Primary osteoliposarcoma of bone.

Radiologic and pathoanatomic findings in two patients with the very rate primary osteoliposarcoma of bone are reported. In one case, there was a manifestation on the left femoral shaft which led to pathologic fracture. Amputation of the femur was followed by a 2.5-year tumor-free interval. In the second case, there was a manifestation in the region of the right upper part of the ilium. After radiation and cytostatic therapy, pronounced intratumoral ossifications occurred and the patient's condition was good up to exitus lethalis 3 years after diagnosis. Osteoliposarcoma thus shows a markedly more favorable prognosis than the osteosarcoma and rather corresponds to that of a liposarcoma. Typical clinical and radiologic symptoms are lacking.

Ultrasound of the neck.

Sonography, when performed by an experienced examiner, can be used for evaluation of many pathologies in the head and neck area. Some benign neck lesions, such as cysts, lipomas, carotid body tumors, and hyperplastic lymph nodes, have typical sonomorphology. Sonography has an accuracy rate of about 90% in cervical lymph node staging and can delineate subclinical lymph node recurrences. It is the method of choice for evaluation of tumor infiltrations of the wall of the great vessels. Salivary gland tumors in the superficial lobe can be delineated completely by sonography. Salivary stones can be detected and localized. Carcinoma of the tongue and floor of the mouth with T1 and T2 staging can be assessed by US. The use and contribution of color Doppler sonography for the assessment of pathologic entities in the neck is a method under clinical investigation. US-guided fine-needle aspiration biopsy of lymph nodes and tumors of the salivary glands is easy to perform and is characterized by high sensitivity and specificity. To perform US examinations of the head and neck area of the highest quality the examiner should be familiar with the anatomy of the head and neck, be informed about the clinical problem, and have experience in the interpretation of abnormal US findings. US of the head and neck area is one of the most difficult sonographic examinations and should be performed by an experienced physician.

Sonography of the thyroid and parathyroid glands.

Sonography is the first line modality for assessment of thyroid and parathyroid pathologies. Sonographic and color Doppler patterns of diffuse and focal pathologies of the thyroid are presented in this article. The accuracy of sonography in the localization of enlarged parathyroid glands is also discussed. The limitations of sonography in specifying focal thyroid diseases and the problems in localizing ectopic parathyroid adenoma are addressed.

Cardiac metabolism of 15 (p-I-123 phenyl-) pentadecanoic acid after intracoronary tracer application.

Myocardial turnover of omega-(p123I-Phenyl-) pentadecanoic acid and release of its metabolites into the coronary sinus and peripheral blood has been studied in patients with coronary artery and valvular heart disease. After intracoronary tracer injection myocardial extraction fractions of 45-53% in control subjects were observed. In patients with coronary artery disease (CAD) normal to reduced values (34-61%) were established. Hydrophilic catabolites of I-PPA, probably p123I-benzoic and -hippuric acid as well as small amounts of the non-metabolized tracer were found in coronary sinus and peripheral blood. Myocardial tracer uptake and clearance patterns were clearly different in normal myocardium when compared to that obtained in patients with CAD. Thus, evaluation of myocardial I-PPA metabolism might provide a new diagnostic tool for assessment of integrity of the heart's muscular metabolic function.

[Sonographic morphology of primary and secondary tumours of the liver (author's transl)]. / Sonomorphologie primärer und sekundärer Leberneoplasmen.

The sonographic morphology of benign and malignant primary and secondary tumours of the liver has been studied in 153 patients who had been investigated histologically. Eight sonographic appearances have been distinguished: Circumscribed tumours, which may be echo-free, with a faint echo, a homogenous strong echo, strong central echo with faint marginal echo, faint echo with strong marginal echo, strong with acoustic shadowing or a combination of various types; there may be diffuse tumour infiltration. Some correlation between sonographic patterns and tumour type can be recognised. However, unequivocal agreement between sonographic appearances and histological findings has not been established. Nevertheless, the various sonographic appearances of intrahepatic tumours provide valuable information concerning tumour architecture; in conjunction with clinical information this makes a diagnosis possible in a proportion of cases.

[Sonographic determination of liver volume. Problems, methods and practical significance of liver volume measurements (author's transl)]. / Sonographische Lebervolumenbestimmung. Problematik, Methodik und praktische Bedeutung der Quantifizierung des Lebervolumens.

