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In a study in the Aegean city of Izmir, Turkey, during the summer of 2002, 2101 patients (1046 boys and 1055 girls) were examined. The examination occurred within the framework of a dental check-up performed at two schools and one pre-school unit. The age span ranged from 3.98 to 24.91 years. Sex, age and present permanent teeth were recorded. Wisdom teeth were excluded. The sequence of tooth eruptions differs significantly in the lower and upper jaw, whereas no significant differences existed when comparing the sides of each jaw. The times of tooth eruption is earlier in females than in males. The entire tooth eruption process of the second dentition occurs in females earlier than in males. The tooth eruption in the lower and upper jaw of male and female probands is symmetrical. In comparing the upper and the lower jaw of both genders, it becomes evident that there is a tendency for earlier tooth eruptions in the lower jaw. In respect to the tooth eruption sequence, a change was noted in the upper jaw. Contrary to the reports of other authors, the second premolar has changed places with the canine and erupts prior to this tooth. Otherwise no major differences concerning the sequence of tooth eruptions, when compared to the results gained from other populations, were observed. Concerning the entire dentition, no acceleration of the tooth eruption could be noted. The computed differences of teeth eruption as a mean value calculated over all teeth, was +/- 1 year at maximum, compared to studies from different continents. Oral examination of teeth is a simple tool to calculate tooth eruption intervals. This first investigation on a population of Izmir revealed a change in the eruption sequence of permanent teeth. These findings are relevant for dental treatment planning and forensic odontology and should be reconfirmed at certain intervals.

PURPOSE: To evaluate the image quality of thin-section MSCT examinations of low-contrast objects such as liver lesions, and to find out whether a thin slice technique requires an increase in radiation dose. MATERIALS AND METHODS: MSCT examinations of the liver were performed in the portal venous phase on a Volume Zoom Scanner (Siemens, Erlangen) with a collimation of 4 x 2.5 mm, 120 kV, 125 mAs and table speed of 12.5 mm. Forty small hypodense liver lesions with a mean size of 3 mm (1 to 8 mm) were reconstructed using a slice thickness of 3, 5, 7, and 10 mm. All lesions were evaluated for each slice thickness by 3 independent radiologists using a 5-point scale (excellent to poor) for the following 7 criteria: contrast, demarcation and contour of the lesion, image noise and quality, demarcation of liver veins and liver contour. The mean values of the reviewers' scores were calculated. The correlation of the three observers in the evaluation of the criteria was determined using the Kendall's Tau coefficient. RESULTS: The 3-mm thin sections were excellent in the evaluation of lesion detection, lesion contrast and lesion contour with a mean score of 1.4 compared to 4.1 for 10-mm sections. Concerning the criteria image quality and liver contour, thin sections achieved the best results in our series. Image noise was pronounced in thin sections but did not affect negatively the image analysis. Interrater agreement was 0.53 for the criterium image noise. CONCLUSION: Thin sections in MSCT examinations of low contrast objects such as liver lesions do not require an increase in radiation dose because the increase in image noise is compensated by improved lesion contrast.

Purpose: To optimize the examination protocols of multislice CT (MSCT) of the pelvis for dose reduction with regard to image quality. Materials and Methods: 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 × 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. Results: 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. Conclusions: 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.

Purpose Detection of malignant liver lesions with gadolinium-enhanced volumetric interpolated breath-hold examination (VIBE) in comparison with SPIO-enhanced MRT (four different SPIO-enhanced T2w sequences) and histological and imaging follow-up in non-cirrhotic livers at 1.5 T. Patients and methods Twenty-two patients with suspected focal liver lesions prospectively underwent a gadolinium-enhanced 3D VIBE. Four T2w sequences (HASTE sequence, fast spin-echo-sequence with and without fat-saturation, FLASH 2D gradient echo-sequence) after administration of superparamagnetic iron oxide (SPIO) served as gold standard combined with histological work-up in 17 patients and histological and imaging follow-up in five patients. The image quality was evaluated and the detectability of intrahepatic lesions was rated by the alternative free-response receiver operating characteristic (AFROC) analysis. In addition, the contrast-to-noise ratio was compared. Results Altogether 49 malignant and 35 benign liver lesions were found. Concerning the image quality, VIBE turned out to be of slightly poorer image quality than the SPIO-enhanced examination with HASTE sequence (4.95 vs. 5.0). The fast spin-echo-sequence without fat-saturation demonstrated the highest contrast-to-noise ratio. All sequences showed a comparable certainty in detecting lesion (area under the curve 0.68-0.73) and identifying malignant liver lesions. Conclusion Despite the small number of patients, VIBE seems to be a comparable, inexpensive and fast method in diagnosing malignant liver lesions.

