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Background Incarceration of a gravid uterus (IGU) is a rare manifestation in obstetrics that may be associated with serious complications. Case We report on a 29-year-old patient at 34+2 weeks’ gestation who presented with HELLP syndrome. IGU had been initially diagnosed in our department at 23+6 weeks’ gestation. Urgent cesarean section was performed taking into account the specific characteristics of IGU. A healthy premature child was born. With the prior knowledge of IGU no complications during delivery occurred and mother and child had favorable outcomes. Conclusion IGU is a rare condition in pregnancy that should not be overlooked. Early diagnosis and treatment of IGU can prevent serious complications to the mother and child during pregnancy and delivery. In this report, we discuss the specific peculiarities of an incarcerated uterus that need to be considered in this regard.

Chest X‑ray is the most commonly performed X‑ray examination in children and adolescents. The aim of this review is to present the benefit of this radiologic modality, but also its limitations.Compared with older children, most X‑ray examinations of the chest were performed in newborns. After the neonatal period, this review focusses on the diagnosis of inflammatory pulmonary changes, foreign body aspiration, detection of pulmonary nodules, and cystic fibrosis.The radiation exposure of X‑ray examinations is continuously decreasing due to technical innovations. However, other imaging modalities were also continuously being optimized; therefore, alternatives without radiation exposure, i.e., magnetic resonance imaging [MRI] and ultrasound, should be considered in case of specific clinical indications.Even if the diagnostic performance of chest X‑ray examinations is often minor compared to computed tomography or MRI, chest X‑ray still has a high value in children and adolescents, due to its ubiquitous availability and the relatively simple acquisition.KLINISCHES PROBLEM: Die Röntgenaufnahme des Thorax ist die häufigste konventionelle Röntgenuntersuchung im Kindes- und Jugendalter. Das Ziel dieser Übersichtsarbeit ist es, den Benefit der Röntgenmodalität, aber auch ihre Limitationen darzulegen.Neugeborene erhalten verglichen mit älteren Kindern proportional die häufigsten Röntgenaufnahmen des Thorax. Nach der Neugeborenenperiode setzt diese Übersichtsarbeit einen Fokus auf die Diagnostik entzündlicher Lungenveränderungen, die Fremdkörperaspiration, die Detektion von Rundherden und die zystische Fibrose.Aufgrund verbesserter Technologien sinkt die Strahlenexposition konventioneller Thoraxaufnahmen kontinuierlich. Jedoch werden die anderen Bildgebungsmodalitäten ebenfalls stetig optimiert, so dass insbesondere die strahlungsfreien Alternativen Magnetresonanztomographie (MRT) und Sonographie bei Vorliegen einer bestimmten klinischen Fragestellung in Erwägung gezogen werden sollen. EMPFEHLUNG FüR DIE PRAXIS: Auch wenn die diagnostische Aussagekraft von Röntgen-Thorax-Aufnahmen häufig geringer als von Computertomographie (CT) oder MRT ist, hat sie weiterhin aufgrund ihrer ubiquitären Verfügbarkeit und der relativ einfachen Durchführbarkeit einen hohen Stellenwert im Kindes- und Jugendalter.

ZusammenfassungDie Staaten Europas laufen Gefahr, ihre ambitionierten verkehrs- und klimapolitischen Ziele für den Güterverkehr zu verfehlen. Zugleich sind wesentliche Kernstrecken in Europa durch den massiven Lkw-Verkehr überlastet. Dem nur langsamen Ausbau der Fernstraßen steht eine signifikante Zunahme der Transportleistung durch schwere Lkw gegenüber. Europas Straßenverkehr drohen Fahrermangel, Dauerstau und Kostensteigerung. Bereits seit 2010 übersteigt die Transportleistung im Straßengüterverkehr mit über 400 Mrd. Tonnen- Kilometer die Kapazität der Autobahnen. Grafik 1 zeigt die tatsächliche Verkehrsleistung in Mrd. Tonnenkilometern (rote Kurve), welche die nominale Kapazität der Bundesautobahnen in Deutschland seit etwa 2010 übersteigt (schwarze Kurve) – und die Anzahl der Staus in Deutschland, die sich seit der Überlastung der Autobahnen in nur sechs Jahren vervierfacht hat.

