Despite there being an increasing number of installations of ultra high field MR systems (> 3 T) in clinical environments, no functional patient investigations have yet examined possible benefits for functional diagnostics. Here we performed presurgical localization of the primary motor hand area on 3 T and 7 T Siemens scanners with identical investigational procedures and comparable system specific sequence optimizations. Results from 17 patients showed significantly higher functional sensitivity of the 7 T system measured via percent signal change, mean t-values, number of suprathreshold voxels and contrast to noise ratio. On the other hand, 7 T data suffered from a significant increase of artifacts (ghosting, head motion). We conclude that ultra high field systems provide a clinically relevant increase of functional sensitivity for patient investigations.

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Pain of uncertain origin in the jaws should alert clinicians to the potential of metastatic disease in patients with a history of cancer and a bone scintigraphy should be done to rule out metastatic involvement. Although metastatic lesions in this area usually herald generalized neoplastic spread according to our experience, prompt diagnosis nevertheless can lead to useful palliation and an enhanced quality of life.

Summary:The so-called pinch-off syndrome is observed in up to 1% of all central venous catheters (CVCs), and is a valuable warning prior to fragmentation, which occurs in approximately 40% of the respective cases. As long-term indwelling CVCs are used with increasing frequency, this paper describes the necessity of pinch-off monitoring following the experiences of a case study and a review of the current literature on this specific topic in order to point out preventive practice guidelines.Besides easy preventive practices such as a high level of suspicion and adequate X-ray controls, findings give strong evidence that the most important specific factor might be the adequate approach.In our hands, the supraclavicular technique has provided the best results with regards to percutaneous introduction of large bore CVCs. Central venous catheters (CVCs) are useful therapeutic and diagnostic devices for administration of fluids, chemotherapeutic agents, parenteral nutrition and for central venous pressure monitoring, for vascular access, for extracorporal treatment regimens, and bone marrow transplantation. [1][2][3] As with most invasive procedures, central venous catheterization is associated with numerous potential complications, both during placement and later in long-term maintenance. Pneumothorax, infection, bleeding, arrhythmias, malposition, and thrombosis are well-known complications. 3,4 A rare but serious complication is catheter fragmentation with subsequent embolization through the heart into the pulmonary artery occurring in approximately 40% of patients who develop the possible precursor warnings of catheter fragmentation, the so-called pinchoff sign described by Aitken and Minton in 1984. [5][6][7] As long-term indwelling, CVCs have often become the patient's lifeline and are used with increasing frequency worldwide, we report a representative case of our own experience and summarize the current literature on this specific topic in order to emphasize preventive practice guidelines. Case reportA 35-year-old female presented with acute lymphatic leukemia in 1988. After treatment with standard chemotherapy she achieved complete remission. After 4 years, she relapsed and required reinduction. Prior to reinduction a port-a-cath was inserted by surgical cut-down technique. After chemotherapy the patient was scheduled for autologous bone marrow transplantation. Since the treating physicians considered an additional long-term device necessary for autologous bone marrow transplantation a double-lumen Hickman-catheter (Bard 12.0 Fr, Round Dual Lumen; Cranston, RI, USA) was inserted by surgical cut-down to access the contralateral subclavian vein. The procedure was performed by the surgeons without complications. The slight kinking of the line on the postprocedural chest radiograph was accepted because the catheter lines were functioning, the catheter tip was positioned correctly and the lumina of both catheter lines were inconspicious.Conditioning chemotherapy was administered and was followed by bone marrow tra...