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Objective: This randomized controlled study aimed to find out the combined effects of hip and knee muscle strengthening vs. knee muscle strengthening alone on pain, function and gait in knee osteoarthritis. Methods: Individuals with unilateral knee osteoarthritis (n=40; male, 18; female, 22) were randomized to participate hip and knee muscle strengthening exercise (n=20; mean age, 53.1 years) or knee muscle strengthening exercise (controls, n=20; mean age, 54.2 years). Participants were randomized to receive 18 sessions (45-min sessions a day/3 days/week for 6 weeks) of either hip and knee muscle strengthening exercises or knee muscle strengthening exercise alone. The numeric rating scale (NRS) and reduced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index were used to measure the pain intensity and knee function, respectively. Gait parameters were measured using the computer dynography (CDG). Results: The hip and knee muscle strengthening exercise group has shown a significantly greater reduction of pain and improvement of knee function as compared to the knee muscle strengthening exercise group (p Conclusion: This study concluded that the addition of hip muscle strengthening along with knee muscle strengthening reduces pain and improves function, and gait parameters in individuals with knee OA.

Maternale Hepatopathien stellen eine Bedrohung in Schwangerschaft sowie Wochenbett und eine Herausforderung fur behandelnde Arzte dar. Die Leberaffektionen konnen ein breites Spektrum an schwangerschaftsassoziierten und –unabhangigen Erkrankungen wie HELLP-Syndrom, Leberentzundungen oder akute Schwangerschaftsfettleber zur Ursache haben. In dieser Studie stellen wir eine Serie von 3 lebensbedrohlichen Verlaufen peripartaler Hepatopathien vor und diskutieren diesbezuglich den aktuellen Wissensstand mit einem speziellen Augenmerk auf pathogenetische Zusammenhange und mogliche Differenzialdiagnosen. Pathologische und radiologische Begutachtungen wie auch gynakologische oder chirurgische Masnahmen wurden entsprechend den geltenden Leitlinien durchgefuhrt. Laborchemische Untersuchungen wurden in den Routinediagnostik-Abteilungen der Universitatskliniken durchgefuhrt. Literatur wurde uber das durch die US National Library of Medicine bereitgestellte Verzeichnis „PubMed.gov“ selektiv recherchiert. Im ersten Fall kam es nach Entbindung bei fulminantem HELLP-Syndrom in der 32. Schwangerschaftswoche (SSW) zu einem subtotalen Leberinfarkt mit folgender schwerer Gerinnungsstorung und septischer Peritonitis. Die zweite Patientin wurde bei mildem HELLP-Syndrom in der 36. SSW entbunden. Postpartal verschlechterte sich die Erkrankung rasant und mundete in einen hamorrhagischen Schock mit akutem Nierenversagen. Die dritte Geburt fand mit 36 SSW bei asymptomatischer Hepatitis B statt. Die Hepatitis exazerbierte nach Entbindung mit der Entwicklung einer subakuten Leberdystrophie mit ausgepragter Gerinnungsstorung. Wenn mutterliche Leberaffektionen im Zusammenhang mit Schwangerschaften auftreten gilt es, verschiedene Diagnosen und unterschiedlicher Pathogenese zu berucksichtigen. Diagnostische und therapeutische Ansatze mussen rasch abgewogen werden. Ferner ist eine schnelle, effektive interdisziplinare Zusammenarbeit notwendig, um Folgeschaden zu minimieren und das Uberleben der betroffenen Patientinnen zu sichern, weil fulminante bis todliche Verlaufe auch heute immer noch moglich sind.

