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Which are the differences in health-related quality of life and stress management in medical and dental students?101 dental and 237 medical students from different years of Justus-Liebig University Giessen were examined during winter term 2008/09 and summer term 2009 using the specific Questionnaire on Health Promotion, Life Satisfaction, and Stress Management in Dental or Medical Students (addressing work satisfaction and choice of subject, private life, relaxation behavior and stress management, and health behavior), Beck Depression Inventory (BDI) and SF-36 Health Survey. For statistical analysis, Mann-Whitney-U-Test, analysis of variance (ANOVA), Pearson correlation and Chi2-Tests were primarily used.Dental and medical students showed considerable mental impairment in SF-36. Every fifth dental student suffered from slight to moderate depression. Though averaging more hours per week, medical students were more satisfied with their studies. More than half of the dental and medical students did not have appropriate strategies of coping with stress.Concerning the mental impairment in both groups and regarding a higher health-related quality of life, specific prevention courses or mentoring programs should already be offered at the beginning of medical training in order to cope with strains of medical school and future job strains in the medical or dental profession.

International studies have indicated a high prevalence of depression and a lack of coping with stress in medical students. Freshman and advanced medical students were investigated using a specific questionnaire and the Beck Depression Inventory (BDI) with a response rate of 100%. Of the subjects studied 81.1% did not have any depression, 13.1% slight and 5.8% clinically relevant symptoms of depression. The severity of symptoms was highly associated with subjective appraisal of stressors. Coping skills of first year students significantly influenced the depression symptoms calling for preventative measures even in freshman medical students.

According to recent studies, there may be differences in quality of life for physicians depending on gender and field of medicine. Presently, there are hardly any data with respect to health-related quality of life in dermatologists.Using the SF-36 Health Survey, 112 dermatologists and 113 physicians in other fields of medicine were studied in a cross-sectional study.Dermatologists' mental health level averaged lower than their physical health level (chi2=28.49; p.001). The mental and physical health level were higher in female dermatologists than in their male colleagues (e.g., GH: chi2=6.15; p.05 and MH: chi2=6.83; p.05). These findings are the opposite of results in other medical specialists. The differences between mental and physical health dimensions on the one hand, and between women and men on the other hand, were found in all age groups.In comparison to other medical specialists, dermatologists differ only slightly in their health-related quality of life. Therefore, it may be advisable to implement preventive measures concerning their comparatively low mental health status.

Within a hospital, the radiology department has taken over the role of a cost center. Cost accounting can be applied to analyze the costs for the performance of services. By assigning the expenditures of resources to the service, the cash value can directly be distributed to the costs of equipment, material and rooms. Time-oriented catalogs of services are predefined to calculate the number of the employees for a radiology department. Using our own survey of time data, we examined whether such catalogs correctly represent the time consumed in a radiology department. Only services relevant for the turnover were compared.For 96 primary radiological services defined by the score-oriented German fee catalog for physicians (Gebuhrenordnung fur Arzte), a ranking list was made for the annual procedures in descending frequency order. According to the Pareto principle, the 11 services with the highest frequency were chosen and the time consumed for the technical and medical services was collected over a period of 2 months. This survey was compared with the time-oriented catalogs TARMED and EBM 2000plus.The included 11 relevant radiological services represented 80.3 % of the annual procedures of our radiology department. When comparing the technical services between the time-oriented catalogs and our own survey, TARMED gives a better description of the time consumed in 7 of the 11 services and EMB 2000plus in 3 services. When comparing the medical services, TARMED gives a better description of the time consumed in 6 of the 11 services and EBM 2000plus in 4 services. When averaging all the radiological services, TARMED overestimates the current number of physicians necessary for primary reading by a factor of 10.0 % and EBM 2000plus by a factor of 2.6 %.As to the time spent on performing the relevant radiological services, TARMED is slightly superior to describe the radiology department of a hospital than EBM 2000plus. For calculating the number of physicians necessary for primary reading, EBM 2000plus is superior to TARMED.

