[Interventional radiological treatment of tumor pain]. / Interventionell-radiologische Behandlung des Tumorschmerzes.

Tumor pain occurs in 70-80% of all cancer patients who have reached an advanced tumor stage. In the case of failure or poor response to chemotherapy and in cases of recurrence following radiotherapy, tumors will often become enlarged with infiltration of organs, nerve roots or bone which causes severe pain to the patient. Interventional radiological minimally invasive local tumor therapy is often the last resort for tumor patients suffering from severe pain. Interventional radiologists have several options to treat tumor pain but firstly the cause of the pain must be identified. This article presents a classification of patients suffering from tumor pain which can help therapists to decide on the correct form of treatment. Treatment options are discussed using typical case histories and it is shown that patients suffering from severe tumor pain must be treated sequentially, which means that treatment is carried out in multiple steps and each cycle of therapy has to be adapted to the stage of the disease. Local pain treatment is fundamentally based on individual case decisions which should be discussed within an interdisciplinary tumor board and the panel should arrive at a consensus decision. In addition, the radiologist performing the procedure should have many years of experience in interventional oncological radiology. By fulfilling these conditions the interventional radiologist can help the patient in a variety of ways because the available treatment options are effective and do not result in much distress for the patient.

[Diagnosis of and therapy for hepatocellular carcinoma]. / Diagnostik und Therapie des hepatozellulären Karzinoms.

The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.

Loss of capsaicin-induced meningeal neurogenic sensory vasodilatation in diabetic rats.

Neuropathic alterations of sensory nerves involved in the mediation of neurogenic inflammation of the meninges may contribute to the increased incidence of headaches in diabetics. In the rat, activation of capsaicin-sensitive nociceptors, which express the transient receptor potential vanilloid type 1 (TRPV1) receptor, induces meningeal vasodilatation, a significant component of neurogenic inflammation, through the release of calcitonin gene-related peptide (CGRP). This study examines the effects of streptozotocin-induced diabetes on TRPV1 receptor-mediated neurogenic sensory vasodilatation, CGRP release and nerve fiber density in the rat dura mater. In a cranial window preparation, epidural application of capsaicin (10(-7) M) produced distinct vasodilatory responses in control animals as measured by laser Doppler flowmetry. In diabetic rats, capsaicin-induced vasodilatation was reduced or even abolished 6, but not 2 or 4 weeks after diabetes induction. In contrast, vasoconstriction, a non-neurogenic response to capsaicin at a higher concentration (10(-5) M), was not altered in diabetic rats. The vasodilatory effects of histamine (10(-5) M), acetylcholine (10(-4) M) and CGRP (10(-5) M) were similar in control, diabetic and insulin-treated diabetic animals. In diabetic rats, a significant decrease in the capsaicin-evoked release of CGRP and reduction in the density of TRPV1-immunoreactive (IR) nerves were demonstrated. Treatment of the diabetic rats with insulin restored both the vasodilatory response and the capsaicin-induced CGRP release toward control values. In conclusion, this study revealed a marked impairment of meningeal TRPV1-IR nerves in streptozotocin diabetic rats by showing reduced neurogenic sensory vasodilatation, decreased capsaicin-evoked CGRP release and reduction in the number of TRPV1-IR nerve fibers of the dura mater. The findings suggest that capsaicin-sensitive afferents may play an important role in meningeal nociceptor function and their dysfunction, e.g. due to a limited removal of inflammatory mediators and/or tissue metabolites from the meningeal tissue, may contribute to the enhanced incidence of headaches in diabetics.

[Prevalence of latent and manifest hyperthyroidism in an iodine-deficient area: non-selected patient population admitted for CT studies with iodine-containing contrast agents]. / Prävalenz der latenten und manifesten Hyperthyreose in einem Jodmangelgebiet: Erhebung an einem nichtselektionierten Patientenkollektiv vor Durchführung einer Computertomographie mit jodhaltigem Kontrastmittel.

