visualized inside the microchamber by pH sensitive fluorophores and confocal laser scanning microscopy. From this setup it is expected that properties of multilayers displayed at distinct pH values can be realised in a gradient manner inside the µFL device. Behaviour of the osteoblast cell line MG-63 seeded and cultured on top of multilayers created inside the µFL device support this hypothesis. It is observed that more cells adhere and spread on multilayers build-up at the basic side of the µFL channel, while those cells on top of multilayers built at pH 5 are fewer and smaller. These results are consistent with the behaviour of MG-63 cells seeded on multilayers formed at discrete pH values. It is particularly interesting to see that cells start to migrate from multilayers built at pH 5 to those built at pH 9 during 6 h of culture. Overall, the presented multilayer formation setup applying pH gradients leads to surfaces that promote migration of cells.

Estimation of the minimum dose required to measure ventricular width in follow-up cranial computed tomography (CCT) in children with hydrocephalus.

PURPOSE: To estimate the minimum dose needed at follow-up cranial computed tomography (CCT) to reliably determine ventricular width in children with hydrocephalus. MATERIALS AND METHODS: For the study, a phantom was created using the calvarium of an infant which was filled with gelatin and the shaped inner cones of two carrots serving as lateral ventricles. The phantom was scanned ten times with two multi-slice CTs (LightSpeed Ultra, GE, and Somatom Sensation, Siemens), using a tube current of 400, 350, 300, 250, 200, 150, and 100 mA, and a tube voltage of 140, 120, 100, and 80 kV. The width of both lateral ventricles was measured at 4 sites. The values derived from scans performed at 380/400 mA and 140 kV (LightSpeed/Somatom) served as a reference. Measurements scored 1 point if they did not differ by more than 0.5 mm from the reference values. RESULTS: The radiation dose can be reduced from 61.0 mGy to 9.2 mGy (15.1%) with LightSpeed and from 55.0 mGy to 8.0 mGy (14.6%) with Somatom without impairing the reliability of ventricular width measurements. However, in the case of both scanners, certain combinations of tube voltage and current yielded less reliable measurements although the dose was higher and the pixel noise was lower. CONCLUSION: There is no single cut-off dose or setting for tube voltage and current which guarantees reliable ventricular width measurements with the least radiation exposure for both scanners. As a guideline, it is safe to use the standard protocols with a reduced tube current of 100 kV.

Endovascular brachytherapy with (192)Ir and (188)Re to treat de novo and recurrent infrainguinal restenoses.

We present a review of the literature on endovascular brachytherapy (EVBT) after percutaneous transluminal angioplasty (PTA) in the femoropopliteal and tibial arteries. The pathophysiological changes induced by PTA and EVBT within the vessel wall, technical considerations regarding 192Ir and 188Re, the results of clinical trials, and the medication required before, during, and after EVBT are summarized.

Improvement of the quality of life concerning the health of patients with peripheral arterial disease (PAD) after successful bypass surgery.

BACKGROUND: To test whether quality of life depends on the psyche of patients after successful bypass surgery for peripheral arterial disease (PAD). PATIENTS AND METHODS: A total of 74 consecutive patients aged 36-69 years (57.7 +/- 8.8 years) with symptomatic PAD in the stages Fontaine IIb-IV were enrolled in a prospective study after successful bypass surgery. Because of bypass failure and one death during the study period, 11 of these patients were excluded from evaluation. Prior to surgery, Doppler sonography and digital subtraction angiography were carried out in all patients. Before and after revascularization, the ankle / brachial index (ABI) was determined in all study objects and the pain free walking distance (PFWD) in those with PAD stage Fontaine IIb. Health-related quality of life was measured by using the "Medical Outcomes Study Group Short Form 36" (SF-36), and personality was determined by employing the Psycho-Diagnostic-Test (PDT). RESULTS: After surgery, there was an increase in ABI from 0.32 +/- 0.13 to 0.79 +/- 0.19 (p < .01), in PFWD from 42.6 m +/- 38.6 m to 419.7 m +/- 152.3 m (p < .01), and in the SF-36 scales "Physical functioning", "Bodily pain", "General health perceptions", and "Role-functioning physical" (p < .05). ABI correlated positively with "Bodily pain" (p < .01), "General health perceptions" (p < .01) and "Mental health" (p < .05). Among SF-36 and PDT-scales, "Role-functioning physical" correlated negatively with "Moodiness" / "Neuroticism" (p < .05), and "Social functioning" correlated positively with "General activity" (p < .01). CONCLUSIONS: Whether objective clinical improvement increases quality of life mainly depends on the psyche of patients: A high level of general activity favors an improved quality of life and neurotic characteristics are more likely to be a hindrance.

