[Changes in liver haemodynamics after mesenterico-caval dacron prosthesis anastomosis ("H-shunt") in portal hypertension (author's transl)]. / Anderungen der Leberhämodynamik nach mesenterikokavaler Dacron-Prothesen-Anastomose (sog. "H-Shunt") bei portaler Hypertension.

In fourteen patients with portal hypertension and bleeding from oesophageal varices, mesentericocaval anastomoses using a dacron-velour prosthesis ("H-shunt") were carried out. Evaluation of the haemodynamics showed: 1. Comparison of 13 pre- and post-operative angiograms showed an haemodynamicically effective shunt in 12 and a stenosed shunt in one. 2. The aim of relieving the portal circulation while maintaining antegrade portal flow was achieved in six patients. 3. In six patients, the portal vein was not seen in a splenic or mesenteric portogram despite an open shunt. Functionally, this corresponds to a porto-caval anastomosis. 4. Pressure reduction in the portal circulation can be so marked as to obtain retrograde portal flow from the hepatic artery. 5. If the portal blood flow through the liver disappears, the hepatic artery may obtain additional flow from the superior mesenteric artery (reversed flow in the gastroduodenal artery). 6. Increased arterial flow to the liver is made possible by a reduction in intrahepatic resistance. The role of collaterals, either arterio-portal shunts or shunts between the sinusoids, is discussed. 7. The hepato-fugal collateral circulation was reversed in twelve patients.

[Catheter embolisation of metastasising renal carcinomas using butyle-2-cyano-acrylate (author's trabsl)]. / Katheterembolisation von metastasierten Nierenkarzinomen mit Butyl-2-Cyanoacrylat

Embolisation with butyle-2-cyano-acrylate was carried out in four inoperable renal carcinomas. By mixing this tissue adhesive with 50% glucose it remains suitable for embolisation for eight to ten minutes. Contact with blood produces the desired effect of immediate and permanent vascular occlusion. Since the material adheres to the vessel wall, it is not carried to any other vascular areas. No complications due to this material have been observed.

[Bone scintigraphy with 99mTc-methylene diphosphonate in parodontopathy (author's transl)]. / Knochenszintigraphie mit 99mTc-Methylen-diphosphonat bei Parodontopathien.

In a total of 20 patients (of these 8 without parodontopathy and 12 with parodontitis marginalis profunda), a quantitative scintigraphy of the jaw bones was carried out after application of 99mTc-methylene diphosphonate with a gamma camera computer system. In 8 patients without parodontopathies, approximately the same metabolic activity in the bone was found in the os occipitale as well as in the mandible and maxilla. The 12 patients with parodontitis marginalis profunda showed in contrast to this an appreciable raised bone metabolism in the region of the affected jaw bone. This finding was in agreement with corresponding alterations in the X-ray of the jaw. The use of bone scintigraphy in marginal parodontopathies thus provides in addition to the radiological finding information on processes of bone transformation and degradation which can be registered quantitatively. Digital analysis enables control of the course of therapie.

[Does bone metabolic activity determined scintigraphically correlate with calcium and phosphorus measurements by x-ray microanalysis?]. / Korrelieren szintigraphisch ermittelte Knochenstoffwechselaktivitäten mit der Kalzium- und Phosphorbestimmung durch die Röntgen-Mikroanalyse?

An animal experiment on bone healing of dental implants offered the opportunity of comparing scintigraphic images with histological findings, specially with electron microscope results and analysis of the calcium and phosphorus values in different stages. The clear correspondence between the scintigraphic results and the calcification level of the new bone parts must be seen with reservation because of possible methodical mistakes of the radio-micro-analysis from surfaces and of intraindividual differences.

Residual activity after radioembolization of liver tumours with 90Y resin microspheres. A safe calculation method.

UNLABELLED: The actual number of resin microspheres is approximately 30-60 times higher than glass microspheres per 3 GBq vial. Thus, radioembolization (RE) with resin microspheres exerts an embolization effect besides the radiation effect. This embolization effect can occasionally cause early back flow of the microspheres before application of the entire calculated dose. To avoid these adverse side effects, RE has to be terminated at an earlier time point. Measurement of the residual activity in the delivery box, which includes the v-vial, tube and catheter, to calculate the achieved target dose is often challenging. The aim of the current study was to establish a post-RE measurement method comparable to the glass microspheres method without unnecessary radiation exposure to the staff and risk of contamination. METHODS: Two different measurements were performed. First, total radioactivity in the shipping vial was measured in an ion chamber and then it was put in the delivery box and the radiation was measured from a 30 cm distance from the centre of the box with a dosimeter. The required radioactivity was then transferred to the v-vial, and the shipping vial was measured again. After that, the v-vial was measured from the same distance from the centre of the box with dosimeter. RESULTS: Altogether 62 times the shipping vial with different activities were measured with a significant positive correlation between the amount of the activity measured in the iron chamber and the radiation dose, measured with dosimeter (r² = 0.98; p< 0.001). There was also a strong positive correlation between these measurements of the v-vial (r² = 0.98; p< 0.001). CONCLUSION: With measurement of the residual activity in the delivery box using a dosimeter the percentage of the whole injected activity can be easily calculated. This facilitates the calculation of the actual, achieved target and non-target dose in those cases, where therapy had to be stopped because of eminent flow reversal or obstruction.

The clinician and the thyroid.

The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a minor role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases.

[Bleeding intrarenal pseudodiverticulum: successful superselective embolization (author's transl)]. / Blutendes intrarenales Pseudodivertikel: Erfolgreiche superselektive Embolisation.

The article reports on a successful superselective transcatheteral embolization of a small but massively bleeding calyciform pseudodiverticulum. The tissue adhesive butyl-2-cyanoacrylate, mixed with lipiodol, was used as embolisate. This material offers the the advantage of permanent vascular occlusion and can be injected via smallest catheters, using the coaxial catheter technique. The differential diagnosis of such a calyciform pseudodiverticulum is discussed.

[Scintigraphic panoramic imaging of the jaws]. / Szintigraphische Orthopandarstellung der Kiefer.

A method for the generation of a panoramic image from skeletal scintiscans of the jaws with the aid of a cylindrical projection of emission CT scans ist presented. Based on this "panoramic tomoscintigraphy" the jaw regions, arranged in the order of the arch segments, are evaluated numerically and the quantitative results are presented in a clearly organized form. The relative activity of each segment is computed relative to the corresponding contraletaral segment or to the average activity of the respective jaw. In the case of pathologic findings the respective segments are highlighted in the dental chart. A set of normal values with standard deviations has been generated using this method in 24 patients without evidence of any jaw pathology. Within the framework of the significance limit it was not possible to demonstrate any right/left asymmetry in the metabolic activities of the jaw bone.

[Sequential scintigraphy of liver and spleen in patients with polyvinyl chloride disease (author's transl)]. / Sequenzszintigraphische Untersuchungen von Leber und Milz bei Patienten mit Vinychlorid-Krankheit

Occurence of severe liver damage including angiosarcoma in polyvinyl chloride production workers necessitates regular control investigations of liver and spleen. Radioisotope techniques with small irradiation doses which give valid results should be used. Investigations of 15 patients with PVC-induced liver disease showed that hepatic perfusion as demonstrated by 99mTc pertechnate does not correlate with the uptake of sulphide colloid in the hepatic reticuloendothelial system. This provides evidence that in VC disease specific damage of the reticuloendothelial system of the liver occurs. Sequential scintigraphy also proved that the liver perfusion quotient can be considered as a measure of portal pressure. In practice this may be used for follow-up controls. Vascularized tumours described in VC disease can also be demonstrated by scintigraphy.