Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption.

BACKGROUND AND PURPOSE: CTA is the imaging modality of choice in many institutions for the evaluation of the supraaortic vessels, but radiation exposure remains a matter of concern. Our aim was to evaluate a 70-kV protocol for CT angiography of the carotid arteries with respect to image quality and radiation exposure compared with automated tube voltage adaption. MATERIALS AND METHODS: A total of 90 consecutive patients were included in this prospective study and randomized to the study group (n = 45, 70 kV) or control group (n = 45, automated tube voltage adaptation). Volume CT dose indices and dose-length products were recorded in the examination protocol. Image quality was assessed as arterial vessel contrast, signal-to-noise ratio, contrast-to-noise ratio, and contrast-to-noise ratio in reference to the radiation dose. Subjective overall image-quality analysis, image-artifact analysis, and diagnostic evaluation were performed by 2 observers by using a 4-point Likert scale. RESULTS: Radiation exposure was significantly lower in the study group (volume CT dose index reduced by 22%, dose-length product reduction by 20%; each P < .001). Contrast (P = .15), SNR (P = .4), and contrast-to-noise ratio (P = .5) did not show significant differences between the groups. The contrast-to-noise ratio in reference to the radiation dose was not significantly increased using the study protocol (P = .2). Subjective image quality and visualization of pathologic findings did not differ significantly between the groups. CONCLUSIONS: Carotid CTA using the lowest available voltage (70 kV) is feasible at very-low-dose levels, while overall image quality is comparable with protocols using automated tube voltage selection.

Extracapsular dissection in the parapharyngeal space: benefits and potential pitfalls.

The aim of this study was to investigate the benefits and potential pitfalls of transcervical extracapsular dissection in the treatment of parotid gland tumours in the parapharyngeal space. We retrospectively evaluated the records of all patients with parapharyngeal parotid gland lesions treated between 2000 and 2015 by transcervical extracapsular dissection. Patients having revision operations and patients whose records were not complete were excluded, leaving 49 patients in the study. We found acceptable oncological and functional outcomes throughout. Special attention should be paid in cases with multilobular growth of the tumour on magnetic resonance imaging, satellite tumours of pleomorphic adenomas, tumours in broad contact with the inner surface of the deep lobe, and lesions suspected of malignancy. Extracapsular dissection in the parapharyngeal region is associated with acceptable oncological and functional outcomes. These outcomes can be expected only after a thorough assessment of patient's history and preoperative imaging.

Ultrasound elastography of pulmonary lesions - a feasibility study.

INTRODUCTION: The potential of sonography in the examination of lung tissue is extremely limited by the air-filled alveoles of the lung. Only in special circumstances like pleural adhesion lesions, atelectasis or pneumonia can lung tissue be visualized by B-mode sonography. Real-time elastography was primarily applied to detect and visualize pulmonary lesions. METHODS AND PATIENTS: 8 patients with a total of 18 histologically proven metastases of the lung were included. All pulmonary lesions were detected by computed tomography. Sonographic examination was performed with a 7.5 MHz linear transducer (Acuson Antares premium edition, Siemens, Erlangen, Germany), including B-mode and real-time elastography (RTE). The mean distance between pleura and the lesions ranged from 0 to 2.5 cm. Two lesions were located in the upper right lobe, eleven lesions in the lower right and five in the lower left lobe. RESULTS: RTE was able to detect and visualize all 18 pulmonary lesions in contrast to B-mode. The size and distance of the lesions from the pleura correlated with the CT findings. CONCLUSION: In contrast to B-mode sonography, RTE is able to detect and visualize peripheral, non-pleural adherent pulmonary lesions.

[Septal delineation using a 20 % diluted contrast chaser bolus in coronary CT angiography: a comparison of 64-slice and dual source CT]. / Abgrenzbarkeit des interventrikulären Septums mit einem 20 % Kontrastmittelspülbolus in der CT-Koronarangiografie: Ein Vergleich von 64-Schicht- und Dual-Source-CT.

