[Obstructive jaundice and acute pancreatitis due to an obstruction of the afferent loop after billroth-II-resection]. / Verschlussikterus und akute Pankreatitis durch Obstruktion der zuführenden Schlinge nach Billroth-II-Resektion.

An obstruction of the afferent loop after Billroth-II-resection is an extremely rare late complication of this procedure. We report on a 76-year-old female patient with a history of Billroth-II-resection 11 years ago who was admitted due to acute pancreatitis and obstructive jaundice. Abdominal sonography lead to the suspicion of a dilated afferent loop, which could be proven by means of magnetic resonance imaging. A tumorous lesion as cause of the obstructive jaundice was not detectable. Intraoperatively a volvulus of the small intestine and strangling adhesions near the Braun's anastomosis were seen, causing the obstruction of the afferent loop. Following reposition of the small intestine and adhesiolysis the patient gained a quick relief of symptoms and the jaundice disappeared completely.

Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US.

PURPOSE: To determine the usefulness of ultrasound (US) in the differentiation of displaced and nondisplaced tears of the ulnar collateral ligament (UCL). MATERIALS AND METHODS: A 7.5-10-MHz linear-array transducer was used to examine 69 patients in whom a UCL tear was suspected, 43 of whom also underwent surgery. The US findings were compared with those obtained at surgery. RESULTS: Results of US corresponded to results of surgery in 37 of 43 patients. Findings were false-positive in six patients. Twenty-six patients were treated conservatively with thumb casts. These patients showed stability and free range of motion at the first metacarpophalangeal joint at clinical follow-up (9-13 months). CONCLUSION: Sonography is useful for evaluating nondisplaced and retracted tears of the UCL and determining the need for surgery.

[Skier's thumb. Sonographic clarification of retracted ruptures]. / Der Skidaumen. Sonographische Abklärung retrahierter Rupturen.

Rupture of the ulnar collateral ligament (LCU) is the result of traumatic abduction of the metacarpophalangeal joint of the thumb ("skier's thumb"). If the ligament becomes retracted superficially to the adductor aponeurosis, surgical treatment is advocated, non-displaced tears can be treated by immobilization. Differentiation between displaced and non-displaced tears by radiography is not possible. We examined 45 patients to assess whether sonography was of help in this respect. The retracted LCU appeared as a hypoechogenic, mostly round structure medial to the metacarpal head. Using this criterion, 86% of retracted ruptures could be diagnosed correctly. Although intact LCU and nondisplaced tear cannot be differentiated consistently by sonography, high sensitivity in diagnosis of retracted ruptures seems promising, as it enables specific planning of therapeutic decisions.

[Magnetic resonance tomographic studies of pancreatic transplants]. / Kernspintomographische Untersuchungen von Pankreastransplantaten.

In a pilot study, a total of 16 recipients of a combined pancreatic-renal allograft were examined by means of magnetic resonance imaging. Two groups were formed according to the management of the exocrine secretion: In group I patients (n = 8) the pancreatic duct was occluded with an alcoholic prolamine solution, in group II (n = 8) pancreatic juice was diverted either into a Roux-loop of jejunum (IIa, n = 4) or into the urinary bladder (group IIb, n = 4). On the T1-weighted images no difference was found between both groups with respect to signal intensity. In contrast, on T2-weighted images of group IIb, which were in situ for a significantly shorter time, a higher signal intensity was noticed as compared with the other patients. From these findings it is concluded that graft fibrosis may occur even in pancreas transplants with diversion of the exocrine secretion.

[Duplex sonography in carotid-cavernous sinus fistula]. / Duplexsonographie bei Karotis-Sinus-cavernosus-Fistel.

The absence of valves in the ophthalmic veins leads to a reversal of flow and marked vascular dilatation if there is a carotid-cavernous sinus fistula. Based on a case report, the possibility of accurate duplex sonographic evaluation of these findings is shown. Duplex sonography should be employed as a simple, non-invasive and inexpensive diagnostic method even if the likelihood of a carotid-cavernosus sinus fistula is remote.