A sonographic procedure is described which permits accurate determination of liver volume by simple means. Comparison between the sonographic measurements and volume determinations at autopsy carried out by water displacement of the isolated organ showed a statistical error of +/- 1.58% and for average liver volumes of 1,800 ml and 95% limits of confidence of -84 to +20 ml. Quantitation of liver size may be an important clinical measurement, e.g. in assessing the possibility of shunts in the lieno-portal system in portal hypertension with recurrent bleeding from oesophageal varices due to cirrhosis of the liver, for evaluating liver atrophy after shunts affecting the liver, for demonstrating liver size in right heart insufficiency and congestive states or for the control of the effectiveness of cytostatic drugs in lymphatic or haematological disease.

[Radiological detection of the Medina worm (Dracunculus medinensis)]. / Radiologischer Nachweis des Medinawurms (Dracunculus medinensis).

Atypical linear or convoluted calcification in the subcutaneous tissues of patients from tropical areas in Africa and Asia may be caused by D. medinensis. The radiological appearances and differential diagnosis are described. Dead, calcified worms may occur in the soft tissues of the thorax, abdomen, pelvis or extremities and may cause complications due to a foreign body reaction, particularly when related to major joints.

[Chondroplasia punctata (author's transl)]. / Die Chondroplasia punctata.

The rare condition of chondroplasia punctata is illustrated by two patients. The very different manifestation and course of the disease in these two patients confirms Spranger et al's (1971) view that it is an heterogeneous disease which can be divided into two types. The rhizomelic type is characterised by well marked punctate cartilage calcification, shortening of the extremities, deformities of the metaphyses and epiphyses, frequent cataracts and a fatal outcome. In the Conradi-Hünermann-type the changes are less marked and the patients may survive. In order to classify the disease correctly, radiological examination in early childhood is desirable.

[The multiplicity of radiological findings in pulmonary hamartomas (author's transl)]. / Die Vielgestaltigkeit des Röntgenbefundes beim Lungenhamartom

Difficulties in the differential diagnosis of pulmonary hamartomas are illustrated on the basis of 19 patients with this condition, and with reference to the radiological literature. All the patients in the present series were treated surgically, either because a mistaken diagnosis of a bronchial carcinoma had been made, or because a carcinoma could not be excluded with sufficient certainty. In several cases the patient requested removal of the tumour in order to clarify the diagnosis after several years without symptoms. Pulmonary hamartomas do not always show the appearances described as typical; atypical appearances occur and were rather frequent in our material, amounting to 25%. Despite various difficulties, it is occasionally possible to put an hamartoma first in the differential diagnosis of a lung tumour, particularly if there are no clinical features to suggest malignancy. A definitive diagnosis can be made only by histology after removal of the tumour.

[Intraoperative sonographic localization of brain tumors]. / Intraoperative sonographische Lokalisation von Hirntumoren.

Twenty-six patients with mostly small intracranial space-occupying lesions were examined sonographically during surgery. In all patients, accurate localisation and complete delineation of the intra-cerebral lesion proved possible. The extent of the lesion could be determined accurately and surrounding cerebral structures were identified unequivocally. There were no significant differences in the appearances before and after opening of the dura. The significant advantage of the intra-operative use of sonography lies in the accurate localisation of the space-occupying lesion. This results in a reduction of interference with normal cerebral tissue and in a reduction of the duration of the operation.

[Intraoperative sonographic demonstration of intraspinal tumors]. / Intraoperative sonographische Darstellung intraspinaler Tumoren.

Four examples are given to demonstrate the problems, methods and advantages of intra-operative sonography for intra-spinal tumours. The value of intra-operative sonography for localising the tumours and for judging their extent is demonstrated and related to other imaging methods, such as myelography, CT and MR.

[CT demonstration of venous collaterals with occlusion or agenesis of the vena cava (author's transl)]. / CT-Nachweis des venösen Umgehungskreislaufs bei Verschluss oder Agenesie der Vena cava.

The value of computer tomography in the demonstration of venous collaterals in cases with occlusion or malformation of the superior and inferior vena cava has been demonstrated in five patients. The ascending lumbar veins and the vena azygos are of special significance in the formation of collaterals.

[Primary tumors of the mesentery and greater omentum]. / Primäre Tumoren der Mesenterien und des Omentum majus.