The idea for this project was born by the necessity to offer medical students an easy approach to the theoretical basics of magnetic resonance imaging. The aim was to simulate the features and functions of such a scanner on a commercially available computer by means of a computer program.The simulation was programmed in pure Java under the GNU General Public License and is freely available for a commercially available computer with Windows, Macintosh or Linux operating system. The graphic user interface is oriented to a real scanner. In an external program parameter, images for the proton density and the relaxation times T1 and T2 are calculated on the basis of clinical examinations. From this, the image calculation is carried out in the simulation program pixel by pixel on the basis of a pulse sequence chosen and modified by the user. The images can be stored and printed. In addition, it is possible to display and modify k-space images.Seven classes of pulse sequences are implemented and up to 14 relevant sequence parameters, such as repetition time and echo time, can be altered. Aliasing and motion artifacts can be simulated. As the image calculation only takes a few seconds, interactive working is possible.The simulation has been used in the university education for more than 1 year, successfully illustrating the dependence of the MR images on the measuring parameters. This should facititate the approach of students to the understanding MR imaging in the future.

To build an infrastructure that enables radiologists on-call and external users a teleradiological access to the HTML-based image distribution system inside the hospital via internet. In addition, no investment costs should arise on the user side and the image data should be sent renamed using cryptographic techniques.A pure HTML-based system manages the image distribution inside the hospital, with an open source project extending this system through a secure gateway outside the firewall of the hospital. The gateway handles the communication between the external users and the HTML server within the network of the hospital. A second firewall is installed between the gateway and the external users and builds up a virtual private network (VPN). A connection between the gateway and the external user is only acknowledged if the computers involved authenticate each other via certificates and the external users authenticate via a multi-stage password system. All data are transferred encrypted. External users get only access to images that have been renamed to a pseudonym by means of automated processing before.With an ADSL internet access, external users achieve an image load frequency of 0.4 CT images per second. More than 90 % of the delay during image transfer results from security checks within the firewalls. Data passing the gateway induce no measurable delay.Project goals were realized by means of an infrastructure that works vendor independently with any HTML-based image distribution systems. The requirements of data security were realized using state-of-the-art web techniques. Adequate access and transfer speed lead to a widespread acceptance of the system on the part of external users.

To optimize the examination protocols of multislice CT (MSCT) of the pelvis for dose reduction with regard to image quality.MSCT of the pelvis was performed on 5 cadaver specimens with stepwise reduction of the tube current at 140 kV (250, 200, 150, 100, 75, 50, 35, 25 mAs) and 120 kV (50, 27 mAs). The remaining scan parameters like collimation (4 x 1 mm) and table speed of 4 mm per rotation remained unchanged. Axial sections and coronal reconstructions were used to evaluate cortex, trabecular structures, subjective image quality, image noise and detail detectability (pelvis and SI joint), with evaluation performed independently by four blinded experienced radiologists on a 5-point scale. Kappa coefficient, accuracy of the observers to sort the films with regard to dose reduction and mean scores of image evaluation were determined for statistical analysis.The deterioration of the image quality was most pronounced for all criteria between 75 mAs and 50 mAs at 140 kV. Good results with adequate image quality were obtained for detail detectability at 50 mAs and 140 kV (effective dose [E]: 3.3 mSv) and for the remaining four criteria at 75 mAs (E: 4.9 mSv). There was a moderate agreement between the four observers (kappa coefficient: 0.27). All observers were excellent in arranging the images according to the increasing dose reduction.Image quality of MSCT of the pelvis appears to be acceptable at 75 mAs and 140 kV with the dose reduced to 46% of the average value of the nation-wide survey of the German Roentgen Society in 1999 for this type of examination.

Retrospective examination of 44 patients with central pontine and/or extrapontine myelinolysis leads to the conclusion that in early diagnostics cerebral NMR is superior to cCT. T2-weighted images turned out to be the most sensitive parameter. Frequent contrast-medium enhancement early in the course up to 4 weeks after clinical manifestation in 7 patients underlines the pathogenetic idea of an initial transient blood-brain barrier. According to our results, central-pontine myelinolysis (CPM) proof by NMR can be expected after 1 week. During the clinical course, cCT and NMR findings showed no regression. Also no connection was noted between the size of the pontine lesion and the favorable clinical course in 72.2% of the patients, nor was there a correlation with the extent of the neurological symptoms at the crisis of the disease. Altogether, cCT and NMR are irrelevant for the prognosis of cerebral myelinolysis.