PURPOSE: To evaluate the prevalence of latent and manifest hyperthyroidism in a non-selected group of patients admitted for contrast enhanced CT studies blood samples were tested for the levels of thyroid-stimulating hormone (TSH). MATERIAL AND METHODS: TSH blood levels were obtained in 548 consecutive patients who were scheduled for contrast-enhanced (Iopromide; 300 mg iodine/ml) CT scanning. In case of TSH levels < 0.4 mU/l, blood samples were also tested for triiodothyronine (T3) and tetraiodothyronine (T4) blood levels, and treatment with Irenat (sodium perchlorate) was commenced before scanning. In case of TSH levels < 0.1 mU/l, CT scanning was not performed but further evaluation of the thyroid function was initiated. RESULTS: TSH blood levels ranged from 0.4 to 7.5 mU/l in 512 patients, and 36 patients (6.6%) had TSH blood levels < 0.4 mU/l and 9 patients blood levels < 0.1 mU/l, with 32 of those patients (5.8%) having regular T3 and T4 blood levels consistent with latent hyperthyroidism. In 4 patients (0.8%), T3 or T4 blood levels were increased consistent with manifest hyperthyroidism. CONCLUSION: In South Germany, the prevalence of latent or manifest hyperthyroidism in a non-selected patient group is high. Therefore TSH blood levels should be obtained prior to contrast-enhanced CT studies.

[Experimental testing of a new coil design for endoluminal MRI applied to the pig stomach]. / Experimentelle Erprobung eines neuen Spulendesigns zur endoluminalen MRT am Beispiel des Schweinemagens.

PURPOSE: Experimental feasibility study of a new MR-Coil concept for enhanced visualization of the gastric wall. MATERIAL AND METHODS: The newly developed single-loop receiver coil for endoluminal imaging (Fraunhofer Institute, St. Ingbert, Germany) was evaluated in 4 explanted pig stomachs in a 1.5T MR unit (Siemens Symphony, Erlangen, Germany) with T1 w and T2 w MR sequences in three planes. The new coil consists of a foldable and self-expanding single loop coil (receiver coil) of a shape memory metal (nitinol). It was covered with a biocompatible material (silicone) to prevent direct contact of the wire with stomach tissue. The coil assumes a circular configuration with a diameter of 8 cm because of its memory metal properties. The flexible characteristics of the material used allow the passage through the instrument channel (13 mm diameter) of a specially designed MR-compatible endoscope. The purpose of our study was to assess feasibility of the coil design as a first step in developing a new endoluminal MRI-concept. Additionally the number and signal intensity of visible gastric wall layers were evaluated and findings were correlated with histopathological results of a pig stomach. RESULTS: The new coil concept was a feasible system in all 4 cases and showed good image quality for analysis. On T1 w images, 3 layers were visible in all cases, and on T2 w images 4 different gastric wall layers were seen in 2 cases. Due to histopathological correlation, the different gastric wall layers were identified as follows: mucosa, submucosa and muscularis propria if three layers were depicted; in cases of 4 visible wall layers, serosa and subserosa could be detected additionally. For each gastric wall layer, a distinct signal intensity was found. CONCLUSION: The new MR coil concept for endoluminal imaging proved to be a feasible technique. Good differentiation of gastric wall layers in the pig stomach could be demonstrated. We have shown that endoscopic MR-imaging with our new coil concept is a valuable technique for the visualization of gastric wall layers. Due to this fact, follow-up studies including assessing safety aspects are necessary to finally conduct an experimental-clinical study on in-vivo human gastric specimens to detect tumor growth and morphology within the gastric wall. Endoscopic MRI may have the potential in the future to overcome today's limitations of diagnostic imaging in gastric cancer.

Perineural capsaicin induces the uptake and transganglionic transport of choleratoxin B subunit by nociceptive C-fiber primary afferent neurons.

The distribution of spinal primary afferent terminals labeled transganglionically with the choleratoxin B subunit (CTB) or its conjugates changes profoundly after perineural treatment with capsaicin. Injection of CTB conjugated with horseradish peroxidase (HRP) into an intact nerve labels somatotopically related areas in the ipsilateral dorsal horn with the exceptions of the marginal zone and the substantia gelatinosa, whereas injection of this tracer into a capsaicin-pretreated nerve also results in massive labeling of these most superficial layers of the dorsal horn. The present study was initiated to clarify the role of C-fiber primary afferent neurons in this phenomenon. In L5 dorsal root ganglia, analysis of the size frequency distribution of neurons labeled after injection of CTB-HRP into the ipsilateral sciatic nerve treated previously with capsaicin or resiniferatoxin revealed a significant increase in the proportion of small neurons. In the spinal dorsal horn, capsaicin or resiniferatoxin pretreatment resulted in intense CTB-HRP labeling of the marginal zone and the substantia gelatinosa. Electron microscopic histochemistry disclosed a dramatic, ∼10-fold increase in the proportion of CTB-HRP-labeled unmyelinated dorsal root axons following perineural capsaicin or resiniferatoxin. The present results indicate that CTB-HRP labeling of C-fiber dorsal root ganglion neurons and their central terminals after perineural treatment with vanilloid compounds may be explained by their phenotypic switch rather than a sprouting response of thick myelinated spinal afferents which, in an intact nerve, can be labeled selectively with CTB-HRP. The findings also suggest a role for GM1 ganglioside in the modulation of nociceptor function and pain.

