Transforming growth factor-{beta} gene polymorphisms in different phenotypes of sarcoidosis.

The aetiology of sarcoidosis is unclear. Single nucleotide polymorphisms (SNPs) in transforming growth factor (TGF)-ß2 and -ß3 have been reported to be associated with the development of lung fibrosis in patients with sarcoidosis. SNPs in TGF-ß2 (rs1891467) and TGF-ß3 (rs3917200) were investigated in 296 patients with sarcoidosis (acute/self remitting, n = 70 (including 62 patients with Löfgren's syndrome); chronic, n = 168; acute/chronic, n = 58) by real-time PCR. 32 patients showed radiological signs of lung fibrosis. The genotype frequencies were compared among the sarcoidosis groups as well as to 377 healthy controls. We found a significant association with the G-allele in rs1891467 in TGF-ß2 and an acute/self remitting course of sarcoidosis compared to a chronic course (p = 0.001). The results were even more evident for patients with Löfgren's syndrome (p<0.001). Moreover, we could demonstrate a borderline significance between TGF-ß3 (rs3917200) and lung fibrosis (p = 0.050). Carriers of the G-allele in rs1891467 might be protected from developing a chronic course. Moreover, there is evidence that rs3917200 is involved in the development of lung fibrosis in sarcoidosis. This study is the first in sarcoidosis patients to suggest a genetic implication of TGF-ß2 as a protective factor in the course of sarcoidosis.

Two complementary approaches to study peroxisome biogenesis in Saccharomyces cerevisiae: forward and reversed genetics.

In order to investigate the mechanisms of peroxisome biogenesis and to identify components of the peroxisomal import machinery we studied these processes in the yeast Saccharomyces cerevisiae. The forward genetic approach has led to pas-mutants (peroxisomal assembly) which fall into 12 complementation groups and allowed to identify 10 of the corresponding wild-type PAS genes (PAS 1-7, 9, 11 and 12). Recent sequence analysis data of some of these genes are beginning to provide first hints as to the possible function of their gene products. The PAS genes and their corresponding mutants are presently used to address some important questions of peroxisomal biogenesis. Reversed genetics has been started as a complementary approach to characterize especially the function of peroxisomal membrane proteins. For this purpose we describe a technique to isolate highly purified peroxisomes. This led to the identification of 21 polypeptides as constituents of this organelle. Some of them are presently sequenced.

[Direct radiological magnification of thin objects compared with contact exposures and mammographic techniques (author's transl)]. / Die direkte röntgenologische Vergrösserung an dünnen Objekten im Vergleich zu Kontaktaufnahmen und Aufnahmen in Mammograhietechnik.

Image quality of phantom objects examined by direct radiographic magnification was analysed. The following results were obtained. Improvement in image quality by direct x 2 magnification of fine, but contrasted, details is very limited. Contact examination using suitable imaging systems provides images of equal quality. Course detail with poor contrast is poorly rendered by direct radiographic magnification. Mammographic techniques are better suited for this purpose. Exposures, using mammographic techniques, produce the same dose rates as direct magnification. In view of the improved image quality, this method is therefore to be preferred. It also appears that the dose rate for comparable image quality for different techniques (direct magnification, mammography, contact exposures) is approximately the same.

[Mammographically distinguishable parenchymal patterns and their significance in estimating breast cancer risk]. / Mammographisch differenzierbare Parenchymmuster und ihre Bedeutung zur Abschätzung eines Brustkrebsrisikos.

A retrospective study of the mammograms of 11020 women was carried out; amongst these, 490 had carcinomas, including 51 so-called interval carcinomas. An attempt was made to test the suggestion advanced by Wolfe that certain dense types of parenchymal pattern on the mammogram are associated with a significantly increased carcinoma risk. We were unable to confirm Wolfe's suggestion. There is a slightly higher risk for pattern P2-DY, which cannot be used as the basis for future management of the patient. Attention is drawn to the risk of missing many carcinomas of the breast, if the suggestions made by Wolfe are followed.

[Image quality from direct radiological magnification (author's transl)]. / Bildgüteuntersuchung zur direkten röntgenologischen Vergrösserung.