Aufgrund der hoheren mechanischen Stabilitat hat die kombinierte dorsoventrale Stabilisierung von Frakturen des thorakolumbalen Ubergangs in den letzten Jahren zunehmend an Bedeutung gewonnen. Bislang liegen nur wenige Daten zum postoperativen Verlauf nach einer dorsoventralen Instrumentierung vor. Unklar ist insbesondere, welche Auswirkungen sich auf die Lebensqualitat ergeben.Zielsetzung dieser Untersuchung war es,die allgemeine gesundheitsbezogene Lebensqualitat nach einer dorsoventralen Stabilisierung des thorakolumbalen Ubergangs zu erfassen. Dabei sollte eruiert werden, ob bestimmte Faktoren die Entwicklung chronischer Beschwerden bei diesem Krankengut begunstigen. 30 Patienten einer konsekutiven Serie mit traumatischen Frakturen des thorakolumbalen Ubergangs wurden in eine prospektive klinische Studie eingeschlossen. Nach dorsaler Stabilisierung mit einem Fixateur interne (USS,Synthes®) wurde der verletzte Wirbelsaulenabschnitt von ventral mit einem autogenen Beckenkammspan und einem winkelstabilen Implantat (MACS, Aesculap®; VentroFix, Synthes®) instrumentiert. Die Lebensqualitat wurde mit dem SF- 36-Fragebogen 2 Jahre postoperativ untersucht. Der Grund-Deckplatten-Winkel (GDW) wurde praoperativ,unmittelbar postoperativ und 2 Jahre postoperativ erfasst. Die Auswertung der Daten ergab eine deutliche Beeintrachtigung der Lebensqualitat, hauptsachlich in den Dimensionen "Korperliche Rollenfunktion", "Korperlichen Schmerzen" und "Emotionale Rollenfunktion". Bei 42% der Patienten bestanden 2 Jahre postoperativ noch masige oder starke Schmerzsymptome. Radiologisch zeigte sich zu diesem Zeitpunkt ein geringfugiger Korrekturverlust, in den meisten Fallen ohne Anzeichen einer relevanten kyphotischen Deformitat. Die statistische Auswertung der Daten ergab keinen Zusammenhang zwischen den Parametern der Lebensqualitat und den klinisch-radiologischen Ergebnissen.Insbesondere fand sich keine Korrelation zwischen "Korperlichen Schmerzen" und dem GDW (r=0,112, Korrelationskoeffizient nach Spearman). Die hier vorgestellten Patienten wiesen 2 Jahre nach einer dorsoventralen Stabilisierung der thorakolumbalen Wirbelsaule eine eingeschrankte Lebensqualitat auf.Im Vordergrund stand dabei die anhaltende Schmerzsymptomatik. Diese ging uberwiegend nicht mit einer relevanten radiologischen Fehlstellung einher. Neben der eigentlichen Verletzung kommt als Schmerzursache der ausgedehnte operative Eingriff in Frage, wobei keine Unterschiede zwischen dem offenen und dem minimal-invasiven Verfahren zur ventralen Stabilisierung gesehen wurden. Insgesamt kann festgestellt werden, dass der SF-36 ein geeignetes Messinstrument darstellt, um die postoperative Lebensqualitat bei wirbelsaulenverletzten Patienten mit einer dorsoventralen Stabilisierung des thorakolumbalen Ubergangs zu erfassen.