Does velocity of dilatation influence the result of dilatation? A postmortem study.

We evaluated the influence of velocity of dilatation on the success of and the vascular damage produced by dilatation. Nonatheroslerotic segments of distal superficial femoral arteries were dilated "fast" (n = 69) or "slow" (n = 45) under standard conditions with balloon catheters. The arterial wall was overstretched between 1% and more than 60%. The success of dilatation rose continuously with increasing overstretching during dilatation. The damage to the arterial wall by dilatation increased discontinuously with increasing overstretching. Dilatation success and damage patterns did not differ in the "slow" and "fast" groups.

Histological demonstration of increased vascular permeability in the dura mater of the rat.

Neurogenic inflammation of the dura mater encephali has been suggested to play an important role in the pathophysiology of headaches. Although functional studies using extravasation techniques indicate an enhanced permeability of blood vessels after chemical or electrical stimulation of C-fibres supplying the dura mater, histological demonstration of leaky blood vessels is still a problem. We used the vascular labelling method combined with i.v. injection of colloidal silver solution to test the permeability increasing effect of intravenous administration of substance P, topical application of mustard oil or acidic phosphate buffer and local electrical stimulation of the exposed dura mater. Histological characteristics of increased vascular permeability were observed exclusively after mustard oil and acidic phosphate buffer. This observation may indicate different mechanisms of increased vascular permeability involving pinocytosis and formation of interendothelial gaps selectively visualized by the vascular labelling method.

A new technique for the direct demonstration of overlapping cutaneous innervation territories of peptidergic C-fibre afferents of rat hindlimb nerves.

A new technique based on the phenomenon of vascular labelling has been devised for the direct visualisation of overlapping innervation territories of cutaneous nerves. The saphenous, peroneal and sural nerves on one side in anaesthetised rats were exposed, cut centrally and successively stimulated antidromically to induce a neurogenic inflammatory response after an intravenous injection of either a 1% colloidal silver solution or a suspension of 3% Monastral Blue B. Light microscopic examination of transparent preparations of the dorsal hindpaw skin revealed labelled blood vessels of different colours which represented cutaneous territories served by different nerves. Blood vessels labelled with both substances were regarded as areas of overlapping innervation. Such areas were typically localised along the border of adjacent innervation territories. In addition, distinct areas exhibiting double-labelled blood vessels were regularly encountered in regions separate from this border zone. Areas of interest were drawn with the aid of a camera lucida and measured by means of a computerised system. The results indicate a significant, although topographically variable, degree of overlap of these cutaneous innervation areas. This new technique offers a possibility to explore the importance of normally existing overlap in the reinnervation of a denervated skin area by collateral nerve sprouting.

Neurogenic inflammation in the gastrointestinal tract of the rat.

In contrast to the skin and some visceral organs the capability of capsaicin-sensitive sensory nerves of evoking an inflammatory response in the gastrointestinal tract is equivocal. We have therefore investigated the neurogenic plasma extravasation induced by local application of capsaicin to the stomach, duodenum, jejunum, ileum and colon of the rat. Permeable vessels were visualised histologically with the vascular labelling technique using colloidal silver. In the smooth muscle layer of the small intestine, capsaicin elicited a 3-fold increase in the density of labelled blood vessels (diameter, 7-35 microns). Significant capsaicin-evoked plasma extravasation was also observed in the submucosa of the jejunum and ileum, and in the basal layer of the jejunal mucosa. Capsaicin-induced extravasation was not noted in the stomach and the colon. The data suggest the involvement of capsaicin-sensitive afferents in inflammatory processes in the rat small intestine.

Beta-amyloid (1-42) peptide impairs blood-brain barrier function after intracarotid infusion in rats.