Although chest radiograph (CXR) is commonly used in diagnosing pediatric community acquired pneumonia (pCAP), limited data on interobserver agreement among radiologists exist. PedCAPNETZ is a prospective, observational, and multicenter study on pCAP. N = 233 CXR from patients with clinical diagnosis of pCAP were retrieved and n = 12 CXR without pathological findings were added. All CXR were interpreted by a radiologist at the site of recruitment and by two external, blinded pediatric radiologists. To evaluate interobserver agreement, the reporting of presence or absence of pCAP in CXR was analyzed, and prevalence and bias‐adjusted kappa (PABAK) statistical testing was applied. Overall, n = 190 (82%) of CXR were confirmed as pCAP by two external pediatric radiologists. Compared with patients with pCAP negative CXR, patients with CXR‐confirmed pCAP displayed higher C‐reactive protein levels and a longer duration of symptoms before enrollment (p

Aim To investigate whether zinc-free insulin is an effective treatment option for lipoatrophy. Methods Controlled, randomized, open-label parallel study in young people with type 1 diabetes, pump treatment and lipoatrophy at injection sites. Participants underwent dermatological examination and evaluation of affected areas using ultrasound and MRI. After randomization, half of themswitched to insulin glulisine (intervention group) for 6 months. The control group continued their treatment with zinc-containing insulin and switched to insulin glulisine 6 months later. Both groups were followed-up until month 12. Primary endpoint was the increase of the relative thickness of the subcutaneous fat layer of the most atrophic site at 6 months as documented by MRI. Results Fourteen participants were included into the study. While relative thickness of subcutaneous fat tissue was comparable between intervention [-60% (-98.8 to -17.6), n=7) and control group [-50% (-72.7 to -1.0), p=.511; median (range), n=7]at baseline, it improved in the intervention [-14.3% (-85.7 to 83.3) vs. -31.3% (-66.7 to 0), p=.031], but not in the control group (p=.125) after 6 months. At 12 months, relative fat thickness (p=.003), number (p=.015) and size of most atrophic sites (p=.001) were improved in the intervention group. Number (p=.018) and size of most atrophic sites (p=.008) were also reduced in the control group between 6 and 12 months. Conclusions Although the present pilot study is based on a small sample, the data give first hint that the use of the zinc-free insulin glulisine may be beneficial in people with diabetes, pump and lipoatrophy. This article is protected by copyright. All rights reserved.

Tabaksteuerstrafrecht ist ein Stiefkind des Steuerstrafrechts: Von Staatsanwälten und Gerichten mitunter nur mit spitzen Fingern angefasst, von reinen Strafrechtsverteidigern oft ohne ausreichende Sachkunde betrieben. Auch die für die Verfolgung zuständige Zollverwaltung liefert nicht stets gerichtsfeste und rechtlich stimmige Ermittlungsergebnisse. Das notwendige Rüstzeug für alle Verfahrensbeteiligten stellt Ihnen Jürgen Weidemann jetzt erstmals systematisch und mit Verweisen auf die einschlägige Rechtsprechung zusammen. Viele Beispiele, taktische Hinweise und Praxistipps unterstützen Sie auf den verzweigten Wegen durch das facettenreiche Arbeitsfeld.

Whole-body MRI is an imaging method that uses advanced modern MRI equipment to provide high-resolution images of the entire body. The goal of these guidelines is to specify the indications for which whole-body MRI can be recommended in children and adolescents and to describe the necessary technical requirements. CITATION FORMAT: · Schaefer JF, Berthold LD, Hahn G et al. Whole-Body MRI in Children and Adolescents - S1 Guidelines. Fortschr Röntgenstr 2019; 191: 618 - 625.Die Ganzkörper-Magnetresonanztomografie (GK-MRT) ist eine bildgebende Methode, welche unter Nutzung fortgeschrittener Verfahren moderner MRT-Geräte eine hochaufgelöste Darstellung des gesamten Körpers ermöglicht. Ziel dieser Leitlinie ist es, Indikationen zu benennen, bei denen die GK-MRT im Kindes- und Jugendalter empfohlen werden kann, und dafür notwendige, technische Voraussetzungen zu beschreiben. ZITIERWEISE: · Schaefer JF, Berthold LD, Hahn G et al. Whole-Body MRI in Children and Adolescents – S1 Guidelines. Fortschr Röntgenstr 2019; 191: 618 – 625.

