Pre-interventional prognostic value of renal endocrine, hemodynamic and arteriographic parameters in hypertensive patients with uni- and bilateral renal artery stenosis: a ten years' experience.

In order to improve pre-interventional prognosis of blood pressure normalization, in patients normalization, in patients with angiographically proven uni- (n = 75) and bilateral (n = 38) renal artery stenosis, (RAS) evaluation of renal venous and peripheral renin activity including stimulative procedures and Saralasin-infusion-test was carried out. In addition selective renal arteriographic, hemodynamic and pharmacodynamic (133 xe-washout) investigations were performed. The data were correlated with operative results concerning response of blood pressure to surgical treatment in 54 patients with uni- and 30 patients with bilateral RAS. Our results suggest that a postoperative normalization of blood pressure can only be expected if pre-interventional selective arteriograms reveal a normal vascular tree accompanied with normal cortical flow rates of both kidneys in uni- and bilateral RAS. Selective renin determinations, stimulative procedures of the renin-angiotensin system and application of angiotensin antagonists are only of value for selection of patients.

Anomalous intrapulmonal vein drainage and pulmonary vein connection in DSA.

Anomalous pulmonary venous drainage can be detected and evaluated by angiographic studies. Now that intravenous DSA is available, this method can be used to demonstrate pulmonary venous return. This study presents the results of DSA examination in three patients having anomalous pulmonary vein connection with the left innominate vein and the superior vena cava respectively. In a fourth patient, intra-pulmonary atypical venous return could be demonstrated by DSA without anomalous connection. This minimal invasive procedure is diagnostically useful in anomalies of pulmonary veins when recommended post-processing techniques are evaluated, particularly in patients with additional cardiac septal defects.

Transvenous digital subtraction angiography (DSA) for diagnostic control following percutaneous transluminal angioplasty (PTA) in patients with renovascular hypertension.

Transvenous digital subtraction angiography (DSA) of the kidneys has shown to be useful in detection of renovascular abnormalities in hypertensive patients. In this study DSA was performed in 27 patients (fibrom. dyspl. n = 12, arterioscl. n = 15) following percutaneous transluminal angioplasty (PTA) of renal artery stenosis. Concerning PTA-effect on blood pressure, patients were classified in 3 groups (normal n = 13, improved n = 10, failure n = 4). DSA images and simultaneously determined effective renal plasma flow (ERPF) were correlated with response of blood pressure to PTA. The results demonstrate the usefulness and accuracy of transvenous renal DSA-imaging in follow-up studies. Normal ERPF correlated with a completely re-opened renal artery and normal renal parenchyma in DSA in normotensive patients. In patients with persistent or recurrent hypertension (n = 14) ERPF was reduced in 10 cases and DSA demonstrated disorders such as peripheral renal infarction or reduced renal size (n = 6) and re-stenosis (n = 2).

[Long-term radiological and clinical observations following surgery for tibio-fibular syndesmosis after fractures of the upper ankle joint (author's transl)]. / Ergebnisse röntgenologischer und klinischer Langzeitbeobachtungen nach operativ versorgten Läsionen der tibiofibularen Syndesmose bei Luxationsfrakturen im oberen Sprunggelenk.

Forty-two patients treated surgically for tibio-fibular syndesmosis were observed radiologically and clinically for a period of five years; the lesions followed fracture-dislocations type B, type C and following intra-articular fractures. Surgery consisted, as usual, of bone reconstruction and, where necessary, of transfixation of the syndesmosis with a horizontal screw introduced 2 cm. above the syndesmosis at a 30 degree angle to the frontal plane (15 cases). A new classification of the severity of subsequent arthrosis, as seen radiologically, was introduced and its correlation with clinical findings were determined. There was good agreement between the degree of arthrosis and functional results. The earliest signs of posttraumatic arthrosis following an incompletely treated lesion can be seen within the first year following the injury. An arthrosis of severity O due to sclerosis is of no, or only little, significance; it does not share the poor prognosis of severity grades I to III which, once they have developed, always show further deterioration.

[Periostal new bone formation in ulcerative colitis during adolescence (author's transl)]. / Periostale Knochenneubildung bei Colitis ulcerosa im jugendlichen Alter.

Periostal new bone formation can be observed as a symptom secondary to numerous diseases. In gastrointestinal disease this hypertrophic osteoarthropathy occurs very rare. The present case report demonstrates an extensive periostal proliferation involving the long bones in a 14 years old girl with longstanding ulcerative colitis.