The effects of intracarotid infusions of beta-amyloid (1-42) peptide was studied on the permeability of brain vessels. Using a quantitative Evans blue method a dose-dependent increase of brain tissue albumin content was established following intracarotid injections of the peptide. Cerebral vessels of increased permeability were also demonstrated with a vital 'staining' technique. Lectin histochemistry revealed an almost complete abolition of specific lectin binding sites of affected endothelial cells. The findings indicate a significant deterioration by beta-amyloid (1-42) peptide of blood-brain barrier function and suggest that this may result from endothelial damage. It is assumed that altered permeability of cerebral vessels may be involved in the development of brain pathologies associated with Alzheimer's disease.

Capsaicin-sensitive local sensory innervation is involved in pacing-induced preconditioning in rat hearts: role of nitric oxide and CGRP?

UNLABELLED: Among several mediators, nitric oxide (NO) and calcitonin gene-related peptide (CGRP) were suggested to be involved in the mechanism of preconditioning. We examined the possible role of the cardiac capsaicin-sensitive sensory innervation in pacing-induced preconditioning, as well as in the cardiac NO and CGRP content. Wistar rats were treated subcutaneously with capsaicin or its solvent in the sequence of 10, 30, and 50 mg/kg increasing single daily doses for 3 days to deplete neurotransmitters of the sensory innervation. Isolated hearts from both groups were then subjected to either preconditioning induced by three consecutive periods of pacing at 600 beats per minute for 5 min with 5 min interpacing periods, or time-matched non-preconditioning perfusion, followed by a 10-min coronary occlusion. NO content of left ventricular tissue samples was assayed by electron-spin resonance, and CGRP release was determined by radioimmunoassay. CGRP immunohistochemistry was also performed. In the non-preconditioned, solvent-treated group, coronary occlusion decreased cardiac output (CO) from 68.1 to 32.1 mL/min, increased left ventricular end-diastolic pressure (LVEDP) from 0.58 to 1.90 kPa, and resulted in 200 mU/min/g LDH release. Preconditioning significantly increased ischaemic CO to 42.9 mL/min (P < 0.05), decreased ischaemic LVEDP to 1.26 kPa (P < 0.05) and decreased LDH release to 47 mU/min/g (P < 0.05) in the solvent-treated group. Preconditioning did not confer protection in the capsaicin-pretreated group (ischaemic CO: 35.6 mL/min; LVEDP: 1.76 kPa; LDH 156 mU/min/g). Capsaicin-treatment markedly decreased cardiac NO content, CGRP release, and CGRP-immunoreactivity. CONCLUSIONS: (i) The presence of an intact local sensory innervation is a prerequisite to elicit pacing-induced preconditioning in the rat heart. (ii) A significant portion of cardiac basal NO content may be of neural origin. (iii) Release of NO and CGRP from capsaicin-sensitive nerves may be involved in the mechanism of pacing-induced preconditioning.

[Imaging methods in the diagnosis and therapy of cystic echinococcosis]. / Bildgebende Verfahren in Diagnostik und Therapie der zystischen Echinokokkose.

Imaging studies, ultrasonography, play a central role for the diagnosis and follow-up of cystic echinococcosis (hydatid disease) due to the non-specific clinical symptoms and still inadequate sensitivity and specificity of currently available serological tests. Due to the increasing number of people immigrating to central Europe from countries with a high incidence of cystic echinococcosis, cystic echinococcosis has become an important differential diagnosis of cystic lesions. The imaging modality to localize and stage the disease depends on the organs affected. Ultrasonography is the most important imaging technique to screen for abdominal lesions (more than 75 % of the cases). Therefore, an expert committee of the WHO Working Group on echinococcosis has recently suggested a standardized ultrasonographic classification of hepatic cystic echinococcosis. This classification proofs to be very useful for staging echinococcal cysts with respect to parasite activity. Ultrasonography is not only an excellent tool for the primary diagnosis and therapeutic decision but also for follow-up of patients treated for cystic echinococcosis. Indications for computed tomography or magnetic resonance tomography are restricted to extra abdominal disease, patients not suited for ultrasonography because of obesity or meteorism, complicated cysts and planning of surgery or interventional therapy. Apart from surgery three other treatment options are well established: (1) chemotherapy with albendazole or mebendazole, (2) percutaneous drainage and sterilization (PAIR) and (3) observation of inactive echinococcal stages ("watch and wait" approach).

