Recognition and imitation of pantomimed motor acts after unilateral parietal and premotor lesions: a perspective on apraxia.

We compared gesture comprehension and imitation in patients with lesions in the left parietal lobe (LPAR, n=5) and premotor cortex/supplementary motor area (LPMA, n=8) in patients with damage to the right parietal lobe (RPAR, n=6) and right premotor/supplementary motor area (RPMA, n=6) and in 16 non-brain damaged control subjects. Three patients with left parietal lobe damage had aphasia. Subjects were shown 136 meaningful pantomimed motor acts on a videoscreen and were asked to identify the movements and to imitate the motor acts from memory with their ipsilesional and contralesional hand or with both hands simultaneously. Motor tasks included gestures without object use (e.g. to salute, to wave) pantomimed imitation of gestures on one's own body (e.g. to comb one's hair) and pantomimed imitation of motor acts which imply tool use to an object in extrapersonal space (e.g. to hammer a nail). Videotaped test performance was analysed by two independent raters; errors were classified as spatial errors, body part as object, parapraxic performance and non-identifiable movements. In addition, action discrimination was tested by evaluating whether a complex motor sequence was correctly performed. Results indicate that LPAR patients were most severely disturbed when imitation performance was assessed. Interestingly, LPAR patients were worse when imitating gestures on their own bodies than imitating movements with reference to an external object use with most pronounced deficits in the spatial domain. In contrast to imitation, comprehension was not or only slightly disturbed and no clear correlation was found between the severity of imitation deficits and gesture comprehension. Moreover, although the three patients with aphasia imitated the movements more poorly than non-aphasic LPAR patients, the severity of comprehension errors did not differ. Whereas unimanual imitating performance and gesture comprehension of PMA patients did not differ significantly from control subjects, bimanual tasks were severely disturbed, in particular when executing different movements simultaneously with the right and left hands.

[Intraarterial digital subtraction angiography (i.a. DSA) of the lower limb using fine needle technique]. / Intraarterielle digitale Subtraktionsangiographie (i.a. DSA) der unteren Extremität in Feinnadeltechnik.

PURPOSE: Severe peripheral arterial occlusive disease (pAOD) requires adequate diagnostic imagery of poststenotic and postocclusive vascular regions. This study was designed to evaluate the validity of i.a. DSA using fine-needle technique (FNA) especially concerning the vascular area of the lower limb. MATERIAL AND METHODS: 206 FNA of the lower limb wer evaluated retrospectively. Besides evaluation of the image quality of the 1119 angiographic image series, main points of interest were the determination of accuracy of the FNA in comparison to the operative findings, the average radiocontrast agent consumption and the rate of complication. RESULTS: In all cases the image quality was rated either very good or good in the pelvic, femoral and popliteal vessels. 94% of the image series of the lower leg and foot could be rated as well as very good/good although 75% of all patients demonstrated an advanced stage of pAOD. Accuracy of FNA compared to operative findings came up to 82%. The average radiocontrast consumption amounted to 69 ml per examination. Overall, two major complications were seen. CONCLUSION: I.a. DSA of the lower limb using fine-needle-technique is an easily applied angiographic method of low radiocontrast agent consumption and a low complication rate. Essential information can be acquired preoperatively in planning far peripheral bypass anastomoses. Postoperative vascular complications can be safely assessed.

[The computed tomographic diagnosis of inflammatory abdominal aortic aneurysms]. / Computertomographische Diagnostik des inflammatorischen Bauchaortenaneurysmas.

Amongst 1599 patients undergoing surgery for abdominal aortic aneurysm, there were 89 patients (5.6%) who showed typical features of inflammatory aneurysms of the abdominal aorta (IAAA). 37 of the 89 patients had been examined preoperatively by CT. In 73% of the cases (27/37) a correct diagnosis had been made. Localisation, width and extent of the IAAA was correctly diagnosed in all patients. Involvement of the renal arteries by the inflammatory process, the extent of thrombus and of mural calcification were accurately shown. The inflammatory tissues were typically ventral and lateral to the aorta. Frequently, there were adhesions to neighbouring structures. Aortic rupture, aortic dissection and retroperitoneal lymphoma may produce similar CT appearances; nevertheless, CT remains at present the method of choice for the diagnosis of IAAA because of its high sensitivity.

[The spectrum of the findings of arterial digital subtraction angiography in patients following kidney transplantation]. / Befundspektrum der arteriellen digitalen Subtraktionsangiographie bei Patienten nach Nierentransplantation.

Digital subtraction angiography (DSA) was performed in 53 of 417 patients with renal transplants. The incidence of clinical apparent vascular complications was 9.1% of all patients with renal transplants (38/417). The most frequent vascular disorders were formed by arterial stenoses at 5.0% of the cases followed by arterial obstructions in 1.7% of the patients. Rare vascular complications were arteriovenous fistulas (0.7%), aneurysms (0.5%) and venous thromboses (0.2%). Because of the high diagnostic value of intraarterial DSA, all patients with renal transplants with a complicated postoperative course should be eligible for angiographic control. In case of a suspected vascular disorder intraarterial DSA should be performed at an early stage.

[Cytomegalovirus infection of the intestinal tract. Computed tomographic findings in AIDS patients]. / Zytomegalievirusinfektion des Intestinaltraktes. Computertomographische Befunde bei AIDS Patienten.

