[Transfemoral portography (author's transl)]. / Transfemorale Portographie: Studie am Situs.

In 15 cadavers the portal vein was dissected and punctured from the inferior vena cava by means of a coaxial needle (Johnson needle) introduced through the femoral vein. Success was confirmed by screening after contrast injection, by appropriate radiographs and following the use of coloured material by inspection. A modification of the technique was the use of a catheter introduced into the femoral vein by the Seldinger technique. In only one case was extravasation observed, and there was not incorrect injection into the inferior vena cava. These experiments demonstrate the feasibility of transfemoral portography. Its use in patients would also appear to be possible. The puncture is best carried out by radiographic observation and real time ultra sound. Possible complications from damage to neighbouring structures and from bleeding are possible, though apparently not serious. The indications and possible modifications of transfemoral portography are discussed and compared with other methods. The possibility of performing a portocaval shunt by means of the catheter in order to stop bleeding from oesophageal varices is stressed.

[Computed tomographic diagnosis of renal tumors without using contrast media]. / Computertomographische Diagnostik renaler Tumoren ohne Anwendung von Kontrastmittel.

The question whether contrast medium is necessary for diagnosis of renal tumour in CT is studied on the basis of 80 histologically proven cases of hypernephroma. More than 97% of the tumours were diagnosed on plain scan. The presence of structural inhomogeneities was decisive for recognising tumours 2 cm and larger without the use of c.m. In disagreement with current opinion injection of c.m. is not necessary for exclusion of hypernephroma. Injection of c.m. is useful however for differentiating between physiological variations and tumours less than 3 cm in size, and for diagnosis of tumour thrombosis of the renal vein.

[The "false-positive polyp" during contrast examination of the colon (author's transl)]. / Der "falsch-positive polyp" in Kolonkontrasteinlauf.

44 cases of false-positive radiological diagnosis of colonic polyps are reviewed with regard to cause, frequency, distribution and radiological criteria. Most common causes are scybala and air bubbles (77%) and effects of overlapping and projection (19%). Due to extensive folding of the colon misinterpretations are frequently seen in the sigmoid and in the area of both flexures; the folding allows overlapping of mucosal structures and trapping of bowel contents. The validity of roentgen signs in polyp diagnosis and the limits of colonoscopy are discussed. Diagnostic reliability may be improved by optimal technique of examination and standardized proceeding.

[Apophyseolysis, evulsion fractures and osteochondropathy of the anterior inferior iliac spine (author's transl)]. / Apophyseolysen, Abrissfrakturen und Osteochondropathie der Spina iliaca anterior inferior.

Evulsion fractures of the anterior inferior iliac spine in adults usually are the result of sudden contraction of the rectus femoris muscle during sporting activities, particularly football. In children, before fusion of the apophysis, there may be an apophyseolysis. This may result in a chondropathy because of abnormal development of the frequently multiple ossification centres. In contrast to the relatively frequent evulsion fractures of the anterior superior iliac spine, such an event is very rare in the anterior inferior iliac spine. Three illustrative cases are described showing the typical combination of history, localisation, pain recurrence during exercise and x-ray changes, which usually consist of a curved osseous structure separate from the iliac bone. These findings permit a correct diagnosis.

[In vitro tests of barium sulphate suspensions for double contrast examinations of the stomach (author's transl)]. / In-vitro-test von Bariumsulfatsuspensionen zur Magendoppelkontrastuntersuchung.

Four barium sulphate suspensions were investigated with respect to their adhesion and contrast following standard means of spreading the contrast over a model stomach, which corresponds in its detailed structure with the surface of the gastric mucosa. By this means various factors, which make a true comparison in vivo impossible, could be eliminated and a comparison of the suspensions became possible. Using similar mechanical and chemical situations, the radiographs of the artificial mucosa showed very different results from the use of the different preparations. These corresponded well with the findings in vivo.

[Innominate grooves. A discussion]. / Innominate grooves. Ein Diskussionsbeitrag.

