[The radiological diagnosis of shock lung (author's transl)]. / Zur Diagnose der Schocklunge

So-called "shock lung" has typical pathological findings; radiologically it is characterised at first by interstitial, late by alveolar pulmonary oedema. This has been shown by a number of case reports. In addition to shock, however, certain intoxications and all forms of left heart failure produce the radiological changes of pulmonary oedema. Transient hyperhydration of the lungs following infusion therapy causes signs of pulmonary oedema which disappear as soon as the fluid balance becomes normal. The radiographic findings of pulmonary oedema correlate well with the intensity and extent of the pathological changes. The radiologist is therefore in a position to evaluate the severity of the shock lung; this is a valuable addition to the clinical findings and the results of physiological tests and blood gas analysis. It has to be emphasised that the radiological changes appear at an early stage, in any case much sooner than the clinical features. Radiological findings may be present without abnormalities on oscultation or percussion. Radiographs of the lungs are therefore indicated in all patients who may be subject to shock lung, particularly if they suffer from undiagnosed hyperventilation.

[Comparison of ultrasonic and CT diagnosis of solid liver tumors]. / Vergleich zwischen Ultraschall- und CT-Diagnostik solider Lebertumoren.

A prospective study compares the results of ultrasound and CT diagnostics in 323 patients with liver tumours. The accuracy of both methods is high: the sensitivity of ultrasound comes up to 90.4%, of CT to 96.1%. The important role of the comparatively economic ultrasound in specific tumour diagnosis is eg shown by the fact that if lesions of high and low echogenicity were found in one patient, or if there were found calcifications, the tumour was always a malignoma. This specificity was missing in the cost intensive CT which is also more time consuming and needs i.v. contrast.

[The renal pelvic tumor in the sonogram]. / Der Nierenbeckentumor im Sonogramm.

A prospective study evaluates screening investigations of the kidneys of 2350 patients. Sonographic criteria of the renal pelvic tumour are established. So-called "indirect signs" are only recognized by the compound scanner. By these ultrasonic symptoms a pelvic tumor could be detected with 15 patients which is a frequency of 6,5%. Part of the patients were preselected. The possibility of false-negative findings remains unconsidered. The study proves the great relevancy of ultrasonography in this disease. When operations of renal pelvic carcinomas were retrospectively checked our diagnostic results were underlined.

[Liver hemangioma--an angiographic contribution to the differential diagnosis of sonographic lesions (author's transl)]. / Leberhämangiom--ein angiographischer Beitrag zur Differentialdiagnose sonographischer Läsionen.

Small liver hemangiomas are displayed as echogenic as well as sonolucent patterns on ultrasonic scans. Differentiation from malignomas is difficult and responsible, hepatomas and solitary metastases being possible. By partial liver resection the malignant diseases can be treated successfully. Therefore an accurate diagnosis is to be aimed at. Of all the methods only angiography can ensure a certain amount of clarity. This is possible under the following circumstances: The cavernomas must be of a certain size. They must not withdraw from evidence due to large avascular areas which can result from thrombosis, fibrosis or necrosis. Moreover a superselective filling of the hepatic artery is claimed but not always possible. If the portal vein is opacified it conceals the radiologically typical image of the cavernoma. Under these circumstances only few moments of the late arterial and the hepatovenous phases remain to detect the hemangioma in the seriogram.

[About the so-called ischemic-ulcerative innerwall lesion of the bowels proximal to intestinal stenoses (author's transl)]. / Uber die sogenannte ischämisch-ulzeröse Darminnenwandläsion proximal stenosireender Darmprozesse.

The ischemic ulceration resp. the ischemic necrosis of the intestine's internal wall located proximal to an obstruction is a rare complication. At present this diagnosis is established by the radiologist alone. The knowledge of this disease--which is at the time being abscure in its origin--is of great importance to the surgeon, who has to try to resect both, the obstructes and the ischemic-ulcerative regions, in order to avoid insufficiency of the anastomosis postoperatively. The oral border of the alteration can be determined by a frozen section during the operation. In this connection the fatal complications of total necrosis of the large and small intestines resp. is demonstrated for the first time.

[Sonography of the lungs and pleura]. / Die Sonographie der Lunge und Pleura.

