Der Radiologe
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In childhood blunt trauma to the chest wall is more frequent than penetrating injuries. Most of these are the result of traffic accidents. Solitary or serial rib fractures are seen more often than fractures of the sternum. ⋯ The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries.
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Depending on the clinical symptomatology, computed tomography (CT) is the predominant examination technique. CT reliably shows live-threatening intra- or extracerebral hemorrhage. ⋯ In many cases localized edema can be identified, but because of the normally very narrow cortical sulci in children and younger people, the general post-traumatic brain swelling is often diagnosed only retrospectively. Magnetic resonance tomography is more sensitive than CT concerning subtle changes in the depth of the white matter and should be used for follow-up studies as a supplementary examination.
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The principles for estimation of the patient's radiation dose from conventional radiographic and computed tomography examinations are presented on the basis of published exposure simulation data. The relationship between absorbed dose in air, or axis dose, organ doses, and effective dose is explained. ⋯ Calculation of the effective dose from organ doses using tissue weighting factors is described. Finally, examples of dose calculation are given for a conventional radiographic and a CT examination.
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In a prospective study MR-guided laser-induced thermotherapy (LITT) of liver metastases was optimized and the clinical parameters evaluated. Seventeen patients (4 women, 13 men) with a total of 29 lesions underwent LITT in 25 sessions through 1 March 1994. Twelve of them suffered from colorectal carcinomas, 5 from other primary tumors. ⋯ Follow-up evaluation 6 months after treatment shows a significantly better response in lesions with a diameter of 20 mm or smaller, with a local tumor control rate of 66%. In lesions larger than 20 mm only a local tumor control rate of 35% could be achieved. Laser-induced thermotherapy (LITT) represents a new, minimally invasive technique for tumor destruction and a high response rate in small liver metastases.
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Eighteen patients (11 renal tumours, 3 bronchogenic carcinomas, 4 others) with 24 different bone metastases were embolized for preoperative devascularization (11 x) or for intractable pain (7 x). Metastases were localized in the spine (17 x), pelvis (5 x), and shoulder girdle (2 x). All metastases were hypervascularized. ⋯ Intraoperative blood loss was minimized to 2100 ml (600 ml-4200 ml). Pain relief was achieved in 6 out of 7 patients. Eight of 18 patients died as a result of underlying diseases (follow-up 7 months).