Objective To assess the diagnostic power of the umbilical venous−arterial index (VAI) for the prediction of poor fetal outcome. Subjects and methods This was a retrospective, crosssectional clinical study in which normalized umbilical vein blood volume flow rate (nUV) (mL/min/kg estimated body weight), umbilical artery pulsatility index (UAPI), the newly developed VAI (nUV/UAPI), and the uterine artery resistance index (UTRI) were determined in 85 fetuses once (17–41 gestational weeks) during pregnancy using standard ultrasound Doppler equipment. A risk score based on umbilical blood pH, 1-min Apgar score, birth weight, duration of gestation, type of respiratory support, and referral to the pediatric department was constructed, and fetuses were assigned to a control or a pathological group accordingly. Logistic regression and analysis of fitted receiver–operating characteristics curves were performed to evaluate the diagnostic power of nUV, UAPI, UTRI, and VAI. Results The incidence of compromised neonates was 17.6%. The area under the receiver–operating characteristics curve was larger for VAI than for UTRI or for UAPI ( P < 0.002). At a cut-off value of 100 mL/min/kg, the sensitivity of VAI to predict poor neonatal outcome was 85% with a 15% falsepositive rate. Conclusion Determination of the VAI has a greater diagnostic power to predict poor fetal outcome than the pulsatility index in the umbilical artery or the resistance index in the uterine artery.

PURPOSE Evaluation of TSE- and T 1 -3D-GRE-sequences for focal cartilage lesions in vitro in comparison to ultrahigh resolution multi-slice CT. MATERIALS AND METHODS Forty artificial cartilage lesions in ten bovine patellae were immersed in a solution of iodinated contrast medium and assessed with ultrahigh resolution multi-slice CT. Fat-suppressed TSE images with intermediate- and T 2 -weighting at a slice thickness of 2, 3 and 4 mm as well as fat-suppressed T 1 -weighted 3D-FLASH images with an effective slice thickness of 1, 2 and 3 mm were acquired at 1.5 T. After adding Gd-DTPA to the saline solution containing the patellae, the T 1 -weighted 3D-FLASH imaging was repeated. RESULTS All cartilage lesions were visualised and graded with ultrahigh resolution multi-slice CT. The TSE images had a higher sensitivity and a higher inter- and intraobserver kappa compared to the FLASH-sequences (TSE: 70 - 95 %; 0.82 - 0.83; 0.85 - 0.9; FLASH: 57.5 - 85 %; 0.53 - 0.72; 0.73 - 0.82, respectively). An increase in slice thickness decreased the sensitivity, whereby deep lesions were even reliably depicted on TSE images at a slice thickness of 3 and 4 mm. Adding Gd-DTPA to the saline solution increased the sensitivity by 10 % with no detectable advantage over the T 2 -weighted TSE images. CONCLUSION TSE sequences and application of Gd-DTPA seemed to be superior to T 1 -weighted 3D-FLASH sequences without Gd-DTPA in the detection of focal cartilage lesions. The ultrahigh resolution multi-slice CT can serve as in vitro reference standard for focal cartilage lesions.

The role of platelet hyperaggregability as a possible risk factor for venous thromboembolism is not well defined. Some authors described enhanced maximal platelet aggregation in platelet aggregometry as a contributing factor for arterial and venous thrombosis. This syndrome has been termed “sticky-platelet syndrome” (SPS). The diagnosis of SPS is based on the demonstration of platelet hyperaggregability in aggregometry after stimulation with epinephrine (EPI) and/or adenosine diphosphate (ADP). We investigated platelet hyperaggregability in platelet-rich plasma (PRP) of patients (n=34) with unexplained venous thromboembolism in comparison to healthy individuals (n=53). For analysis, platelet aggregometry was performed and the influence of epinephrine, adenosine diphosphate, collagen (Coll) and thrombin receptor-activated peptide (TRAP-6) as agonist were determined. Compared to the control group, patients with venous thromboembolism showed an enhanced maximal platelet aggregation with low concentrations of TRAP-6 (2 μM) and collagen (0.05 μM). In contrast, we could not detect an increased platelet aggregation with EPI or ADP. Our results indicate that platelet hyperaggregability may represent an independent risk factor in patients with otherwise unexplained venous thromboembolism. In our study, low concentrations of TRAP-6 and collagen are superior to EPI and ADP to define platelet hyperreactivity in platelet aggregometry.

