[Malignant lymphoma of the skin: update on diagnostics and therapy of primary cutaneous B-cell lymphoma]. / Maligne Lymphome der Haut : Update zu Diagnostik und Therapie primär kutaner B-Zell-Lymphome.

The diagnosis of primary cutaneous B-cell lymphoma is made based principally on the results of histological investigations and staging. For an exact staging abdominal sonography and chest X-ray examinations and for appropriate clinical symptoms special investigations as well as radiological imaging procedures including PET are indicated in addition to conventional laboratory investigations. For therapy rituximab is normally administered as monotherapy in order to avoid over therapy of indolent lymphoma. Further options are radiotherapy and new approaches with electrochemotherapy as well as pegylated doxorubicin.

Epirubicin and ifosfamide in metastatic breast cancer.

In a randomized, phase II trial, we evaluated the effectiveness of continued chemotherapy with epirubicin/ ifosfamide versus unmaintained treatment interruption in advanced metastatic breast cancer. Three hundred fifty-seven patients were enrolled and 331 were evaluable for response. Complete response was achieved in 25 patients (8%) and partial response in 121 patients (37%). Pretreatment status correlated significantly with response (complete and partial response). While 54% of unpretreated patients responded, only 42% of the patients responded who had been pretreated with adjuvant chemotherapy and 33% who had been pretreated in the metastatic stage of disease; 69 patients (21%) had disease progression. Of 11 patients pretreated in both the adjuvant and metastatic setting, only two responded. Toxicity of treatment was mild, with leukopenia being the treatment-limiting factor. Thrombocyte levels were not altered significantly by treatment. Thus, there seems to be room for dose escalation using granulocyte colony-stimulating factor. There was no considerable cardiotoxicity, central nervous system toxicity, or cystitis observed. The low rate of cardiotoxicity appeared to be related to dose fractionation of epirubicin. After randomization of patients to treatment interruption versus continuation of chemotherapy, a longer relapse-free survival was observed for patients who continued chemotherapy (mean relapse-free survival, 2+ months); however, this did not translate into prolonged survival. The cumulative scores of toxicity and quality of life parameters showed increasing superiority for treatment interruption. Therefore, a strategy of treatment until maximum response and subsequent treatment interruption seems to be superior to treatment continuation.

Neurosarcoidosis: an unusual indication for radiotherapy.

Up to 70% of patients with systemic sarcoidosis developing neurosarcoidosis do so within the first 2 years of their systemic illness. Central nervous system (CNS) involvement as the only manifestation of sarcoidosis can be seen both at first time of disease and at recurrence in a few isolated cases. A young man showed neurological symptoms caused by isolated CNS sarcoidosis after unsuccessful treatment of primary pulmonary sarcoidosis by steroids. MRI scans of the head showed a distinct structural lesion temporodorsal in the left hemisphere and in the left-sided basal ganglia. The diagnosis was proved by neurosurgical resection. Post-operative systemic treatment with long-term corticosteroids was ineffective. After low-dose whole-brain irradiation of the isolated CNS lesion with 20 Gy, partial resolution of the clinical features and stabilization of disease proved by MRI ensued. In neurosarcoidosis the use of radiation therapy remains an appropriate therapy option with minimal adverse sequelae if primary medical treatment fails.

[CT studies following ethanol embolization of malignant kidney tumors]. / CT-Untersuchungen nach Athanolembolisation maligner Nierentumoren.

CT studies were carried out in 25 patients after alcohol embolisation. It was shown that the embolisation reaches the very periphery of the renal capsule. Nevertheless, contrast enhancement in renal tumours persists, due to capsular and collateral vessels. These subsequently permit further tumour growth. Intratumoral gas could be demonstrated in all patients. In the absence of symptoms, this must be regarded as a normal post-embolic event.

[Computer tomography following renal tumour embolisation (author's transl)]. / Computertomographie nach Nierentumorembolisation.

CT examination of eight patients after palliative embolisation of a malignant renal tumour showed a distinct reduction in renal size, beginning after a week and lasting for two or three months. In the patients who survived for more than six to twelve months, the tumor increased in size, as was shown by an increase of tumour volume and tumour revascularisation which could also be demonstrated by computer tomography. Gas in the tumour after embolisation was seen in four out of six cases within the first week and in another case it persisted for five months, without evidence of the presence of a renal abscess or urinary sepsis.

[The diagnosis and differential diagnosis of benign polyps of the ureter (author's transl)]. / Diagnose und Differentialdiagnose benigner Ureterpolypen.

The radiological appearances of fibro-epithelial polyps of the ureter are demonstrated by four cases and the differential diagnosis is discussed. These mesenchymal tumors are characterised by their variable position and change in shape during the course of a retrograde pyelogram; they appear as smooth intraluminal filling defects with a narrow base and occasionally a racemose pattern. In general, they do not cause ureteric obstruction--and are more common on the left and in the proximal ureter.

