[Clinical results of a simple new nuclear medical method for determining cerebral blood flow]. / Klinische Ergebnisse einer einfachen und neuen nuklearmedizinischen Methode zur Beurteilung der Hirndurchblutung.

Dynamic cerebral scintigraphy is a widely used, non-invasive procedure for the diagnosis of haemodynamic changes in the supra-aortic arterial territory. Eighty examinations have been carried out using a new method, which depends on demonstrating the time of arrival of the bolus within certain parameters. A definite advantage of the simultaneous demonstration of flow in various vascular territories is the fact that it is easily and rapidly perceived and that it is readily interpreted without depending on the subjective judgement of the operator. In addition, it is unnecessary to measure regions of interest.

[Aneurysms of the sinus of Valsalva (author's transl)]. / Die Aneurysmen der Sinus Valsalvae

Twenty-seven patients in whom a diagnosis of sinus of Valsalva aneurysm had been made during life were re-examined and the results have been evaluated. The clinical symptoms are not diagnostic. Routine radiological examination may also fail to show any significant findings. Large sinus of Valsalva aneurysms may show an atypical prominence of the right upper heart border, and in leutic aneurysms there may be fine calcification of the aortic wall. A definitive diagnosis can be made only by thoracic aortography. Five patients had a congenital saccular aneurysm connected with a sinus of Valsalva. Three patients had acquired aneurysms of which two were leutic and one developed shortly after rheumatic fever. A diffuse aneurysms of the sinus of valsalva was found in fourteen patients with Marfan's syndrome. The radiological appearances are demonstrated. Indications for surgery are discussed; the indications must be considered for each situation separately.

[The valve of selective retrograde cholangiography in the radiological diagnosis of diseases of the biliary passages(author's transl)]. / Der Stellenwert der gezielten retrograden Cholangiographie in der radiologischen Diagnostik der Gallenwegserkrankungen

The value of selective endoscopic retrograde cholangiography in the radiological diagnosis of diseases of the biliary passages and neighbouring organs is discussed on the basis of 400 retrograde pancreatocholangiograms. The results of this endoscopic examination were compared with the findings of all the other preoperative examinations carried out. The diagnostic usefulness and limitations of various methods are discussed in relation to stenosis of the papilla, pancreatitis, carcinoma of the pancreas, tumours of the extrahepatic bile ducts and postoperative bile duct abnormalities. The diagnostic accuracy of 97% emphasises the value of co-operation between radiologists and endoscopists.

[Parametric visualization of cerebral perfusion by intravenous digital angiography]. / Parametrische Darstellung der Hirnperfusion mittels intravenöser digitaler Angiographie.

Intravenous digital subtraction angiography is often used for evaluation of the extracranial and major intracranial vessels. The information obtained by this examination concerning cerebral perfusion is usually judged visually. In 50 patients a time-density curve at a specific point was analysed using 128 X 128 matrix. The level of grey scale at the moment of arrival of the bolus permits estimation of the haemodynamics of the intracranial vessels and provides a simple demonstration of differences of perfusion.

[The endoscopic retrograde cholangiography (author's transl)]. / Die endoskopische retrograde Cholangiographie.

This is a report of 760 endoscopic cholangiographic procedures. 76% of all examinations answered the given clinical problem. Prepapillar stenosis of the choledochus resulting from pancreatic diseases can be found in 35% of all pathologic findings. The diagnosis of a possible stenosis of the papilla Vateri is not facilitated by a retrograde cholangiographic examination. The intravenous cholangiogram with special regard to bile drainage seems to yield more information. A common drainage hindrance of the pancreatic and bile duct in connection with a stenosis of the papilla was shown in 26%. In 65% of patients with a postcholecystectomy-syndrome organic disease could be demonstrated which made a second operation necessary.

[Fibrinolytic treatment of peripheral artery disease and phlebothrombosis (author's transl)]. / Die fibrinolytische Therapie bei arterieller Verschlusskrankheit und Phlebothrombosen

Standardised streptokinase-heparin treatment was used in 30 patients with stenoses or occlusions of the large arteries and phlebothrombosis. Apart from three cases of occlusion of the popliteal artery it was possible to revascularise all occluded vessels and markedly widen any haemodynamically effective stenoses.

[Radiographic differential diagnosis of tumors of jejunum and ileum (author's transl)]. / Röntegenologische Diagnose und Differential-Diagnose der Tumoren des Jejunum und Ileum

Tumors of the small intestine form only 1.5-8% of intestinal tumors. After a survey of localization, type of growth and tendency towards degeneration the most important clinical findings are described. The most common sign is high ileus. Barium swallow is recommended which, when all radiologic criteria are taken into account, may even permit identification of the type of tumor. Typical individual tumors are illustrated and described and differential diagnostic data are given. The potential and limits of angiography are discussed.