[Does multi-slice CT provide reliable attenuation values if measured with low slice thickness and low tube current? Results of a phantom study]. / Sind mit der Mehrschicht-Computertomografie Dichtemessungen auch bei geringer Schichtdicke und niedrigem Röhrenstrom verlässlich? Ergebnisse einer Phantomstudie.

PURPOSE: To test whether CT with low slice thickness and low tube current provides reliable attenuation measurements. MATERIALS AND METHODS: Using multi-slice CT and a phantom, we measured the attenuation values of thrombi with different proportions of erythrocytes, using a slice thickness of 1.25 mm, 2.5 mm, and 5 mm with tube currents of 200 mA, 300 mA, and 400 mA and a slice thickness of 0.625 mm with tube currents of 150 mA, 175 mA, and 200 mA. Differences in attenuation values and pixel noise between the three thrombi for tube current and slice thickness were statistically analyzed. RESULTS: The attenuation values of all thrombi increased (p<0.05) when the slice thickness decreased using a tube current of 200 mA or when the tube current decreased using a slice thickness of 1.25 mm. With higher tube currents and thicker slices, the CT values depended on the type of thrombus and the slice thickness. In slices with a thickness of 0.625 mm, the CT values decreased with the tube current in the mixed thrombus with a low proportion of erythrocytes and in the red thrombus (p<0.05). The maximal difference in mean attenuation values was 4.3 HU with a slice thickness of 0.625 mm and 2.2 HU with a slice thickness of 1.25 mm. The pixel noise increased as the slice thickness decreased (p<0.05) with the exception of the red thrombus, if reduced to 0.625 mm. The pixel noise also increased as the tube current decreased (p<0.05) except in mixed thrombi measured with 0.625 mm. The maximal difference in mean standard deviation was 1.8 HU with a slice thickness of 1.25 mm. CONCLUSION: The accuracy of attenuation values as determined by CT with low slice thickness and low tube current with a maximal difference of 4.3 HU suffices for the purposes of clinical routine. A reduction of slice thickness from 1.25 mm to 0.625 mm yields the greatest differences in CT values.

[Disease-specific Questionnaire for Quality of Life in Patients with Peripheral Arterial Occlusive Disease in the Stage of Critical Ischemia (FLeQKI): psychometric evaluation of its responsiveness and practicability (Part 2)]. / Fragebogen zur gesundheitsbezogenen Lebensqualität von Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) im Stadium kritischer Ischämie (FLeQKI): Psychometrische Bestimmung von Veränderungssensitivität und Praktikabilität (Teil 2).

PURPOSE: To test the "Questionnaire for Life Quality in Patients with Peripheral Arterial Occlusive Disease at the Stage of Critical Ischemia" (FLeQKI) in a prospective study with respect to responsiveness and practicability. PATIENTS AND METHODS: The responsiveness of the FLeQKI for therapy-induced changes of health related quality of life was prospectively determined in 65 consecutive patients with peripheral occlusive arterial disease at the stage of critical ischemia prior to percutaneous transluminal angioplasty (PTA) or bypass operation, and 1 month and 6 months after. 40 healthy individuals who were matched for age and questioned with the FLeQKI twice within 6 months served as the control. Additionally, all patients and healthy volunteers were questioned with the "Medical Outcomes Study Group Short Form" (SF-36). In all patients, the ankle/brachial index (ABI) was measured along with each of the three interviews. To validate practicability, we measured the time needed to fill out the questionnaires and asked the patients to indicate on a visual analog scale (VAS) graduated from 0 - 10 how strenuous they found the questionnaires to be. For statistical analysis, two-sided paired t-tests were used. RESULTS: The treatment group consisted of 35 men and 30 women with an age of 75.1+/-7.0 years, and the control group was comprised of 21 men and 19 women with an age of 73.4+/-7.8 years. In the control group, none of the FLeQKI scales showed significant changes over time (p>0.05). In the pAVK group, all scales improved between the interviews before and 6 months after therapy. Changes were either significant (comorbidity, p<0.05) or highly significant (all other scales, p<0.005 or p<0.0001). ABI increased above 0.5 (p<0.05). With an average of 12 minutes, the FLeQKI required less time than the SF-36 with an average of 15.57 minutes (p<0.05). Both questionnaires were evaluated with a VAS value of less than 1 (p>0.05) as non-strenuous. CONCLUSION: Regarding responsiveness and practicability, the FLeQKI is well suited for determining the specific impairments of life quality in patients with peripheral arterial occlusive disease in the stage of critical ischemia. Compared with the SF-36, the FLeQKI reached similar or better psychometric values.

