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This case report presents an osteosclerotic bone lesion in a 49-year-old man with MDM2 amplification. The final diagnosis shows metastasis to the bones from stomach cancer. In primary bone tumours, the MDM2 amplifications observed have been described for many other tumour entities as well, and therefore do not exclude bone metastasis from a carcinoma.

Sports injuries of the foot can occur as sequelae of acute trauma or chronic overuse. Besides clinical examination, imaging plays a major role in the detection of structural abnormalities and the differential diagnostics. This article reviews the most important sports-related soft tissue and bone pathologies of the forefoot and midfoot together with their typical findings on radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).

Osteochondral lesions (OCL) of the talus show a distinct distribution pattern. Vascular, metabolic, idiopathic, and biomechanical factors have been proposed as influencing factors. However, the association of hindfoot alignment and the location of talar OCL is not known.In 22 patients undergoing autologous osteochondral transplantation for OCL of the talus we collected preoperative data on radiographic hindfoot alignment and clinical performance using the AOFAS score and the VAS for pain. The inter-observer reliability between two investigators was calculated. The association between hindfoot alignment and OCL location was statistically assessed.The preoperative AOFAS score was 64.1 ± 13.9 points and the VAS 5.1 ± 1.4. The mean measurement difference between the two observers was less than 0.5 degrees and the reliability of the measurements was good with a high association (κ = 0.83). Surprisingly, the location of the OCL of the talus was independent from hindfoot alignment (p = 0.766).In our study the hindfoot alignment showed no association with the location of OCL of the talus. Hence, hindfoot alignment per se does not correlate with the localisation of talar OCL.

Summary In more than 20% of subjects, at least one kidney is found to be supplied by more than one artery arising from the aorta. This aberrant renovascular anatomy has been reported in the literature to occur in up to 80% of patients who suffer from essential hypertension. Predominant numbers of the so-called ‘accessory' vessels are longer and narrower than the segmental arteries arising in the main renal artery. As a result (in accordance with Poiseuille's law of fluid flow), the renal segments supplied by these ‘accessory' vessels may have lower levels of blood pressure than the remainder of the parenchyma, thereby increasing the renin secretion. This hypothesis could be significant in terms of finding a causal treatment for a disorder induced by such a mechanism. We first review the literature in which the frequency of these vascular anomalies in normotensive and hypertensive patients is described, and then advance a hypothesis explaining the frequent incidence of essential hypertension in these subjects, as well as the ramifications of this phenomenon.

Summary Retroperitoneal paraganglioma is a rare tumor, especially occurring in childhood and adolescence, with a marked tendency to become biologically malignant. It has not been possible to predict the clinical outcome of paraganglioma patients by conventional histology, hence malignancy can only be demonstrated by the occurrence of metastatic lesions. Currently, only limited information on the genetics of this tumor is available. We report on a 16-year-old girl with a large retroperitoneal paraganglioma and an osseous metastasis to the first lumbar vertebra. In addition to morphological and immunohistochemical examinations, a molecular cytogenetic analysis was performed. Comparative genomic hybridization (CGH) revealed imbalanced chromosomal aberrations with a loss of chromosome 1p and a gain of 1q, indicating isochromosome 1q. A loss of chromosome 3 as well as low-level gains of chromosomes 4, 5, 6q, 11q and 13q were detected. A PCR-based microsatellite analysis of 1p confirmed the loss of heterozygosity, including NB 1 and NB2 putative tumor- suppressor gene regions. Telomerase activity, which is found in the majority of malignant tumors, could not be detected. The case presented here is the first more comprehensive molecular genetic analysis of a sporadic malignant paraganglioma.

Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.