Purpose To assess the accuracy of right- (RV) and left-ventricular (LV) heart volume and muscle mass determinations by cine MR imaging. Materials and methods Ten subjects were examined twice by a segmented, ECG-triggered cine sequence in the short axis plane and breath-hold technique by two independent operators and again 4 weeks later by one of the operators. The contours were evaluated manually by two independent examiners and again four weeks later by one of the examiners. LV and RV end-diastolic and end-systolic volumes, stroke volume, cardiac output, ejection fraction (EF), and left-ventricular muscle mass were compared. Results The RV evaluation variations (RV-EF: 6.46%) were higher than the LV (LV-EF: 4.46%). The intra-examiner variations were smaller than the inter-examiner variations. The generally operators did not cause a significantly increased variation (LV-EF: 5.77%). In contrast, the repeat examinations at different times did lead to a significant increase in the variation (LV-EF: 10.15%). Conclusions The rapid ECG-triggered cine MRI in breath-hold technique allows the simultaneous RV and LV, artefact-free determination of heart volumes and LV muscle mass. The LV volumes can be determined more accurately than the RV. The examiner has a distinct influence on the accuracy, the operator has a lesser effect. Physiological fluctuations of cardiac activity significantly influence the follow-up.

Zusammenfassung: Gegenstand und Ziel: Untersuchung einer Schilddrüsenwerterhöhung in Zusammenhang mit einer entzündeten Dachsbissverletzung. Diskussion der klinischen Befunde. Material und Methode: Fallbericht einer acht Jahre alten Dackelhündin, die nach einem Biss in den Hals veränderte Werte der Schilddrüsenparamter aufwies. Ergebnisse: Das Tier zeigte erhöhte Werte an Thyroxin (T4) und freiem Thyroxin (fT4) sowie eine erniedrigte cTSH-Konzentration, die mittels Sonographie und Szintigraphie hinsichtlich des hormonproduzierenden Gewebes abgeklärt wurden. Vorberichtlich war ein noch sichtbarer Dachsbiss mit Abszedierung im Kehlbereich bekannt. Sonographisch fiel eine schlechte Abgrenzbarkeit des Lobus dexter der Schilddrüse zum umgebenden Gewebe auf. Die Szintigraphie ließ eine normale Anreicherung im Bereich der Schilddrüse ohne versprengtes aktives Gewebe erkennen. Bei einer Kontrolle der Schilddrüsenwerte 14 Tage nach der ersten Untersuchung lagen diese wieder im Referenzbereich. Schlussfolgerungen: Die transient erhöhten Werte der Schilddrüsenhormone wurden bei diesem Patienten sehr wahrscheinlich durch eine möglicherweise infektionsbedingte Thyreoiditis oder Perithyreoididtis infolge eines Dachsbisses hervorgerufen. Die Möglichkeit, dass durch Bildung von Thyroxin-Autoantikörpern nach verletzungsbedingtem Austritt von T3/T4 in das umliegende Gewebe falsch hohe Schilddrüsenhormonkonzentrationen gemessen wurden, lässt sich nicht komplett ausschließen. Klinische Relevanz: Die Ergebnisse der Untersuchungen decken sich mit den Befunden humanmedizinischer Fallberichte über nicht autoimmun bedingte Schilddrüsenentzündungen. Differenzialdiagnostisch sollte bei erhöhten Schilddrüsenhormonwerten des Hundes auch an eine Entzündung der Thyreoidea gedacht werden.

Purpose The well-defined model of angioplasty and stent implantation in the rabbit aorta is useful in experimental studies of restenosis. This study was performed to evaluate the feasibility of Micro-CT for quantification of in-stent restenosis in a rabbit aortic in-stent-restenosis model. Material and methods To induce in-stent restenosis seven female New Zealand rabbits underwent balloon dilation and denudation prior to stenting the abdominal aorta. After six weeks on atherogenic diet, animals were killed and the aorta was perfused with contrast agent. Micro-CT morphometric analysis of balloon and stent injured arteries obtained by 700 transverse sections (voxel size 10 microm) was compared to conventional histological analysis. Results Intimal hyperplasia was present in stented and balloon injured arteries with a moderate intimal area assessed by Micro-CT and conventional histology (3.91 +/- 0.5 mm(2) vs. 4.18 +/- 0.42; r = 0.9). High significant correlations between Micro-CT image analysis and conventional histomorphometry were obtained for lesion size, size of media, size of lumen and stent area (r = 0.84 to 0.96). Conclusion Micro-CT is feasible for quantitative information about restenosis following balloon angioplasty and stent implantation and has the potential to become a standard technique in many laboratories which will augment serial histology as the reference method for ex-vivo studies of restenosis.