The aim of this prospective study was to evaluate the potentials and limits of Doppler waveform analysis of intrarenal vessels in patients with suspected renal artery stenosis.In a three-year study we compared our colour Doppler results of 111 patients with the angiography results. Evaluated parameters were acceleration time (AT), acceleration index (AI) and early systolic peak (ESP).The sensitivity of severe stenoses (or = 70%) was 89%. In moderate stenoses (50-70%) it was possible to increase the sensitivity from 56% to 76% if a comparison with the contralateral side was included. The specificity was 91%. Causes for limited sensitivity and specificity were poor examination conditions, stenoses of accessory renal arteries and moderate stenoses as well as diffuse non-stenosing lesions.In comparison with angiography, the diagnostic value of Doppler waveform analysis in the detection of renal artery stenoses has specific limitations. In significant stenoses, however, additional valuable haemodynamic information, useful for PTA, can be obtained by this easy and accessible method.

In dilation of nasolacrimal duct stenosis materials now being used originally were developed for percutaneous transluminal coronary angioplasty (PTCA). Suitable modifications of the angioplasty equipment could improve therapeutic results and thus influence the area of indication of this new technique. In addition to the standard PTCA equipment, we used a cannula designed to fit the guide wire, leading to less traumatic intubation of the lacrimal duct and allowing radiographic control of the recanalization procedure. Five patients showing relative stenosis and ten patients showing complete obstruction of the nasolacrimal duct were treated by dacryocystoplasty. Clinical and radiographic follow-up was done over a period of 6 months. In a total of seven patients, dilation proved successful. Out of these, four showed stenosis (80% recanalization rate) and three complete obstruction (30% recanalization rate) before dilation. Recanalization by dilation using balloon catheters seems to be possible even in cases of complete nasolacrimal duct obstruction. However, the success rate is considerably lower than in relative stenosis.

An unusual cardiac metastasis, occurring in a 63-year-old man 19 years after nephrectomy because of renal cell carcinoma, is reported. The tumor extended from the right ventricle apex to the mid-portion of the interventricular septum. A complete excision could be achieved. To our knowledge, this is the third case of a renal cell carcinoma metastasis to the right ventricle which could be detected during a patient's lifetime and treated surgically. A review of the literature is also reported.

To assess the clinical value of magnitude contrast angiography in arteriosclerosis of the lower limb.187 examinations were done in 105 patients with arteriosclerotic lesions of the femoropopliteal vessels. The MRA results were compared to DSA and conventional angiography. 36 patients were investigated before and after angioplasty.Occlusions were detected correctly in all cases. In mild and moderate stenoses there was 90% agreement. High-grade stenoses may simulate occlusions. All interruptions of the signal with a length of 1 to 10 mm have to be read as high-grade stenoses (MRA sensitivity was 0.96 and specificity 0.94). In patients with low cardiac output MRA may be advantageous in comparison to DSA: collaterals and vessels distal to occlusions were visualized better in MRA. Axial scans show morphology of stenoses and occlusions and influenced the choice of treatment in 6 cases. In 3 cases, thrombotic material and calcified plaque were distinguished. After angioplasty vessel wall lesions such as dissection of the intima or compressed plaque inside the vessel wall were well visualized. Agreement was 92% with MRA as opposed to lesser values with DSA.

Forty-two patients underwent endoluminal Doppler examination of blood flow velocity proximally, at the stenosis and distal to it by means of a 0.018 in. Doppler guide wire. The method was found to be an accurate tool for documentation of a wide spectrum of stenoses of different morphology. The changes induced by percutaneous transluminal angioplasty (PTA)-hemodynamic changes as well as vascular wall lesions-could be documented precisely. Remaining stenoses after PTA were precisely verified as compared to angiography. In multiple stenoses or in stenoses with pure run-off, the hemodynamic significance of the lesion was evaluated. Intravascular Doppler flow measurement is valuable in angiographically imprecise cases. The method fits well into the angiographic routine examination.

CT provides a clear, unobstructed and reproducible view of the shoulder joint. This permits, unlike conventional methods, for the first time a complete view of the anatomy and of the factors which predispose to a recurrent subluxation of the shoulder. In addition it is possible to see bone lesions resulting from the subluxation.

The basic abnormality of neurofibromatosis consists not only of a maldevelopment of the neuroectoderm but also of the mesoderm. Therefore any organ or system of the body may be involved. Following a short clinical review of the central (acoustic) and peripheral type the well known and the more unusual radiographic findings are summarized. They include cranial and intracranial manifestations (orbitosphenoid dysplasia, bone defects of the skull, acoustic neuroma, glioma of the optic nerve and chiasm, meningioma), spinal lesions (scoliosis, vertebral scalloping, meningocele, neuroma, ependymoma), skeletal abnormalities (pseudarthrosis), cardiovascular manifestations, pulmonary fibrosis, tumors of the gastrointestinal and urinary tract and different endocrinopathies. Some of the roentgenologic symptoms are very characteristic and allow definitive diagnosis.

