[Ultrastructural study of the diseased and contralateral testes in unilateral testicular torsion]. / Ultrastrukturelle Untersuchungen des torquierten und kontralateralen Hodens bei einseitiger Hodentorsion.

In 15 patients with acute unilateral testicular torsion, bilateral orchiopexy was performed and biopsies were made at the same time for the purpose of light-microscopic (semi-thin section method) and electron-microscopic examination. All tissue specimens from the twisted and nontwisted gonads showed changes in the form of tubular atrophy, atrophy of the Leydig cells and malformation at the spermatid level. Nevertheless, it is not possible, on the basis of these findings, to determine definitely whether the disorders of spermatogenesis frequently found in unilateral testicular torsion are the result of congenital dysplasia or damage to the germinal epithelium caused by recurrent subtorsion.

Ultrastructural studies of the contorted and contralateral testicle in unilateral testicular torsion.

In 7 patients with acute unilateral testicular torsion, bilateral orchiopexy was performed and biopsies were made at the same time for the purpose of light microscopic (semi-thin section method) and electron microscopic examination. All tissue specimens from the twisted and non-twisted gonads showed changes in the form of tubular atrophy, atrophy of the Leydig cells and malformation at the spermatid level. The results indicate primary tissue damage of the testicles, which was already present before torsion occurred. Nevertheless, it is not possible, on the basis of the these findings, to determine definitely whether the disorders of spermiogenesis frequently found in unilateral testicular torsion are the result of possible congenital dysplasia or damage to the germinal epithelium caused by recurrent subtorsion.

[Liver metastases: diagnostic value of blood tests, scintiscanning, and laparoscopy (author's transl)]. / Lebermetastasen: dignostischer Wert von Bluttests, Szintigraphie und Laparoskopie

In 90 patients with known extra-hepatic malignancy the liver was examined for metastases. The diagnostic value of clinical information, blood examinations, 99mTc scintiscan, and laparoscopy for the diagnosis of the liver metastases was evaluated. Clinical data (age, sex, time since onset of symptoms and localisation of primary tumor) are of no diagnostic value. The most reliable blood tests are alkaline phosphatase (AP) and GOT. The probability of liver metastastases rises with increasingly abnormal values of AP and GOT. However, the probability is not much greater in cases with highly abnormal values than in cases with only moderate elevation of AP and GOT. Diagnostic accuracy of AP is optimal by using a cutoff point of 76 U/l (sensitivity 79%, specificity 64%). Bilirubin, prothrombin time, haemoglobin and blood sedimentation rate are of very little value. Combinations of AP with these blood tests does not improve diagnostic accuracy. Therefore, it is not useful to determine more blood tests than AP alone. Informed reading of liver scans has a specificity of 75% and a sensitivity of 91%. Blind reading of scans has a sensitivity of 94% and a specificity of 95%. This diagnostic accuracy cannot be improved by additional blood tests. Laparscopy has a sensitivity of 85% and a specificity of 95%. Scanning and laparoscopy are complementary methods. When optimal diagnostic accuracy is required both methods should be used.

[The diagnosis of liver metastases and primary hepatomas by means of scintigraphy, laparoscopy and laparotomy]. / Diagnose von Lebermetastasen und primärem Hepatom mit Szintigraphie, Laparoskopie und Laparotomie

To evaluate the presence or absence of hepatic metastases or primary hepatoma 106 patients were examined by liver scintigram as well as laparoscopy or laparotomy. A definite diagnosis was established in all patients by histology, autopsy or observation of clinical course for at least one year. Only scintigrams resulted in false positive diagnosis (in 5%). False negative diagnoses were obtained in 29% of laparoscopies and in 36% of scintigrams when evaluated routinely with knowledge of the clinical findings and laboratory examinations. Analysis of the same scintigrams by an experienced examiner without knowledge of the clinical findings lowered the proportion of false negative scintigrams to 12%. In 5 patients with liver metastases or hepatoma coexisting in liver cirrhosis or advanced chronic liver congestion, both methods of examination gave false negative results.