[The clinical importance of angiography in the diagnosis of periarteritis nodosa]. / Die klinische Bedeutung der Angiographie bei der Diagnose der Periarteriitis nodosa

Report on a 53 years old patient with renal failure. Angiography showed multiple micro-aneurysms in kidneys and liver, in some instances also in the pancreatic, duodenal and mesenterial arteries. Muscle biopsy confirmed the suspicion of arteriitis nodosa. Clinically the diagnosis of necrotizing arteriitis is difficult. Angiography settles the diagnosis, but only positive findings of micro-aneurysms prove it. The differential diagnosis is discussed and illustrated.

[Embolism by ultrasound-thrombolysis (author's transl)]. / Die Emboliegefahr bei der Ultraschall-Thrombolyse

By ultrasound it is possible to destroy thrombi intravascular and remove them by a hollow flexible probe at the same time. Experiments were now performed in 6 dogs with 2-9 days old thromboses in the femoral or iliac veins, to detect embolisation during ultrasound-thrombolysis. Parameters were pulmonary angiograms and lung scans. Only in one dog with a floating thrombus in the iliac vein signs of pulmonary embolism were found after thrombolysis. The controls of the other 5 dogs were normal.

Thrombolysis by ultrasound.

1. A new method of destroying thrombi in blood vessels by ultrasound and simultaneously removing them is reported. 2. Experiments were performed in twenty dogs with artificial thrombi in the iliac and femoral arteries and veins. The length of the thrombi ranged from 4 to 5 cm and the age from 12 h to 10 days. The unit used consisted of a generator, a frequency counter, an ultrasonic transducer with the hollow waveguide and a vacuum pump. For protection of the vessel wall the guide is surrounded by a plastic tube. The ultrasonic frequency is 26-5 kHz, the amplitude 25-30 micronm. The time needed to destroy the thrombus by ultrasound and suck out the thrombotic material ranged from 2-5 to 5 min. 3. To check side effects, experiments were performed in forty-four dogs. No significant changes were seen in the fibrinolytic system or microscopic structure of the vessel wall after ultrasound.

[Primary aldosteronism: diagnosis, laterality and regulation of hormone secretion]. / Primärer Aldosteronismus: Diagnose, Seitenlokalisation und Regulation der Hormonsekretion

In 16 patients with hypokalemic hypertension the combination of abnormally high and unsuppressible plasma aldosterone with low or undetectable renin activity led to the diagnosis of primary aldosteronism. To differentiate between aldosterone producing adenoma and idiopathic bilateral hyperplasia, determination of aldosterone concentration in both adrenal veins was performed in 12 patients. In 4 of these patients the two forms of primary aldosteronism could not be differentiated as in these cases only one of the two adrenal veins simultaneously showing an abnormally high aldosterone concentration could be canulated. Plasma aldosterone and plasma cortisol were determined overnight (20.00-8.00 h) at short time intervals in 8 patients with adenoma, 1 patient with carcinoma of the adrenal cortex and 3 patients with bilateral hyperplasis. In all patients with adenoma a significant correlation between aldosterone and cortisol was observed (p less than 0.05-0.001) whereas no correlation was seen in the patients with hyperplasia and carcinoma. The clinical importance of these findings is that in the presence of ACTH-dependent secretion of aldosterone the site of the adenoma can be predicted even when blood from only one adrenal vein is obtained.

[Primary aldosteronism]. / Primärer Aldosteronismus

The syndrome of primary aldosteronism is caused either by an aldosterone-producing adenoma or by idiopathic bilateral adrenal hyperplasia. Hypokalemic hypertension is the leading symptome of the disease. Diagnosis is by the combination of abnormally high and non-suppressible aldosterone values with undetectable or low renin values unresponsive to postural changes or salt restriction. Patients with aldosterone-producing adenoma normally show a fall in plasma aldosterone in response to posture and ACTH-dependent circadian rhythm of aldosterone, whereas bilateral hyperplasia is characterized by postural increases in plasma aldosterone and an ACTH-independent diurnal aldosterone rhythm. These creteria serve to differentiate between adenoma and hyperplasia. An aldosterone-producing adenoma can be localized by veinography, determination of aldosterone concentration in both adrenal veins and by 131I-cholesterol scintigraphy. In our hands the determination of aldosterone in blood from both adrenal veins is the most efficient procedure. In interpreting the results, however, rhythmic and sudden changes in adrenal hormone secretion should be considered. In cases where no adrenal venous blood is obtained, 131I-cholesterol scintigraphy may be used to localize adenoma. In patients with aldosterone-producing adenomas unilateral adrenalectomy should be performed, whereas patients with idiopathic bilateral hyperplasia should receive antihypertensive therapy. As rare instances of primary aldosteronism, a case of aldosterone-producing carcinoma of the adrenal cortex and a case of presumably unilateral adrenal hyperplasia are reported.