[Sonographic diagnosis of parathyroid carcinoma]. / Sonographische Diagnostik eines Nebenschilddrüsenkarzinoms.

Prognosis and survival of patients suffering from parathyroid carcinoma are completely dependent on correct surgical therapy in form of an en-bloc resection of the tumour. A correct preoperative diagnosis of this rare carcinoma is therefore absolutely mandatory in order to perform a curative operation. We demonstrate a case of parathyroid carcinoma in which scintigraphy and CT diagnostics did not produce the right diagnosis. Preoperative high-resolution ultrasound (8 MHz) in combination with power-Doppler-sonography, however, led to the right diagnosis by demonstrating the correct topography, signs of malignancy and the feeding vessels of the tumour. As it could be demonstrated that the inferior thyroid artery was displaced by the tumour and was not a tumour feeding artery, the inferior thyroid artery was an important additional landmark for making the decision between thyroid or parathyroid carcinoma. The use of power-Doppler-sonography for identification of feeding arteries associated with parathyroid carcinoma in addition to high-resolution small parts sonography is of great value for the distinction between thyroid or parathyroid tumour.

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.

[High resolution small parts sonography (7.5 MHz) of the head and neck region]. / Die hochauflösende small-parts-sonographie (7,5 MHz) der kopf-hals-region.

Frequently, sonography of the head and neck serves only for assessment of the thyroid and arteriosclerotic lesions of the extracranial vessels. This article gives a review of ultrasound of the remaining cervical structures, particularly spaceoccupying lesions. The differentiation between malignant and benign lymphadenopathy or between intraglandular and extraglandular abnormalities of the salivary glands is possible with an accuracy between 90 and 95 %. Limitations of the method lie in the difficult access to the skull basis as well as the retropharyngeal and retrotracheal space.

Ultrasound of the neck.

In many institutions sonography still is used for evaluation of the thyroid gland and for assessment of sclerotic lesions of the carotid arteries only. The aim of this article is to summarize the potentials and limitations of sonography in the investigation of the extrathyroidal cervical soft tissues. The knowledge of the anatomy of this complex region is mandatory for the investigation of cervical soft tissue lesions.

[Correlation of scintigraphic and x-ray findings in Marie-Bamberger secondary hypertrophic osteoarthropathy]. / Korrelation szintigraphischer und röntgenologischer Befunde bei der sekundären Osteoarthropathia hypertrophicans Marie-Bamberger.

The radiological and scintigraphic findings in the rare condition of hypertrophic osteoarthropathy (Marie-Bamberger) were followed up for a period of two years. They are described and compared. Skeletal scintigraphy shows the abnormalities in the skeleton at an earlier stage than does radiology and also shows more extensive manifestations. The specific symmetrical distribution of abnormally increased uptake in the diaphyses and metaphyses of the long bones of the extremities, with sparing of the axial skeleton, produces highly specific appearances which can be considered as diagnostic.

[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.

[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.

[Experiences with a modified nephrostomy instrument kit in ultrasound-guided kidney fistulization]. / Erfahrungen mit einem modifizierten Nephrostomiebesteck bei ultraschallgeführter Nierenfistelung.

During a period of 24 months, ultrasound-guided percutaneous nephrostomies were performed in 51 patients in the Hospital at Köln-Merheim. The procedure was carried out with a modified nephrostomy instrument manufactured by Angiomed, Ettlingen, according to our own design. The procedure was successful in 49 patients. In one case it had to be abandoned because of lack of patient co-operation. In one patient a pyonephrosis was found and the patient was treated surgically.

[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.

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.

[Accuracy in the diagnosis of renal masses. Computed tomography, sonography, urography, angiography]. / Treffsicherheit in der Diagnostik renaler Raumforderungen.

One hundred and twelve renal masses, whose histology was confirmed at operation, as well as renal vein thrombosis and renal infiltration, were examined by urography, sonography, CT and angiography. In general the results showed good agreement. For the diagnosis of the type of tumour, its size, infiltration into the renal capsule, demonstration of regional lymph node metastases and infiltration into neighbouring organs and for the diagnosis of liver metastases, CT was superior to the other methods.

[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.

[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.

[Computer-tomographic findings in portal hypertension caused by liver cirrhosis. 2. Analysis of results]. / Computertomographische Befunde bei portaler Hypertension infolge Leberzirrhose. Teil 2: Diskriminanzanalytische Ergebnisse.

The results of a discriminant analysis for the objective diagnosis of cirrhosis of the liver are reported. Eight quantitative parameters seen on CT which, by themselves, are not diagnostic, were studied, and three relationships found to be of discriminatory significance; they are the diameter of the superior mesenteric vein, the ratio of the diameter of the caudate lobe and the right lobe of the liver and a quotient derived from the splenic and hepatic index. Cirrhosis of the liver with portal hypertension could be distinguished with a specificity of 100%, an accuracy of 96% and a sensitivity of 94%.

[Pseudocysts of the adrenal gland]. / Pseudocysten der Nebenniere.

Diagnosis, clinic and therapy of adrenal pseudocysts are described by means of three cases. The three characteristic signs of this rare diseases are: 1. traumatic anamnesis, 2. radiating lumbal pains, 3. calcified, paravertebral cyst.

[Computer tomographic findings in portal hypertension caused by liver cirrhosis. 1. Morphologic changes--qualitative and quantifiable parameters]. / Computertomographische Befunde bei portaler Hypertension infolge Leberzirrhose. Teil 1: Morphologische Veränderungen--qualitative und quantifizierbare Parameter.

The CT findings in 80 patients with confirmed portal hypertension due to intrahepatic block were analysed retrospectively. The findings included ascites, hypo-dense areas in the liver, nodular or irregular liver contour, the inability to define intrahepatic portal vessels with narrow window settings, the so-called "kissing" sign and evidence of hepato-fugal collaterals and thickening of the wall of the oesophagus. Electronic measurements of various organs (liver, spleen) and vessel diameters (portal vein, superior mesenteric vein) provide parameters which permit classification of patients into the cirrhotic group, as compared with a control group. The statistical significance of this classification was checked by the Kolmogoroff-Smirnoff test.

[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.