Infektionskrankheiten und Verletzungen der Harnblase und der ableitenden Harnwege

Urinary tract infections are the most common infectious diseases in Germany. In most cases clarification does not rely on imaging techniques other than sonography and is made mostly based on clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) can be used in selected cases to find the cause and detection or exclusion of complications, e.g. recurrent or atypical and complicated courses. The method of choice for clarification of urolithiasis is CT. Using low-dose techniques, detection or exclusion of urinary stones can be achieved with a high sensitivity and specificity as well as an acceptable level of radiation exposure. Native stone CT supplies additional fundamental information that can substantially influence further therapy planning. The diagnosis of ureteral injuries is clinically and radiologically not trivial and clarification is aided by urographic contrast media. The method of CT cystography has an important role in the diagnostics of urinary bladder injuries.     

Karotisstenose: Technik der PTA und Stentimplantation

Percutaneous transluminal angioplasty and stenting of carotid artery stenosis represents an innovative experimental modality which has been increasingly employed in high-risk patients. Currently, results from prospective randomized trials are not available; thus, guidelines with regard to indications and technique are preliminary. Numerous technical innovations to avoid associated complications have evolved in neurointerventional procedures. Dedicated guiding catheters and stents using a transfemoral approach have been introduced for treatment of carotid artery disease. Low-profile stent delivery systems may decrease risk of releasing embolic load when crossing high-grade stenosis or kinking of the vessel. The introduction of a cerebral protection with the use of temporary occlusion balloons or filter systems has resulted in a reduction of procedure-related neurological complications, and is strongly recommended by leading experts in the field.     

Interventionelle Sonographie der Leber und der Niere

Clinical/methodical issue

Optimization of ultrasound guided interventional procedures of the liver and kidneys using new imaging methods.

Standard radiological methods

Punctures, biopsies, drainage, intraoperative ultrasound, fusion, embolization in correlation with ultrasound and other imaging methods.

Methodical innovations

Real-time-sonography, contrast-enhanced ultrasound (CEUS) and fusion for planning, monitoring and postinterventional control.

Performance

The use of CEUS enables better detection, characterization and execution of interventional procedures. Fusion facilitates detection.

Achievements

The CEUS procedure is superior for detection and characterization of smaller lesions in comparison to the B scan. Fusion enables the performance of difficult interventional procedures.

Practical recommendations

The B scan is the standard imaging method but CEUS and fusion could be helpful for smaller lesions.     

Haus- und fachärztliche Versorgung: Statusfragen und Rechtsprobleme der Bedarfsplanung

Ohne Zusammenfassung     

CT Kolonographie: Techniken der Visualisierung und Befundung

Evaluation and interpretation of CT colonography is based on both 2D and 3D techniques. The 2D techniques are popular mainly because the time needed for evaluation is short. The 3D techniques allow better definition than the 2D techniques, especially of polyps close to folds or at the base of a fold. The evaluation strategies generally accepted so far (primarily 2D, with 3D for problem cases, or vice versa) demand knowledge of both 2D and 3D techniques. Newer 3D visualization techniques help make it possible to acquire more complete and faster recording particularly of areas that are not easily accessible to endoscopic examination. These user-friendly developments are thus well suited to improving the detection and the security of detection of polyps. It must be remembered that experience and the knowledge of associated artifacts and the limitations they can impose on diagnosis are prime requirements for the implementation of such visualization techniques.     

Berufsausübung der Psychologischen Psychotherapeuten und Kinder- und Jugendlichenpsychotherapeuten im Sinne der Heilberufs- und Kammergesetze

Ohne Zusammenfassung     

Pathologie der Leberzirrhose und der portalen Hypertension

Cirrhosis is a late stage finding in chronic liver diseases of different aetiology. It is defined morphologically as a diffuse process with the presence of fibrosis and structurally abnormal nodules. The consequences of cirrhosis are both, mechanical and functional. The mechanical complications result from intra- and extrahepatic shunting of blood and portal hypertension while the functional relevance bases upon a failure of liver cells to perform their physiological role in metabolism, synthesis and secretion. Beside these complications that are directly linked to liver function cirrhosis in itself is a risk factor for hepatocellular carcinoma.     