Pediatric sonography of the neck should take place in a calm environment. Communication should be adapted to the particular needs of children and parents. It is useful to analyze pathologies in children on the basis of anatomical spaces and morphological (cystic, solid, vascular) components, including lymph node involvement. In particular, although some may also occur in adulthood, pediatric age-related pathologies such as embryological remnants and malformations should be considered, and individual findings may indicate a syndromic disease that may require further investigation.

In the original version of this article unfortunately two authors were missing: Dr. Jurgen Weidemann and Dr. Daniel Berthold. The correct list of authors is presented above.

Repetition priming denotes a behavioural change caused by prior exposure to a stimulus. The effect is known to last for weeks. This study addresses the underlying neural mechanisms for very-long-term picture priming by using event-related functional magnetic resonance imaging complemented by a behavioural paradigm. Previous functional imaging studies with shorter retention intervals have shown that priming is associated with changes in the activity of both the occipital and posterior temporal cortex. In this study we compared retention intervals of 1 day and 6 weeks after initial exposure to a picture stimulus. Priming-related decreases in cortical activity in posterior extrastriate and dorsal left inferior frontal areas were found only for the shorter retention interval. In contrast, fMRI activation in the inferior posterior temporal and anterior left inferior frontal cortex was reduced following priming for both retention intervals. In the behavioural paradigm, the priming effect was stable over time. We conclude that the left inferior frontal and inferior posterior temporal cortex play a key role in the very-long-term priming effect.

A 17-year-old patient with a symptomatic cavernoma of the optic radiation underwent surgery supported by functional magnetic resonance imaging (fMRI), diffusion weighted magnetic resonance imaging (DWI) and navigated 3D-ultrasound. The primary visual cortex was visualized with fMRI. The optic radiation was delineated by means of DWI. The diffusion weigthed images were used for 3-dimensional reconstruction of the optic radiation. During surgery, the information of the localisation of functional brain regions were used together with the 3D-ultrasound, enabling the surgeon to remove the cavernoma without morbidity. This is the first report of the combined use of fMRI, fiber tract imaging and 3D-ultrasound for the safe resection of an optic radiation lesion.

BACKGROUND Functional MRI (fMRI) combines anatomic with functional information and has therefore been widely used for preoperative planning of patients with mass lesions affecting functionally important brain regions. However, the courses of functionally important fiber tracts are not visualized. We therefore propose to combine fMRI with diffusion-weighted MRI (DWI) that allows visualization of large fiber tracts and to implement this data in a neuronavigation system. METHODS DWI was successfully performed at a field strength of 1.5 Tesla, employing a spin-echo sequence with gradient sensitivity in six noncollinear directions to visualize the course of the pyramidal tracts, and was combined with echo-planar T2* fMRI during a hand motor task in a patient with central cavernoma. RESULTS Fusion of both data sets allowed visualization of the displacement of both the primary sensorimotor area (M1) and its large descending fiber tracts. Intraoperatively, these data were used to aid in neuronavigation. Confirmation was obtained by intraoperative electrical stimulation. Postoperative MRI revealed an undisrupted pyramidal tract in the neurologically intact patient. CONCLUSION The combination of fMRI with DWI allows for assessment of functionally important cortical areas and additional visualization of large fiber tracts. Information about the orientation of fiber tracts in normal appearing white matter in patients with tumors within the cortical motor system cannot be obtained by other functional or conventional imaging methods and is vital for reducing operative morbidity as the information about functional cortex. This technique might, therefore, have the prospect of guiding neurosurgical interventions, especially when linked to a neuronavigation system.