Micro-CT has become a powerful technique in non-destructive 3D imaging and morphometric analysis. First results were limited to the investigation of osteoporosis in cancellous bone. But the availability of systems with almost microscopic resolution and sufficient soft tissue contrast has opened up entirely new applications for laboratory investigation of blood vessels and soft tissues. This article gives an overview of micro-CT technology and the potential of three-dimensional imaging of the vessel wall and soft-tissue architecture imaging in different organs using different contrast perfusion and staining techniques. Micro-CT provides quantitative information on human plaque morphology equivalent to histomorphometric analysis. Based on differences in grey-scale attenuations, micro-CT also correctly identifies atherosclerotic lesions that are histologically classified as fibrous plaques, calcified lesions, fibroatheroma, and lipid rich lesions. Micro-CT is a promising method to visualize the architecture of the renal vasculature and, importantly, to separate cortex and medulla for the visualization of glomeruli and their afferent and efferent arterioles. Micro-CT can determine the vascular surface in a defined placental volume. Combining of micro-CT data and total placental volume enables an estimation of the approximate surface of the placental vasculature. The diameter of opacified vessels in the investigated samples ranged from 2 mm (chorion plate artery) to 14 micro m (smallest vessel diameter, terminal loop). Recognizing that lung parenchyma can only be visualized if the alveoli are completely expanded and the contrast of the thin alveolar walls is enhanced, we tested two preparation methods: (1) fixation of lung tissue with formalin vapour and staining with silver nitrate, and (2) intravenous injection of a barium sulfate-gelatine-thymol mixture in vivo in the anesthetized animal. We evaluated the ability of this mixture to enter the pulmonary microcirculation and the technical feasibility of micro-CT to assess lung micro-architecture.

OBJECTIVES Since the early 1990's when callus distraction of hypoplastic mandibles was developed, surgeons have been looking for a reliable method to monitor distraction treatment. X-rays films resulted in insufficient quality of images of low calcified structures and are only of little support in follow-up. Therefore, a standardised protocol using ultrasound was introduced. METHODS 24 patients were included (aged 4 - 29 years with hemifacial microsomy [19], mandibulary micrognathia [5]), 20 intraoral (Howmedica-Leibinger/Muhlheim) and 9 extraoral distractors (Normed/Tuttlingen). Standard procedures for intra- and extraoral distraction were carried out and all postsurgical treatment steps were monitored by ultrasound. RESULTS The mineralisation of the neocallus shows the following sequence: echogenic dots, needles directed along the distraction direction, bands, plaques, and modulation of the neocompacta. Additional therapeutically relevant questions of distraction distance, inflammation or occurrence of pus, arising during treatment were answered by sonography. Distance measurements could be performed reliably. CAT scan and MRI cannot be carried out because of metal artefacts. X-ray pictures like orthopantomogram and Clementschisch projection cannot show the early mineralisation and do not allow an exact distance measurement. CONCLUSIONS Sonography is a effective, method to investigate the callus field without using X-rays and supports monitoring and decision making in distraction treatment of hypoplastic mandibles.