PURPOSE: Purpose of this study was to determine the value of the delayed-phase (DP) of helical CT in the detection of hepatocellular carcinoma (HCC) in cirrhotic liver in comparison to the arterial phase (AP) and the portal-venous phase (PP). MATERIAL AND METHODS: 51 patients with liver cirrhosis and suspected HCC were examined by triple-phase helical-CT (THCT). Images were standardized and obtained 20 seconds - AP, 60 - 70 seconds - PP, and 300 seconds - DP after injection of 140 ml of intravenous iodinated contrast material. Pictures were reviewed by two experienced radiologists for typical intrahepatic lesions. First, each single phase of contrast distribution were seen separately. Then all contrast phases were reviewed together. RESULTS: In 17 patients 49 typical lesions were found, histological work-up was performed, whereas in 34 patients clinical follow-up of at least 6 months was obtained. The arterial phase (AP) itself depicted 55 % of these lesions, whereas the portal-venous phase (PP) depicted 57 % and the delayed phase 78 %. DP showed a significantly higher detection rate in comparison to the PP (p = 0.008). By performing a biphasic helical CT 40 lesions would have been detected with AP and PP, whereas all 49 lesions would have been visualised by combining AP and DP. This means a significantly higher detection rate for AP/DP instead of using AP/PP (p = 0.031). CONCLUSION: Additionally to the AP and PP, a delayed phase should be performed when cirrhosis is present. Even though AP and DP depicted all HCC's in this study, the PP provides undispensable additional information, so that, in our opinion, a THCT should be given preference when HCC is suspected.

Zielsetzung: Einschatzung des Stellenwertes der MRT in der Beurteilung der praoperativen Diagnostik der chronischen Sinusitis und Vergleich mit koronarer CT und intraoperativem Befund. Material und Methodik: 42 Patienten mit klinischen Zeichen einer chronischen Sinusitis wurden jeweils innerhalb eines Tages mittels CT und MRT untersucht. Am Folgetag wurde eine transnasale endoskopische Operation an den Nasennebenhohlen durchgefuhrt. Die CT erfolgte in Bauchlage und koronarer Schichtfuhrung (5 mm Schichtdicke und Tischvorschub). Die MRT wurde an einem 1,5 T-Gerat in Ruckenlage mittels Kopfspule durchgefuhrt. Eingesetzt wurden koronare Protonen-w-, T2-w TSE- und T2- HASTE- sowie eine transversale T2-HASTE-Sequenz. Die Akquisitionsdauer der MRT betrug unter 8 Minuten, Schichtdicke und -abstand entsprachen den CT-Parametern. CT und MRT wurden von zwei Radiologen unabhangig voneinander nach anatomischen Variationen und Zeichen einer Sinusitis ausgewertet. Die Ergebnisse wurden mit den intraoperativ erhobenen Befunden verglichen. Ergebnisse: Die MRT erwies sich als vollstandig unempfindlich gegenuber Zahnmetall, wodurch die Abbildungsqualitat deutlich besser als die der CT eingeschatzt wurde. Beide Verfahren zeigten in Bezug auf die Darstellung von Schleimhautveranderungen (κ = 0,46 - 0,87) und anatomischen Variationen (κ = 0,55 - 0,86) eine hohe Ubereinstimmung der Befunde. Alle fur einen sicheren operativen Eingriff wichtigen anatomischen Strukturen konnten ausreichend mit der MRT dargestellt werden. Fur beide Methoden ergab sich jedoch eine nicht zufriedenstellende Korrelation mit den intraoperativ erhobenen Befunden (τ = - 0,08 - 0,3) bezuglich der Ethmoidalzellen und der Sinus maxillares. Schlussfolgerungen: Die MRT ist eine schnelle und geeignete Alternative zur praoperativen CT-Untersuchung der Nasennebenhohlen bei chronischer Sinusitis. CT und MRT zeigen Schwachen in der Darstellung des ethmoidalen Komplexes. Purpose: To determine the value of MRI in the preoperative evaluation of chronic paranasal sinusitis and to compare the results with CT and intraoperative findings. Method/Materials: 42 patients with clinical signs of chronic parnasal sinusitis underwent MRI after CT evaluation on one day, with subsequent functional endoscopic sinus surgery on the next day. Coronary CT was obtained with 5-mm slices and table-feed in the prone position, while MRI was performed in the supine position with coronary T2-TSE + pd and coronary and transverse HASTE, each with 5-mm slice thickness. Aquisition time in MRI was less than 8 minutes. Two radiologists reviewed the CT and MRI scans for signs of sinusitis and detection of anatomical landmarks. The results were correlated with the intraoperative findings. Results: MRI offered no artifacts of dental work and showed more often high quality pictures than CT. CT and MRI demonstrated a good correlation in the detection of mucosal pathologies (κ = 0.46 - 0.87) and anatomic variants (κ = 0.55 - 0.86). All important anatomical structures could be evaluated sufficiently with MRI for preoperative management. Both diagnostic tools showed an unsatisfactory correlation with intraoperative findings in the ethmoidal complex and maxillary sinus (τ = - 0.08 - 0.3). Conclusions: MRI is a fast and reliable alternative to preoperative CT in examining paranasal sinuses and offers a good visualization of mucosal changes. CT and MRI both give an unreliable representation of the ethmoidal complex.