Large osteochondral defects of the weight-bearing zones of the femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle. This technique is a salvage procedure and aims at pain-free mobility of patients.Between July 1999 and December 2000, 18 patients were operated on. Sixteen patients were evaluated using the Lysholm score. X-rays were done, and eight individuals underwent magnetic resonance imaging (MRI) analysis. The average age at the date of surgery was 37.4 (15-59) years, and the mean follow-up time was 55.2 (46-62) months. The mean defect size was 5.4 cm(2) (3.1-7.1). Trauma or osteochondrosis dissecans was pathogenetic in 81%.The Lysholm score showed a significant (p=0.001) increase from a preoperative median of 65.0 to a postoperative median of 86.0 points. Fifteen patients returned to sport activities. X-rays showed a rounding of the osteotomy edge in 12 patients and a partial bone-dense remodelling of the posterior femoral condyle in 11 patients. All MRI examinations showed vital and congruent grafts.Thus, the procedure is recommended for treating large and deep focal osteochondral lesions in the weight-bearing zone of the femoral condyle.

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence.This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes.

To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance.Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test.Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p=0.6665), intraarticular air bubbles (p=0.1567) and occurrence of contrast extravasation (p=0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed.Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming.

The ongoing discussion about CT and MR arthrography is at least in part due to the lack of definite guidelines. The intention of the musculoskeletal workgroup of the DRG (Deutsche Röntgengesellschaft) was the establishment of recommendations for general guidance. After review of the recent literature, the indications for arthrographic examinations were discussed during a consensus meeting. Since the published data are insufficient and partially contradictory, no precise statements could be extracted from the literature. Therefore, the proposed recommendations are mainly based on expert opinions. In this review the main statements of the published literature are summarized and the recommendations of the musculoskeletal workgroup of the DRG are presented.

The case of a female Patient with increasing pain and a palpable mass in the right popliteal fossa shows the spectrum of possible differential diagnoses for the radiologist. The diagnosis of a juxtaarticular myxoma made on the interpretation of conventional x-ray and magnetic resonance imaging was finally confirmed by biopsy.

The usefulness of whole-body MRI (WB-MRI) for the detection of skeletal lesions in patients with Langerhans cell histiocytosis should be documented on the basis of case presentations.In six patients with histologically proven Langerhans cell histiocytosis, 14 WB-MRI examinations were performed to evaluate the skeletal system within disease staging (6 primary, 8 follow-up examinations). The examinations were performed on a 1.5 Tesla, 32-channel whole-body scanner. The examination protocol consisted of T 1-weighted and STIR sequences in coronal and sagittal orientation. For comparison, radiographs of the initial skeletal lesions and those that were additionally detected on WB-MRI were available.In 4 patients no additional skeletal lesions were found on WB-MRI besides the initial lesion leading to the diagnosis of unifocal single system disease. In 2 patients WB-MRI was able to identify additional skeletal lesions. In a 5 S year-old boy with the primary lesion located in the cervical spine, a second lesion was detected in the lumbar spine on the initial scan and in the skull and proximal femur during follow-up examination. In a 12 year-old girl with a primary lesion of the thoracic spine, WB-MRI diagnosed additional lesions in the pelvic bone and the tibia. In both patients the diagnosis of multifocal skeletal involvement led to chemotherapy. During follow-up examination, the healing response under therapy could be demonstrated. Comparison with conventional imaging showed that especially lesions located in the spine or the pelvis were not detectable on radiographs even when knowing the MR results.The extent of skeletal involvement in Langerhans cell histiocytosis has crucial impact on therapy and prognosis. Whole-body MRI has been reported to be an established method for the evaluation of disseminated skeletal disease with distinct advantages over conventional radiography and bone scintigraphy. Our results suggest that WB-MRI should also be the imaging modality of choice for the assessment of skeletal involvement in children with Langerhans cell histiocytosis.

Since its introduction into clinical use, magnetic resonance imaging (MRI) has become well established in the diagnosis of injuries of the knee joint and has replaced diagnostic arthroscopy as the primary evaluation method. Traumatic lesions of the ligaments, menisci, and articular surfaces are common injuries that can be confidently detected using MRI. This article reviews the basic principles of the examination technique of the knee, the normal MRI anatomy of the internal joint structures, and the typical findings in injuries of the cruciate ligaments, collateral ligaments, and mensci, in traumatic dislocation of the patella, and in acute osteochondral lesions.