Background: Functional MRI (fMRI) combines anatomic with functional information and has, therefore, been widely used for preoperative planning of patients with mass lesions affecting functionally important brain regions. However, the course of functionally important fiber tracts is not visualized. We therefore propose to combine fMRI with diffusion weighted MRI (DWI) that allows visualization of large fiber tracts and to implement these data in a neuronavigation system. Methods: DWI was successfully performed at a field strength of 1.5 T, employing a spin-echo sequence with gradient sensitivity in six non-colinear directions to visualize the course of the pyramidal tracts and combined with echo-planar T2*fMRI during a hand motor task in 15 patients and 30 healthy controls. Results: Fusion of both data sets allowed visualization of the displacement of both primary sensorimotor area (M1) and corresponding large descending fiber tracts in patients. Intraoperatively, these data were present in a neuronavigation environment. Conclusion: The combination of fMRI with DWI allows for assessment of functionally important cortical areas and additional visualization of large fiber tracts. Information about orientation of fiber tracts in normal appearing white matter in patients with tumors within the cortical motor system cannot be obtained by other functional or conventional imaging methods and is as vital for reducing operative morbidity as the information about functional cortex. This technique might, therefore, have the prospect of guiding neurosurgical interventions, especially when being linked to a neuronavigation system.

The Amplatzer Vascular Plug (AVP) is a device originally intended for arterial and venous embolization in peripheral vessels. From December 2004 to March 2007 we implanted a total of 8 AVPs in the portal venous system in our institution for preoperative portal vein embolization in 4 patients (55-71 years) prior to right hemihepatectomy. AVP implantation was successful in all patients. Total occlusion of the embolized portal vein branches was achieved in all patients. There were no major complications associated with the embolization.

In this paper a model of a six-legged walking machine is introduced considering biological principles. Principles from nature are used both for the geometry of the model and the architecture of the controller. First finding biological principles from measurements of the walking stick insect is presented. As walking machines have a severe load-to-weight problem, a calculation for the best drive combination in the leg joints is done which is a non-linear optimization problem. The investigated ideal motor-gear-combination for the joints is then transferred to a weight-optimal single-leg construction. After the introduction of the mechanical part of the walking machine the new decentral, three-layer control concept is shown. With this biological-like controller the machine can move on unknown, uneven ground automatically detecting and climbing obstacles.

Der BGH macht es sich mit der Begründung unnötig schwer. Bereits aus dem zwischen Begehung und Unterlassung bestehenden Umkehrverhältnis folgt, dass für die Verhinderung einer ärztlichen Behandlung durch aktives Tun dieselben Rechtfertigungsgründe gelten wie für die Unterlassung einer Behandlung. Der Umweg über das Institut des „Behandlungsabbruchs“ ist nicht nötig.

Repetition priming denotes a behavioural change caused by prior exposure to a stimulus. The effect is known to last for weeks. This study addresses the underlying neural mechanisms for very-long-term picture priming by using event-related functional magnetic resonance imaging complemented by a behavioural paradigm. Previous functional imaging studies with shorter retention intervals have shown that priming is associated with changes in the activity of both the occipital and posterior temporal cortex. In this study we compared retention intervals of 1 day and 6 weeks after initial exposure to a picture stimulus. Priming-related decreases in cortical activity in posterior extrastriate and dorsal left inferior frontal areas were found only for the shorter retention interval. In contrast, fMRI activation in the inferior posterior temporal and anterior left inferior frontal cortex was reduced following priming for both retention intervals. In the behavioural paradigm, the priming effect was stable over time. We conclude that the left inferior frontal and inferior posterior temporal cortex play a key role in the very-long-term priming effect.

In this paper we report our experience with diffusion-weighted imaging (DWI) for optic radiation (OR) visualization during resection of tumors. We hypothesize that intraoperative OR visualization helps to maintain patients' visual fields. DWI studies were performed together with T1-weighted postcontrast magnetic resonance imaging (MRI) in four patients with lesions in or adjacent to the OR (glioblastoma, oligo-astrocytoma, cavernoma, and metastasis; n = 1 each). The OR was identified from one of six DWI data acquisitions, segmented and reconstructed three-dimensionally. The image data were neuronavigationally transferred into the operative field, and provided the neurosurgeon with information on lesion site and adjacent OR localization. Preoperative and postoperative neuroophthalmological testing included, among others, perimetry to define the value of diffusion-weighted image guidance during OR lesion resection. Three lesions were removed completely. In one case, low-grade tumor parts infiltrating the OR were intentionally left. No persistent visual field deficits were induced. In one patient, a transient homonymous hemianopia attributable to postoperative swelling completely resolved under steroid medication. The authors conclude that intraoperative OR visualization, realized by neuronavigationally displayed DWI data, might prove to be helpful to maintain patients' visual fields.