[Disease-specific Questionnaire for Quality of Life in Patients with Peripheral Arterial Occlusive Disease in the Stage of Critical Ischemia (FLeQKI)--methodical development of a specific measuring instrument and psychometric evaluation of its validity and reliability (Part 1)]. / Fragebogen zur gesundheitsbezogenen Lebensqualität von Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) im Stadium kritischer Ischämie (FLeQKI)--methodische Entwicklung eines krankheitsspezifischen Messinstruments und psychometrische Bestimmung seiner Validität und Reliabilität (Teil 1).

PURPOSE: To develop a disease-specific measuring instrument for quality of life in German-speaking patients with peripheral arterial occlusive disease in the stage of critical ischemia and to test it in a prospective study for validity and reliability. MATERIALS AND METHODS: We developed a questionnaire compiling items representing subjective disease relevant health states. With 35 of these items, we designed the scales comorbidity (KO), physical pain (SZ), physical functioning (KF), physical state (KS), social functioning (SB), mental health (PB), and therapy-induced limitations (TE). Each item was to be valued as never, seldom, often or always. The scales were standardized with a control group of 40 individuals without peripheral arterial occlusive disease who were interviewed twice in an interval of 6 months using both the FLeQKI and the Medical Outcomes Study Group Short Form 36 (SF-36). Convergent and discriminative validity was determined in 65 consecutive in-patients with peripheral occlusive arterial disease in the stage of critical ischemia who were interviewed with FLeQKI and SF-36 prior to percutaneous transluminal angioplasty (PTA) or bypass operation and 1 month and 6 months after. The internal consistency and test-retest reliability of the FLeQKI were determined in the control group. For statistical analysis, Cronbach's alpha Test and Pearsons Product Moment Correlation were used. RESULTS: The control group consisted of 21 men and 19 women with an age of 73.4+/-7.8, and the treatment group was comprised of 35 men and 30 women with an age of 75.1+/-7.0. In the treatment group, convergent validity reached high values in the scales SB, KF, PB, and SZ (r=0.41-0.70). With their discriminative validity (r=-0.04-0.30), TE and KS were independent, specific dimensions of life quality. The control group showed good values for internal consistency (Cronbach's alpha=0.54-0.93) and for test-retest reliability (r=0.44-0.96). CONCLUSION: The FLeQKI is well suited for determining the specific impairments of life quality in patients with peripheral arterial occlusive disease at the stage of critical ischemia. Its psychometric scores for validity and reliability corresponded to those of the SF-36.

[Do ultrasound-guided core needle biopsies of lymph nodes allow for subclassification of malignant lymphomas?]. / Ist mittels sonografisch gesteuerter Lymphknoten-Stanzbiopsien die Subtypisierung maligner Lymphome möglich?