The treatment of soft tissue sarcoma requires an individually tailored, multimodal therapy due to the high variability in the clinical situation. Resection is the usual treatment for patients with superficial, low grade tumors with a diameter of5 cm. For intermediate grade, differentiated lesions, resection with negative resection edges combined with radiotherapy attains an almost 80% total survival rate. For patients with high grade sarcoma of5 cm, local control can be attained by resection and radiotherapy, however every second patient will develop metastases. Patients with a local recurrence should consider a new resection. Radiotherapy is the more effective the lower the remaining postoperative tumor burden.

On account of the considerable variability of the clinical situation, treatment of soft tissue sarcoma requires an individually oriented multimodal approach. In the case of patients with superficial low-grade tumors measuring less than 5 cm in diameter, resection alone is usually adequate. In the event of medium-grade lesions, resection with negative margins, resection in combination with radiotherapy achieves excellent local control rates associated with an overall survival rate of almost 80%. In patients with high-grade sarcomas measuring more than 5 cm in diameter, local control can be achieved with resection and radiotherapy, although every second such patient develops metastases. For patients with local recurrence, further resection should be considered/performed. Radiotherapy is all the more effective, the smaller the postoperative tumor cell burden.

Long distance running has become a fashionable recreational activity. This study investigated the effects of external impact loading on bone and cartilage introduced by performing a marathon race. Seven beginners were compared to six experienced recreational long distance runners and two professional athletes. All participants underwent magnetic resonance imaging of the hip and knee before and after a marathon run. Coronal T1 weighted and STIR sequences were used. The pre MRI served as a baseline investigation and monitored the training effect. All athletes demonstrated normal findings in the pre run scan. All but one athlete in the beginner group demonstrated joint effusions after the race. The experienced and professional runners failed to demonstrate pathology in the post run scans. Recreational and professional long distance runners tolerate high impact forces well. Beginners demonstrate significant changes on the post run scans. Whether those findings are a result of inadequate training (miles and duration) warrant further studies. We conclude that adequate endurance training results in adaptation mechanisms that allow the athlete to compensate for the stresses introduced by long distance running and do not predispose to the onset of osteoarthritis. Significant malalignment of the lower extremity may cause increased focal loading of joint and cartilage.

Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primary impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications.

In the detection of SLAP (superior labral anterior to posterior) lesions of the shoulder MR arthrography shows a significantly higher sensitivity compared with conventional MR techniques and therefore, represents the method of choice in diagnostic imaging of the superior labral-bicipital complex. On the basis of morphological criteria it mostly allows distinction of traumatic lesions and anatomic variants of the superior labrum and the biceps anchor as well as classification of detected SLAP lesions (types 1-4 according to Snyder). However, the differentiation of a SLAP type 2 lesion and a sublabral recess can be very difficult, even if all distinction criteria are considered.

There are difficulties in diagnosing pathologies of the labrum-biceps tendon complex (LBTC) because of the great individual variability of this structure. Anatomical variations, such as the sublabral recess, are frequently found and can also be misinterpreted as Andrews or SLAP II lesions. The etiology and mechanisms of creating such a sublabral recess are not exactly known. The examination of 31 cadaveric shoulder specimens from an age group between 49.3 and 83.6 years showed a sublabral recess in 63.6-85%. This high frequency of sublabral detachment of the labrum in older patients indicates that according to the high range of motion of the humeral head and therefore the changing angle of the long biceps tendon (LBS) a certain mobility of the superior LBTC is physiological and should not necessarily be seen as a sign of instability. Besides mobility-increasing factors such as overhead professions and sports with high repetitive maximal abduction and external rotation and the individual age, the type of insertion of the LBT at the glenoid influences the development of sublabral recess. Accordingly, posterior oriented insertion types of the LBT determine deeper and more posterior oriented sublabral recesses whereas in cases of anterior directed types of insertions no or less deep recesses can be found. Anamnestic aspects, such as the mechanism of injury and overhead activities, these macroscopic and functional associations in MR arthrography and arthroscopic inspection have to be considered in order to differentiate between physiological and traumatic changes of the labrum-biceps tendon complex.