Diagnoses were made by ultrasound in 73 out of 80 cases with unclear thorax x-ray. One case was misinterpreted, no diagnoses were possible in 6 cases. Pleural effusion or opacities reaching the pleura are necessary to perform ultrasound examination. Sonographic findings in pleural or pulmonary changes are discussed and correlated with pathological anatomical findings. Additional information can be obtained by sonography in pleural lesions and in pulmonary lesions masked by pleural effusion. Atelectases can be differentiated from pneumonia, and tumours can be identified in peritumorous pneumonia or atelectases.

[Pre- and postoperative diagnosis of an aortic aneurysm by dynamic computed tomography with omission of angiography]. / Prä- und postoperative Diagnostik des Aortenaneurysmas mittels dynamischer Computertomographie unter Verzicht auf die Angiographie.

A study which was prospective with regard to the method, showed 41 cases of aortic aneurysms in a collective of 3597 body-CT-examinations (1.14%). By means of CT and its possibility of reconstruction all morphological details of an aneurysm become visible. The course of the vessels to the bowel and to the kidneys are shown with the same excellence as in angiography. However, additional information which angiography cannot supply, is also given, like non-perfused lumen, changed wall structure and perivascular changes. Measurement of flow can be performed in the vessel and in the organ, the arterial supply of which is involved in aneurysmatic disease. The method is non-invasive. This is important for control after operation. Morphological changes of the vessel prosthesis are detected, as well as bleeding and infection. Functional parameters are determined semiquantitatively.

[Cerebral blood flow measurement by dynamic computed tomography before and after reconstructive vascular surgery]. / Durchblutungsmessung des Gehirns mit dynamischer Computertomographie vor und nach rekonstruktiver Gefässoperation.

Sequential changes of cerebral regional blood flow and parenchymal perfusion were examined with dynamic CT in 12 patients with arteriosclerotic occlusive disease before and after vascular reconstructive surgery. ROI density values were recorded bilaterally in corresponding regions of the brain tissue and vessels. Interpretation is based on transient time of the bolus (timing of peak), delay of the peak and amplitude of the change of density-time curve. Differences of hemodynamics before and after surgery are demonstrated, a practical technique for measuring the relative perfusion.

[Laryngeal and hypopharyngeal carcinoma--the limits and advantages of sonography]. / Das Larynx- und Hypopharynxkarzinom--Grenzen und Vorteile der Sonographie.

29 patients with carcinoma of the larynx and the hypopharynx were evaluated not only for staging cervical lymph nodes but also for classification of the primary tumour. With appropriate technique it is possible to assess tumour infiltration (T4) of surrounding tissue of the larynx at all levels. Tumour classification T1 to T3 is possible in patients with tumour of the epiglottis (regio supraglottis, UICC). The endolaryngeal tumour T1 to T3 (regio glottis and subglottis, UICC) still remains the domain of the microlaryngoscopy. The limits of the method are apparent in hypopharynx carcinomas where in only 50% of the patients the tumour could be assessed.

[The value of barium double-contrast study in the aftercare of gastrectomy patients (Roux-Y)]. / Stellenwert der Barium-Doppelkontrast-Untersuchung in der Nachsorge von Gastrektomierten (Roux-Y).

We evaluated 32 patients who had undergone jejuno-oesophagostomy for gastric carcinoma. Double contrast radiography was performed 3 to 36 months after gastrectomy, 3 to 14 days prior to routine endoscopy. Endoscopy is superior to double contrast radiography in detecting tumour recurrence, particularly in small tumours, due to the possibility of biopsy. Double contrast radiography is excellent in demonstrating the afferent loop. We found a high number of jejuno-oesophageal reflux and very different small intestine transit times without correlation to clinical signs and symptoms.

[Comparative study on the effect of the dopamine receptor blockers metoclopramide and domperidone on stomach emptying and the visualization of the small intestine in monocontrast]. / Vergleichende Untersuchungen der Wirkung der Dopaminrezeptoren-Blocker "Metoclopramid" und "Domperidon" auf die Magenentleerung und die Darstellung des Dünndarmes in Monokontrast.