PURPOSE: We examined how often ultrasound-guided core needle biopsies of lymph nodes yield subclassification of malignant lymphoma according to World Health Organization (WHO) criteria and help to avoid excisional biopsies. MATERIALS AND METHODS: The prospective study included 124 consecutive patients in whom 126 core needle biopsies of lymph nodes were performed to diagnose or rule out malignant lymphoma. If possible, we obtained 5 cylinders with a 14-gauge (G) needle. The pathologists of our institution, partly in cooperation with a lymphoma registry, decided whether a core needle biopsy was sufficient for subclassification or an excisional biopsy was necessary. RESULTS: 95 of the 126 core needle biopsies (76.6 %) were performed with a 14-G needle. In 101 biopsies (80.2 %), we obtained at least 5 cylinders. In 120 of the 126 core needle biopsies (95 %), malignant lymphoma was diagnosed and subclassified or ruled out. Of the 64 lymphoma, 60 (94 %) were subclassified. Among them were 41 (93 %) of the 44 primary lymphomas and 19 (95 %) of the 20 recurrent lymphomas. In 5 of 126 cases (4 %), an excisional biopsy was necessary. CONCLUSION: With ultrasound-guided core needle biopsy of lymph nodes, lymphoma can be reliably diagnosed and subclassified if preferably 5 cores are obtained with 14-G needles. Excisional biopsy is rarely necessary if core needle biopsy is inconclusive.

[Incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in the treatment of peripheral arterial occlusive disease in a German referral center 1996-2003]. / Inzidenzen von Major-Amputationen, Bypass-Operationen und perkutanen transluminalen Angioplastien (PTA) zur Behandlung der peripheren arteriellen Verschlusskrankheit in einer deutschen Klinik der Maximalversorgung 1996-2003.

PURPOSE: To determine the current incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in a study population of patients with peripheral arterial occlusive disease in a German referral center. MATERIALS AND METHODS: In a retrospective study, we recruited patients with peripheral arterial occlusive disease who underwent an amputation, bypass procedure, or PTA in the region of the pelvis or lower limbs between 1996 and 2003 at the Augsburg Medical Center. Patients were identified via the hospital database. This was performed with the help of the International Classification of Diseases (ICD 9 and 10), the operation code (OPS), and appropriate invoices. The incidence of PTAs was further estimated with 200 charts. RESULTS: Of 5379 patients, 627 underwent amputation, 1832 a bypass procedure, and 2920 a PTA. The incidence of PTAs increased during the study period from 51.3/100 000/year to 64.4/100 000/year (p < 0.01), while the number of amputations and bypass procedures remained stable. The incidence of PTAs was exceeded by that of bypass procedures only in patients older than 85 years. The age of the amputees decreased during the study period from 72.2 to 70.5 years (p < 0.01). The age of patients who underwent a bypass procedure increased from 67.2 to 69.4 years, and the age of patients who underwent PTA increased from 66.3 to 69.8 years (p < 0.01). Bypass procedures and PTAs were performed in men 6.3 years earlier than in women (p < 0.01). CONCLUSION: The result is a population-corrected need of 8.4/100 000/year major amputations, 23/100 000/year bypass procedures and 64.4/100 000/year PTAs for patients with peripheral arterial occlusive disease within the referral area of our hospital. The performance of major amputations and bypass procedures stagnates, while the incidence of PTAs is increasing.

Evaluation of a new Spin-echo diffusion-weighted sequence on a 0.35 T open magnetic resonance imaging (MRI)-system: first experiences within 3 h after acute stroke.

In acute stroke, diffusion-weighted magnetic resonance imaging helps to select patients who are eligible for thrombolysis, but is almost exclusively implemented on closed-bore scanners, which make monitoring of patients difficult. We developed and tested a cardiac gated Spin-echo diffusion-weighted sequence with prescan finetrim and motion correction on an open system with 0.35 T. Nineteen stroke patients appropriate for thrombolytic therapy by clinical criteria were enrolled in a prospective study on an intention-to-treat basis. In all but one patient, computed tomography and magnetic resonance imaging including the new diffusion-weighted sequence were performed within 3 h after symptom onset. Images were evaluated for acute cerebral ischemia and hemorrhage by two radiologists blinded to clinical information. Magnetic resonance imaging required a mean total acquisition time of 26 min. Sensitivity for early infarction was 94% in diffusion-weighted imaging and 73% in computed tomography. Six patients were excluded from thrombolysis due to an infarct size of more than 1/3 of the territory of the middle cerebral artery exclusively diagnosed with diffusion-weighted imaging. Hemorrhage was recognised by both, magnetic resonance imaging and computed tomography. We conclude that in acute stroke, diffusion-weighted imaging with an open system at 0.35 T is practicable. The implemented sequence reliably demonstrated the size of the infarction and improved the selection of patients who are eligible for thrombolysis.