Benign bone-forming tumors include osteomas, enostomas, osteoid osteomas, and osteoblastomas. These lesions are often characterized by typical imaging findings on radiographs, CT and MR imaging studies. Radiologic findings and additional clinical information allow for a specific diagnosis in most cases. This review article emphasizes the radiological patterns of benign bone-forming tumors as well as their epidemiological, clinical, and pathological characteristics. In addition, minimally invasive interventional procedures for the therapy of osteoid osteoma are reviewed.

We report the case of a 42-year-old male who was admitted to our hospital after an acute hypertensive crisis despite four-way anti-hypertensive therapy. The renal scintigraphy, the excretory urogram and the biochemical profile performed two years before were unremarkable, except for slightly elevated serum creatinine and plasma aldosterone, in presence of normal aldosterone/ renin ratio. The renal arterial angiography that was performed despite a second unremarkable scintigraphy revealed high-grade bilateral arterial stenosis in the presence of multiple renal arteries. Following dilatation of the left stenosis, the aldosterone/renin ratio was pathologic. Recumbent and orthostatic aldosterone values were 830 pg/ml and 1824 pg/ml, respectively, and recumbent and orthostatic renin values were 0.82 and 1.21 ng angiotensin I/ml/h, respectively. The abdominal computed tomography performed to investigate a possible concomitant Conn’s syndrome resulted in the detection of a left adrenal tumor. After resection of the lesion, plasma-aldosterone levels normalized and a pronounced rise in serum potassium levels was observed. Following angioplasty of the right renal artery stenosis, blood pressure could easily be managed with combined gB and calcium channel blocker therapy. Particularly in cases of bilateral (but also in the presence of unilateral) renal artery stenosis in association with Conn’s syndrome, all the available screening methods for these disorders can fail. In cases of poor response to combination hypertensive therapies, renal arteriography and a fludrocortisone- suppression test should be performed in order to rule out both renal arterial stenosis and Conn’s syndrome, even in the absence of clinical and biochemical findings suspicious for either disorder.

We treated 58 patients with osteoid osteoma by CT-guided radiofrequency ablation (RF). In 16 it followed one or two unsuccessful open procedures. It was performed under general anaesthesia in 48, and spinal anaesthesia in ten. The nidus was first located by thin-cut CT (2 to 3 mm) sections. In hard bony areas a 2 mm coaxial drill system was applied. In softer areas an 11-gauge Jamshidi needle was inserted to allow the passage of a 1 mm RF probe into the centre of the nidus. RF ablation was administered at 90 degrees C for a period of four to five minutes. Three patients had recurrence of pain three, five and seven months after treatment, respectively, and a second percutaneous procedure was successful. Thus, the primary rate of success for all patients was 95% and the secondary rate was 100%. One minor complication was encountered. CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma.

To define MR imaging characteristics of primary aneurysmal bone cyst.MR imaging studies of 38 patients with histologically proven primary aneurysmal bone cyst were reviewed with reference to morphological features, signal characteristics, and patterns of contrast-enhancement.Most lesions were well marginated towards bone and soft tissues (95%), either surrounded by a complete (84%) or incomplete (16%) rim of low signal intensity on images of all pulse sequences. Frequent features were polycyclic margins (84%), cortical expansion (87%), cystic spaces (100%), contrast-enhancing cyst walls (100%), internal septations (89%), fluid levels (71%) and diverticula-like projections of cyst walls (68%). Solid tissue components could be identified by MR imaging in all lesions which, on pathological examination, contained larger portions of solid material (18%). Edema of surrounding soft-tissues was observed in 29% of the cases.Primary aneurysmal bone cysts demonstrate a relatively uniform MR imaging appearance, which reflects the patho-anatomic composition of the lesion.

Renovascular hypertension as a secondary form of hypertension can be improved or cured in many cases by interventional radiology or vascular surgery.The renin-angiotensin-aldosterone system and the development of hypertension are linked in renovascular hypertension.Early clinical symptoms are of special interest in diagnosing renovascular hypertension.Nowadays, angioplasty or stenting have mostly replaced surgery in view of treatment of renovascular hypertension.Renovascular hypertension, if diagnosed early, can be improved or cured in many cases regarding hypertension and/or renal insufficiency.