Pulmonary complications pose a major clinical problem after bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). The underlying pathophysiological mechanisms are under investigation. Twenty patients with infectious or non-infectious pulmonary complications after BMT or PBSCT underwent bronchoalveolar lavage (BAL) and tumor necrosis factor-alpha (TNFalpha), interleukin-10 (IL-10) and interleukin-18 (IL-18) mRNA expression was determined in BAL cells in comparison to 11 healthy volunteers. Patients were divided into two groups (infectious pneumonia, n = 14 or idiopathic pneumonia syndrome (IPS)/bronchiolitis obliterans (BO), n = 6). TNFalpha expression was significantly increased in both patient groups compared to the control (0.40 +/- 0.07 and 0.39 +/- 0.09 vs 0.15 +/- 0.05; P0.05; semiquantitative PCR analysis; mean +/- s.e.m.). IL-10 expression was significantly elevated the group of patients with infectious pneumonia in comparison to normal controls (0.15 +/- 0.06 vs 0.01 +/- 0.01; P0.05) but not in patients with IPS/BO (0.05 +/- 0.04; P0.05). However, IL-10 was not expressed in BAL cells of all patients and control individuals. IL-18 expression was significantly decreased in the both patient groups (1.47 +/- 0.24 and 1.79 +/- 0.63) in comparison to the control group (4.29 +/- 0.77; P0.05). Survival analysis showed a significant association between elevation of TNFalpha and poor prognosis (P0.05). These results highlight the immunoregulatory disturbances in the lungs after BMT/PBSCT.

The trouble with Greek is that too few are taking it. This is a great loss, for Greek has unique cultural value and is in itself the most educative item on the highly varied menu for young minds which our schools set forth. A small percentage of students are taking Greek, and finding it a real benefit. But there are surely many more who could be profiting from a substantial helping of Greek yet are not. Why? And can anything be done to remedy the situation?I would like to diagnose the ill and suggest a feasible cure—one which has worked out quite satisfactorily in practice in over ninety schools of the United States and Canada where a new technique has been used the past few years. Considerable interest in this experiment has developed in England and Scotland, and it has been repeatedly suggested to me that I describe the innovations entailed, for wider notice and under-standing on the part of those who might find it adaptable to their own needs. The following report endeavours to meet this desire.It is a harsh fact, in Britain as across the Atlantic, that under present educational conditions and economic urgencies the proportion of able young students who can afford to devote six or more years to intensive study of Greek is very small. Why not take up their problem and work out a compromise? If we can assure them that on a special method and programme they could in only two years (at four or five hours a week) learn enough Greek to read a substantial portion of at least one major author before the two years are up, would not many of them accept the opportunity and take that much Greek at any rate? It would mean, too, in practice, many more students taking Greek, if only on a short-term basis.