[Diagnostic and therapeutic control of varicoceles using angiodynography]. / Diagnostik und Therapiekontrolle der Varikozele mittels Angiodynographie.

We report on the results of angiodynography of 21 patients with suspected varicoceles. In 14 cases a varicocele could be diagnosed. Additionally, 19 patients underwent conventional Doppler sonography (16 with positive findings), 7 thereof also a testicular phlebography (5 positive findings). Thus, in conventional Doppler sonography there were 2 false positive findings. With angiodynography it was possible to detect an existing varicocele in all 14 (of the 21) cases even if only a small retrograde flow existed. In 11 of the cases this could be graded with the help of the flow velocity. In case of negative findings in angiodynography, further invasive techniques are unnecessary. However, before embolisation of a varicocele and to show preoperatively vessel variations or collateral vessels, testicular phlebography is still indicated.

[Color-coded Doppler sonography of chronic venous insufficiency]. / Farbkodierte Dopplersonographie der chronisch venösen Insuffizienz.

20 patients (i.e. 40 lower extremities) with chronic venous insufficiency were examined by means of colour-coded Doppler sonography (CCDS). This method enables the simultaneous visualisation of the anatomy and haemodynamics of the examined vessels. All cases of varicosis of the stem of the vena saphena magna (VSM) (n = 21) and of the vena saphena parva (VSP) (n = 13) were correctly diagnosed by CCDS. However, an incomplete varicosis of the stem was identified in only 3 of 5 cases. Insufficiency of the V. perforantes was identified by CCDS with a high rate of accuracy in diagnosing the insufficiency of the cross of the VSM and VSP. Although assessment of the V. perforantes and diagnosis of incomplete stem varicoses or varicoses of lateral branches is possible, as a rule, it does take up much time and requires a great deal of experience on the part of the investigator.

[Computed tomography and MR tomography before and after radiotherapy of primary and secondary CNS lymphoma]. / Computertomographie und MR-Tomographie vor und nach Strahlentherapie primärer und sekundärer Lymphome des ZNS.

CT scans were made prior to and following radiotherapy in eleven patients with primary or secondary malignant lymphomas of the CNS. Six patients were additionally submitted to MR tomography with calculated T1 and T2 images. Radiotherapy induced a very rapid regression of the lymphomas. A measurable quantitative influence of the irradiation could thus not be visualized in the MR scans. The survival curve of our patients was calculated, too. The median survival after radiotherapy is 17.4 months.

[HMPAO-SPECT during carotid artery compression (Matas test) in the evaluation of cervical tumor surgery with potential carotid involvement]. / HMPAO-SPECT unter Karotiskompression (Matas-Test) in der Diagnostik vor zervikalen Tumoreingriffen mit möglicher Karotisbeteiligung.

For planning the surgical approach in patients with head and neck tumours and extensive cervical metastasis the evaluation of possible vascular involvement is necessary. If the carotid artery is suspected to be infiltrated by the tumour masses its resection or plastic substitute becomes sometimes inevitable. For evaluation of the collateral brain perfusion before a possibly necessary carotid resection we examined 10 patients with neck tumours performing the Matas-Test combined with HMPAO Single-Photon-Emission-Computed-Tomography. During ultrasound-controlled manual compression of the involved common carotid artery 99mTc-labelled HMPAO was injected. The SPECT demonstrated the brain perfusion during the carotid compression time period. 6 patients showed a decreased perfusion of the affected hemisphere with - as far as obtained - normal baseline SPECT-results and balloon occlusion tests. 2 of these patients underwent a carotid artery resection, one of the common carotid artery and one of the internal carotid artery. One patient had a significant perfusion deficit in the SPECT but no pathologic findings in angiography and balloon occlusion test. He suffered from hemiparesis postoperatively. The other patient showed preoperatively a minor decrease in perfusion and had no neurological defects postoperatively. Our findings show that the Matas-Test combined with HMPAO-SPECT is a valuable tool for the preoperative evaluation of the collateral brain perfusion. This technique is not invasive and can be performed in every nuclear medicine department with an ECT camera. The HMPAO-SPECT during carotid compression can add useful information or even replace angiography and the balloon occlusion test.