Innominate grooves are delicate, inconstant speculations on the colonic margin which may be seen on barium enemas; their origin and significance are matters for discussion. Three hundred and fifty-three double contrast enemas (divided into four groups, depending on the techniques uses) were studied in respect of the presence, localisation and circumstances under which innominate grooves could be seen. The results showed that the incidence of grooves depended on the technique used and varied between 91% and 3%. The most common localisations were the descending and sigmoid colon and in the transverse colon, near the hepatic flexure. The grooves could be seen only towards the end of the examination. It follows that innominate grooves are a normal phenomenon in a healthy mucosa, which can be recognised under optimal circumstances. It is probably due to visualisation of the relief pattern of the mucosa, the delicate folds being particularly noticeable in relation to lymph follicles. Innominate grooves should not be misinterpreted as abnormal findings, but must be distinguished from somewhat similar changes in the colon due to inflammatory disease.

[Acute aortic thrombosis (author's transl)]. / Die akute Aortenthrombose.

A case of acute thrombosis of the aorta is described; it extended from the superior mesenteric artery to the bifurkation and was probably due to oestrogen medication. The clinical features and diagnosis of this rare condition are described. The condition usually develops against a background of advanced arteriosclerosis and is initiated by certain haemodynamic factors such as intimal damage from blunt trauma, emboli or the thrombogenic effect of oestrogens. The symptoms, such as pain, absent pulses etcetera are the result of ischaemia and depend on the extent of the lesion. A definite radiological diagnosis can only be made by means of aortography, if necessary with oblique projections. The Seldinger technique with a femoral or axillary approach is the method of choice. Aortography shows a filling defect and occasionally a collateral circulation.

[Non-traumatic myositis ossificans circumscripta (author's transl)]. / Die nicht traumatische Myositis ossificans circumscripta.

The clinical, pathological and radiological features and the differential diagnosis of the very rare condition of non-traumatic myositis ossificans circumscripta are illustrated by one patient. The characteristic radiological appearances make a correct diagnosis of this localised, non-malignant process possible.

[Benign chondroblastoma--malignant radiological appearances (author's transl)]. / Benignes Chondroblastom--malignes radiologisches Bild.

The very rare benign chondroblastoma occasionally invades soft tissues and may grow beyond the epiphysis into the metaphysis. In the present case such a tumour did not show the typical radiological appearances, but presented malignant features both on plain films and on the angiogram. The importance of biopsy of tumours which cannot be identified with certainty must be stressed before radical surgery is carried out.

[Functional control of the renal transplant via sequential computerized tomography. First results (author's transl)]. / Funktionskontrolle des Nierentransplantats durch Sequenz-CT. Erste Ergebnisse.

The enhancement of cortex medulla and arteria iliaca can be visualized separately, evaluated densitometrically and represented graphically by means of sequential computerized tomography of the renal transplant following intravenous contrast medium bolus injection. Since this enhancement performance is mainly dependent on perfusion, it is possible to determine the perfusion value of individual measurement areas. For example, a cortical defective perfusion, as is known in rejection, becomes evident as a flattening-out of the initial rise of cortex enhancement and can be distinguished from the largely normal type of curve obtained in acute tubular necrosis (ATN). The angiographically known prolonged "wash-out time' in rejection corresponds to a long-lasting corticomedullary density gradient. Despite restricted informative value because of the relatively small number of patients, it appears that sequential computerized tomography enables differentiation of postoperative anuria.

[Malignant tumours in horseshoe kidneys (author's transl)]. / Maligne Tumoren in Hufeisennieren.

Hypernephromas were found in horseshoe kidneys in two patients; the diagnostic problems arising from this combination are discussed. Detailed demonstration of horseshoe kidneys by excretion urograms may be poor and tumours may therefore be overlooked and, on palpation, an abnormality within the gastrointestinal tract may be simulated. Angiography usually indicates the diagnosis and helps in planning surgery. Although there is no increase in the incidence of adeno-carcinomas in horseshoe kidneys, there is a significant increase in the incidence of Wilm's tumours and of carcinomas of the renal pelvis. Treatment consists of heminephrectomy or resection of the tumour; complications are relatively common.

Computed tomography in the diagnosis of complications following renal allograft surgery.

Computed tomography was used in a consecutive series of 74 transplantations in the diagnosis of complications to renal allograft surgery. Thirty-nine peritransplant fluid collections were demonstrated, 13 of these were subjected to surgery. A diagnosis of the specific nature of the fluid collection was possible in cases of urine leakage and fresh hematomas. The method was sensitive in defining the size of the renal pelvis though differentiation between postrenal obstruction and large non-obstructed collecting system was not always possible. The cause of postrenal obstruction could be identified in 5 patients out of 10. Renal infarctions were diagnosed in 8 patients. Computed tomography seems to be a highly accurate method in the diagnosis of complications to renal allograft surgery. The method can be used independent of transplant function and the use of contrast medium is necessary only to verify urine leakage and infarction.