[The intracavitary administration of contrast medium in the aftercare of complicated thoracic empyema with long-term drainage: x-ray fluoroscopy compared to computed tomography]. / Die intrakavitäre Kontrastmittelgabe bei der Nachsorge des komplizierten langzeitdrainierten Thoraxempyems: Röntgendurchleuchtung im Vergleich zur Computertomographie.

PURPOSE: To define the value of conventional radiography compared with CT in the follow-up of complicated, long-term tube drained pleural empyema after intracavitary application of contrast medium. METHODS: 28 patients with complicated pleural empyema (stage III) and long-term tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleural space. Both examinations were judged by the following criteria: number and morphology of pleural cavities, quality of drainage and accompanying thoracic disease. RESULTS: 49 pleural cavities were diagnosed. Judgement of drainage corresponded in 79% of cases and differed in 21% with proof of further not drained cavities only on CT. 4 bronchopleural fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only. CONCLUSIONS: Diagnosis of bronchopleural fistulas and judgement of the pleural drainage is best possible using fluoroscopy after application of contrast medium into the pleural space. CT is most accurate to detect further cavities that have not been drained, to look for concomitant thoracic disease, and to judge the morphology of the pleural cavity. Conventional radiography of the pleural space is effective and recommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevated blood markers indicating inflammation) should be examined by both fluoroscopy and CT.

[Carcinoma of the stomach. Role of imaging for primary diagnosis and preoperative tumor staging]. / Das Magenkarzinom. Stellenwert der bildgebenden Verfahren für Primärdiagnose und präoperatives Tumorstaging.

The aim of imaging of gastric carcinoma has to be to diagnose the carcinoma as early as possible and to sort out the tumors that are resectable. At the same time imaging of gastric carcinoma should reduce the number of futile laparotomies in patients with advanced, non-resectable tumors to a minimum. Today, endoscopy is the method of choice to diagnose gastric carcinoma. Endosonography is advantageous if small carcinomas have to be judged for depth of tumor infiltration (early gastric carcinoma vs. advanced gastric carcinoma) because high resolution images of the gastric wall are obtained. Staging of large carcinomas that have grown beyond the gastric wall is best performed by hydro-CT because CT scans most accurately delineate infiltrations of surrounding organs/structures and help to plan surgery. Nowadays MRI is not suited for gastric imaging. MRI, however, has the highest potential to fundamentally improve staging of gastric carcinoma if high resolution imaging of the gastric wall is combined with screening for metastases in one examination.

[Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy]. / Langzeitergebnisse der interventionellen Therapie von grossen, inoperablen hepatozellulären Karzinomen (HCC): signifikanter Uberlebensvorteil von transarterieller Chemoembolisation (TACE) und perkutaner Ethanolinjektion (PEI) gegenüber der TACE-Monotherapie.

PURPOSE: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC). METHODS AND MATERIALS: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared. RESULTS: The 6-,12-, 24- and 36-month survival rates were 61 %, 21 %, 4 %, and 4 % for TACE monotherapy and 77 %, 55 %, 39 % and 22 % for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p = 0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group. CONCLUSION: The combination of TACE and PEI is an effective and safe method in the palliative treatment of large HCC that has the potential of improving long term survival compared to TACE monotherapy.

[Gastrointestinal diagnosis with hydrosonography and hydro-CT. 1: Stomach carcinoma]. / Gastrointestinale Diagnostik mit Hydrosonographie und Hydro-CT. Teil 1: Magenkarzinom.

PURPOSE: Hydrosonography (HUS) and hydro-CT (HCT) were evaluated for diagnostic accuracy and staging efficiency of gastric carcinomas. MATERIAL AND METHODS: 68 patients suspected for gastric carcinoma were examined. At HUS the gastric wall is distended by water, the tumour is localised and enlarged to judge the depth of infiltration. At HCT the stomach is filled with water and after paralysis of the gut a spiral-CT optimised for parenchymal and vessel contrast is performed. Gastric carcinomas were classified according to the TNM-system and histopathological correlation was achieved. RESULTS: The number of normal/pathologic examinations was 10/30 (HUS) and 9/31 (HCT), the detection rate of gastric tumours was 77% (HUS) and 94% (HCT). The T-stage was correctly determined in 27% (HUS) and 55% (HCT), the N-stage in 65% and 45% and the M-stage in 81% and 73% of all cases, respectively. CONCLUSION: HCT is a reliable screening method for gastric tumors. Staging of gastric carcinomas, however, is not improved. Tumour extension beyond the wall and metastases can be assessed by a single examination.

