Background and Purpose-The delineation of the "penumbra" is of particular interest in acute stroke imaging. The "mismatch concept" applying perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) appears to be an oversimplification of the underlying electrophysiological tissue status. An additional parameter reflecting the metabolic state of the threatened brain tissue would improve our ability to describe the penumbra. One candidate is deoxyhemoglobin (deoxy-Hb) as an indicator of the oxygen extraction fraction that can be visualized by T2*-based blood oxygen level-dependent (BOLD) imaging. Methods-We analyzed data from 32 patients with acute stroke in the territory of the middle cerebral artery. MRI included fluid-attenuated inversion recovery, DWI, PWI, time-of-flight angiography, and quantitative T2 and T2* (qT2, qT2*) imaging. Follow-up was performed on day 1 and days 5 to 8. We calculated 1/T2Јϭ1/qT2*Ϫ1/qT2. Changes of T2Ј, representing the deoxy-Hb effect, were analyzed by 3D regions of interest (ROIs): apparent diffusion coefficient lesion day 0 (L0), time-to-peak-lesion day 0 (T0), final infarct size days 5 to 8 (F5-8), lesion growth (LG; F5-8ϪL0), and surviving tissue (ST; T0ϪF5-8). Results-We observed a clear decrease of T2Ј in the infarcted hemisphere compared with the unaffected control ROIs. The mean value showed the most pronounced loss of T2Ј signal intensity in L0 (Ϫ15.7%), followed by LG (Ϫ10.5%) and ST (Ϫ8.0%). Conclusions-The

The presence of a T2'>ADC mismatch is a more specific predictor of infarct growth than is TTP>ADC mismatch and hence may be of clinical value in patient selection for acute stroke therapies in the future.

The technique of radio-radial monobloc-fixation with the small AO external fixator device has been applied to 17 consecutive Colles' fractures. The fracture types were mainly A3 and C2, according to the AO classification. We found this technique to be easy and quick in application and stable in fixation. Direct, precise and atraumatic reduction can be achieved by using the distal pins as joy-sticks. Furthermore, disimpaction of the fracture to regain length is possible without bone grafting. Normal carpal mobility and load transfer is preserved during fracture healing and the injured hand can be used in daily life with certain restrictions. To prevent pin-track infections, early mobilization of the wrist should be avoided. We recommend this technique in the treatment of comminuted AO-type A3 fractures of the distal radius and in certain type C2 cases.

be taken to avoid an overdose that can be reached at lower doses.4 Impaired consciousness, stupor, coma and seizures are all described as side effects of this drug, especially in the case of overdose or intoxication. In our case, the addition of oxocodoneacetaminophen may have caused an additive CNS depression, 4 lowering the threshold for epileptic activity, in a patient at risk because of the underlying silent CNS pathology. Treatment for epilepsy reversed both the clinical opercular signs and the abnormal EEG recordings. Our case recommends exercising caution in the use of oxycodone in patients undergoing dialysis.

Hypo-intense lesions in BOLD imaging were visible and exceeded the lesion in diffusion-weighted imaging in most of the stroke patients. The encouraging results justify further testing of the hypothesis that BOLD lesions, when larger than DWI lesions, are associated with infarct growth from initial DWI to final infarct.

A 50 year old woman underwent laparoscopic supracervical hysterectomy because of symptomatic fibroids. Histologic examination of samples obtained after morcellation revealed typical uterine leiomyomas in all samples investigated. 28 and 47 months later, respectively, the patient presented with peritoneal spreading of nodules that were surgically removed and histologically classified as leiomyosarcoma. In 3/4 of samples obtained after morcellation copy number/SNP-array hybridization showed complex genomic alterations widely identical to the pattern characterizing the sarcoma. Therefore, we conclude that the leiomyosarcoma had unambiguously developed from one of the leiomyomas as a result of secondary genetic alterations i.e. a rearrangement of ALK and a del(14q). The case is challenging the current risk estimates for spreading of unexpected malignant uterine tumors due to power morcellation and highlights the relevance of certain genetic alterations for rare malignant transformation of uterine benign smooth muscle tumors.

Background: Quantification of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and T2 relaxation time are increasingly important for neuroradiologic applications. A transfer of the values established for 1.5-T to 3-T MRI must be supported by a dedicated comparison with special emphasis on possible differences in the spatial distribution. Material and Methods:In the present study, brain scans were carried out in 16 healthy volunteers at both 1.5-T and 3-T systems of the same design and gradient system. The protocol consisted of a fast spin echo (TSE) sequence, two singleshot spin echo echoplanar imaging (EPI) sequences for diffusion-weighted imaging and diffusion tensor imaging. Data from the two field strengths were compared for ADC, FA, and T2 relaxation times. The signal-to-noise ratio (SNR) was also compared for all sequences and echo times. Results: While there were no differences in ADC and FA, the T2 relaxation time was reduced by 15% at 3 T. A higher SNR at 3 T was found for both TSE and EPI sequences as expected (p < 0.05). Conclusion: Special benefits of the T2 measurement at higher field strengths are possible on certain clinical conditions due to reduced T2 relaxation time. Furthermore the results of the ADC and FA obtained from patients at different field strengths could be directly compared with each other -useful in the clinical follow-up.

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.