[The indications for lymphography in urology with special reference to carcinoma of the penis (author's transl)]. / Indikation zur Lymphographie in der Urologie unter besonderer Berücksichtigung des Peniskarzinoms

Lymphograms have been performed on 775 urological patients. Our experience indicates a scheme for lymphography in this particular speciality. According to this, carcinomas of the bladder and kidney are a relative indication for lymphography, whereas carcinomas of the scrotum, penis and prostate present an absolute indication. Fiftyseven lymphograms have been performed on 52 patients with carcinoma of the penis. In one patient the examination was carried out twice in one year, in another, three times and a third patient had three lymphograms over a period of six years. Most patients were aged 60 to 69 years, average age 61.48 years. Agreement between the histological and lymphographic findings was observed in 26 out of 34 patients treated surgically (76.5%).

[Galacto-biopsy (author's transl)]. / Galaktobiopsie.

By galacto-biopsy we understand the expression of a suspected intraductal papilloma by firm palpation as part of preparation for galactography. Using galacto-biopsy the accuracy of galactography in the diagnoses of intraduct papillomas was increased to 95%.

[Gynaecomastia and mammography (author's transl)]. / Gynäkomastie im Mammogramm.

The term gynaecomastia indicates an increase in the mass of the normally rudimentary male breast; morphologically there is hyperplasia and differentiation of the epithelial and mesenchymal breast components. Gynaecomastia is not a disease in itself, but a symptom of some underlying disease or the result of drugs. Of 2895 breast operations performed at the surgical clinic of the University of Göttingen, 2.97% were operations on men with gynaecomastia. Amongst 79222 mammograms in the Radiological Clinic of the University, there were 900 mammograms (1.14%) of 392 men with gynaecomastia. Most benign and malignant conditions in men are retromammary in localisation. For this reason clinical evaluation is frequently wrong. The use of mammography as an additional diagnostic method in men is therefore more important than it is in women. Systematic analysis of the mammograms performed on men has made possible a classification of gynaecomastia according to the radiological appearances: I Septal linear structures (8.5%), II Opacities of varying density and size (26.5%), III Circular, usually inhomogenous shadows (15.5%), IV Homogeneous, demarcated foci of varying size (35.5%), V Soft-tissue hyperplasia-pseudo-gynaecomastia (10%).

[Mammography and age (author's transl)]. / Mammogramm und Alter.

Following Egan (2), Gros et al. (8,9), Ingleby and Gershon-Cohen (11) and Witten (18) the appearances of mammograms were divided into four groups: I. Dense, II. Atrophic, III. Shrunken-fibrous and IV. Cotton-wool, diffuse. In young women up to the age of 30 a dense structure is the most common (74.8%). On the basis of available statistics, the use of mammography for routine detection of carcinoma of the breast cannot be justified in women under the age of 30; not only is this condition very rare at this age, but proper evaluation of the relevant signs is only possible in one woman in four because of the structure of the breast. On the other hand, if there is any suspicion of the presence of a carcinoma, then mammography should be carried out and additional forms of examination, such as thermography and xerography, should not be neglected.

[Mammography in the diagnosis and treatment of non-puerperal mastitis (author's transl)]. / Die Bedeutung der Mammographie in der Diagnostik und Therapie einer nicht puerperalen Mastitis.

Circumscribed or diffuse non-puerperal mastitis is usually associated with local signs of inflammation. In two-thirds of these cases it is possible to demonstrate the radiological features of mastitis. Mammography is an important diagnostic procedure in the demonstration of acute mastitis and its differentiation from an inflammatory carcinoma; it is also valuable in the control of treatment. The success of intensive antibiotic therapy with recovery of normal appearances in the chest can be observed objectively by mammography. In distinguishing mastitis from an inflammatory carcinoma, radiological evidence of regression under the influence of antibiotics is evidence in favour of mastitis.

[The value of lymphography of malignant testicular tumors]. / Der Stellenwert der Lymphographie bei malignen Hodentumoren.

Between 1965 and 1968, 6500 lymphograms were performed at the University of Göttingen. Amongst these, there were 412 patients with malignant testicular tumours. In 81 patients the results of lymphography could be checked histologically. There was agreement between the lymphographic and histological findings in 65 patients (80.3%), sensitivity of 98.1% (51 out of 52) and specificity of 48.3% (14 out of 29). In 50 patients CT was performed in addition. The findings agreed in 31 cases; in eight patients lymphangiography resulted in a false positive finding and CT was incorrect in 12 patients. In all patients with proven retroperitoneal metastases, one or the other method produced a correct diagnosis.

[The diagnostic value of mammography during pregnancy and lactation (the radiological features of the breast during pregnancy) (author's transl)]. / Diagnostischer Wert der Mammographie in der Mammo- und Laktogenese.