GOAL Comparison of fast MRI, echocardiography (Echo), and ventricular angiography (Cath) in the assessment of left ventricular global function. METHODS Fast MRI in short axis plane, biplane Cath, and 2D Echo were performed in 62 patients [35 coronary artery diseases, 16 acquired valvular diseases (VD), 9 dilated cardiomyopathies (DCM), 1 congenital heart disease and 1 heart transplantation]. Enddiastolic (EDV), endsystolic (ESV), stroke volumes (SV), cardiac output (CO), and ejection fraction (EF) were compared in MRI and Cath. EF was visually estimated in 2D Echo by an experienced observer. RESULTS In comparison to MRI, Cath overestimated EF by 8.4%, and Echo underestimated EF by 5.6%. The limits of agreement between MRI and Cath in EF were +/- 23.8%, between MRI and Echo +/- 18%, and between Echo and Cath +/- 19.4%. Significant differences were found between Cath and MRI in EDV, SV, and CO, but not for ESV. The best agreement in EF was found in the group with DCM, the worst in the group with VD. CONCLUSION Important systemic and random errors were found in the comparison of MRI, Echo, and Cath. For therapy decision and follow-up, the methods should not be exchanged unscrupulously.

PURPOSE Definition of the prognostic value of clinical and morphological findings in the mid-term follow-up of OCD of the femoral condyle and talus. Demonstration of the consolidation of OCD on MRI depending on different therapies. MATERIALS AND METHODS 76 patients were examined before and at an average of 30 months after conservative or surgical therapy using T1 and T2 weighted SE and 3D-FISP sequences and contrast enhanced studies. Six clinical (age, gender, site, duration and severity of symptoms, therapy) and six morphological (size, signal intensity, fragmentation, contrast enhancement, condition of cartilage, staging) data were registered on first MRI and correlated with the degree of consolidation of OCD (partial and complete remission, no change and progression) on control MRI. RESULTS Patients under 17 years showed partial or complete remissions in 73%, those of 17 years or older in 33%. Conservatively treated patients had a higher remission rate (54%) than those treated with different surgical techniques (drilling 50%, refixation 43%, abrasio 38%). Small OCDs had a higher remission rate than large lesions (63% vs. 33%). OCDs covered with intact cartilage healed better than lesions with chondral defects (61% vs. 26%). Contrast enhancing fragments had a better prognosis than non-enhancing lesions (100% vs. 40%). CONCLUSIONS Prognosis of OCD can be better estimated when size of OCD, condition of cartilage and enhancement of contrast agent is graduated with MRI and patient age is registered. The consequences for therapy planning are great.

PURPOSE Quantification of left and right ventricular filling and ejection of localized and diffuse heart diseases with fast cine MR imaging in breath-hold technique. METHODS 42 patients (14 idiopathic dilated cardiomyopathies (DCM), 13 hypertrophic cardiomyopathies (HCM) and 15 coronary artery diseases (CAD)) and 10 healthy volunteers were examined. Time-volume-curves of three left ventricular and one right ventricular slices were evaluated and peak ejection and filling rates (PER, PFR end-diastolic volume (EDV)/s) time to PER and PFR (TPER, TPFR ms) and time of end-systole (TSYS in % RR-intervall) were calculated. RESULTS There were significant regional and left-/right-sided differences of the filling and ejection of both ventricles within and between the different groups. In DCM the left ventricular PFR was reduced (DCM 3.1 EDV/s; volunteers 4.9 EDV/s) and Z-SYS prolonged (DCM 50.1%; volunteers 35.4%). In CAD there were localized decreased filling rates in comparison to the normal volunteer group (left ventricle: basal: 2.9 and 6.3 EDV/s, apical: 4.4 and 6.3 EDV/s; right ventricle: 3.6 and 5.7 EDV/s). HCM typically showed an isovolumetric lengthening of the endsystole. CONCLUSIONS Cardiac MR imaging in breath-hold technique is suitable for measuring contraction and relaxation disturbances of localized and diffuse heart diseases by means of ejection and filling volume indices.

