Auswirkung der Feldstärke bei der standardisierten Kernspintomographie des Gehirns am Beispiel der Darstellung von Hirnnerven und Gefäßen in den basalen Zisternen: Vergleich zwischen 1,5 und 3,0 Tesla

PURPOSE

Comparison of MR images acquired as routine examinations at a field strength of 3.0 T and 1.5 T to determine whether and to which degree the image quality improves at the higher field strength of 3.0 T.

MATERIALS AND METHODS

Routine MR images of 200 patients were examined retrospectively, with 100 images obtained at 1.5 T and 100 obtained at 3.0 T. The examinations were performed with a quadrature head coil and focused on the basal cisterns because of the abundance of small distinct structures in this region. We selected the T2-weighted 2D-FSE sequence in transverse direction for comparison. At both field strengths, the same section thickness of 5 mm and a matrix of 512 x 388 (FOV: 220 mm) were used. The quality of the images was evaluated with regard to depicting the cranial nerves N. III, V - X, the AICA and PICA. For comparison, image quality was rated with a score from 1 (well defined) to 5 (not depicted).

RESULTS

A score of 1 was obtained in 46 % of the anatomic structures examined at 3.0 T and in only 9.2 % at 1.5 T. A score of 2 was given in 27.6 % of the anatomic structures at 3.0 T vs. 23.5 % at 1.5 T, a score of 3 in 17.2 % vs. 28.1 %, a score of 4 in 8.6 % vs. 28.7 %, and a score of 5 in 0.4 % vs. 10.3 %, respectively. The Mann-Whitney U test showed significance at p < 0.001 for the comparison of images at 1.5 and 3.0 Tesla.

CONCLUSION

Routine magnetic resonance imaging using the same quadrature coil technique and similar acquisition times at 3.0 T and 1.5 T shows an improvement for T2-weighted images at the higher field strength.

Cyclosporine A and Mycophenolate Mofetil vs Cyclosporine A and Methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

The combination of Cyclosporin A (CSA) and Methotrexate (MTX) is considered to be the standard regimen for the prevention of graft-versus-host disease (GVHD) after stem cell transplantation (SCT) from HLA-identical siblings. Mycophenolate Mofetil (MMF) has been widely used for GVHD prophylaxis after nonmyeloablative SCT, but experience following myeloablative therapy is still limited. We retrospectively compared CSA/MTX and CSA/MMF in 93 patients (median age 35 years, range 17-59 years, male subjects 48, female subjects 45) with acute myeloid leukemia (n=33), myelodysplastic syndrome (MDS) (n=3), acute lymphoblastic leukemia (ALL) (n=20) or chronic myeloid leukemia (n=37) who received CSA/MMF (n=26) or CSA/MTX (n=67) as GVHD prophylaxis following high-dose therapy and allogeneic SCT from HLA-identical siblings. No statistically significant differences were found in overall survival, relapse rate, treatment-related mortality and acute or chronic GVHD. Time to myeloid recovery was significantly shorter in patients who received CSA/MMF. We conclude that the combination of CSA/MMF appears equivalent to CSA/MTX for GVHD prophylaxis in patients receiving conventional-intensity SCT from HLA-identical siblings.

Transplantation of allogeneic CD34+-selected cells followed by early T-cell add-backs: favorable results in acute and chronic myeloid leukemia

BACKGROUND

The aim of this study was to investigate preservation of anti-leukemic activity and protection from opportunistic infections after transplantation of allogeneic + cells in patients with hematologic malignancies and bad prognosis. Methods Thirty-three patients [median age 42 years, range 23-55 years, diagnosis AML/myelodysplastic syndrome (MDS) 14, ALL nine, CML seven and multiple myeloma (MM) three] received myeloablative conditioning followed by infusion of selected CD34+ cells from matched unrelated donors (31) or HLA-identical siblings (two). Early donor lymphocyte infusions (DLI; 0.5 and 1.0 x 10(6) CD3+ cells/kg) were given while patients were on immunosuppressive therapy.

RESULTS

Ninety-seven per cent of patients engrafted and 24 of 29 patients surviving more than 30 days received at least one pre-emptive DLI. Three patients (10%) developed acute (a)GvHD (two grade I-II, one grade III-IV) spontaneously, and 16 patients (67%) developed aGvHD after DLI (12 grade I-II, four grade III-IV). Eight of 24 evaluable patients developed chronic (c)GvHD (33%, six limited, two extensive). After a median follow-up of 590 days (range 138-1610 days) 18 patients were alive (55%), 16 in complete remission (CR), one in hematologic and one in molecular relapse. Seven patients died after relapse (21%) and eight died from transplantation-related causes (24%). Patients with myeloid malignancies had a significantly better survival than patients with ALL or MM (74%+/-10 vs. 30%+/-13, P<0.05).

DISCUSSION

Early pre-emptive low-dose DLI following transplantation of selected CD34+ cells from unrelated donors after myeloablative conditioning is feasible and effective without undue toxicity, especially in patients with myeloid malignancies.

[Prospective cost-benefit analysis of a fully digitized working environment in an ultrasound division applying process simulation]

PURPOSE

Quantification of expected savings of work load and personnel costs after implementation of a digital infrastructure in an ultrasound division of a radiology department.

MATERIALS AND METHODS

The work flow of an ultrasound examination was simulated by means of a computer model. After validation, the computer model was modified to represent a work flow with PACS, electronic patient record, and automatic scheduling. The simulation results of work load, equipment utilization, and personnel costs were compared for both scenarios.