During early and late pregnancy and lactation, there is an increase in the size of the breasts, with increased density of their structure. The moderately dense parenchyma in young women is characterised by a) wavy contours of the subcutaneous zone and b) linear or oval translucencies in the central parenchyma. Our investigations indicate that it usually takes three months after delivery before the breast structure returns to normal and one is able to interpret the mammogram satisfactorily. For this reason mammography should be avoided during these three months and if there is a suspicion of disease in the breast, a biopsy should be carried out immediately.

[Computed tomography and nuclear spin tomography in peripheral lymphedema]. / Computertomographie und Kernspintomographie beim peripheren Lymphödem.

The first reported findings on CT and N.M.R. in two cases of idiopathic peripheral lymphoedema are described. These methods have compared with the generally available volume estimations (volume estimation according to Kuhnke, immersion plethysmography) and have been considered in relation to visual and lymphographic examinations.

[Life expectancy in penile carcinoma (statistical evaluation of 150 penile carcinomas in the period 1912-1970)]. / Lebenserwartung beim Peniskarzinom (Statistische Auswertung von 150 Peniskarzinomen aus dem Zeitraum von 1912-1970)

In the period 1912-1970 in the Göttingen area, 150 patients suffering from penis carcinoma were investigated and/or treated. With regard to method of treatment, three periods can be distinguished: 1912-1930, 1931-1948, and 1949-1970. During the first period, treatment was chiefly radiotherapy, in the second chiefly surgery, and in the third combined radiotherapy and surgery. Independent of the type of therapy and period of observation, the 3-, 5-, and 10-year survival rates were 52.5%, 46.7%, and 31.4%, respectively. The greatest life expectancy was that following combined surgical and high-voltage therapy. The importance of lymphography is emphasized.

[The clinical significance of extratesticular originating tumors (author's transl)]. / Die klinische Bedeutung extratesticulär entstehender Hodentumoren

A case of large retroperitoneal metastasis of a seminoma is demonstrated. The primary tumor was impossible to recognize clinically. The extremely scarred primary tumor was at last discovered histologically in the normal appearing testis on the same side. This experience leads to the conclusion that the diagnosis "extratesticular originating testicular tumor" not be accepted unless a "burned-out" tumor can be exluded histologically in the ipsilateral testis.

[Direct lymphography with special reference to peripheral lymphedema. Historical retrospect--technique--indications--alternative procedures--image documentation]. / Direkte Lymphographie unter besonderer Berücksichtigung des peripheren Lymphödems. Historischer Rückblick--Technik--Indikation--Alternativverfahren--Bilddokumentation

Indication for direct lymphography during the past forty years shows a downward tendency, mainly because of new alternative modern imaging methods. Nevertheless, in agreement with the actual literature it can be shown by own investigations with 8000 patients from 1964 to 1989 that one cannot give up lymphography totally. On principle lymphography is still carried out in case of testicular tumors, malignant lymphomas, unclear fever, lymphatic vessel injury and facultative in peripheric lymph edemas.

[Secondary leg edema--experimental study]. / Sekundäres Beinödem--experimentelle Untersuchungen.

Peripheral lymphedema can be induced experimentally by obliteration or destruction of the veins and/or lymphatics, extirpation of the lymph nodes and occlusion of lymphatics, circular incision of the soft tissues, experimentally induced thrombophlebitis and by simultaneous traumatization of the veins and lymphatics. Our own animal experiments were designed to provoke leg edema after ligation of the femoral vein and/or accompanying lymphatics below the inguinal ligament. In 23 animals, only one ligature of the femoral vein was applied, below the inguinal ligament and in 12 animals all accompanying lymphatics were ligated in addition. In all animals, the leg circumferences were measured in three precisely fixed positions before the experiments and daily for 22 days during the experiment. The greatest increase in circumference was found in the lower leg irrespective of the time of measurement. The peak increase of circumference was between the third and sixth day after the operation. Permanent lymph edema has not developed in any of the animals. At the latest after three weeks, the leg circumference has normalized. Additional ligation of the lymphatics merely led to a nonsignificant increase in circumference and to displacement of the maximum point by two to three days. Immediately after the operation, phlebographic and lymphographic control investigations were carried out in all animals.

[Roentgen anatomy of the lymphatic system]. / Röntgenanatomie des Lymphgefässsystems.

The enormous advances in medicine in the last 30-40 years are chiefly attributable to the constant technical development in imaging and investigation techniques. The instruments offered by the industry, which must be renewed every ten years, the hunger of doctors for information and not least the high expectation of the patients must be reconciled with our action. Besides this rapid technical development in the sector of instrumental medicine, diagnostic and therapeutic techniques have been established in precisely the same period since the beginning of the 1950's, even in the field of the more patient-related medicine. These have proved to be epoch-making, especially in lymphology, namely lymphography and therapeutic lymphatic drainage. There is no doubt that the introduction of modern diagnostic techniques such as computer tomography and nuclear spin tomography has resulted in reduction of the indication for lymphography. However, even today it is still irreplaceable by other methods in diseases of the lymphatic system, in testicular tumors, and also in lymphedema. For this reason, we consider that it is appropriate that lymphography be recalled to memory as a selective technique for application in the lymphatic system.