PURPOSE Evaluation and comparison of localized and global left and right ventricular ejection and filling with fast cine MR imaging in the breath-hold technique. MATERIALS AND METHODS 10 healthy volunteers were examined with a 1.5 Tesla unit and phased-array-coil using a segmented FLASH-2D sequence in breath-hold technique. Peak ejection and peak filling rates [PER, PFR end-diastolic volume (EDV)/s)]. time to PER and PFR [TPER, TPFR ms] and time of end-systole [TSYS in % RR-interval] of all slices (complete-slice-evaluation) were evaluated and compared to three left ventricular and one right ventricular slices (reduced three-slice-evaluation). RESULTS There were significant regional left ventricular differences of PER (p = 0.002) and PFR (p = 0.007), but not of TPER and TPFR. Ejection and filling indices of the left ventricular middle slice were closest to the overall evaluation of all sections. In the left-/right-side comparison the right ventricular PFR was higher than the left ventricular (5.1 and 4.2 EDV/s) and the right ventricular TPFR was earlier than the left (92.2 and 123.5 ms). CONCLUSIONS With fast cine techniques, regional and global left and right ventricular ejection and filling indices can be evaluated in addition to the global heart volume indices. The three-slice-evaluation represents a comprehensive, clear and time-saving method for daily routine.

PURPOSE In glenohumeral instability, CT arthrography and MR arthrography of the shoulder joint were compared to assess accuracy in diagnosis of labral lesions and other internal derangements of the joint, and to evaluate relevance of both imaging methods for therapy. METHODS 38 patients with symptoms of shoulder instability were examined clinically, arthrographically with CT and MRI, and arthroscopically. Arthrography with CT and MRI was performed in a double-contrast technique after single puncture and simultaneous injection of the contrast agents for both imaging methods. Type and extent of lesions on arthrographic imaging were criteria for planning therapy to a conservative, sole arthroscopic, or open surgical approach. RESULTS Sensitivity in diagnosis of labral lesion (26 defects) was 85% in CT, 88% in MRI and 100% if both methods were used. Full-thickness tears of the rotator cuff were visualised in CT in 73%, and in MRI in 100%. Diagnostic accuracy increased from partial to complete to total defects. An open surgical approach was correctly predicted on MRI in 90% and on CT in 71%. A sole arthroscopic therapy was correctly foreseen on both arthrographic techniques in only 38% due to difficulties to assess glenohumeral ligaments. CONCLUSIONS CT arthrography and MR arthrography were excellent for diagnosing labral lesions. MRI is superior to CT in the imaging of all joint structures. Surgical approach can be accurately predicted with both imaging methods but special surgical techniques cannot be effectively planned to replace diagnostic arthroscopy in all cases.

PURPOSE Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest x-ray--Impact on therapy and correlation with mechanical ventilation support and clinical outcome. METHOD In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest x-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. RESULTS We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO2, Goris-Score) (r = 0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r = 0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest x-ray; only 32% and 43%, respectively, were identified by conventional chest x-ray. CONCLUSION CT allows rapid classification and quantification of pulmonary lesions after thoracic trauma and provides higher sensitivity and reliability. Because of the great correlation with the extent of artificial respiration in respect of duration and pressure, prognosis of the individual patient, as well as a differential therapy, appear possible.

PURPOSE: An experimental study was performed on joint specimens of the knee to assess the advantages and disadvantages of 14 generally available sequences in cartilage imaging. METHODS: Each of the 50 surgically exposed cadaveric joints of the knee was examined by the following sequences: T1, proton- and T2 weighted spin echo(SE) sequences, proton- and T2 weighted Turbo-SE, T1 weighted SE with fat suppression, MTC combined with T1-weighted SE and T2 weighted FLASH-2 D, STIR, FISP-3 D, FLASH-3 D (with fat suppression), and MR arthrography. We assessed the image quality by a scale, signal to noise-ratio of cartilage and joint fluid, and the accuracy in detection of cartilage lesions. Pathology and arthroscopy were reference methods to MRI, and demonstrated grade 1-4 lesions on 186 of 300 joint facettes. RESULTS: Advanced stages of cartilage lesions (65 grade 3 and 4 lesions) were detected by standard SE sequences in 67-94%. Application of volume techniques (FISP-3 D, FLASH-3 D), high definition matrix (512 pixel), MTC with FLASH-2 D and MR-arthrography improved the sensitivity up to 82-100%. Superficial lesions (65 grade 2 lesions) were demonstrated in 3-38%, and on MR arthrography in 45%. Structural changes (56 Grade 1 lesions) were recorded on MR) in only 10%. CONCLUSIONS: With regard to standard SE sequences, the detectability of cartilage lesions can be improved by techniques that use 512 matrices, selective cartilage imaging, and volume acquisition.