Diseases of mesentery and greater omentum are commonly the result of lymph node metastases from an abdominal carcinoma, or lymph node involvement as part of a general lymphatic malignancy. Primary tumours are rare. Cysts occur predominantly in children. In addition, one may find mesenchymal benign or malignant tumours, which produce clinical symptoms at a later age. Plain abdominal films, barium meals and angiograms fail to show evidence of a space-occupying lesion, or produce only indirect signs. Only ultrasound or CT can demonstrate these tumours directly.

[Ultrasound examination in obstructive biliary disease (author's transl)]. / Ultraschalluntersuchung bei obstruktiven biliären Erkrankungen

Ultrasound examination with a two-dimensional recording technique has proved increasingly useful in obstructive biliary disease and in abnormalities of the liver parenchyma causing a reduction in biliary contrast excretion. In particular, hydrops of the gall bladder, cholelithiasis and choledocholithiasis and choledocholithiasis can be demonstrated where there is biliary obstruction. Analysis of various planes of section is particularly useful in showing obstruction due to the head of the pancreas. The introduction of grey scale techniques and focussed transducers of various frequencies and sizes, suggests that there will be further improvements in the sonographic diagnosis of the hilum of the liver and of the intrahepatic biliary passages.

[The accuracy of sonography in the diagnosis of renal disease (author's transl)]. / Die Treffsicherheit der Sonographie in der Diagnostik von Nierenerkrankungen.

The accuracy of sonography in the diagnosis of spaceoccupying renal lesions was evaluated by a retrospective study of 221 patients. There were 15 incorrect diagnoses. In 93% of cases the sonographic diagnosis was correct. Erroneous diagnoses, which would have been difficult to avoid even retrospectively, were usually due to complex lesions which were partly cystic and partly solid. In order to differentiate cysts from solid lesions it is considered essential to use both A- and B-scans and step-wise variations of sound energy. These results emphasise the great value of ultrasound in the differentiation of renal abnormalities. Sonography should be used, during the clinical work up, after the urogram, but before angiography or other invasive methods are employed.

[Sonography and computed tomography before and after liver resection and transplantation]. / Sonographie und Computertomographie vor und nach Leberresektion und -transplantation.

The diagnostic value of sonography and CT was studied in 259 patients. In the diagnosis of solid tumours, CT is superior to sonography, whereas ultrasound is more useful in the investigation of cystic lesions. In estimating the extent of intrahepatic tumours, the falciform ligament is more useful than a line from the cava to the gall bladder, both for CT and ultrasound, although in this case CT shows the extent of tumours more accurately. 3.7% of the ultrasound and 2.3% of the CT examinations were of limited value because of unavoidable technical problems.

[Aneurysm of the ascending aorta with aortic valve insufficiency]. / Das Aneurysma der Aorta ascendens mit Aortenklappeninsuffizienz.

Nine cases are reported who had aneurysms of the ascending aorta and aortic valve incompetence and in whom aortic valve prostheses and aortic prostheses had to be implanted. Two patients had dissecting aneurysms. In five patients, the origins of the coronary arteries were involved, and these had to be implanted into the prostheses. Chest x-rays in two planes, kymograms and CT provided the diagnosis. The most important pre-operative examination in order to assess valve function and the origins of the coronary arteries is catheter angiography.

[Primary oxalosis in childhood. Plain film findings during the course of the disease (author's transl)]. / Primäre Oxalose im Jugendalter. Nativbefunde unter Krankheitsprogression.

The radiological changes in the kidneys and skeleton in primary oxalosis in a patient are described. Crystalline calcium oxalate deposits, which are a secondary phenomenon, are responsible for the findings, which are of great significance both functionally and prognostically. Hyperoxalaemia is due to an enzyme defect, which leads to hyperoxaluria; this causes a reduction in renal function and can lead to rapid progression of the condition.

[Coronary artery aneurysms (author's transl)]. / Das Koronararterienaneurysma.

Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

[The manifestations of regional enteritis (Crohn's disease) in the stomach and duodenum (author's transl)]. / Die Manifestation der Enteritis regionalis (M. Crohn) an Magen und Duodenum

Involvement of the stomach and duodenum is relatively rare, but produces distrinct radiological changes. In the stomach the antrum and pyloric portion are affected most frequently. Simultaneous involvement of the duodenum is common. Typical radiological changes consist of funnelshaped narrowing of the antrum, decreased motility of the wall of the stomach, cobblestone mucosa with flat ulcers, deformity of the pylorus and first part of the duodenum and stenosing lesions of the duodenum. If the gastro-duodenal changes occur together with the typical appearances in the jejunum, ileum and colon, then the diagnosis can be made by radiology alone.