Transcranial Doppler study of intracranial circulatory arrest.

To investigate the hemodynamics of intracranial circulatory arrest, the authors correlated the findings of noninvasive transcranial Doppler ultrasonography (TCD) with those of transfemoral four-vessel angiography in 65 patients following brain death and intracranial circulatory arrest due to severe intracranial hypertension. The three TCD stages of intracranial circulatory arrest, which have been described previously, corresponded with different levels of extracerebral angiographic cessation of flow. With TCD progression from the first stage (oscillating flow) to the third stage (no flow), the level where the dye stopped descended caudad from subarachnoid to cervical levels. The study shows that, in progressing intracranial hypertension, arterial circulatory standstill within the cranial cavity develops in a distal-to-proximal direction. The basal cerebral arteries remain patent in the early stages of intracranial circulatory arrest. Experimental evidence from the literature, together with the findings of the present investigation, points to the capillary bed as the initial site of the flow obstruction in progressing intracranial hypertension.

[Sonographic findings in the Cruveilhier-von Baumgarten syndrome (author's transl)]. / Sonographische Befunde beim Cruveilhier-von-Baumgarten-Syndrom.

Portal hypertension is the most common complication of cirrhosis of the liver and leads to a reversal of blood flow and re-opening of pre-formed portal-systemic collaterals. Amongst a variety of possible hepato-fugal collaterals, the Cruveilhier-von Baumgarten syndrome, consisting of the re-opening of umbilical veins, is a rare variant. It has been possible to demonstrate this clearly by sonography in 18 patients.

[Parotid diseases in high-resolution real-time-tomography]. / Die Erkrankungen der Parotis im hochauflösenden real-time-Schnittbild.

Ultrasound examination of the parotid by grey-scale real time is a method which has hardly been used so far. By using a high resolution 5 MHz probe and a water bag, it is possible to obtain detailed information concerning the type, extent, margins and consistency of pathological changes in the parotid. The margins of benign lesions are always clearly defined, whereas malignant processes usually have ill-defined margins. Further differentiation is possible from the type of echo. Normal parotids have a homogeneous structure, similar to the thyroid, with a medium to bright grey-scale value; solid, cystic or inflammatory lesions present irregular or inhomogeneous structures. The sonographic appearances are illustrated by the findings in 43 patients and are compared with their histology.

[Chemoembolization of primary liver cancer using epirubicin-lipiodol]. / Chemoembolisation primärer Leberkarzinome mit Epirubicin-Lipiodol.

The double supply of the liver allows one to perform specific embolisation of liver carcinomas since these are mostly supplied arterially. According to their occlusion characteristics--central, peripheral, capillary--different embolising materials are suitable for tumour embolisation under varying conditions. Oily substances cause capillary occlusion and can be used in conjunction with chemotherapeutic agents. This study deals with the results from lipiodol-epirubicin embolisation in 25 patients with hepatocarcinomas and cholangiocarcinomas. In a three-and-a-half year follow-up period 16 of these 25 patients died, maximum survival time being 28.4 months. Survival varied from 9.2 to 28.4 months compared with a survival time of 2-8 months in untreated patients. In this case hypervascular tumours have a better prognosis than the rarer hypovascular tumours because of improved deposition and activity of the chemotherapeutic agent.

[Skeletal involvement in malignant lymphoma]. / Der Skelettbefall bei malignen Lymphomen.

Of 114 patients with Hodgkin's disease reviewed, 13 (11%) had bone involvement. The typical osseous lesion in Hodgkin's disease is a secondary manifestation in the axial skeleton. The lesions are mainly lytic; there is no relation between the site of the affection and the character of the lesion. Of 261 patients with non-Hodgkin lymphoma, 19 (7.3%) had bone involvement. Non-Hodgkin lymphoma very rarely affects the bone primarily; these lesions are lytic. Involvement of the appendicular skeleton is reported to by typical; this cannot be confirmed by our study. Most secondary osseous lesions in non-Hodgkin lymphoma are found in the cranium, the spine and the sternum; this pattern of distribution as well as the mainly lytic appearance can be considered typical.

[Computer tomographic differential diagnosis of thyroid diseases with special reference to scintigraphic cold spots (author's transl)]. / Computertomographische Differentialdiagnostik von Schilddrüsenerkrankungen unter besonderer Berücksichtigung des szintigraphisch kalten Knotens.

A high proportion of carcinomas of the thyroid produce scintigraphic cold spots, this finding therefore requires further investigation in order to prevent unnecessary thyroidectomies. In order to clarify the value of computer tomography in thyroid disease, 70 patients with scintigraphic cold spots, or equivocal thyroid scans, were submitted to computer tomography of the neck. The findings in the majority of these cases have been correlated with histological results.

[Improvement of oral cholecystography and cholangiography with ceruletid (author's transl)]. / Optimierung der peroralen Cholezyst-Cholangiographie mit Ceruletid.