ter: Purpose: The aim of this study was the assessment of the temporary Gunther filter system concerning handling, complication rate and efficacy in respect of prophylaxis of pulmonary embolism in peripartal patients. Patients and Methods: 10 temporary Gunther filters were placed in patients (29 ± 5 years) with deep venous thrombosis; 6 thromboses had occurred prepartal and 4 postpartal. Results: There was no complication associated with the filter placement. All patients were treated with heparin in therapeutic dosage. 4 women in the postpartal phase (54.3 ± 28.2 days) underwent additionally a thrombolytic therapy. Under filter protection we recognised neither bleeding complications nor pulmonary embolism. The mean time until filter retrieval was 6.1 ± 3.4 days, depending on the success of either thrombolytic therapy or thrombus consolidation. The retrieval of the filter was without complications; occluding thrombi were never seen. Conclusion: Percutaneous placement of inferior vena cava filters is an easy, safe and effective prophylaxis in respect of pulmonary embolism in peripartal patients if combined with thrombolytic therapy or therapeutic he-parinisation.

PURPOSE To assess the temporary Gunther filter system concerning handling, complication rate and efficacy in respect to prophylaxis of pulmonary embolism. PATIENTS AND METHODS 45 temporary Gunther filters were placed in 44 patients (mean age 46 years) with deep venous thrombosis of the iliac and/or inferior vena cava. RESULTS The mean time until filter retrieval was 6.1 +/- 4.1 days (maximum 14 days) dependent on the success of either thrombolytic therapy or thrombus consolidation. 27 patients underwent systemic thrombolytic therapy (61%), three patients (7%) received local thrombolysis. 14 patients (32%) were treated with heparin in a therapeutic dosage (PTT > 60 sec). We observed four complications (8.8%): one accidental arterial puncture (carotid artery on attempting an internal jugular vein approach), one infection located at the puncture site and one caval vein thrombosis in a patient with known heparin-associated thrombocytopenia. One patient died of pulmonary embolism despite correct filter positioning. CONCLUSION Percutaneous placement of inferior vena cava filters is therefore an easy, safe and effective prophylaxis in respect of pulmonary embolism if combined with thrombolytic therapy or therapeutic heparinisation.

We inserted Gianturco-Z stents in 17 patients with tracheobronchial stenoses on 18 occasions. Three patients had benign, all others malignant stenoses due to compression of the tracheobronchial tree by metastasising malignancies. In all cases the stents could be easily positioned and the patients experienced relief of their severe dyspnea. In one case there was fatigue breakage of the stent. The patient was therefore given a silicone tracheal stent.