Two of the most widely accepted approaches to map eloquent cortical areas preoperatively are positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). As yet, no study has compared these two modalities within the same frame of reference in tumour patients.We employed [15O]-H2O-PET and fMRI in patients undergoing presurgical evaluation and compared the results with those obtained by direct electrical cortical stimulation (DECS).Twenty-five patients with tumours of different aetiology near the central region were investigated. fMRI and PET were processed using the same methods, i.e. statistical parametric mapping (SPM) without anatomical normalization, and transformed into the same frame of reference.fMRI activity was found in more cranial and lateral sections, i.e. closer to the brain surface, in comparison with PET, which demonstrated parenchymal activation. The mean localization difference between fMRI and PET was 8.1 +/- 4.6 mm (range, 2-18 mm). fMRI and [15O]-H2O-PET could reliably identify the central sulcus, as demonstrated by DECS.fMRI and [15O]-H2O-PET demonstrate comparable results and are sensitive and reliable tools to map the central region, especially in cases of infiltrating brain tumours. However, fMRI is more prone to artefacts, such as the visualization of draining veins, which may explain the more cranial and lateral activation visualized by fMRI, whereas PET depicts capillary perfusion changes and therefore shows activation closer to the parenchyma.

Background This prospective study employs anisotropic diffusion-weighted (ADW) magnetic resonance imaging for the integration of individual spatial information concerning the principal motor pathways into the operating room during microneurosurgery in the central region. We hypothesize that the three-dimensional (3-D) visualization of the pyramidal tract position (PTV) in a neuronavigation system based on ADW provides valid information concerning the position and extension of the principal motor pathways. Methods A total of 13 consecutive patients with lesions adjacent to the pyramidal tracts and the central region underwent microneurosurgery with the help of pyramidal tract visualization (PTV). An ADW sequence obtained preoperatively was fused to an anatomic navigation sequence. The 3-D reconstructions of the precentral gyrus (PG), the pyramidal tract, and the tumor were available in a customized neuronavigation system during surgery. Intraoperatively the PG was identified on the basis of the aforementioned data. Electric motorcortex stimulation (CS) was used to directly verify the PG location and indirectly the fiber tract position. Results In 11 cases (92%) the prediction of the principal motor pathways' position was correct. In one case of a meningioma, according to PTV, the tumor was falsely localized postcentrally. In the case of a precentral cavernoma, no motor response could be elicited by cortical stimulation. Conclusion Intraoperative PTV on the basis of ADW provides the neurosurgeon with reliable information concerning the position of the principal motor pathways during intracranial procedures as proved with intraoperative electrophysiological testing. The technique has the potential to reduce operative morbidity. PTV is straightforward and can be adapted to other customized neuronavigation devices.

OBJECTIVE: We present a technique that allows intraoperative display of brain shift and its effects on fiber tracts. METHODS: Three patients had intracranial lesions (one malignant glioma, one metastasis, and one cavernoma) in contact with either the corticospinal or the geniculostriate tract that were removed microneurosurgically. Preoperatively, magnetic resonance diffusion-weighted imaging (DWI) was performed to visualize the fiber tract at risk. DWI data were fused with those obtained from anatomic T1-weighted magnetic resonance imaging. A single-rack three-dimensional ultrasound neuronavigation system, which simultaneously displays the MRI scan and the corresponding ultrasound image, was used intraoperatively for 1) navigation; 2) definition of fixed and potentially shifting ultrasound landmarks near the fiber tract; and 3) sequential image updating at different steps of resection. The result was time-dependent brain deformation data. With a standard personal computer equipped with standard image software, the brain shift-associated fiber tract deformation was assessed by use of sequential landmark registration. After surgery, DWI was performed to confirm the predicted fiber tract deformation. RESULTS: The lesions were removed without morbidity. Comparison of three-dimensional ultrasound with DWI and T1-weighted magnetic resonance imaging data allowed us to define fixed and potentially shifting landmarks close to the respective fiber tract. Postoperative DWI confirmed that the actual fiber tract position at the conclusion of surgery corresponded to the sonographically predicted fiber tract position. CONCLUSION: By definition and sequential intraoperative registration of ultrasound landmarks near the fiber tract, brain shift-associated deformation of a tract that is not visible sonographically can be assessed correctly. This approach seems to help identify and avoid eloquent brain areas during intracranial surgery.