To check the value of computed tomography (CT) in the diagnosis of cytomegalovirus (CMV) infection of the intestine, CT findings in ten patients with coloscopically proven CMV infection were reviewed. All patients were chronically ill men with AIDS. In nine of the ten cases CT scans of the small intestine and/or colon disclosed abnormalities. The predominant alteration (9/9) was a symmetric wall thickening in the bowel segments involved (10-30 mm). The location and extent showed good agreement with the inflammatory areas seen on coloscopy. The cecum and terminal ileum were the regions most frequently affected. In seven of the nine patients with CT abnormalities CT revealed pericolonic inflammation, particularly around the cecum. Lymph nodes were increased but not enlarged. Comparison of the findings in intestinal CMV infection with those in other AIDS-related diseases suggests that CT may be to limit the differential diagnosis. Abdominal CT serves as suitable primary imaging modality for the initial evaluation of patients with AIDS and abdominal symptoms of unknown etiology.

[Hypodense oral intestinal contrasting for the diagnostic optimization of abdominal computed tomograms in children]. / Hypodense orale Darmkontrastierung zur diagnostischen Optimierung des abdominellen Computertomogramms im Kindesalter.

37 children were examined for diagnostic improvement of the oral intestinal contrasting images in abdominal computed tomography with a hypodense solution of mannitol (n = 23) in comparison with a suspension of BaSO4 (n = 14). Because of the hypodense intestinal contrasting images the artifacts of the images induced by the bordering surface could be reduced, the condition of fullness of the intestine and the judgement of the intestinal wall improved. The parenchymatous organs and points of abdominal lymph nodes could be defined and judged more easily through the hypodense contrasting images. On the whole the picture quality of the computed tomography of the young child could be increased with the hypodense solution of mannitol.

[Perirenal metastasis of a malignant melanoma in a young child]. / Perirenale Metastase eines malignen Melanoms bei einem Kleinkind.

A perirenal metastasis of a malignant melanoma in a young child can accompany a big tumor volume with extensive calcifications and tumor necroses. The characteristics of the tissue on computed tomography or ultrasound did not allow the certain differentiation of this situation from tumors of the adrenal or tumors of the kidney.

[Diabetic osteoarthropathy (DO) of the forefoot]. / Diabetische Osteoarthropathie (DO) des Vorfusses.

In patients suffering from diabetic osteoarthropathy, a total of 97 forefeet were evaluated concerning their bone tissue and soft tissue transformations. The most prevalent forms of demineralisation were circumscribed osteoporosis (21%) and diffuse osteoporosis (20%). Subluxations (6.2%), dislocations (2.1%), erosions (8.3%), marginal usures (11.3%) or cysts of the bone (11.3%) were seen only rarely. Extensions of the articular space (10.3%) were more prevalent than disappearances of the articular space (4.1%). The MTP (26.8%) and PIP joints (10.3%) were confirmed to be preferred localisations. A sudden loss of articular surface (25%) and a fast transition to mutilation (23.5%) show the increasing tendency of the fast transition to advanced stages of destruction by omitting the earlier stages.

[The imaging diagnosis of acute renal transplant obstruction with special reference to antegrade pyelography]. / Bildgebende Diagnostik des akuten Transplantatnierenaufstaus unter besonderer Berücksichtigung der antegraden Pyelographie.

30 patients with an acute build-up of renal transplant were examined comparatively via antegrade pyelography (AP), computed tomography (CT) and sonography (SONO). In the proof of obstructions and compressions of the ureter of renal transplant, antegrade pyelography was superior to sonography and computed tomography. Perirenal collections of fluids were recognised correctly via sonography by 73% (11/15) and computed tomography by 87% (13/15). The computer tomogram is superior in the differentiation of perirenal collection of fluids. In establishing proof of the cause of an acute build-up of renal transplant it was evident that computed tomography with a sensitivity of 64% and a specificity of 94% was slightly superior.

[Retroperitoneal myxoid liposarcoma of the kidney capsule as a cause of Budd-Chiari syndrome]. / Retroperitoneales myxoides Liposarkom der Nierenkapsel als Ursache eines Budd-Chiari-Syndroms.

A retroperitoneal myxoid liposarcoma of the renal capsule must be differentiated from renal cell carcinomas, angiomyolipomas, fibrogenous lipomas, fibrolipomas and mixed tumours containing fat tissue. Myxoid liposarcomas can lead to intracaval tumour thromboses, which is often the case with renal cell carcinomas and revealed clinical with Budd-Chiari syndrome. Computed tomography and magnetic resonance imaging give additional information in the diagnosis of intracaval tumour thromboses and show the exact expansion of the topographic-anatomical structure.

[Radiologic diagnosis in hyperparathyroidism]. / Radiologische Diagnostik beim Hyperparathyreoidismus.

The most important radiologically detectable effects of the primary and secondary hyperparathyroidism of the skeletal system and the periarticular soft tissue structures are presented. In the following sensitivity and specificity of radiological imaging--sonography, scintigraphy, computed tomography, magnetic resonance imaging, arteriography and selective venous sampling--in the preoperative diagnostic of the parathyroid adenomas are discussed. Therefore, radiological imaging can be omitted before primary surgery. It was only in secondary surgery that radiological process proved useful and a guide during surgical intervention.