Das interventionell-radiologische Vorgehen, der technische Erfolg und die Komplikationsrate wurden bei 15 Beckenarterienverschlussen (5 uber 10 cm, 8 zwischen 5 und 10 cm und 2 unter 5 cm) untersucht. Das Verfahren war in 14 von 15 Fallen (93 %) technisch erfolgreich. Bei sechs Patienten wurde vor der PTA eine lokale Lyse mit Urokinase durchgefuhrt. In der „nur PTA”-Gruppe wurde die Behandlung wegen drohender Emboliegefahr bei einem Patienten abgebrochen, zweimal trat eine ipsilaterale und einmal eine ipsi- und kontralaterale periphere Embolie auf, und bei einem Patienten war eine Stent-Implantation notwendig. Bei den sechs Patienten, die vor der PTA eine lokale Lyse erhalten hatten, traten weder Komplikationen auf noch war eine Stent-Implantation notwendig. Wir halten daher die primare lokale Lyse mit anschliesender PTA fur ein adaquates Vorgehen bei langerstreckigen kompletten Beckenarterienverschlussen. 15 completely occluded iliac arteries (five cases over 10 cm, 8 cases between 5 and 10 cm and two cases below 5 cm) were reviewed for their interventional management, technical results and complications. The procedure was successful in 14 of 15 cases (93 %). In six cases we performed local thrombolysis before PTA. In the patient group with „only PTA” the treatment had to be abandoned in one case because of the risk of embolism. Two patients suffered from a distal embolism of the same side and one patient from an ipsi- and contralateral embolism. A stent implantation was necessary in one patient. In the group of patients with prior local thrombolysis there was no complication nor was there an indication for a stent-implantation. Hence, we conclude that a primary local lysis with a consecutive PTA is an appropriate treatment of complete long occlusions of the iliac artery.

NiTi prostheses were perorally inserted in 12 rabbits. The spiral prostheses were overgrown by normal tracheal epithelium over time. No adverse effects due to impairment of the mucociliary clearance and no chondromalacia occurred. We conclude that perorally insertable prostheses made of the shape-memory alloy NiTi may be used as endotracheal or endobronchial prostheses.

32 patients with secondary Raynaud's syndrome and known basic disease (thromboangiitis obliterans, arterial sclerosis, collagenosis) were examined by high-resolution arterial subtraction angiography. There were typical organic fixed vessel irregularities in relation to the extent of the disease. In early stages, however, the functional vasospastic disorder dominates. The extent and the reversibility of the vasospasm were documented after pharmacological treatment. Pharmacoangiography of the hand can therefore be used as helpful method in the differential diagnosis and therapy of Raynaud's syndrome.

Fragestellung: Die Kenntnis der Lateralisation der Sprachfunktionen beim individuellen Patienten ist fur die Durchfuhrung neurochirurgischer Eingriffe von groster Wichtigkeit. Hierbei gewinnt die funktionelle Magnetresonanztomographie (fMRT) immer mehr an Bedeutung. Im Rahmen dieses Projekts sollten anhand von gesunden Probanden noch wesentliche Fragen zum Einfluss verschiedener Sprachparadigmen und der Handigkeit auf die Hemispharendominanz, sowie zur Reliabilitat der Ergebnisse beantwortet werden. Methoden: Drei Probandengruppen (jeweils 15 Rechts-, Links-, und Beidhander) wurden mit einer visuellen Sprachproduktionsaufgabe (Objekte benennen und Worter generieren) sowie einer auditiven Sprachrezeptionsaufgabe (Worter horen und Zielbegriff assoziieren) zweimal mittels fMRT untersucht. Die Nachverarbeitung erfolgte mit SPM. Pro Proband und Sprachaufgabe wurden Lateralisationsindizes (LI) fur das gesamte Sprachnetzwerk und fur definierte Regionen berechnet und die Unterschiede fur die Handigkeitsgruppen dargestellt. Auf der Grundlage der Wiederholungsmessungen wurden Reliabilitatskoeffizienten (RC) bezuglich der individuellen Aktivierungen und Korrelationskoeffizienten zur Ubereinstimmung der Laterateralisationsindizes berechnet. Ergebnisse: Sprachlateralisation: Linkshemispharische Sprachdominanz findet sich bei allen Rechtshandern mit der Produktionsaufgabe und bei 92,3% der Rechtshander mit der Rezeptionsaufgabe. Der prozentuale Anteil bihemispharischer Sprachlokalisation und rechtshemispharischer Dominanz ist bei den Linkshandern mit 46,2% in der Produktionsaufgabe und mit 30,8% in der Rezeptionsaufgabe am grosten. Rechtshemispharische Dominanz findet sich nur bei Linkshandern (15,4% in beiden Paradigmen). Reliabilitat der kortikalen Aktivierungen und der Lateralisationsindizes: Die generelle Reliabilitat von wiederholten fMRT-Aktivierungen ist in allen Probanden und untersuchten Regionen (Regions of Interest=ROI) im Rezeptionsparadigma deutlich erhoht. Analog hierzu ist auch die Wiederholbarkeit von Lateralisationsindizes im Rezeptionsparadigma verbessert (Tab.1). Schlussfolgerungen: Zerebrale Hemispharendominanz lasst sich mit funktioneller MRT reliabel bestimmen. Mit der komplexeren Sprachrezeptionsaufgabe, die ebenfalls eine produktive Komponente enthalt, konnen robustere und reliablere Aktivierungen erzielt werden. Bei Patienten mit vorhandenen sprachlichen Beeintrachtigungen kann auf die einfachere Sprachproduktionsaufgabe zuruckgegriffen werden.