Following oral cholecystography in 100 patients, the conventional "fatty meal" was replaced by an intramuscular injection of Ceruletid in a dose of 0.4 microgram/kg body weight. The synthetic decapetide Ceruletid is a substance with a hormone-like effect on the gastro-intestinal tract. It contracts smooth muscle in the gut and stimulates secretion in the stomach and the exocrine pancreas. Compared with other substances producing contraction which are given orally, Ceruletid acts more quickly and more powerfully in producing contraction of the gall bladder muscle. In 86% of positive cholecystograms, this resulted in satisfactory demonstration of the bile duct, 66% better than for oral substances. Many abnormalities, particularly localised adenomyomatosis, can only be diagnosed after good contraction of the gall bladder. Side effects, such as nausea, dizziness and a feeling of heat were transitory. In three patients it led to vomiting. The rapid and certain effect of Ceruletid during oral cholecystography requires reassessment of the role of intravenous cholangiography in diagnosis. Particularly amongst out-patients, with a high proportion of normal gall bladders, it is possible to complete the examination in one stage by demonstrating the bile duct with Ceruletid.

[Malignant metastases to the periphery of the skeleton (author's transl)]. / Zur Metastasierung maligner Tumoren in die Skelettperipherie.

Metastases from malignant tumours beyond the knee and elbow are uncommon and represent only 1 to 2% of all bone metastases. Four cases of peripheral skeletal metastases are described, with primaries in the cervix, epipharynx, parotid and breast.

[Sonography in the diagnosis of lymphogranulomatosis]. / Die Sonographie in der Diagnostik der Lymphogranulomatose.

With a rate of 87.7% of exact diagnoses, sonography is a proven method to find intraperitoneal and retroperitoneal manifestations of malignant system diseases. It is not stressing or invasive and can be frequently repeated; needing less expenditure and involving no risks, it can bear comparison with lymphographic methods and is important in the classification of stages of lymphatic system diseases. During one examination, enlarged organs and infiltrations in form of focuses in the parenchymatous organs can be diagnosed, and vessels and formations of lymphomas can be seen within their topographic connection. Independently from their drainage ways, all enlarged lymph nodes, also those situated in areas not accessible by lymphography like the hilus of liver, spleen, kidney, and retrohepatic, mesenteric, and intraperitoneal regions, can be visualized even without administration of a contrast medium. The method offers the possibility of frequent control examinations during radiotherapy or chemotherapy; possible recurrences can be early detected. However, manifestations of a malignant system disease in the lymph nodes can be hardly discerned from metastases of a primary tumor localized in another region. Despite this disadvantage, sonography keeps the first rank in the gradual application of image-producing diagnostic methods (sonography, CT, lymphography).

[Long-term results of chemoembolization of primary liver cancer with epirubicin-lipiodol]. / Langzeitergebnisse nach Chemoembolisation primärer Leberkarzinome mit Epirubicin-Lipiodol.

This pilot study deals with the long-term results from lipiodol-epirubicin chemo-embolisation in 25 patients with hepatocellular or cholangiocellular carcinomas. In a three-and-a-half year follow-up period 16 of these 25 patients died, maximum survival time being 28.4 months. Survival varied from 9.2 to 28.4 months compared with a survival time of 2-8 months in untreated patients. In this case hypervascular tumours have a better prognosis than the rarer hypovascular tumours due to the improved deposition and activity of the chemotherapeutic agent inside the tumour itself.

[Peri- and postoperative roentgen diagnosis following esophageal bypass operation]. / Peri- und postoperative Röntgendiagnostik nach Osophagus-Bypass-Operation.

Between 1981 and 1987, 53 of 102 patients with malignant diseases of the oesophagus underwent bypass surgery with gastric, colonic or jejunic interposition. To recognise the early or later complications, we used X-ray examination of the chest, water soluble contrast medium and barium meal, real-time sonography and CT. With these methods we found insufficiencies of anastomosis, stenosis, fistulae to the adjacent organs, necrosis, infections, erosions and ulcerations of the anastomosis, pleuropulmonary complications and metastases. Without of early complications were 30%, without of late complications only 8% of all patients.

[Long-term results following aorto-femoral Y bypass. Doppler ultrasound pressure measurement, real-time ultrasound, CT and i.v. DSA]. / Langzeitergebnisse nach aorto-femoralem Y-Bypass. Doppler-Ultraschall-Druckmessung, Real-time-Sonographie, CT und i.v. DSA.

Five to seven years after aortoiliac prosthetic reconstruction 29 patients were examined by sonography (Doppler and real-time), CT and intravenous DSA. Doppler-sonography showed findings due to occlusion, stenosis and severe arteriosclerotic changing. By DSA these changing could be shown and exactly localised. CT demonstrated marginal thrombosis of the bypass lumen, aneurysms and fine paravascular fibrosis. So Doppler-sonography and DSA both bring functional and morphological, real-time sonography and CT morphological informations. The methods are complementary.

[Chemo-embolization of inoperable hepatocellular cancer. A surgical-radiologic therapy concept]. / Die Chemoembolisation des inoperablen hepatozellulären Karzinoms. Ein chirurgisch-radiologisches Therapiekonzept.

The dual blood supply of the liver allows embolization therapy of malignant liver tumors nearly complete supplied by arterial vessels. The last three years we treated 25 patients with hepatocellular carcinoma by transcatheter arterial chemotherapy using iodized oil and anticancer agents suspension. The survival rate of untreated patients ranges between 1.6 and 2.5 months. Five patients died within two weeks to 9.7 months following embolization. Twenty of these patients are alive with survival rates of 1 to 22.9 months following the procedure. Because of the low procedural morbidity, transcatheter embolization is superior to surgical dearterialization or systemic chemotherapy.