[Computer tomography of retroperitoneal trauma (author's transl)]. / Computertomographie retroperitonealer Traumen.

Computer tomography changes after retroperitoneal trauma are described on the basis of 19 patients seen by the authors. It appears that this method is superior to conventional techniques, both as a screening method and for carrying out follow-ups. The indications for angiography are thereby reduced.

[Computer tomographic diagnosis of Caroli's syndrome (author's transl)]. / Computertomographische Diagnostik des Caroli-Syndroms.

Congenital cystic dilatation of the intrahepatic bile ducts--Caroli's syndrome--is a rare disease of which about one hundred cases have been reported in the literature. Based on two observations, the value of various radiological procedures is discussed. Compared with other noninvasive procedures, computer tomography has the advantage of being able to show not only the changes in the liver, but also the changes in the liver, but also the medullary sponge kidney which often accompanies this condition. The indications for ERC can therefore be more strictly defined.

[Sonography and endoscopic retrograde cholangio-pancreatography in the diagnosis of diseases of the pancreas and biliary system (author's transl)]. / Sonographic und endoskopisch retrograde Cholangio-Pankreatikographie zur Diagnostik von Pankreas- und Gallenwegserkrankungen.

The value of sonography and ERCP was studied in a retrospective series of 128 patients with pancreatic and biliary disease. Sonography and ERCP employed singly provided a correct diagnosis in 68% and 75.5% respectively; combined diagnostic accuracy rose to 85%. The inclusion of other diagnostic information produced almost identical figures for sonography and ERCP of 82% and 86% respectively. Consequently, sonography must be recommended in the first place as a non-invasive method for the diagnosis of pancreatic and biliary disease. The indications for ERCP are for the elucidation of chronic pancreatitis without pseudo-cysts and for other pancreatic abnormalities not clearly shown by sonography, and also for the demonstration of the biliary system in non-obstructive jaundice.

[CT diagnosis of recurrent subluxation of the shoulder (author's transl)]. / CT-Diagnostik bei habitueller Schulterluxation.

CT provides a clear, unobstructed and reproducible view of the shoulder joint. This permits, unlike conventional methods, for the first time a complete view of the anatomy and of the factors which predispose to a recurrent subluxation of the shoulder. In addition it is possible to see bone lesions resulting from the subluxation.

[Computer tomography in biliary carcinoma (author's transl)]. / Computertomographie bei biliären Karzinomen.

The computer tomographic appearances of cholangio-, cholecysto- and papillary carcinomas in 22 patients are described and the differential diagnosis is discussed.

[Neurofibromatosis and multiple nonossifying bone fibromas]. / Neurofibromatose und multiple nicht-ossifizierende Knochenfibrome.

Three patients with a combination of neurofibromatosis and multiple non-ossifying fibromas are presented. All patients possessed multiple osteolytic lesions with sclerotic margins, resembling non-ossifying fibromas. Two patients showed similar lesions in additional localizations. In two patients, non-ossifying fibroma was histologically verified. The simultaneous occurrence of neurofibromatosis and multiple non-ossifying fibromas can possibly be put down to a generalized mesodermal dysplasia. However, the definite explanation is unknown.

[Significance of computed tomography in the staging of renal pelvic tumors]. / Die Bedeutung der Computertomographie in der Stufendiagnostik von Nierenbeckentumoren.

The computer tomographic appearances of space-occupying lesions in the renal pelvis in 15 patients are described, and the place of CT in the radiological diagnosis is discussed. The clinical symptoms of renal tumours are often not characteristic, and conventional radiological methods frequently produce nonspecific appearances. Computed tomography, which is non-invasive, is therefore a suitable method for diagnosing space-occupying lesions in the renal pelvis at an early stage. Prognosis depends greatly on extra-pelvic spread, which can be demonstrated by CT alone.

[Acute focal bacterial nephritis]. / Die akute fokale bakterielle Nephritis (AFBN).

Acute focal bacterial nephritis is a very rare type of infective nephritis. It is characterised by groups of abscesses of 1 to 5 mm. situated in the renal cortex with pus tracking to the papillae. Urography is normal or suggests a non-specific enlargement. On sonography, non-homogeneous foci with reduced echogenicity are observed. Unenhanced CT shows indefinite lesions of reduced density, which do not enhance as much as the surrounding parenchyma after contrast injection. On angiography these areas appear as hypovascular lesions. The disease must be differentiated from a malignant renal tumour and from an acute renal abscess. The clinical findings and the results of sonographic and radiological observations on five patients with acute focal bacterial nephritis are described.