[Comparison of contrast-enhanced low mechanical index (Low MI) sonography and unenhanced B-mode sonography for the differentiation between synovitis and joint effusion in patients with rheumatoid arthritis]. / Vergleich von kontrastmittelunterstützter Low-Mechanical-Index(Low-MI)-Sonographie und nativer B-Mode-Sonographie bei der Differenzierung von Synovitis und Gelenkerguss bei Patienten mit rheumatoider Arthritis.

PURPOSE: To test whether contrast-enhanced low mechanical index (low MI) sonography is superior to non enhanced B-Mode sonography in differentiating synovitis and joint effusion. MATERIAL AND METHODS: In a retrospective study, 22 patients with proven rheumatoid arthritis underwent B-Mode sonography and low-MI sonography of 25 symptomatic joints of the upper and lower limbs. For low-MI sonography, 5 ml Sonovue (Bracco Altana Pharma GmbH, Konstanz) were injected as an intravenous bolus followed by 10 ml of 0.9 % saline solution. Magnetic resonance imaging (MRI) was obtained additionally in 3 joints. With non-enhanced sonography, we diagnosed a synovitis in case of an echogenic and a joint effusion in case of an anechoic mass. With contrast-enhanced sonography, we diagnosed a synovitis in case of enhancement and a joint effusion in the absence of enhancement of the intraarticular mass. RESULTS: In 13 joints, synovitis and joint effusion were differentiated by both non-enhanced and enhanced sonography. In 12 joints, this differentiation was only possible with contrast-enhanced sonography. In 3 patients diagnosed by sonography as having a synovitis, this diagnosis was proven by MRI. CONCLUSION: Contrast-enhanced low-MI sonography is superior to non-enhanced B-Mode sonography in differentiating synovitis and joint effusion.

[Does the result of thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in rabbits depend on the erythrocyte- and fibrin-content of a thrombus?]. / Hängt das Ergebnis einer Thrombolyse mit rekombinantem Gewebe-Plasminogenaktivator (rt-PA) beim Kaninchen vom Erythrozyten- und Fibringehalt eines Thrombus ab?

PURPOSE: It is known from autopsy studies that thromboembolic stroke can be caused by red, white and mixed clots. We therefore examined whether the efficacy of thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) depends on the proportions of fibrin and erythrocytes within thromboembolic material. METHODS: In 23 rabbits intraarterial thrombolysis with 3 mg rt-PA/kg body weight was started 30 minutes after middle cerebral artery occlusion with either red or white autologous emboli 20 hours old. 20 rabbits served as control. Cerebral perfusion was monitored by MRI. RESULTS: rt-PA enhanced lysis of red but not of white emboli and decreased the infarct volume only if vascular occlusion was due to red emboli (p <.01). Cerebral perfusion improved only in the red treatment group where the normalized first moment (NFM) decreased (p <.05) and the relative regional cerebral blood volume (rrCBV) reached normal values (p <.05). CONCLUSION: We suggest that in our animal model the efficacy of thrombolysis increases with the proportion of erythrocytes within thromboembolic material and decreases with its content of fibrin. lf these findings would also be applicable to patients, pretherapeutic estimation of the efficacy of thrombolysis might become feasible because the CT values of red and white thrombi differ.

Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study.

Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism and cerebellar, autonomic, urinary, and/or pyramidal dysfunction. Urinary and erectile dysfunction (ED) symptoms are prominent early features in men with MSA. Autonomic failure, considered until recently to be the cause of ED in these men, is commonly expressed through symptoms of orthostatic hypotension (OH). The aim of this retrospective study is to examine the chronological relationship between the development of urogenital symptoms and those of OH in patients diagnosed with MSA and discuss its significance in the aetiology of ED in these patients. A total of 71 male patients, referred to a Uro-Neurology department with a diagnosis of 'probable MSA', were reviewed in terms of 'autonomic' symptoms only--OH and lower urinary tract symptoms, accompanied by ED--present at the time of their referral. Laboratory investigations including anal sphincter EMG and/or autonomic function tests (AFTs) were performed in 75 and 90% of the patients, respectively. At presentation, urinary complaints were recorded in 96% of patients and ED in all patients that this was inquired about. The onset of ED had preceded the onset of bladder symptoms in 58% and the onset of OH symptoms in 91% of these men. Bladder symptoms also preceded symptoms of OH in 76% of patients. Sphincter EMG was abnormal in 91% and AFTs in 77% of the patients tested. Almost all patients with abnormal EMG had troublesome urinary symptoms. AFTs showed similar sensitivity relating to symptoms. At presentation, urogenital symptoms are common in patients with probable MSA and are often not accompanied by symptoms of OH. The earlier occurrence of ED in men with MSA suggests a lack of a causal relationship to hypotension. The notion that MSA possibly affects the dopaminergic mechanism of erectile function is discussed.