[Intra-arterial digital subtraction angiography (i.a. DSA) in the preoperative diagnosis of abdominal masses]. / Die intraarterielle digitale Subtraktionsangiographie (i.a. DSA) in der präoperativen Diagnostik raumfordernder Prozesse des Abdomens.

The diagnostic value of i.a. DSA, compared with conventional arteriography (n = 48), was proven in patients (n = 116) with abdominal tumours including intrahepatic masses. Arteries supplying the tumour, anomalous vessels and pathological malignant vascular abnormalities were visualised reliably in i.a. DSA despite reduced spatial resolution. An improved definition of hypervascular tumours was possible during the early arterial phase and of hypovascular or avascular masses during the late parenchymal phase of i.a. DSA. The dynamic evaluation of contrast flow is simpler and more reliable using the continuous mode in i.a. DSA than with the static imaging of a conventional film sequence. The advantages of i.a. DSA in preoperative vascular mapping and in detailed diagnosis of abdominal tumours and masses result in replacing conventional arteriography with very few exceptions.

[Indications for digital subtraction angiography of the pulmonary vessels]. / Indikationen zur digitalen Subtraktionsangiographie (DSA) der Pulmonalgefässe.

Different indications of pulmonary DSA are discussed based on experiences in 122 cases. The quality and accuracy of imaging is demonstrated by representative examples. Indications of DSA and conventional pulmonary angiography are principally identical. However, our experience in DSA suggests that this minimal invasive procedure may replace conventional angiography in most cases and abolish the strict indication. Supported by further critical tests the high diagnostic quality of DSA imaging in pulmonary embolism and therapeutical control may substitute radionuclide methods (perfusion-ventilation-scintigraphy) to avoid costs of a double examination.

[Intravenous digital subtraction angiography for imaging pulmonary vessels]. / Die intravenöse digitale Subtraktionsangiographie (DSA) zur Darstellung der Pulmonalgefässe.

The experience in venous digital subtraction angiography (DSA) of the pulmonary vessels is presented in order to evaluate the new method. The results of angiographic examinations in 30 patients could be classified as follows: embolic lung disease (n = 13), atelectatic disease of left lower lobe (n = 3), findings of arteritis in right upper lobe (n = 1), arteriographic alterations due to chronic pulmonary emphysema (n = 2), normal lung vessels (n = 10), and failure of examination (n = 1). Using this new angiographic method it was possible to analyze embolic clots in the subsegmental arteries and total occlusions of the peripheral small vessels. The advantage of DSA compared with the conventional technique is evident: No complications due to transcardial catheters, short examination period, easy handling of the technique, and small number of images.

[The acquired hyperostosis syndrome. Synthesis of 13 personal observations of sternocostoclavicular hyperostosis and 300 cases from the literature. 1]. / Das akquirierte Hyperostose-Syndrom (AHS). Synthese aus 13 eigenen Beobachtungen von sternokostoklavikulärer Hyperostose und über 300 Fällen aus der Literatur--Teil 1.

Sterno-costo-clavicular hyperostosis (SCCH) is the most common manifestation of a syndrome, consisting of increased bone metabolism, mostly new bone formation and heterotopic ossification of fibrous tissue, which we have characterised as the acquired hyperostosis syndrome. In part I we discuss the terminology, radiological appearances, scintigraphy, clinical and laboratory findings, bacteriology, histology, nosology, complications, treatment and differential diagnosis of SCCH. Chronic recurrent multifocal osteomyelitis (CRMO) is regarded as a phenotype of SCCH, depending on the age. CRMO occurs in children, adolescents and young adults, SCCH predominantly in middle-aged and elderly adults.

[Advantages in the diagnosis and classification of intra-articular fractures of the calcaneus using computed tomography]. / Vorteile in Diagnose und Einteilung der intraartikulären Kalkaneusfraktur durch die Computertomographie.

The superiority of CT over conventional radiography in demonstrating intra-articular fractures of the os calcis was demonstrated in 34 patients. The advantages consist in being able to demonstrate the joint without superposition and the exact demonstration of the position, size, shape and number of fragments. Shortening or widening of the os calcis can be easily recognized, as well as fractures of the medial or lateral cortex. At the same time it is possible to evaluate soft tissues, particularly the peroneal ligament. The conventional classification of calcaneal fractures has been newly evaluated in the light of the ability to recognize involvement of the joint and the course of the main fracture lines.