Electrophysiological studies have shown that forceful activation of the hand muscles (power grip) is accompanied by an increased excitability of the ipsilateral corticospinal system. This increase in excitability may be due to spinal or cortical mechanisms. Here we show with fMRI that this phenomenon is at least in part mediated at a cortical level. We used TMS to show that the increased ipsilateral excitability during a forceful maneuver leads to enhanced stimulus-response curves. fMRI was used to compare the activation during a repetitive hand movement with or without an accompanying power grip on the opposite site. The power grip reduced movement-related activation in the ipsilateral sensorimotor cortex. Peak deactivation was located in the left postcentral gyrus extending into the adjacent precentral gyrus. This finding suggests that a forceful activation of the hand muscles disinhibits a distinct functional representation in the ipsilateral sensorimotor cortex. Consequently, the excitability of the corticospinal system increases and less neuronal excitatory activity is needed to perform a given task. The results may be important for a variety of studies as they suggest that fMRI may show decreased hemodynamic response under conditions in which other neurophysiological methods have shown increased functional activity.

Es ist die in sehr vielen Arbeiten studierte Kunst der „mechanischen Modellbildung”, die Summe der technischen Einzelteile und Baugruppen durch einzelne, mathematische Modelle in der Form zu approximieren, dass sich die im realen System auftretenden, unerwuchten Phanomene wie etwa Schwingungen, Stick-Slip-oder spezielle Stosereignisse in analoger Form mit dem mathematischen Ersatzmodell abbilden lassen. Es gilt hierfu der bekannte und vielzitierte Hinweis, dass diese Ersatzmodelle einerseits so aufwendig wie moglich und andererseits nur so aufwendig wie notig sein mogen. Grundlage einer Entscheidung in dieser Hinsicht ist die Wahl der Phanomene, welche man mit dem jeweiligen Ersatzmodell abbilden mochte.

Rotierende Wellen und Rader stellen Maschinenkomponenten dar, bei denen dynamische Probleme eine wichtige Rolle spielen. Im Falle hoher Winkelgeschwindigkeiten sind betragsmasig hohe kinetische Energien gespeichert. Elastische Schwingungen sind durch einen zyklischen Wechsel von kinetischen Energien und elastischen Formanderungsarbeiten charakterisiert. Gerade in Rotorsystemen sind hohe Betrage dieser Energien im Spiel, welche durchaus gefahrlich sind und zu Havarien und Schaden fuhren konnen. Fur Rotorsysteme und Antriebsstrange existieren eine Reihe von Mechanismen und Anregungen, welche Schwingungen hervorrufen. Klassifizierungen der wesentlichen Anregungsmechanismen sind unter anderem in [132] fur Turbomaschinen und in [59] fur Zahnradgetriebe erarbeitet. Die folgende Zusammenstellung dient einer Ubersicht und erreicht keine Vollstandigkeit.

A study of the geometrical aspects, the nonlinear dynamics, and the control design of a six-legged walking machine is presented. Emphasis is placed on the design and control concepts used by nature in six-legged insects, which walk and climb very efficiently over arbitrary irregular surfaces. The non-Cartesian geometry of a living prototype, the walking stick insect, is used. By means of calculating and optimizing the force/torque distribution in living stick insects, biological design principles are evaluated and presented. A suitable control routine based on a small net of three-step-controllers uses simple coordination rules found in nature. It is able to establish stable gate phase characteristics with a few steps. >

The paper presents a survey of the six-legged walking robot designed and constructed at the Institute of Mechanics at the Technical University in Munich. This robot was designed in 1993 with special regard for principles found in natural walking of hexapods, which walk and climb very efficiently over arbitrary irregular surfaces. The investigated insect and its main features are presented. A description of the mechanical hardware and electronics used in the robot is included. >