[Consensus double reading of mammograms in private practice]. / Konsensuelles Zweitbefunden von Mammographien in der Praxis.

PURPOSE: To evaluate retrospectively the results of consensus double reading of mammograms in a private practice for a period of 1.5 years (November 2001 to March 2003). MATERIALS AND METHOD: Two independent experts with dedicated training read all mammograms on a weekly basis. All mammograms including sonographic examinations were evaluated independently and categorized using the BI-RADS classification. The achieved consensus included a possible recommendation for recall or therapy. A total of 3936 mammograms and 1912 sonography studies were evaluated. All cases with BI-RADS 4 and 5 categories were compared with the histologic results. For a period of three months, the acceptance of double reading including a delay of the final report by one week was tested with a questionnaire and informed consent sheet. RESULTS: BI-RADS categories 4 and 5 were found in 57 cases, with 41 consensus results by two independent readers and 26 carcinomas verified by histology. No consensus could be reached in 16 patients, of which 10 had a final histologic result, with 5 benign lesions and 5 carcinomas of less than 1 cm in diameter. Clinical symptoms or alterations were absent in all patients. The 5 carcinomas were discovered by the double reading procedure. The result of the questionnaire (695 questionnaires) showed a refusal rate of 0.7 %, with only 5 women refusing the opportunity of double reading their mammograms. CONCLUSION: Double reading of mammograms by independent experts is feasible, shows a measurable increase in quality and is accepted by almost all women.

[The value of sonography in the intensive care unit for the diagnosis of diaphragmatic paralysis]. / Wertigkeit der Sonographie auf der Intensivstation zur Diagnostik von Zwerchfellparesen.

PURPOSE: To assess the value of bedside sonography in the detection of diaphragmatic paralysis in patients in the intensive care unit. METHODS: In this study, 100 patients who were admitted to the intensive care unit after thoracic operations were evaluated. Sonography of each hemidiaphragm was performed with coronal scans at the mid-axillary line on both sides with the patient supine. Absent and paradoxical diaphragmatic movement was considered to be indicative of diaphragmatic paralysis. All patients underwent additional fluoroscopy within 5 days. RESULTS: In 13 patients (13%) sonography revealed diaphragmatic paralysis. All these results were confirmed with fluoroscopy resulting in a sensitivity and specificity for sonography of 100%. CONCLUSION: Bedside sonography of the diaphragm at the intensive care unit is a reliable tool for diagnosing diaphragmatic paralysis.

Venous contrast fluid level in computed tomography.

OBJECTIVE: To evaluate the clinical significance of a venous contrast fluid level during computed tomography (CT). METHODS: An incidentally found contrast fluid level in the left internal jugular vein during CT in an otherwise healthy patient was the reason for investigation of this phenomenon. We collected data over a 4-year period at our institution and reviewed the case notes of seven patients exhibiting this CT finding. We also performed conventional radiography, CT, venography and colour-coded Doppler sonography to rule out an underlying pathology in those patients. Additional in-vitro CT studies were performed to define conditions of flow leading to a contrast fluid level. Flow dynamics in the internal jugular veins were studied in vivo by using colour-coded Doppler sonography in 20 normal volunteers. RESULTS: In addition to our first patient, we found seven patients with a venous contrast fluid level among a total of 58400 contrast-enhanced CT examinations performed in our institutions. The investigations were performed on various CT-units, with different scan protocols, injection rate, dose and manufacturer of non-ionic contrast agent. The contrast fluid level was encountered unilaterally in the left internal jugular vein in seven patients and in the inferior vena cava in one patient. All patients were free of symptoms and the outcome of all other examinations was unremarkable. In-vitro and in-vivo studies showed that pure contrast agent entering a vessel (in case of the internal jugular vein due to physiological flow and/or stasis) can produce a contrast fluid level. CONCLUSION: The occurrence of a venous contrast fluid level during contrast enhanced CT is an incidental finding of no pathological significance and need not initiate costly further examinations.

[Calcium in the lung or: it might not always be tuberculosis]. / Der Kalk in der Lunge oder: Es muss nicht immer die Tuberkulose sein.

Pulmonary calcifications are a frequent finding in CT examinations of the chest. In many cases, characteristic CT morphology and distribution of pulmonary and mediastinal calcifications may lead to a straightforward specific diagnosis of the underlying disease. In that respect, calcifications are often the residual finding of previous infections. Less often, they may be due to neoplasms, metabolic disorders, occupational exposure or previous therapy. This review focuses on the etiology, pathogenesis and morphological CT features of pulmonary calcifications. A knowledge of the technical aspects of CT imaging is required to verify calcifications and avoid pitfalls.

[Sliding axis endoprosthesis in severe unstable gonarthrosis and as revision prosthesis]. / Gleitachsenendoprothese bei schweren instabilen Gonarthrosen und als Revisionsprothese.

42 patients with 45 implanted total knee endoprostheses (sliding axis endoprosthesis Lübeck, Rp. SG implant) were investigated clinically according to the score of the Knee Joint Society in mean 27.9 months postoperatively. Mean total knee score increased from 34.9 +/- 14.7 to 72.5 +/- 3.1 and mean total functional score could be ameliorated from 40.2 +/- 25.7 to 55.7 +/- 4.5 (maximum points: 100). Evaluation of X-rays (anterior-posterior and lateral views) exhibited a satisfactory position of the prosthesis. Comparison between cemented and cementless implants as well as between primary implants and revision did not reveal any statistically significant differences. Patients with a longer follow-up period (59.8 months) showed results comparable to the mean of the total group. Frequently observed malposition of the axis of more than 3 degrees requires modifications of the orientation instruments. For revision surgeries a modular system for elongation of the stem would be desirable.