[Mounier-Kuhn disease/tracheobronchomegaly]. / M. Mounier-Kuhn/Tracheobronchomegalie.

This paper reports on a 45-year-old male patient with tracheobronchomegaly, a very rare pathological picture, which is thought to be associated with autosomal, recessive genetic transmission. Radiological, nuclear-medical and pulmonary function-analytical findings, together with treatment, are presented.

Scintigraphic images of Swyer-James syndrome.

The Swyer-James Syndrome, first described in 1953, is a rare entity which consists of severe oligemia of one or more pulmonary lobes accompanied with bronchial deformation. Recurrent bronchial infections in childhood are believed to be the cause, leading to obliteration of small airways, alveolar overdistension and, ultimately, the destructive changes characteristic of emphysema. Secondary vascular alterations occur resulting in oligemia of the afflicted lobe. The clinical presentation is variable ranging from the totally asymptomatic patient to dyspnea on exertion or recurrent lower respiratory tract infections. The physical examination may reveal hyperresonance over the affected area, restricted chest expansion on one side, or occasionally rales on auscultation. Radiological findings are characteristic and include a pronounced one sided hyperlucency of the lung (due to oligemia), a mediastinal shift toward the affected side on inspiration, a small ipsilateral hilus, and bronchial deformities as disclosed by bronchography. Another radiologic feature, described as a "sine quanon" condition for diagnosis by Fraser and Paré is the development of air trapping during expiration. Various diagnostic modalities including roentgenography, bronchoscopy, bronchography, angiography and radionuclide imaging are necessary to obtain the diagnosis.

Diagnostics of extra-cranial carotid stenoses. Comparison of CW-Doppler sonography and intravenous digital subtraction angiography.

In 98 internal carotid arteries, continuous-wave ultrasound Doppler sonography (USD) and i.v. digital subtraction angiography (DSA) of the internal carotid arteries were performed. The findings were compared with each other prospectively and on the basis of conventional angiography findings. The aim of this investigation was to clarify, whether DSA would show stenoses with lumen restriction of less than 50% more precisely than USD, or whether it would enable clearer localization of any vascular lesions. The results revealed that in cases of haemodynamic effective stenoses and occlusions both procedures correlated well with each other and also with catheter angiography. However, USD and DSA showed increasing discrepancies of findings with decreasing degree of severity of the stenosis. The accuracy for localization of stenoses also decreased markedly for both methods with increasing distance from the carotid bifurcation. In the case of congruent findings of USD and DSA in haemodynamic effective stenoses (degree of stenosis more than 75%) or occlusions conventional angiography did not increase the diagnostic information, and it seems therefore dispensable for vascular surgical decisions. However, in cases with existing clinical symptoms with contradictory or negative USD and DSA findings angiography is still indicated.

[Diagnostic significance of intravenous digital subtraction angiography of the supra-aortic extracranial vascular system. Comparative study of i.v. DSA and plain film angiography]. / Diagnostische Aussagekraft der intravenösen digitalen Subtraktionsangiographie des supraaortalen extrakraniellen Gefässsystems. Eine vergleichende Studie von i.v. DSA und Blattfilmangiographie.

Digital intravenous subtraction angiography (DSA) and conventional film angiography were used to evaluate the diagnostic reliability of DSA-examinations. In 90% of 650 DSA-angiogramms the image quality was diagnostic. For 124 carotid angiographies a comparison of both methods was possible and gave a sensitivity of 87%, a specificity of 96% and an accuracy of 90% for the DSA examinations. The authors believe that digital subtraction angiography is suitable as a screening method for supraaortal vascular occlusive diseases.

[Angiographic diagnosis of vascular impotence]. / Angiographische Diagnostik der vaskulär bedingten Impotentia coeundi.

Twelve patients (average age 40 +/- 15 years) with impotentia coeundi were angiographically examined under suspicion of a vasculogenic impotence. Overview angiographies of the pelvis and selective iliaca interna injections were performed. The normal anatomy of the pudendal artery and the penile branches is shown. Ten patients were suffering from a stenosis or total occlusion of the dorsal pudendal artery, the dorsal penile artery or the profound penile artery with or without filling of a peripheral segment. The role of arteriography in surgical treatment is discussed.

[Changes in the pattern of pulmonary vessels shown on x-ray film (author's transl]. / Andrungen der pulmonalen Gefässzeichnung im Röntgenbild.

The pattern of the pulmonary vessels seen on plain film of the thorax depends on the perfusion of the lungs which depends on the respiratory condition, position in which the x-ray film is taken, and various pathological processes. Pathological findings become evident as localised or generalised increase or decrease in the marking of the vessels, sharpness of outline and pattern of distribution being further assessment criteria. Early analysis of these changes is an important diagnostic step to identify the beginning of pulmonary-venous or pulmonary-arterial pressure increase.

[Indications for oral TRH in a study of 998 patients (author's transl)]. / Zur Indikation des oralen TRH-Testes.

The authors determined values for T3, T4, T7, T3RIA and basal TSH, as well as TSH stimulation after intravenous administration of TRH in 998 patients. The test was negative in 259 patients (26%); in 51 of these patients (5.1%) no clinical or laboratory reasons could be found (low- or non-responders). In this group of patients the TRH test was repeated using a hundred times greater dose orally; in 27 cases (54%) of the low- or non-responders the oral test proved positive. In total, the TRH test was positive in 76.8%, negative in 20.9% and there were 2.3% non-responders. It was concluded that the oral test is more informative than the intravenous. Since the intravenous test gives poor results in only 5.1% of euthyroid patients, the extra effort appears hardly worth while. Further, failure of the intravenous TRH tests should lead to a repetition of the TRH test using oral application before a radioiodine test is done, since this will clarify more than half the tests with negative results.