[Rare intramuscular haemangioma of the sternocleidomastoid muscle]. / Seltenes intramuskuläres Hämangiom des M. sternocleidomastoideus.

Intramuscular tumours of the head and neck often represent a differential diagnostic challenge. We report the rare case of an intramuscular haemangioma arising from the sternocleidomastoid muscle in the 6th decade. Pre-operative diagnosis was difficult, as these tumours are extremely uncommon in the head and neck region, with only very few cases reported in the literature. Due to the marked tendency of intramuscular hemangiomas to recur, accurate preoperative diagnosis forms the basis of adequate surgical therapy with sufficient safety margins.

[Teleradiology--blessing or curse? 4 years routine in the North Hessia teleradiology data network]. / Teleradiologie--Segen oder Fluch? Vie Jahre Routine im Teleradiologischen Datennetz Nordhessen.

Several hospitals in northern Hessen, not having their own radiology departments, want to run CT-scanners with the goal of improving medical quality. They requested co-operation from the Radiological Institute in the Hardtwaldklinik I in Bad Zwesten. Therefore a teleradiological network was developed, which enables the exchange of radiological-images and -reports between 19 hospitals today. An elementary requirement for this co-operation is an efficient and functional computer infrastructure and verified co-operation contracts. The conception, structure and development of the program, as well as associated difficulties are presented and discussed from different perspectives in the light of the controversy among experts. The results, experiences and benefits gained in four years, in which the teleradiological network of northern Hessen has been in place, demonstrate the importance and possibilities of teleradiology as an element of telemedicine. Teleradiology/telediagnostics improves the quality of patient care in smaller hospitals located in less-populated areas and present possibilities to optimize and integrate health care structures, taking economic considerations into account.

[Cranial magnetic resonance tomography--value in diagnosis of dementia. Important additional information for differential diagnosis]. / Kraniale Magnetresonanztomographie-Stellenwert in der Demenzdiagnostik. Wichtige Zusatzinformationen für die Differentialdiagnose.

The clinical data and the magnetic resonance imaging (MRI) findings of 41 patients with clinically diagnosed dementia of the Alzheimer type (DAT) and 20 age-matched healthy controls were evaluated with the aim of determining the value of MRI in the diagnosis and differential diagnosis of dementia. Patients and controls with cerebrovascular risk factors, including a history of stroke, were excluded from the analysis. The MRI findings of patients with dementia revealed pathological changes, in particular cerebral atrophy (p < 0.0005), significantly more frequently than did those of controls (p < 0.005). Periventricular demyelinisation and lesions of the white matter were found in 23 (56%) patients, and in 6 (30%) of the controls. MRI revealed one case each of subdural hematoma, hydrocephalus and cerebral amyloid angiopathy. In 14 patients, the detection MRI scans of cerebral infarctions or hematomas suggested a major vascular component of the dementia. In contrast, lesions of the white matter can not reliably by ascribed to a vascular etiology. On the basis of our findings, it is concluded that cranial MRI is of great value for the differential diagnosis of dementia, even when the clinical diagnosis of Alzheimer's dementia is probable and cerebrovascular risk factors are absent.

[Central pontine myelinolysis following severe hyponatremia]. / Zentrale pontine Myelinolyse nach ausgeprägter Hyponatriämie.

Central pontine myelinolysis is a process of demyelinisation with variable neurological symptoms related to the localization. Predisposing factors are alcoholism and malnutrition. Rapid correction of severe hyponatremia is suspected to be a primary cause for central pontine myelinolysis. We report a 43 year old chronic alcoholic and polytoxicomanic female patient, who was admitted comatose with a serum sodium level of 94 mmol/l, caused by a syndrome of inappropriate ADH secretion. After initial improvement under careful sodium correction, the patients neurologic condition degraded progressively and within 4 weeks she developed a "locked-in"-syndrome. Only then the suspected central pontine myelinolysis could be demonstrated in nuclear magnetic resonance and computer tomography. We presume that, although sodium correction was done relatively slowly in this patient, it probably contributed to her development of central pontine myelinolysis all the same. Due to this case we review the literature on correction of hyponatremia, which shows growing evidence that it should start early but be continued very slowly (rise in serum-Na: max. 0.6 mmol/l/h) and requires frequent laboratory controls.

[The value of computerized tomography for preoperative staging of stomach cancer]. / Stellenwert des Computertomogramms für das präoperative Staging beim Magenkarzinom.