Background and Purpose: Intraoperative mapping (IOM) in the awake patient is, for some clinical groups, considered to be the gold-standard for the identification of essential language sites; the most widely used task is confrontation naming. On the other hand, functional imaging is rapidly evolving and claims to complement or even substitute IOM. However, little is known on the test-retest reliability of imaging data in the language domain; for naming controversial data exist even for core language areas such as Broca's area. The aim of our study was to assess the reliability of activations in repeated measurements for a naming paradigm; we focused our analysis on the opercular and triangular parts of the inferior frontal gyrus (Broca's area). Methods: We examined 13 healthy right-handed subjects; fMRI was performed on a 1.5 Tesla clinical system (Siemens Vision) as a block design experiment using a BOLD-sensitive EPI sequence in three sessions on different days. Visual stimuli consisted of drawings of objects which should be named aloud. Data were analyzed using SPM99 and custom software; a group analysis (whole brain) as well as individual voxel counts (for the opercular and triangular parts of the inferior frontal gyrus as identified by AAL) were performed. Common voxels were defined as being significantly activated in all three sessions. Results: Group analysis did not result in significant activations in Broca's area. Analysis of individual subjects revealed that although some subjects showed activation in the regions of interest, these activations were reproducible only in a limited way and only in the opercular part of the inferior frontal gyrus. Conclusion: Naming does not activate Broca's area in a reproducible way; earlier contradictory data may result from the large interindividual differences in activation patterns. Although being a reliable task in IOM, naming is not suitable for identifying Broca's area in a clinical context such as for planning neurosurgical interventions. For other linguistic tasks, reproducibility still has to be tested before clinical applications are safe for the patient. Remarks and Acknowledgement: The data used in this study are part of the unpublished doctoral dissertation by S. Rau, Medical Faculty of the Ludwig-Maximilians-University, Munich, Germany. The study was supported by the Bayerische Forschungsstiftung (Grant No. 475/01) and BrainLab AG, Heimstetten (Germany).

PURPOSE The aim of the present study was to evaluate the efficacy of fluoroscopically controlled implantation of subcutaneous tunneled single- or double-lumen-catheters for short- and long-term dialysis. PATIENTS AND METHODS In total, 104 patients were implanted with either a single-lumen Demer catheter or a Permcath double-lumen catheter into the subclavian vein under fluoroscopic control. RESULTS In 99 of 104 cases (= 95.2%) the implantation remained without complications. Implantation-related occurrences included one pneumothorax, one mediastinal haematoma and one death. 61.5% of the indwelling catheters remained in situ for the intended duration. In 78% of the patients, dialysis was carried out to completion. 37 explantations (38.3%) were required due to various factors including infection (5), thrombosis (3), dislocation (9) and malfunction (20). The average duration of implantation was 59.1 days (range 1-851 days). CONCLUSIONS Fluoroscopic-controlled implantation of subcutaneous tunneled catheters for dialysis is superior to surgically implanted catheters with regard to lower rates of infections and is equally reliable in respect of rates of complication and patency. Thus, this mode of implantation is a safe and reliable alternative to other procedures as access for haemodialysis.