[Changes in the chest x-ray following postoperative irradiation of breast cancer]. / Veränderungen im Thoraxröntgenbild nach postoperativer Bestrahlung von Mammakarzinomen.

The radiogenic modifications of the thorax radiography were evaluated in 100 patients irradiated postoperatively for mammary carcinoma between January, 1980 and March, 1983. No adjuvant chemotherapy was given. A telecobalt unit was used for the irradiations. A computer-assisted planning (Evados) was applied in order to obtain an individual optimization especially for the fields situated at the thoracic walls. The average focal doses to the thoracic wall and the regional lymph nodes were between 50 and 52 Gy. Taking into consideration all modifications visualized by radiography, 65% of patients had subacute radiogenic reactions in the lungs, especially in the apex fields. In general the modifications had no clinical importance. Only seven patients presented more severe forms of pneumonitis with clinical symptoms. Fibroses were developed only in the apex fields; infraclavicular infiltrations were seen only in exceptional cases. There were no costal necroses, essential pleural reactions, or radiogenic enlargements of the heart shadow. The rate of pulmonary reactions with clinical symptoms is reduced as compared with former techniques, e.g. opposing tangential fields. The knowledge of anamnesis and typical radiographic modifications should help to avoid problems of differentiation between apex reactions and tuberculosis.

Damaging venous reflux into the skull or spine: relevance to multiple sclerosis.

Unequal propagation of central venous excess pressure into the different cerebral and spinal venous drainage systems is the rule rather than the exception. The intensity of the forces thus to be exerted on vulnerable cerebrospinal structures by the resulting pressure-gradients in the craniovertebral space is unknown. There is a need to consider the various conditions which may cause individual proneness to heavier reflux into particular cerebral as well as epi- and subdural spinal venous compartments. An attempt is made to indicate eventual consequences of excessive retrograde dilatation especially of internal cerebral veins. The importance of elucidating the neuropathological and clinical implications of undue reflux into the skull or spine is deduced from the probability of relations between localized backflow into the craniovertebral space and unexplicated cerebrospinal diseases. In this regard the features of multiple sclerosis are discussed.

[The emissaries of the human skull (author's transl)]. / Die Emissarien des menschlichen Schädels.

The range of hemodynamic conductivity of the venous outlets of the skull, called emissary veins, and factors influencing them have been explored in 888 closed and 210 opened human skulls: Exept the condylar canal and the mastoid emissary vein only emissary veins joined to cranial nerves are of importance. The straighter the connection to the heart the wider the related emisary vein tends to be, which explains the predominance of the right emissary veins in the occipital cranial fossa. The right and the left jugular vein as well as the jugular and the mastoid emissary vein compensate each other. The influence of constitutional factors is shown by the sex difference in the conductivity of the jugular veins corresponding to the sex difference of the mean cerebral weight.