[MR imaging of gastric wall layers in vitro: correlation to thehistologic wall structure]. / Experimentelle Darstellung der Schichten der Magenwand mittels MRT: Korrelation mit demhistologischen Wandaufbau.

PURPOSE: To correlate gastric wall layers visible of MRI with the anatomical structure of the gastric wall. METHODS: After macroscopic preparation 5 x 5 cm post-mortem tissue sections of the gastric antrum were evaluated using a 2.4 Tesla MR unit (Bruker, Ettlingen, Germany). MR imaging consisted of T2-weighted multi-spinecho sequences in longitudinal and axial directions. The specimens then were stained with hematoxylin-eosin for histological examination. After that histological correlation of the gastric wall layers visible on MRI was performed. RESULTS: In all specimens four gastric wall layers could be clearly identified on MRI. The direct comparison of those layers to the histological findings showed the following correlation: 1) intermediate signal = mucosa, 2) hypointense signal = lamina muscularis mucosae, 3) hyperintense signal = submucosa, 4) intermediate signal = muscularis propria. CONCLUSIONS: Gastric wall layers visible on MRI were successfully correlated to the anatomic layers of the gastric wall. This allows us for the first time to classify invasion of gastric carcinoma using high spatial-resolution MR imaging. However, the subserosa and serosa are excluded from this conclusion, because so far a reliable statement concerning the value of MRI to depict these very variable layers is not possible.

[Therapeutic efficiency of of pulsed spray lysis in peripheral arterial occlusions]. / Therapeutische Effizienz der gepulsten Sprühlyse bei peripheren arteriellen Verschlüssen.

PURPOSE: To determine the clinical efficacy of pulse-spray thrombolysis. MATERIAL AND METHODS: In a prospective trial 28 patients with acute arterial (n = 14) and bypass (n = 14) occlusions of the lower extremities were treated with pulse spray thrombolysis. 23/28 legs were at risk. RESULTS: Technical and clinical success were 89% and 68% respectively. Time interval until restitution of antegrade flow was less than two hours, the median duration of the complete intervention was 17 hours. Two patients (7.1%) needed transfusions for inguinal haematomas. After six months 50% of occluded segments remained patent, secondary patency is comparable at 53%. Bypasses show significantly lower patency (p = 0.04) and higher amputation (p = 0.009) rates than native arteries. Bad run-off (< or = 1 artery patent) is a significant predictor for clinical failure and early amputation. CONCLUSIONS: The distinct advantage of pulse-spray thrombolysis is fast restoration of antegrade flow and thereby effective treatment of acute ischaemia. The complication rate is low without associated mortality.

[Gastrointestinal imaging with hydrosonography and hydro-CT]. / Gastrointestinale Diagnostik mit Hydrosonographie und Hydro-CT, Teil 2: Dickdarmkarzinom.

AIM: To determine the accuracy of hydrosonography (HUS) und hydro-CT (HCT) for staging colon carcinoma. MATERIAL AND METHODS: 74 patients in whom colorectal carcinoma was suspected were examined. At HUS the colonic wall ist distended by a methylcellulose/water suspension and the carcinoma is enlarged to perform staging of the tumour. HCT is a spiral-CT optimised for parenchymal and vessel contrast. Before the scan is started, up to two litres of fluid are given rectally and spasmolytics are administered to reduce peristalsis. Colorectal carcinomas were classified according to the TNM system and histopathologic correlation was achieved. RESULTS: Out of 43 (HUS) and 39 (HCT) colonic lesions 33 (77%) and 36 (92%), respectively, were diagnosed. T-stage accuracy was 88% (HUS) and 66% (HCT), N-stage accuracy 33% and 46% and M-stage accuracy 88% and 85%, respectively. CONCLUSION: The T-stage of sonographically visible tumours of the colon is determined precisely by HUS. In contrast to predicting lymph node involvement distant metastases are reliably detected by both methods. If performed together, HUS and HCT achieve high diagnostic accuracy for staging carcinoma of the colon.