[Nonaccidental traumatic brain injury in infants and children]. / Nichtakzidentelles Schädel-Hirn-Trauma bei Säuglingen und Kleinkindern.

Violent traumatic brain injury (TBI) can cause brain dysfunction and injury. Accidental and nonaccidental trauma are still the leading cause of childhood death worldwide. It is assumed that about 20% of TBI in children under 2 years of age are nonaccidentally caused. In all cases, nonaccidental TBI is caused by the violent impact on the brain and spinal cord by the massive shaking of the child held by the upper arms or body. This can lead to a rupture of blood vessels, especially bridge veins, as well as axonal shear injuries to the nerve connections and brain swelling. Involvement of the brain stem can lead to initial short-term respiratory arrest. The resulting clinical symptoms include poor drinking, drowsiness, apathy, cerebral seizures, breathing disorders, temperature disorders, and vomiting as a result of increased intracranial pressure. Long-term disorders can include neurological and neuropsychological disorders, hearing disorders, visual disorders up to blindness, and poor school performance. In addition, there are metaphyseal fractures and rib fractures of various forms, also of different ages. Since shaking trauma has a poor prognosis, preventive measures are useful: education!

[Spontaneous craniocervical dissection]. / Spontane Dissektionen der hirnversorgenden Arterien.

Spontaneous craniocervical dissection is one of the main causes of stroke in juvenile and middle-aged patients. It is caused by intramural hematoma which may result in stenosis or even occlusion of the artery. Clinical manifestation varies from local pain to ischemic complications. The imaging modality of choice is magnetic resonance imaging (MRI) which is able to detect all characteristic signs of dissection. Intramural hematoma is detected with thin slice fat-saturated 3D black-blood images. However, with the use of special imaging techniques, questionable findings can be clarified and especially the more difficult to detect intradural dissection can be accurately diagnosed. Acute treatment depends on the severity of neurological symptoms and their duration. Factors like the location of the dissection, cerebral infarction or hemorrhage influence the choice of medication for primary and secondary prophylaxis. Resorption of the intramural hematoma often leads to spontaneous recanalization within a few months.

[COVID-19: neurological manifestations-update : What we know so far]. / COVID-19: neurologische Manifestationen ­ Update : Was wir bisher wissen.

Beyond pulmonary presentation, COVID-19 infection can manifest with a variety of both acute and chronic neurologic and neuropsychiatric (concomitant) symptoms and diseases. Nonspecific symptoms such as headache, fatigue, olfactory and gustatory disturbance have been reported more frequently, and severe disease such as encephalopathy, encephalitis, and cerebrovascular events have been reported relatively rarely. The heterogeneity of neurologic and neuropsychiatric presentations is large, as well as the range of recorded prevalences. Older patients, pre-existing neurologic and non neurologic comorbidities and severe COVID-19 disease were associated with increased risk of severe neurologic complications and higher in-hospital mortality. Probable neurotropic pathomechanisms of SARS-CoV­2 have been discussed, but a multifactorial genesis of neurologic/neuropsychiatric symptoms and disease beyond these is likely.

A rare case of raoultella planticola peritonitis in a chronic ambulatory peritoneal dialysis patient and review of the literature.

Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.

Brain death confirmation.

The number of patients waiting for a new organ has continuously decreased in recent years. Brain death confirmation plays an important role in the clinical routine concerning a possible organ transplantation. In many countries a strictly defined protocol prescribes the required neurological examination and ancillary test criteria. Therefore, many years of experience and expertise is absolutely necessary for neurologists and neuroradiologists. Pitfalls can sometimes be very challenging for the treating physicians.

Evaluation of two different CAD-CAM inlay-onlays in a split-mouth study: 2-year clinical follow-up.

OBJECTIVE: To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period. CLINICAL CONSIDERATIONS: A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years. CONCLUSION: Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations. CLINICAL SIGNIFICANCE: The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

The role of miRNAs targeting K-ras and APC genes in colorectal cancer.

OBJECTIVES: The occurrence of abnormal expression patterns in different types of cancer suggests that micro RNAs (miRNAs) may play an important role in tumorigenesis. The aim of this study was to examine the expression levels of miRNAs known to be associated with the regulation of the expression levels of the APC and K-ras, which are important in the development of colorectal cancer (CRC). METHODS: The expression levels of miR-27, miR-663, miR-217, miR-181d, APC and K-ras in the serum, tumor and adjacent tumor-free (healthy) tissues of the patients and serum of the healthy controls were investigated with qRT-PCR. RESULTS: Expression levels of miR-217, mR-181d, miR-663, miR-27 and K-ras were found to be higher in CRC tissues than in adjacent tumor-free tissues of the patients. In patient serum samples, miR-663 levels were statistically more elevated than in controls. In patient tumor tissues, miR-217, miR-181d and miR-27 expressions were found to be higher. CONCLUSIONS: Increased miR-181d and miR-217 expression levels are associated with increased K-ras expression in the tumor tissues, and the expression of K-ras, which takes part as an oncogene in the CRC development, might be regulated by these miRNAs (Tab. 4, Ref. 33).