[Focal cortical dysplasias: neuroradiological findings and differential diagnosis]. / Fokale kortikale Dysplasien: Neuroradiologische Befunde und Differenzialdiagnosen.

PURPOSE: To describe MRI findings of four types of focal cortical dysplasia (FCD) and compare them with diagnostic criteria reported in the literature. MATERIAL AND METHODS: This study includes eight patients with seizures in whom cranial MRI diagnosed an FCD, with histologic confirmation in two patients. RESULTS: In all patients, the dysplastic cortex was thickened. Its signal was hyperintense on T 2 -weighted and FLAIR images, but variable on T 1 -weighted images. Blurring of the corticomedullary junction was present in 5 patients. In one patient, MRI demonstrated vascular proliferation within the FCD. Type l or II FCD was diagnosed in six patients, and transmantle FCD and type IV FCD with capillary proliferation in one patient each. DISCUSSION: Thickening and hyperintensity of the cortex on T 2 -weighted and FLAIR images are more reliable signs of FCD than blurring of the gray matter-white matter junction and signal changes on T 1 -weighted images. Typical vascular proliferation may be detectable with MRI and suggests the diagnosis of FCD with glial proliferation. Edema, calcification, or pathologic contrast enhancement has not been observed in FCD to date.

[Is the attenuation of thromboembolic vascular occlusions a criterion for the prognosis of thrombolysis?]. / Die Röntgendichte am Ort thrombembolischer zerebraler Gefässverschlüsse: Prognostischer Faktor für eine Lysetherapie?

PURPOSE: To test whether the prognosis of systemic thrombolysis can be estimated with the attenuation values of vascular occlusions as measured with multi-slice computed tomography (MSCT). METHODS: Prior to thrombolysis with rt-PA, the attenuation values of vascular occlusions were determined with a helical MSCT using a collimation of 0.5 mm. We examined 5 patients that were 63 - 79 years old. With the help of reference values that were obtained from a phantom study we categorised the vascular occlusions according to their attenuation values as being mixed thrombi with low or high proportions of erythrocytes, or red thrombi. TOF angiographies were done before and after the thrombolytic therapy. RESULTS: The systemic therapy with rt-PA was effective in vascular occlusions that had attenuation values of red thrombi or of mixed thrombi with a high proportion of erythrocytes. The therapy showed no effect when the attenuation values matched with mixed thrombi with a low proportion of erythrocytes. Due to artefacts that were caused by beam hardening, attenuation measurements could not be performed in the posterior fossa. CONCLUSION: The presented cases are in accordance with the results of experimental studies which indicate that the efficacy of thrombolysis increases with the attenuation values of thromboembolic vascular occlusions. The predictive value of attenuation measurements by MSCT for the prognosis of systemic thrombolysis cannot be given yet.

[The value of multi-slice computed tomography for early diagnosis of focal cerebral ischemia]. / Zur Rolle der Mehrschicht-CT in der Frühdiagnostik der fokalen zerebralen Ischämie.

The aim of this survey is the characterization of the present value of multi-slice computed tomography (MSCT) for the assessment of hyperacute cerebral ischemia based on our experience and a review of the literature. MSCT is compared with single-slice CT (SSCT) as to the diagnostic value of standard cranial CT, CT angiography (CTA) and perfusion CT. CTA obtained with MSCT surpasses CTA obtained with SSCT. For perfusion CT, the value added by MSCT is small. With regard to standard cranial CT, MSCT and SSCT are considered equivalent. CTA and perfusion CT should be used in patients with acute stroke if the indication for thrombolysis is entertained but diffusion and perfusion weighted MRI cannot be carried out. This applies to both SSCT and MSCT. If advanced MRI and advanced CT are available, MRI continues to be the preferred imaging modality.