The effects of a new dopamine receptor blocking agent, domperidone are compared pharmacoradiographically with the well-know action of metoclopramide. The investigated parameters were pyloric muscle function, passage time through the small intestine and, in correction with this, an evaluation of barium filling of the small intestine. Our investigations show that domperidone at dosages of 0.1 mg/kg and 0.2 mg/kg body weight does not accelerate intestinal junction as markedly as 0.3 mg/kg metoclopramide. Nevertheless, domperidone is as well suited as metoclopramide for pharmacoradiography of gastric emptying and for radiological examination of the small intestine. Hence, it can be concluded that the stimulation of the pyloric muscle as the leading pace maker of propulsion is achieved satisfactorily. Contrary to the findings with metoclopramide, domperidone shows no central nervous side effects. It appears that domperidone, at therapeutic dosages, does not pass the blood-brain barrier. Hence, this pharmaceutical preparation should prove of particular value in paediatrics.

[Angiographic investigation with parathyroid hormone administration as functional gauge of liver blood flow (author's transl)]. / Angiographische Untersuchung unter dem Eimfluss von Parathormon zur funktionellen Beurteilung der Leberdurchblutung.

Parenteral administration of parathyroid hormone causes dilatation of the main hepatic artery adn the intrahepatic branches, as demonstrable on coeliacography. This applies to healthy persons as well as to patients suffering from cirrhosis of the liver. When hormone is given intraarterially, i.e. into the coeliac trunk, the effect on the hepatic arteries is stronger than after intravenous administration. No effect can be be shown on the splenic, upper mesenteric or gastroduodenal arteries. The reaction of the hepatic arteries to parathyroid hormone seems to be a good parameter of the degree of dilatory capacity of these vessels in cirrhosis. Relevant conclusions can probably be drawn as to the prognosis of porto-systemic shunt operations and their indication. This haemodynamic hormone effect, the cause of which is still unknown enabled better visualisation of primary liver tumours on coeliacography.

[Typical changes of the intestinal wall due to oral stenosing processes (author's transl)]. / Typische Wandveränderungen des Darmes oralwärts stenosierender Prozesse.

Two different changes of the intestinal wall, which seem to be of stenotic orgin, can be observed prä-stenotically. One of these changes is represented by diverticulosis, whereas the other is the so-called ischaemic-ulcerous lesion of the mucosa. The latter accompanying disease supplies highly important preoperative information. This condition can be diagnosed practically exclusively by the roentgenologist. In many cases, stenosis makes endoscopic assessment impossible. Diverticulosis is of theoretical interest in this connection. The article goes into the possible aetiology of the changes. Two typical cases underline the importance of the diseased conditions under discussion, which are relatively rare, as is evident from a statistical evaluation of the author's case material.

[About the advantages of the sonographic diagnostic in the field of the radiologist (author's transl)]. / Uber die Vorteile der Ultraschalldiagnostik in der Hand des Radiologen

1. Ultrasound techniques as a new diagnostical method are included in the work and administration of an already existing institution of a central hospital, i.e. the X-ray department. Avoiding a special organizational unit in the hospital or an organization depending on a department which e.g. a gynecology could not be asked to undertake (considering the amount of work and qualification needed) means an advantage from the economic point of view. 2. The radiologist is able to learn the interpretation of the B-Scan of the ultrasound method very quickly because the visual imagination necessary to handle both methods is the same. 3. Sonography is an important supplement for radiological diagnosis. 4. Suspecting a lesion of an retroperitoneal or intra-abdominal organ sonography can be used as the first check-up. Renal sonographie could prove to be a screening-method. Often the ultrasound finding indicates the further diagnostical procedures which are successful, saving X-rays and time. Under certain circumstances X-ray investigations can possibly be avoided. Considering the last two points would mean for the future that the radiologist indicates the diagnostical method to be used - not only the ultrasound but also the X-ray method. Five cases demonstrated confirm this conclusion.

[Crisis in medical ethics]. / Krise der Medizinethik.

There is a disproportion between diagnostic and therapeutic medical achievements and the doctor/patient relationship. Are we allowed to do everything we are able to do in medicine? People are concerned and worried (genetic technology, invasive medicine, embryos in test tubes etc.). The crisis of ethics in medicine is evident. The analysis of the situation shows one of the causes in the shift of the paradigma-modern times to postmodern following scientific positivism-but also a loss of ethics in medicine due to an extreme secularism and to modern philosophical trends (Hans Jonas and the responsibility for the future and on the other hand modern utilitarism).