[Differential diagnoses of ischemic stroke using imaging]. / Differenzialdiagnosen des ischämischen Schlaganfalls in der Bildgebung.

Diffusion-weighted imaging enables us to detect acute ischemic stroke early and with high sensitivity and specificity. Its signal changes are based on decreased diffusion of water molecules that is caused by cytotoxic edema. Several different neurological diseases can also cause restricted diffusion and therefore mimic stroke. These can generally be reliably distinguished from ischemic stroke based on location, morphology and signal behavior in other magnetic resonance imaging sequences.

[Anatomy of the petrous portion of the temporal bone]. / Anatomie des Felsenbeins.

CLINICAL METHOD: The complexity of the anatomy of the petrous portion of the temporal bone with the crossing nerval, vascular, and muscular structures together with the important parts of the human vestibulocochlear organ poses challenges in clinical routine, especially in the preoperative diagnostic workup. In particular, the presence of standard anatomical variations bears a higher risk of intraoperative injuries. STANDARD RADIOLOGICAL METHOD: MRI and CT examinations are important image-based diagnostic methods in the detection of neoplastic, traumatic and inflammatory lesions of the petrous part of the temporal bone. These kinds of methods are absolutely necessary for the identification of the entity of the lesion, the extent of the infiltration, possible bone involvement or the presence of standard anatomical variations.

Is there a new pathway relationship between melatonin and FEZ1 in experimental rat model of Alzheimer's disease?

Alzheimer's disease (AD) is a progressive neurodegenerative disease. This study was performed to determine the possible relationship between melatonin, which is known to play a role in the neuro-protective mechanism in AD, and fasciculation and elongation protein zeta 1 (FEZ1). Thirty male rats were included and separated into 3 groups (n = 10) as vehicle (artificial cerebrospinal fluid), streptozotocin (STZ) and STZ+melatonin (MLT). Two intracerebroventricular (icv) injections of 3 mg/kg STZ were made 48 hours apart. MLT injections were implemented for 14 days (ip; 10mg/kg/day). The Morris Water Maze (MWM) test was performed and rats were sacrificed to assess FEZ1 gene expression and protein levels from the hippocampus tissues and serum levels of noradrenaline (NA), dopamine and serotonin were determined from the blood samples. It was determined that the FEZ1/ß-actin protein ratio in the STZ group was significantly higher than that of the Vehicle group (p < 0.05) and in the MLT­administered group, the protein levels were decreased to the levels observed in the Vehicle group. Serum NA levels of STZ and STZ+MLT groups were found to be lower than those in the Vehicle group, while no difference was found regarding dopamine and serotonin levels. These findings show that reversal of increased FEZ1 levels in AD-induced rats with melatonin administration is the evidence of the effect of melatonin through FEZ1 in AD (Tab. 2, Fig. 5, Ref. 67). Keywords: FEZ1, Alzheimer's disease, melatonin, rat, microtubules, mitochondria.

[Magnetic resonance cisternography]. / Magnetresonanz-Zisternographie.

CLINICAL/METHODICAL ISSUE: Conventional MRI can be insufficient to depict certain pathologies of the cerebrospinal fluid (CSF)-filled spaces. STANDARD RADIOLOGICAL METHODS: 3-D T2-weighted sequences and phase-contrast imaging have a high sensitivity for pathologies of the CSF-filled spaces, but are susceptible to artifacts in some cases. METHODICAL INNOVATIONS/PERFORMANCE: Magnetic resonance (MR) cisternography directly depicts the connection between CSF-filled spaces.

[Fetal magnetic resonance imaging]. / Fetale Magnetresonanztomographie.

CLINICAL ISSUE: The most important prenatal screening method for the detailed assessment of the fetus is ultrasound, which is often combined with colour-coded Doppler sonography. In case of sonographically diagnosed fetal pathologies or technical limitations of the ultrasound, supplementary diagnostics may be necessary. STANDARD RADIOLOGICAL METHODS: With fast MRI sequences, fetal MRI screening provides important additional information especially with regard to the most common congenital pathologies-central nervous system (CNS) pathologies (agenesis of the corpus callosum, ventriculomegaly, arachnoid cyst, pathologies of the posterior cranial fossa, dysfunction of the gyrification). Knowledge of the developmental stages of the CNS is very important for accurate clinical assessment and interpretation.

[Metabolic induced changes of the central nervous system]. / Metabolisch verursachte Veränderungen des Zentralnervensystems.

CLINICAL ISSUE: The diagnosis of metabolic disorders of the central nervous system (CNS) can be very challenging for radiologists because of the nonspecific white matter lesions of the brain, the rarity of these diseases, and the variety of possible differential diagnoses. RADIOLOGICAL STANDARD METHODS: Standard for the evaluation of the metabolic disorders is cranial MRI. The MRI spectroscopy can additionally help to reduce the possible differential diagnoses.

Prognostic significance of standardised uptake value (SUVmax ) measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer.