The validity of computed tomography (CT) for the preoperative staging (TNM) of gastric carcinoma was studied in 74 patients, first in a prospective study, then under routine clinical conditions. Comparing CT-staging to intraoperative findings in the study patients showed correct assessment of the T-category in 70%, the N-category in 36%, and of both T and N in 26%. Validity was also low with 27% for both T- and N-staging when the CT was set against pathological-anatomical findings. The results in clinical routine were even more disappointing. The examination is of little value for deciding on operative indication and planning. Computed tomography therefore should not be part of a preoperative routine diagnostic assessment in gastric carcinoma.

[Multiple sclerosis: atrophy of the corpus callosum and psychosyndrome]. / Multiple Sklerose: Balkenatrophie und Psychosyndrom.

Examination with magnetic resonance imaging of 176 patients with multiple sclerosis showed that corpus callosum (CC) atrophy is common. The thinning of the CC depends on the extension of the coalescent periventricular white matter changes. A highly significant association was found between CC-atrophy and, the severity of organic mental disorder.

Neural tolerance of iotrolan 300 in ascending cervical myelography: results of a multicenter study.

This study examined the opacification, dose, and tolerance of iotrolan 300 on 231 patients in ascending cervical myelography. The contrast was rated good in 188 (81.4%) of the cases and satisfactory in 40 (17.3%) of the cases. The contrast was poor in only three (1.3%) cases. In 152 patients a dose of 10 ml or less of iotrolan 300 was administered. A good contrast quality was obtained in 84.2% of all examinations. From a total of 231 patients, 146 exhibited no concomitant effects. The intensity of the headache and neck ache was recorded by the patients themselves by means of an analog scale. The frequency and degree of the postmyelographic complaints did not increase with higher doses, i.e., they were not dose dependent. Neurologic irritation, in the form of radicular symptoms, appeared in only 2 of 231 examinations. These data demonstrate that iotrolan 300 is excellent for use in ascending cervical myelography.

[Prognostic significance of lacunar lesions in magnetic resonance tomography in multiple sclerosis]. / Die prognostische Bedeutung von lakunären Herden im Magnetischen Resonanztomogramm bei Multipler Sklerose.

175 patients with definite multiple sclerosis underwent nuclear magnetic resonance imaging. T1-weighted images showed in 59 patients (34%) periventricular lesions with a central area of decreased signal intensity. They appear as lacunar defects in the walls of the lateral ventricle system. In accordance with neuropathological findings we suggest that in these plaques a cystic degeneration has replaced gliosis. Patients with cystic defects are characterized by a high activity of the disease (e.d. increased annual production of plaques) and a poor prognosis. Lacunae are found in the early stages of the disease and provide a prognostic sign in multiple sclerosis.

[Diagnostic value of magnetic resonance tomography in disseminated encephalomyelitis]. / Zur diagnostischen Wertigkeit der magnetischen Resonanztomographie bei Encephalomyelitis disseminata.

In 83 of 86 patients with multiple sclerosis (MS) cranial magnetic resonance imaging (MRT) demonstrated lesions consistent with the clinical diagnosis. All the patients had either clinically typical MS oralaboratory-confirmed diagnosis of MS. The sensitivity of MRI is compared to those of computed tomographic (CT) scanning, evoked potential testing and cerebrospinal fluid analysis. The features of MS revealed by MRI are interpreted in terms of the macroscopic pathology and correlated with the clinical findings. The importance of particular findings (cystic appearance of lesions, spread of periventricular patches into the centrum semiovale) for the patients prognosis in stressed.

[Differential diagnosis of the clinical picture of multiple sclerosis in MR tomography]. / Differentialdiagnosen zum Erscheinungsbild der multiplen Sklerose im MR-Tomogramm.

Magnetic resonance imaging (MRI) has the advantage of high sensitivity compared to other diagnostic imaging techniques in focal pathological lesions of the brain in multiple sclerosis patients. However, the specificity of this examination method is limited. Diseases of the central nervous system due to other, different causes could produce a similar magnetic resonance image. Clinically examined cases of malignant and toxic affections of the brain caused by inflammatory, degenerative, traumatic and vascular diseases are presented and compared with the changes occurring in multiple sclerosis.

[Fracture of skull-comparative study of conventional and computer-assisted roentgenological examination (author's transl)]. / Die Schädelfraktur-Vergleich der konventionellen und der computerassistierten Röntgenuntersuchung.

Using a skull like phantome imaging characteristics of conventional x-ray technique and computerized tomography are compared. The contrast transfer function of x-ray films proofs to be superior, whichis due to overrange artefacts found in computerized tomography. Only 8 out of 50 skull fractures diagnosed by plain film technique were identified on computer-tomograms. Even though CT technique is excellent for the detection of intracranial lesions, fractures are more easily seen on conventional films. This is especially important for analysing size and site of impression fractures.