[The acquired hyperostosis syndrome. 2]. / Das akquirierte Hyperostose-Syndrom. Teil 2.

In the second part of this publication, we describe some additional findings in cases of sternocostoclavicular hyperostosis. These include focal hyperostosis of the spine, in the pelvis and in the extremities and psoriatic skin lesions and severe forms of acne (acne conglobata, acne fulminans). Other features, which are not diagnostic, include erosive or non-erosive peripheral arthritis and unilateral or bilateral sacro-iliitis. An analysis of our 13 patients and of the relevant literature indicates that the hyperostosis is due to increased bone metabolism and heterotopic ossification of fibrous tissue and that these are the pathogenic bases of the changes in the axial skeleton, the pelvis and the bones of the extremities. We have suggested a scheme which would categorize the syndrome into complete, incomplete and possibly acquired forms.

[The imaging of regional brain perfusion with dynamic magnetic resonance tomography]. / Darstellung regionaler Hirnperfusion mit dynamischer Magnetresonanztomographie.

Bolus injections of gadolinium-DTPA result in high contrast concentration in the distal vessels within the brain and cause a local disturbance of the magnetic field with a shortening of T2 relaxation time. Pulse frequencies were designed to demonstrate inhomogeneities in the magnetic field. The resultant reduction in T2-weighted gradient echo signals was used in order to examine changes in regional perfusion caused by pathological conditions. Cerebral tumours showed variable perfusion patterns but were always better perfused than surrounding brain tissue; oedema surrounding the tumour resulted in reduced perfusion. Ischaemic infarcts showed significant underperfusion compared with control areas. In both groups the areas involved were larger on the perfusion scans than on T2-weighted images.

[Imaging of cerebral flow dynamics using MR angiography and selective pre-saturation: initial experiences]. / Darstellung zerebraler Flussdynamik mit MR-Angiographie und selektiver Vorsättigung: erste Erfahrungen.

MR angiography with selective pre-saturation was applied in 5 normal volunteers, 22 patients with cerebrovascular disease, 3 patients with arteriovenous malformations (AVM) and one patient with thrombosis of the superior sagittal sinus. The results were compared with Doppler ultrasound and conventional angiography. MR angiography reliably demonstrated the direction of blood flow and the presence or absence of collateral flow in the circle of Willis. Collateral flow via leptomeningeal vessels and the ophthalmic artery could not be demonstrated. In the patient with superior sagittal sinus thrombosis, the absence of flow was well seen. MR angiography was able to demonstrate the major supplying arteries in the patients with AVMs. MR angiography is a valid noninvasive means to demonstrate direction of flow and blood supply of the major intracranial arteries.

[Significance of pulmonary DSA for assessing the operability of lung tumors]. / Bedeutung der pulmonalen DSA für die Beurteilung der Operabilität von Lungentumoren.

In lung tumours histological findings, exclusion of metastatic disease and different diagnostic procedures such as bronchoscopy, mediastinoscopy and thoracic CT play an important role for tumour staging to plan the correct therapeutic approach. Selection of patients for thoracotomy depends on results of these examinations. This study was carried out to assess the value of an additionally applied pulmonary DSA in 17 patients with lung tumours (bronchogenic carcinoma n = 14). Our results demonstrate that in 4 cases angiography could prove inoperability of tumours (compression of sup. v. cava, occlusion of a main pulmonary artery): one patient had a negative mediastinoscopy, one patient had a small cell bronchogenic carcinoma; in two patients an additional mediastinoscopy could be omitted. In two other patients with bronchogenic carcinoma who appeared operable in mediastinoscopy and DSA, explorative thoracotomy only could ensure inoperability due to an infiltration of the thoracic wall. As a minimal invasive method applicable in outpatients pulmonary DSA seems to be useful in giving additional important diagnostic information particularly in central bronchogenic carcinomas.

[Value of the normal chest x-ray in the anamnestic and clinical suspicion of traumatic aortic rupture]. / Die Bedeutung der Thoraxübersichtsaufnahme bei anamnestisch-klinischem Verdacht auf traumatische Aortenruptur.