[The diagnosis of renal perfusion abnormalities by sequential CT (author's transl)]. / Diagnostik renaler Perfusionsstörungen durch Sequenz-CT.

Abnormalities of renal perfusion can be recognised more readily by sequential CT than by a plain CT scan or after "static" enhancement with contrast medium. Haemodynamically significant stenoses of the renal arteries and total, or partial, infarct can be diagnosed in this way. Intrarenal and capsular collaterals can be recognised by slow contrast accumulation in the infarcted area, or by the development of contrast in the sub-capsular portion of the cortex. Renal cortical necrosis is very well demonstrated by the absence of cortical perfusion; this is seen, for instance, in the DIC syndrome or during rejection after renal transplant.

[Kirlian photography: accidental or person-specific pattern?]. / Kirlian-Fotografie: Zufälliges oder personenspezifisches Entladungsmuster?

OBJECTIVE: Is the corona electrography of Kirlian photography an accidental pattern or an individual specific discharge pattern? PATIENTS: 30 patients of the Stauferklinik Schwäbisch Gmünd, suffering from a great variety of diseases. STUDY DESIGN: At intervals of 10-15 min 10 Kirlian photos each of all fingers and toes were taken from each patient. Out of this material, from 8 patients 4 Kirlian photos each with evident similarity of the discharge radiographs of 3 fingers were selected. These images were scanned for mathematical procedures, and heuristic measurements of the histograms were evaluated by a genetic algorithm. RESULTS: Three pattern groups showed different heuristic measurements: accidental pattern 0.28 +/- 0.01, Kirlian pattern in general 0.3 +/- 0.02, and Kirlian pattern of the same person 0.44 +/- 0.05. CONCLUSIONS: The mathematical objectivation of the Kirlian photographs confirm the visual impression of strong similarity. Because of the lack of anatomical irregularities and since, due to new positioning, physical and chemical surface characteristics were changed in the single Kirlian photographs, the identification of the basic pattern stresses the existence of an individual discharge pattern and thus of an individual electromagnetic field.

[Ultrasound diagnosis of non-aneurysmic pulsating abdominal tumors]. / Ultraschalldiagnostik beim nicht aneurysmatischen pulsierenden Abdominaltumor.

Ninety-two patients with a pulsating abdominal mass and suspected abdominal aortic aneurysm (AAcA) were examined by ultrasonography. We diagnosed 48 cases (52%) of AAA and 5 unexpected lesions ventral to the aorta (5%), but in 39 cases (42%) we were not able to explain the symptom in spite of extensive diagnostic efforts and follow-up. Changes of the aorta or transmission of the pulse by adjacent structures are the main cause of a pulsating abdominal mass. Ultrasound examination appears to be optimal screening method for diagnosing AAA as well as the other symptoms no further diagnostic efforts are necessary after a negative ultrasound study.

[Double-contrast examination of the gastric antrum without duodenal superposition (author's transl)]. / Uberlagerungsfreie Antrumdarstellung durch Modifikation der Doppelkontrastuntersuchung.

By using a modified technique of double-contrast examination of the stomach it was possible in 75% to perform a study without superposition of the duodenum and jejunum on the distal stomach compared to 36% with the usual method. In this technique a small amount (50 ml) of Barium-suspension is given to the patient in left decubitus position by a straw or gastric tube after antiperistaltic medication. There was no difference in the quality of mucosa-coating compared to the technique using higher volumes of Barium.

Adrenal cortex dysfunction: CT findings.

The computed tomographic appearance of the adrenal gland was studied in 302 patients with possible endocrinologic disease and 107 patients undergoing CT for nonendocrinologic reasons. Measurements of adrenal size were also made in 100 adults with no known adrenal pathology. CT proved to be a sensitive diagnostic tool in combination with clinical studies. When blood hormone levels are increased, CT can differentiate among homogeneous organic hyperplasia, nodular hyperplasia, benign adenoma, and malignant cortical adenoma. When blood hormone levels are decreased, CT can demonstrate hypoplasia or metastatic tumorous destruction. Calcifications or caseations can be demonstrated earlier than on plain radiographs. When hormone elimination is increased, the morphologic substrate can be identified; tumorous changes can be localized and infiltration of surrounding organs recognized.