Purpose of this review is to demonstrate typical X-ray, CT and MR morphology of primary bone tumors and "tumor-like lesions" of the shoulder in correlation with histopathology. 711 primary bone tumors of the shoulder and proximal humerus were studied. 602 were localized in the humerus, 90 in the scapula and 19 in the clavicula. The most frequent benign tumors were osteochondromas (n = 143), simple bone cysts (n = 115), enchondromas (n = 75) and aneurysmal bone cysts (n = 50). Fibrous dysplasia (n = 25), chondroblastoma (n = 15), osteoid osteoma (n = 13), giant cell tumors (n = 12) and non ossifying fibroma (n = 11) were less frequent. The most frequent malignant bone tumors were osteosarcoma (n = 72), chondrosarcoma (n = 52) and Ewing's sarcoma (n = 46). Focal plasmocytoma (n = 20) and lymphoma (n = 10) were less frequent. The average age of the patients was 31.5 years. Some of these tumors were typically located in the shoulder, i.e. simple bone cysts and chondroblastoma. In summary the shoulder was a rather infrequent site of primary bone tumors, but since most of these tumors were benign, the radiologist should be aware of the differential diagnosis to guide therapy.

Presently, the degree of the hemophilic arthropathy is estimated by the classification system of Pettersson, which is recommended by the Orthopedic Advisory Committee of the World Federation of Hemophilia. This classification system bases upon plain radiographs of the joints and analyses only those changes which represent the progression of the arthropathy. The value of this classification system has been established by inter-observer studies. However, it shows drawbacks at the exact definition of some parameters. Presently, it is more valuable for longitudinal than for transversal studies. Due to the possibilities of an adequate substitution therapy, only minor degrees of an arthropathy are observed in children. The ankle joints are more severly affected than the elbow joints and they more than the knee joints. This distribution is explained by an increasing sports activity in children. If more than 3 joint bleedings occur within a year the invent of an arthropathy must be presumed. Because the classification system of Pettersson analyses only osseous changes representing late changes, important early changes like hypertrophy of the synovialis and focal destruction of the joint cartilage are overlooked. Magnetic resonance imaging is suitable to show these early changes reliably. MRI can be recommended for the investigation of recurrently bleeding joints without evidence of major osseous changes and for decision making to perform a synovectomy.

To develop a strategy for the complete work-up of vessel lumen and vessel wall for planning and follow-up of radiological interventions of lower extremity arteries.A total of 36 patients (21 pre-, 8 post- and 7 pre- and postinterventional) were studied. MRA studies were performed using an ECG-triggered phase contrast technique for the demonstration of intraluminal flow and an axial high resolution time-of-flight technique to assess the vascular wall. All MRA studies were analysed by intraindividual DSA comparison for the assessment of flow and wall structures.Combined MRA techniques provided a good correlation with DSA for the assessment of vascular flow. The kappa test revealed a value of greater than 0.61 for most on the vessel segments proving a good correlation of both methods. Orthogonal high-resolution TOF-MRA provided additional information for the assessment postinterventional wall haematomas and hard plaques.Combination of PCA to study flow and axial TOF to study wall pathology improves the usefulness of peripheral MRA.

