Der Radiologe
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Since patient cooperation in neonates and infants up to 5 years is always reduced, deep sedation is usually recommended to obtain constant high-quality images during MRI. According to the widely accepted AAP Guidelines, deep sedation is not always distinguishable from general anesthesia, substantiating the demand for state-of-the-art anaesthesia. This is particularly true in this age group, where pharmacokinetics and pharmacodynamics show wide interindividual variation. In this review we outline the techniques required to provide safe and effective patient care in the unique MRI environment. ⋯ The level of sedation required for MRI in newborn and infants can only be achieved safely and efficiently by general anesthesia performed by trained staff. Complete state-of-the-art anesthesia care can be delivered if appropriate instrumentation is used.
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Comparative Study
[Magnetic resonance angiography and magnetic resonance tomography in dissection of the vertebral artery].
Vertebral artery dissection (VAD) is an important cause of posterior circulation stroke in young adults. Initial symptoms are often non-specific and diagnostic arteriography is not performed until neurological deficits are obvious. Since magnetic resonance tomography (MRT) is superior in the diagnosis of vertebrobasilar ischemia, we retrospectively analyzed the role of MRT and MR angiography (MRA) in the detection of dissections of the vertebral artery. ⋯ Therefore, MRT/MRA should be recommended in patients with suspected VAD and especially in those who have no definite neurological deficit. These patients will benefit greatly from early diagnosis and therapy. The fact that all our patients were diagnosed after neurological symptoms and that 64% of them have residual deficits gives an ethical and economical rationale for advocating early MRT/MRA in these patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Incidence of postmyelography syndrome and postmyelography complaints after lumbar puncture with the Sprotte pencil-like needle in comparison with the Quincke needle].
Myelography in combination with a postmyelography CT is an important presurgical examination because of its excellent visualisation of the disc, the bone and the contrast-filled dura. Side effects after myelography can be observed in up to 50% of patients. The pathophysiological mechanism is thought to be increased cerebrospinal fluid leakage at the puncture site. Since the introduction by Sprotte in 1979 of the pencil-point needle, a modification of Whitacre's needle, fewer complaints after lumbar puncture have been reported. The aim of the study was to examine the influence of two types of needle points and the temperature (37 degrees C vs 21 degrees C) of the contrast medium (CM; iotrolan, Isovist) on the incidence of side effects of lumbar puncture for myelography. ⋯ Complaints after lumbar puncture and myelography are caused by the cerebrospinal fluid leakage at the puncture site. The incidence of side effects related to this leakage can be reduced by using a pencil-point needle. The temperature of the CM has no influence on the complaints.