PURPOSE: Due to the technical advance of multislice cardiac CT and the recently introduced dual source CT, the acquisition times for cardiac CT exams are < 10 sec. At the same time the assessment of left ventricular function is possible. However, in many patients a complete right ventricular outwash is noted, leading to insufficient septal delineation. Studies were able to demonstrate that contrast media (CM) mixed in the saline chaser bolus is sufficient for significantly better visualization of septal structures. The aim of this study was to investigate whether this dual flow concept works as well for 64-slice and dual source CT angiography using only 20 % CM in the saline chaser bolus. MATERIALS AND METHODS: 97 patients were included in this prospective study. 47 patients underwent 64-slice CT coronary angiography. 80 cc were administered at 5 cc/sec as the main bolus followed by a 50 cc saline chaser bolus containing 20 % contrast media. The other 50 patients were examined using dual source CT. They received a CM protocol adapted for the scan time with the identical saline/CM chaser bolus. The datasets were quantitatively examined in defined ROIs along the septum and in the right ventricle with respect to the density. The septal delineation was qualitatively analyzed and both groups were compared. In a final step the density was measured in the proximal and distal RCA as well as in the LAD and also compared. RESULTS: Using the protocol adapted for the scan time, significantly less CM was used. No significant difference was able to be found regarding the septal delineation or coronary enhancement. CONCLUSION: The study shows that the dual flow concept allows for robust septal delineation regardless of the CM injection protocol used as long as a 20 % saline chaser bolus is used. A CM protocol adapted for the scan time also leads to significant CM reduction at equal image quality.

[Geriatric day clinic. What is the status of an acute geriatric day clinical in the service chain?]. / Geriatrische Tagesklinik. Welche Stellung hat die akutgeriatrische Tagesklinik in der Versorgungskette?

Geriatric care covers a variety of differentiated services and structures, and the well-established system of in- and outpatient treatment has now been expanded to include the day hospital. The 30-bed geriatric day hospital at the "Zentrum für Akutgeriatrie und Frührehabilitation", ZAGF (Center for Acute Geriatric Medicine and Early Rehabilitation) at the Municipal Hospital Munich Neuperlach provides diagnostic and therapeutic services for acute and chronic illnesses with the aim of obviating or shortening hospitalization, helping patients to practise self-help, and preserving social competence. A multi-dimensional interdisciplinary geriatric assessment is used to clarify indications and contraindications, and to plan holistic individual therapeutic strategies.

[Effectiveness of short-term triple therapy for healing Helicobacter pylori infection in ulcer disease]. / Effektivität der Kurzzeit-Tripel-Therapie zur Heilung der Helicobacter-pylori-Infektion beim Ulkusleiden.

There is evidence that triple therapy with two antibiotics and a proton pump inhibitor is more cost-effective than various dual therapies for the eradication of Helicobacter pylori. We have analyzed the effectiveness and acceptability of the so-called "Italian protocol" (clarithromycin 250 mg b.i.d., metronidazole 500 mg b.i.d. and omeprazole 20 mg daily for one week, followed by 20 mg omeprazole daily for further 3 weeks) in a prospective study of 36 patients with Helicobacter pylori-associated ulcers (10 gastric ulcers, 26 duodenal ulcers). Primary eradication was achieved in 35 out of 36 patients (96%). Side effects such as dysgeusia and diarrhea were rare and rapidly reversible. We conclude that this triple therapy was cost-effective and well tolerated in our study population.

[Cystic lymphangioma of the mesenterial root as a rare cause of acute abdomen]. / Das cystische Lymphangiom der Mesenterialwurzel als seltene Ursache des akuten Abdomens.

Mesenteric lymphangioma is a rare, benign cystic tumor of the lymphatic system, which is commonly found in younger children and may in certain cases lead to an acute abdominal manifestation. The treatment of choice is surgical resection without damage to the blood supply of the bowel. The prognosis is generally favourable, but with increasing tumor size radical resection becomes more difficult and local recurrence more probable.

