Sacral distribution of prostatic lymph nodes visualized on spiral computed tomography with three-dimensional reconstruction.

OBJECTIVE: To evaluate the involvement of sacral lymph nodes in prostatic lymphatic drainage, using contemporary radiological imaging techniques. PATIENTS AND METHODS: The study included six patients (mean age 61.8 years, range 51-75) with suspected prostate cancer. First, an oil-based contrast medium was injected into the prostate under transrectal ultrasonographic and fluoroscopic guidance, after which a standard ultrasound-guided sextant biopsy was taken. Before injecting the contrast medium, and 20 min and 24 h thereafter, the patients underwent spiral computed tomography of the pelvic region with three-dimensional reconstruction. RESULTS: In all patients the prostate drained via the sacral lymphatic region. Compared with the iliac lymphatic drainage system, there were fewer and narrower sacral lymph nodes. Prostatic sacral lymph nodes were located at S2 to S5, with an emphasis on S3-4. Lymph nodes were detected as presacral and in the sacral foramen, suggesting a direct lymphatic connection to the bony pelvis. CONCLUSION: These results suggest that sacral prostatic lymphatics are a potential route of spread of prostate cancer cells.

[The diagnostic value of pharmacoangiography in tumourous and inflammatory diseases of bones and soft tissues (author's transl)]. / Diagnostischer Wert der Pharmakoangiographie bei tumorösen und entzündlichen Knochen- und Weichteilprozessen. Ein Bericht über 81 Fälle.

The value of pharmaco-angiography (Priscol, angiotensin) in the diagnosis of tumourous and inflammatory diseases in bones and soft tissues was investigated in 81 patients. Priscol was used in 49 patients, angiotensin in 28 and both substances in four. It was shown that neither Priscol nor angiotensin produced results of diagnostic value, provided an optimal technique was used (antegrade, selective contrast injection with an adequate volume of contrast and in the absence of vascular spasm). Priscol was of value for reducing or preventing spasm in peripheral vessels. Angiotensin is superior to Priscol in demonstrating the angiographic criteria, but pharmaco-angiography did not result in a better distinction between tumours and inflammatory lesions.

[The angiographic diagnosis and differential diagnosis of inflammatory disease of bones and soft tissues (a report concerning 40 cases) (author's transl)]. / Angiographische Diagnose und Differentialdiagnose bei Entzündungen des Knochens und der Weichteile (Ein Bericht über 40 Fälle).

The angiographic appearances of inflammatory disease of bones and soft tissues was analysed in 40 patients. The angiographic findings in inflammation of bone (28 patients) differed greatly, from normal findings (14.2%), moderate angiographic changes corresponding to the severity of the inflammatory process (32.1%), marked changes in the arterial, capillary and venous beds (42.9%) and significant local staining with little peripheral reaction (10.7%). Soft tissue inflammation on the other hand showed increased vascularity in all cases. A typical angiogram was found in 50% of cases and shows the following characteristics: vascularity as compared with the surroundings is usually increased and may be extensive, far more so than is found surrounding vascular bone foci; the contrast staining is usually ill-defined and the veins in the late phase are increased in calibre. Early venous filling is common and should not be regarded as a sign of malignancy. In 17.5% of patients the angiogram simulated a tumour; in four patients (10%) a false positive diagnosis of tumour was made, in two (5%) a tumour could not be excluded and in one case a benign tumour was diagnosed because of localised staining. None of the angiograms which had been interpreted incorrectly showed typical pathological vessels, which are the most important tumour criteria.

[Vascular embolisation in uncontrolled haemorrhages of the bladder caused by tumours and radiation (author's transl)]. / Gefässembolisation bei unstillbaren tumor- und strahlenbedingten Blutungen der Harnblase.

Unilateral or bilateral embolisation of the internal iliac artery was effected in nine patients with incontrollable bleeding due to bladder tumour or invasion of a tumour into the bladder, or as a result of massive alterations of the urinary bladder caused by radiation exposure. A clearly superior haemostasis was achieved via bilateral embolisation (in 4 out of 5 patients) compared with unilateral embolisation (2 of 4 patients). Side effects were observed in two-thirds of the cases (elevated temperature, transient pareses and pain in the gluteal and leg regions).