Einige Probleme der Rechtsmedizin und der gerichtsmedizinischen Begutachtung

Zusammenfassung Folgende Fragen sollten auf internationaler Grundlage geregelt werden:1. Die Systemisierung des Wissensgebietes unseres Faches.2. Die medizinische Terminologie.3. Die Abgrenzung medizinischer Begriffe von Rechtsbegriffen.4. Fragen des Kausalzusammenhangs.5. Probleme der Nachweismöglichkeit.6. Die Kompetenz und Verantwortlichkeit des Experten.7. Forderungen der Ethik bei der Tätigkeit des gerichtsmedizinischen Sachverständigen.

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Summary The author has the opinion that it is necessary to describe and to define carefully the following areas of forensic medicine, preferably on the base of internationally accepted terminology:1. The system of our special discipline.2. Medical terminology.3. The delineation of medical and forensic concept.4. The problem of causality.5. The problem of evidence.6. The competence and responsibility of the expert.7. The ethical requirements of the forensic-science expert.

Herrn Prof. Dr. B. Mueller zum 75. Geburtstag gewidmet.     

Molekulare Bildgebung in der Magnetresonanztomographie und der Nuklearmedizin

The identification of genetic and biochemical changes allows a more conclusive characterization and classification of disease. Up to now this information is mostly obtained through in vitro analysis after resection or biopsy by immunohistopathology and molecular biology. There is a definite need for non-invasive detection and repeated monitoring of such changes in experimental research as well as in clinical trials. Therefore, it is necessary to develop radiological imaging techniques that not only visualize morphologic and physiologic alterations, but track genetic and biochemical processes. This short review reports some of the various ongoing research projects that address this problem and provide some very promising approaches.     

Medulloblastome bei Erwachsenen: Eine Analyse der Überlebensrate und der prognostischen Faktoren

Ohne Zusammenfassung     

Information der Leistungserbringer und Patienten im rechtlichen Handlungsrahmen von G-BA und IQWiG: Voraussetzungen und Haftung

Ohne Zusammenfassung     

Duplexsonographie der Arterien und Venen Teil I: Grundlagen und extrakranielle hirnversorgende Arterien

Die farbkodierte Duplexsonographie hat aufgrund ihrer breiten Verfügbarkeit und ihrer hohen diagnostischen Aussage eine wichtige Rolle in der vaskul?ren Diagnostik übernommen. Ebenso wie die kontrastmittelgestützte MR-Angiographie verdr?ngt sie in zunehmendem Ma?e den diagnostischen Einsatz der arteriellen Angiographie, die immer mehr auf interventionelle Eingriffe beschr?nkt wird.     

Indikationen und Ergebnisse der CT-Kolonographie: von der Vorsorge bis zum symptomatischen Patienten

CT colonography (CTC) is also referred to as virtual colonoscopy and is being used with increasing frequency in radiological practice. While there are still no generally accepted, clear-cut indications for its use in mass colorectal cancer screening, there is evidence that this investigation is useful in patients in whom colonoscopy has not been successful or who have known stenotic lesions in the colon. Recent results of significant comparative studies of CTC and conventional colonoscopy will have some influence on the future place of CTC in screening for cancer of the bowel; they show the great potential of CT-aided bowel examination.     

Aus der Praxis eines Heilwesenversicherers: Aktuelle Entwicklungen in der Arzt- und Krankenhaushaftpflicht

Ohne Zusammenfassung     

Molekulare Bildgebung in der Magnetresonanztomographie und der Nuklearmedizin

Die Bestimmung genetischer und biochemischer Ver?nderungen erlaubt in zunehmendem Ma?e die eindeutige Charakterisierung und Klassifikation von Erkrankungen. Bisher ist hierzu in der Regel eine gezielte immunohistopathologische oder molekularbiologische In-vitro-Analyse nach Resektion oder Entnahme einer Biopsie erforderlich. In der experimentellen Forschung wie auch in der klinischen Anwendung sind bildgebende Verfahren wünschenswert, die eine nichtinvasive Detektion und ein wiederholt durchführbares Monitoring gew?hrleisten. Aus diesem Grunde ist die Entwicklung radiologischer Untersuchungsmethoden erforderlich, die über die morphologischen und physiologischen Ver?nderungen hinaus eine Beurteilung der genetischen und biochemischen Vorg?nge erm?glichen. In diesem kurzen übersichtsartikel werden einige der zahlreiche aktuellen Forschungsprojekte zusammengefasst, die sich mit diesem Problem besch?ftigen und inzwischen aussichtsreiche Techniken zur Verfügung stellen.