RESULTS

The total number of work steps was reduced from 29 in the conventional scenario to 14 work steps in the scenario with digital infrastructure. The work load of administrative activities decreased by 89 % whereas the work load of activities directly related to the ultrasound examination remained unchanged. The productive personnel costs declined from euro; 24 to euro; 16 per examination. The gross labor costs declined from euro; 33 to euro; 20 per examination. Given unchanged equipment and number of patients, the required number of physicians can be reduced from 3 to 2 and that of technicians from 2 to 1 by use of a digital infrastructure.

CONCLUSION

A digital infrastructure possesses a great potential for efficiency provided that it is implemented comprehensively and the work flow is adapted utilizing the capabilities of automation in all work processes.

Methoden des Prozessmanagements in der Radiologie

The main emphasis in health care has been on quality and availability but increasing cost pressure has made cost efficiency ever more relevant for nurses, technicians, and physicians. Within a hospital, the radiologist considerably influences the patient's length of stay through the availability of service and diagnostic information. Therefore, coordinating and timing radiologic examinations become increasingly more important. Physicians are not taught organizational management during their medical education and residency training, and the necessary expertise in economics is generally acquired through the literature or specialized courses. Beyond the medical service, the physicians are increasingly required to optimize their work flow according to economic factors. This review introduces various tools for process management and its application in radiology. By means of simple paper-based methods, the work flow of most processes can be analyzed. For more complex work flow, it is suggested to choose a method that allows for an exact qualitative and quantitative prediction of the effect of variations. This review introduces network planning technique and process simulation.

Tetramethylphosphonium fluoride: "naked" fluoride and phosphorane

Me(4)PF was investigated in the solid state, in the gas phase, and in solutions. Vibrational spectra of the solid and a single-crystal structure show an ionic tetramethylphosphonium fluoride. The compound crystallizes in the space group Pbca with a = 1016.0(1), b = 1018.0(1), c = 1205.8(4) pm, and Z = 8. The fluoride ion is nearly trigonal planar surrounded by three Me(4)P+ cations forming six H...F contacts between 218 and 240 pm. The compound is stable below 120 degrees C and sublimes in a vacuum. It possesses a phosphorane structure in the gas phase that was studied by electron diffraction and vibrational spectra, and additionally by theoretical calculations. The Me(4)PF molecule has a trigonal bipyramidal structure with one methyl group and the fluorine atom in axial positions and bond lengths of d(PC(eq)) = 182.6(4) pm, d(PC(ax)) = 188.4(8) pm, and d(PF) = 175.3(6) pm. The compound is remarkably soluble in acetonitrile, water, and alcohols, and slightly soluble in benzene, dimethyl ether, and diethyl ether. The solutions were studied by (1)H, (13)C, (19)F, and (31)P NMR spectroscopy. The hygroscopic Me(4)PF forms a tetrahydrate which crystallizes in the space group I4(1)/a with a = 1106.1(1) pm, c = 816.3(1) pm, and Z = 4. The fluoride ion in Me(4)PF.4 H(2)O is surrounded by four water molecules. These units form a three-dimensional network in which the Me(4)P+ cations are embedded without any contacts.

Predictors of falls in elderly people during rehabilitation after hip fracture--who is at risk of a second one?

BACKGROUND

A fall in old age is known as a common consequence of frailty and decline as well as a risk factor for further falls. Studies identifying hip fracture patients who are at risk of a further fall are lacking. Therefore it was of interest to evaluate the risk factors for falling in a high-risk population, i.e., patients during rehabilitation after recent proximal femur fracture.

METHODS

935 consecutive patients who had surgical intervention after acute fracture of the proximal femur underwent a multidimensional assessment within the first two days after admission to the rehabilitation ward. Falls during the stay on the rehabilitation ward were registered. The baseline data were compared between fallers and non-fallers.

FINDINGS

11.8% of the patients fell during rehabilitation. Risk factors associated with a fall were increasing age, male gender, type of surgery, the use of a rollator and nocturnal urinary incontinence. The risk of falling increased in the middle of the second week of rehabilitation, when frailer patients gained mobility and ability to walk by themselves, while they were not yet safe enough.

INTERPRETATION

It was possible to compose a risk profile for future falls. Those identified as 'at risk of a further fall' should be selectively offered protective devices and special training programs in order to prevent future fractures. As for the surgical intervention, the type of surgery in relation to age and long-term outcome is of particular interest since the use of the more expensive total hip arthroplasty procedure may be more cost effective in the long term.

Treatment of severe steroid refractory acute graft-versus-host disease with infliximab, a chimeric human/mouse antiTNFalpha antibody

Acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic peripheral blood stem cell transplantation (PBSCT). Patients with severe aGVHD not responding to treatment with steroids have a poor prognosis. We treated four patients with severe aGVHD refractory to steroids with infliximab, a chimeric human/mouse antiTNFalpha antibody. Patients (CML 2, MM 1, AML 1) developed grade III-IV GVHD at a median of 34 days (range 15-76) after myeloablative PBSCT (two), donor lymphocyte infusion for relapsed CML (one) or non-myeloablative PBSCT (one), respectively. All patients had severe intestinal involvement in addition to skin and/or liver disease and had received treatment with high-dose steroids (four) for a median of 11 days (range 5-17) in addition to CsA (four) and MMF (three). Infliximab (10 mg/kg) was given once a week until clinical improvement. In three of four patients a complete resolution of diarrhea and significant improvement of skin and liver disease were observed. Two patients received one, one patient two and one patient three infliximab infusions. At present two patients are alive >200 days after therapy, one with limited cGVHD. Two patients died, one of progressive malignant disease without GVHD and one of refractory GVHD. Infliximab is apparently an active drug for the treatment of aGVHD.