[Ulcer symptoms without demonstration of ulcer: causative therapy with demonstration of Helicobacter pylori]. / Ulkusbeschwerden ohne Ulkusnachweis: kausale Therapie bei Helicobacter-pylori-Nachweis.

Helicobacter pylori-associated gastritis was found by endoscopy in 15 (= 28%) out of 53 patients presenting gastric pain of ulcer type without macroscopically detectable lesion of the gastric mucosa. Following a treatment of four weeks with bismuth subcitrate tablets (2 x 2 tablets daily), in 73% improvement of histological findings and in 87% elimination of bacteria could be attained. Thus, this causal therapy had a favourable effect on patient complaints.

The lung after trauma and shock--fine structure of the alveolar-capillary barrier in 23 autopsies.

We have examined the ultrastructure of the alveolar septa in the lungs of 23 victims of severe trauma and shock. In ten patients, who died within a week after trauma, protein-poor interstitial edema and fat emboli were the most constant ultrastructural change. The alveolar epithelium and the capillary endothelium were surprisingly devoid of morphologic evidence of injury. A high incidence of pneumonia and/or sepsis complicated the hospital course of patients surviving for longer periods of time. Ultrastructurally, the lungs of these patients showed variable degrees of injury to the alveolar epithelium and capillary endothelium and accumulation of protein-rich edema fluid in the extravascular spaces. The study suggests that most of the pulmonary pathologic lesions attributed to tissue trauma and shock are the consequence of systemic or local infections to which trauma patients are particularly susceptible.

[Salmonella colitis]. / Die Salmonellen-Kolitis.

Salmonella colitis is defined on the basis of 3 case reports and 75 well-documented cases from the literature. Salmonella colitis is an acute ulcerative colitis occurring in enteric salmonellosis. There is complete clinical and endoscopic remission within 4--8 weeks and no relapse. The disease is to be distinguished from idiopathic ulcerative colitis in a salmonella carrier state. The difficulties of this differential diagnosis are demonstrated in a further case report.

[Bronchiolo-alveolar cell carcinoma]. / Das Bronchioloalveolarzellkarzinom.

15 cases of bronchiolo-alveolar cell carcinoma were observed at the Dept. of Surgery of the University Hospital of Zurich from 1961 to 1976. The mean age of these patients was 56 years. The sex distribution was 13 males and 2 females. Five cases were discovered accidentally; the symptoms of the remaining 10 were uncharacteristic. Cytology, bronchoscopy and mediastinoscopy were negative at early stages. Diagnosis was made by histologic examination of the specimens only. Needle biopsy, performed routinely over recent years, proved helpful in 4 cases. In 12 out of 14 patients, lobectomy was considered 'radical'; nevertheless, only 2 survived more than 5 years. The disseminated form of the bronchiolo-alveolar cell carcinoma is characterized by a particularly poor prognosis. According to our experience and to the literature, only the solitary, nodular type shows a more favourable outlook.

[Silicosis, chronic bronchitis and smoking habits]. / Silikose, chronische Bronchitis und Rauchgewohnheiten

In 333 patients suffereing from silicosis the incidence of chronic bronchitis and/or obstruction of the respiratory tract has been correlated with cigarette smoking. The incidence of chronic bronchitis and/or airway obstruction in patients who had acquired either slight or severe silicosis in Switzerland was over 50%. A positive correlation between cigarette smoking and chronic bronchitis and/or airway obstruction could be found only in younger patients with slight silicosis. Chronic bronchitis and/or airway obstruction was not more frequent in foundry-workers suffering from silicosis where they had been exposed to fumes which irritated the respiratory tract. Deformation of the respiratory tract due to silicosis has a greater bearing on the development of chronic bronchitis and airway obstruction than immoderate cigarette smoking.