13 patients with verified primary aldosteronism (unilateral adrenal adenoma = 10, bilateral idiopathic hyperplasia = 3) underwent examination by CT and 131J-cholesterol-scintigraphy. CT-scan can successfully employed for localization of unilateral adenoma exceeding 10 mm in diameter. Small lesions and hyperplasia are rare CT-findings. The value of 131J-cholesterol-scintigraphy for differentiation of the two main subgroups of primary aldosteronism--adenoma and hyperplasia--is limited. In our experience both non-invasive methods are helpful to avoid misleading interpretation. In controversial cases bilateral adrenal venous blood sampling by catheterization is mandatory.

Since 1986 more than 150 patients with testicular carcinoma, trauma or chronic inflammation and subacute torsion were investigated with MRT. Using a 1.5 Tesla-Magnetom (Siemens) with surface coils and a special Helmholtz coil, we imaged T1-weighted, proton-density and T2-weighted coronary and axial slices. The excellent spatial resolution facilitated the imaging of fine structures as the septula testis. In 55 surgically proven cases the proof or rejection of a testicular tumour was always possible without false negative or positive cases. We were also able to correlate certain types of tumours with the imaged morphologic structure. Embryonal carcinomas showed typical focal hemorrhages. Pure seminomas showed a clean cut surface, correlating with that of the surgical preparation. The T2 image gave always a low intensity signal. Beta-HCG-positive seminomas showed different signal patterns. Inflammatory processes in epididymitis were detected, as well torsion of the testicles. In traumatic conditions a differentiation of a ruptured tunica albuginea as an indication for surgery was possible. MRT is an important contribution for the indication of urological surgery. Unnecessary surgery of the testes can be prevented, small tumours can be detected at an early stage and can be differentiated from other conditions.

In 41 patients with adrenal diseases and hormonal excess (pheochromocytoma n = 9, Cushing's syndrome n = 6, primary aldosteronism n = 26) computer tomography was performed for localization and classification of the adrenal lesion(s). In all patients diagnosis was confirmed by surgery. In all patients with pheochromocytoma a tumor was detected. 8 patients had unilateral adrenal pheochromocytoma, whereas in one female patient the pheochromocytoma was multilocular. 4 of the 6 patients with hypothalamic-pituitary Cushing's syndrome had enlargement of the adrenals. In the 26 patients with primary aldosteronism, computed tomography showed normal adrenal glands in 2 of the 17 patients with unilateral adenoma (with a diameter of 8 mm in both of the 2 patients) and in 6 of the 9 patients with bilateral hyperplasia. In the remaining patients adenoma or hyperplasia was detected. The results document that in patients with pheochromocytoma, with Cushing's syndrome, and in those with primary aldosteronism, computed tomography is a simple and valid method for localization and classification of the adrenal lesion(s). In primary aldosteronism with a normal adrenal computed tomography, however, differentiation between a small unilateral adrenal adenoma and bilateral adrenal hyperplasia remains problematic.

Based on 584 compiled cases of renal tumour embolization the materials used, the results and complications, are analyzed. The most serious complication proved to be the displacement and dislocation of particles from the embolization. Personal experience with 102 of our patients confirmed these results. In our clinics we have carried out tumour embolization in 20 patients using 95% alcohol since 1980. The first results are presented. The particular advantages of embolization using ethanol are: 1. The high risk of dispersal of particles from an embolization is eliminated. 2. It leads not only to destruction of the vascular system but also of the peripheral tissues as well to an extent rarely seen with the majority of other embolization materials. Attention must also be drawn to the comparatively safe and simple usage of ethanol during embolization.

There are a variety of applications for contrast media in CT. They can be used for better anatomic demonstration or for showing pathological processes. Nearly all available contrast media may be found useful. Intravenously injected renographic contrast media are most commonly employed. In addition to their inherent contrast, specific pharmaco-kinetic changes may be of diagnostic value. This adds some knowledge of function to the purely morphological information obtained by computer tomography. For this purpose, contrast has to be injected rapidly and a fast scanner must be used (so-called angio-CT).