A study was conducted to find out whether in a rear-impact motor vehicle accident, velocity changes in the impact vehicle of between 10 and 15 km/h can cause so-called "whiplash injuries". An assessment of the actual injury mechanism of such whiplash injuries and comparison of vehicle rear-end collisions with amusement park bumper car collisions was also carried out. The study was based on experimental biochemical, kinematic, and clinical analysis with volunteers. In Europe between DM 10 and 20 billion each year is paid out by insurance companies alone for whiplash injuries, although various studies show that the biodynamic stresses arising in the case of slight to moderate vehicle damage may not be high enough to cause such injuries. Most of these experimental studies with cadavers, dummies, and some with volunteers were performed with velocity changes below 10 km/h. About 65% of the insurance claims, however, take place in cases with velocity changes of up to 15 km/h. Fourteen made volunteers (aged 28-47 years; average 33.2 years) and five female volunteers (aged 26-37 years; average 32.8 years) participated in 17 vehicle rear-end collisions and 3 bumper car collisions. All cars were fitted with normal European bumper systems. Before, 1 day after and 4-5 weeks after each vehicle crash test and in two of the three bumper car crash tests a clinical examination, a computerized motion analysis, and an MRI examination with Gd-DTPA of the cervical spine of the test persons were performed. During each crash test, in which the test persons were completely screened-off visually and acoustically, the muscle tension of various neck muscles was recorded by surface electromyography (EMG). The kinematic responses of the test persons and the forces occurring were measured by accelerometers. The kinematic analyses were performed with movement markers and a screening frequency of 700 Hz. To record the acceleration effects of the target vehicle and the bullet vehicle, vehicle accident data recorders were installed in both. The contact phase of the vehicle structures and the kinematics of the test persons were also recorded using high-speed cameras. The results showed that the range of velocity change (vehicle collisions) was 8.7-14.2 km/h (average 11.4 km/h) and the range of mean acceleration of the target vehicle was 2.1-3.6 g (average 2.7 g). The range of velocity change (bumper car collisions) was 8.3- 10.6 km/h (average 9.9 km/h) and the range of mean acceleration of the target bumper car was 1.8-2.6 g (average 2.2 g). No injury signs were found at the physical examinations, computerized motion analyses, or at the MRI examinations. Only one of the male volunteers suffered a reduction of rotation of the cervical spine to the left of 10 degrees for 10 weeks. The kinematic analysis very clearly showed that the whiplash mechanism consists of translation/extension (high energy) of the cervical spine with consecutive flexion (low energy) of the cervical spine: hyperextension of the cervical spine during the vehicle crashes was not observed. All the tests showed that the EMG signal of the neck muscles starts before the head movement takes place. The stresses recorded in the vehicle collisions were in the same range as those recorded in the bumper car crashes. From the extent of the damage to the vehicles after a collision it is possible to determine the level of the velocity change. The study concluded that, the "limit of harmlessness" for stresses arising from rear-end impacts with regard to the velocity changes lies between 10 and 15 km/h. For everyday practice, photographs of the damage to cars involved in a rear-end impact are essential to determine this velocity change. The stress occurring in vehicle rear-end collisions can be compared to the stress in bumper car collisions.

Venous involvement in renal cell carcinoma (RCC) represents an advanced state of disease. Nonetheless, its influence on survival is rather secondary compared with that of local tumor growth, grading and metastasis. Since conservative treatment in advanced RCC is mainly ineffective, surgical management offers the most promising approach for potential cure. Only patients without metastasis, however, seem to benefit from an aggressive surgical intervention. The surgical technique itself is determined by the vena caval extent of the tumor thrombus. Preferably, noninvasive imaging techniques should provide information about metastasis and the extent of the tumor thrombus. Diagnostic efforts should be adapted to therapeutic feasibility and prognosis in every individual patient in order to avoid fatiguing and costly over-examination. The standards requested above can be realized by use of modern sonographic and computed-tomographic imaging techniques or by magnetic resonance imaging alone. Thus, nowadays, the essential diagnostics in RCC with vena caval involvement may dispense with angiographic examinations.

A 44-year-old patient underwent radical prostatectomy and adjuvant radiotherapy for adenoid cystic carcinoma of the prostate. After 7 years and 3 months he recurred locally and was treated with external beam irradiation. The current follow up comprises 9 years and 5 months at which the patient is asymptomatic with stable disease. Lymph node or distant metastases did never occur and the prostate specific antigen level was always within the normal range.

The standard osteosynthetic implants suggested by the AO (Association for Osteosynthesis Problems) are surveyed: lag screws, tension band wires, plates, nails, external fixators, as are other bone-fixation aids with regard to function, implementation and important aspects concerning radiological evaluation.