A retrospective study of plain radiographic findings in 11 patients with traumatic rupture of the aorta was conducted, and the results compared with the incidence of numerous chest x-rays signs previously described in 294 cases of angiographically proven thoracic aorta dissection. It is concluded that positive plain radiographic signs obtained from patients with blunt chest trauma reveal high sensitivity and may thus be used as an indication for emergency aortography. However, since this procedure lacks 100% specificity even those patients with normal x-ray findings but clinically and/or anamnestically adequate thoracic trauma should be submitted to aortography.

[Progressive pulmonary fibrosis due to combined treatment with BCNU, cyclophosphospahmide and cytosin-arabinoside (author's transl)]. / Progrediente Lungenfibrose unter der Kombinationstherapie mit BCNU, Cyclophosphamid und Cytosin-Arabinosid.

Two patients treated for acute leukaemia with BCNU, cyclophosphamide and cytosin-arabinoside are reported, in whom pulmonary fibrosis developed and progressed during therapy. The development of lung fibrosis during combined treatment, together with serological exclusion of other diseases known to be associated with pulmonary fibrosis, make a causal connection between the treatment and the fibrosis very probable.

[The use of sonography in the diagnosis of fresh talofibular ligamentous lesions]. / Einsatz der Sonographie in der Diagnostik der frischen fibulo-talaren Bandläsion.

Sonography of the ankle joint is a simple method of exploring articular soft tissue. 100 patients with acute injury of the lateral ligaments were examined with a 7.5 MHz linear array transducer. Diagnostic criteria were haematoma and capsular deformation. Sonographic findings were assessed by stress films (n = 94), arthrography (n = 29) and operative evaluation (n = 28). In 94 of 100 joints, acute injury could be demonstrated with sonography. In most cases sonography was able to differentiate the site of the lesion: anterior talofibular or fibulocalcaneal ligament. The positive predictive value in relation to the operative findings is 100% for talofibular ligament and 96% for fibulocalcaneal ligament.

[The diagnosis of spinal trauma: the indication for CT and myelo-CT on the day of the injury]. / Diagnostik des Wirbelsäulentraumas: Indikation zur CT und Myelo-CT am Unfalltag.

During a period of 24 months, 211 patients were investigated in our radiological clinic by emergency CT of the spine on the day of the injury. In 128 (61%) a traumatic lesion could be demonstrated. Most frequently involved were the transitional zones of the spine (occipito-atlanto-axial segment, cervico-thoracic and thoracolumbar segments). In 68% of these patients, conventional radiographs of the spine of these critical zones proved to be inadequate. 20% of the lesions demonstrated by CT could not be seen on conventional radiographs and 41% were shown incompletely. In 61% of cases CT provided additional information when compared with conventional radiography.

[MR angiography of occlusive changes in the superior thoracic inlet veins]. / MR-Angiographie okklusiver Veränderungen der oberen thorakalen Einstrombahn.

We used MR angiography to assess the thoracic inlet veins in 5 normal volunteers and 14 patients with thrombosis of these veins. The results were compared with conventional venography and contrast-enhanced computed tomography (CT). The normal anatomy was readily depicted by MR angiography in all normal volunteers. Pathology was assessed correctly by MR angiography in all patients. Thrombosis of the internal jugular vein was seen on MR angiography in all cases whereas conventional venography failed to demonstrate this region adequately in 3 cases. The best overview of the thoracic inlet veins was achieved in the coronal plane; however, for detailed demonstration of pathology, imaging in additional planes was necessary. We conclude that MR angiography is a promising method for non-invasive assessment of thoracic veins.

[Congenital and acquired anomalies of the inferior vena cava. Differential diagnosis using digital subtraction angiography and computed tomography]. / Kongenitale und erworbene Anomalien der Vena cava inferior. Differentialdiagnose durch digitale Subtraktionsangiographie (DSA) und Computertomographie (CT).

Segmental aplasias of the inferior vena cava, thrombosis of the vena cava, tumour infiltration (e.g. renal neoplasms via the renal vein) and external compression (e.g. large hepatic metastases) may produce similar radiomorphologic changes in chest x-ray DSA and CT. These radiomorphological changes are described by case reports. DSA clearly demonstrates the course of the vessels and the collaterals involved. CT may elucidate the paracaval vascular changes. It is only a synopsis of cavography (DSA) and CT with reference to embryogenesis that will lead to a reliable diagnosis and enable a definite decision on therapy and prognosis.