Certain prognostic factors for small cell lung cancer (SCLC) have been validated, but the prognostic role of 18F-FDG PET/CT still remains unclear. The aim of this study was to evaluate the prognostic significance of 18F-FDG PET/CT in patients with SCLC. We reviewed 142 patients with pathologically proven SCLC who underwent pre-treatment 18F-FDG PET/CT. Standardised uptake value (SUVmax ) and other potential prognostic variables were chosen for analysis. The mean age of the study population was 58.2 ± 10.1 years (range, 25-84), and 124 (87.3%) patients were men. The median SUVmax value was 11.6 (4.0-29.3). Among the variables included in the univariate analysis, performance status (P = 0.001), disease stage (P < 0.001), administration of thoracic radiotherapy (TRT; P < 0.001), albumin level (P = 0.030) and LDH level (P < 0.001) showed prognostic significance. Further, multivariate analysis showed that performance status (P = 0.007), albumin level (P = 0.002), LDH level (P < 0.001) and administration of TRT (P = 0.001) were independent prognostic factors for survival. In conclusion, performance status, TRT, LDH level and albumin level were identified as important prognostic factors, while 18F-FDG PET/CT uptake of the primary lesions did not have any prognostic significance for survival in patients with SCLC.

[MR spectroscopy in metabolic disorders of the brain]. / MR-Spektroskopie bei Stoffwechselerkrankungen des Gehirns.

CLINICAL ISSUE: Metabolic disorders of the brain often present a particular challenge for the neuroradiologist, since the disorders are rare, changes on conventional MR are often non-specific and there are numerous differential diagnoses for the white substance lesions. STANDARD RADIOLOGICAL METHODS: As a complementary method to conventional brain MRI, MR spectroscopy may help to reduce the scope of the differential diagnosis. Entities with specific MR spectroscopy patterns are Canavan disease, maple syrup urine disease, nonketotic hyperglycinemia and creatine deficiency.

[Stroke in children and adolescents]. / Schlaganfall bei Kindern und Jugendlichen.

The occurrence of a stroke in children and adolescents constitutes a rare, critical event that is associated with substantial morbidity and mortality. In addition to the individual suffering for the young patient and the medical burden for the affected family, a stroke is also associated with high follow-up costs for the health system because of the necessary long-term rehabilitative treatment. Establishing an early and prompt diagnosis is of great therapeutic importance. Because of the rarity of the illness and the plethora of clinical manifestations, diagnosis is often delayed. The most frequent clinical presentation is an acute focal-neurological deficit, usually in the form of hemiparesis, but headache, seizures or alteration of consciousness may also be seen. Nowadays, the prompt performance of diffusion-weighted, blood-sensitive magnetic resonance imaging (MRI) constitutes the gold standard. The most relevant risk factors for the occurrence of a stroke in this age cohort are vasculopathies, infections, pathological cardiac conditions or coagulopathies. Recurrence of stroke is dependent on the underlying risk factors. In a substantial percentage of patients, residual neurological deficits are seen.Owing to a lack of randomized controlled trials in children and adolescents with stroke, the optimal treatment approach is still under debate. In addition to anti-platelet medication and heparinization, systematic intravenous thrombolysis and endovascular thrombectomy are other potentially effective treatment options. The long-term prognosis in children is dependent on establishing a correct, early diagnosis.

Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Are serum leptin levels a prognostic factor in advanced lung cancer?

AIM: The aim of the present study was to evaluate pre-treatment concentrations of leptin in patients with advanced lung cancer and to investigate possible associations between their levels and clinicopathological variables, response to therapy and overall survival. MATERIAL AND METHODS: There are 71 previously untreated patients with cytological or histological evidence of primary lung cancer who were admitted to the oncology department between November 2013 and August 2014. Forty-five healthy individuals with age, sex and BMI matching the lung cancer patients, were recruited to take part in the study as a control group. Leptin levels were measured quantitatively by using a microELISA kit. RESULTS: The serum leptin levels at diagnosis were significantly lower in lung cancer patients than those in control subjects (4.75±4.91 ng/ml, 9.67±8.02 ng/ml; p<0.001). We did not find any significant difference in leptin values related to clinicopathological parameters such as ECOG PS, weight loss, histological type, disease stage and TNM classification. Nevertheless, we demonstrated a significant correlation between serum leptin levels and BMI in lung cancer patients (correlation coefficient: 0.303; p>0.010). The analysis of serum leptin values did not show any association with the overall survival of the patients. CONCLUSION: Our results showed that the serum leptin level has no prognostic indications in advanced lung cancer patients. Leptin is decreased in lung cancer, and there is lack of correlation with tumour­related factors including prognosis. Therefore, leptin is not a useful clinical marker in lung cancer (Tab. 2, Fig. 2, Ref. 22).

[Cervical spine trauma]. / HWS-Traumata.

CLINICAL/METHODICAL ISSUE: In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. METHODICAL INNOVATIONS: Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. PRACTICAL RECOMMENDATIONS: Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

[Mechanical Thrombectomy - Recent Trials]. / Mechanische Thrombektomie - Studienlage.

BACKGROUND: The publications of five prospective randomized trials have made 2015 a milestone in the development of stroke therapy. Up till then, IV rtPA had been the only evidence-based recanalizing treatment for ischemic stroke. AIM: In this article we review the results of five trials: MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, and REVASCAT.