An assessment of image quality from a direct radiological magnification method with a microfocus was carried out. It was found that direct magnification has advantages for the magnification of thin objects (5 cm. thickness). Because of the marked radiation scarrer in thick objects an improvement in picture quality is not possible. Scatter, despite the Groedel effect, is too large. Optimum results are obtained with a microfocus tube using universal screens. Comparable image quality is not possible with high intensification screens. High definition screens are not suitable for magnification. Dose measurements revealed unexpectedly low levels, particularly for thin objects. The reasons for this were examined and are described.

[Videodensitometric determination of relative blood regurgitation volume in aortic valve insufficiency]. / Videodensitometrische Bestimmung des relativen Blutregurgitationsvolumens bei der Aortenklappeninsuffizienz.

A simple video densitometric method based on the indicator distribution principle in the region of interest permits the determination of the relative amount of regurgitation between the ascending aorta and the left ventricle in cases of aortic valve insufficiency. The experimental basis and early clinical measurements are described and are compared with the more conventional methods of cine angiography and radionuclide ventriculography.

[Digital subtraction angiography (DSA) of the upper extremities]. / Digitale Subtraktionsangiographie (DSA) der oberen Extremität.

Amongst 1500 digital subtraction angiograms, there were 93 examinations of the arteries of the upper extremities. After intravenous contrast injection, DSA provided good demonstration of the subclavian, axillary, brachial, radial and ulnar arteries. In order to demonstrate the arteries in the hand and fingers, an intra-arterial injection of 5 ml contrast into the brachial artery has proved satisfactory. DSA makes the examination easier and quicker and reduces the risk of complications. Conventional catheter angiography is now required only for a few selected problems.

[The treatment of idiopathic varicocoeles by transfemoral spiral occlusion of the left testicular vein (author's transl)]. / Die Behandlung der idiopathischen Varkozele durch transfemorale Spiralokklusion der Vena testicularis sinistra.

The standard surgical procedures for the treatment of idiopathic varicocoeles are unsuccessful in, or show a recurrence rate of, up to 25%. An alternative method is transcutaneous embolisation using the Seldinger catheter technique. For this technique of transcutaneous catheter embolization, we have used the Gianturco spiral. The embolization is carried out following diagnostic transfemoral phlebography of the left testicular vein, which also provides the indications or contra-indications for this procedure. The method has been used on nineteen patients with varicocoeles requiring treatment; amonst these were three patients who had had unsuccessful operations. Follow-up period so far is six months. In all cases the varicocoele had disappeared, including one patient who had suffered complications following previous surgery.

[Radiographs of the thorax in acute myocardial infarction]. / Die Röntgenuntersuchung des Thorax beim akuten Myokardinfarkt

Radiographs of the thorax were evaluated in 240 patients during the acute phase following a myocardial infarct. Following the acute infarct, 53% of the patients showed some cardiac enlargement, in a quarter this was marked. Congestive lung changes were found in 53% of patient following the infarct, interstitial pulmonary oedema in 22% and intra alveolar oedema in 9%. Patients with marked cardiac enlargement and those with congestive lung changes showed a bad prognosis, particularly if the congestion did not regress rapidly. Even advanced pulmonary congestion and interstitial oedema may be missed by clinical examination. Radiography of the thorax following acute myocardial infarction is of value in treatment and prognosis.

[Venous digital subtraction angiography of the renal arteries in hypertensive patients]. / Die venöse digitale Subtraktionsangiographie der Nierenarterien bei Hypertoniekranken.

We carried out 1890 venous digital subtraction angiograms; this included 113 patients with hypertension in order to exclude renal artery stenosis. On four occasions it was used following surgery on a renal artery. Renal artery stenosis or occlusion was demonstrated in twelve patients, and other vascular diseases or anomalies were found in 24. Two abnormal renal arteries were found following renal artery surgery. The results are compared with smaller groups of patients examined by DSA, and with the results of conventional subtraction methods reported in the literature. In only eight patients (6.8%) DSA provided insufficient information and had to be supplemented by aortography. The method has proved to be a valuable and simple screening method for the investigation of hypertension.

[Aneurysms of the sinus of Valsalva (author's transl)]. / Die Aneurysmen der Sinus Valsalvae

Twenty-seven patients in whom a diagnosis of sinus of Valsalva aneurysm had been made during life were re-examined and the results have been evaluated. The clinical symptoms are not diagnostic. Routine radiological examination may also fail to show any significant findings. Large sinus of Valsalva aneurysms may show an atypical prominence of the right upper heart border, and in leutic aneurysms there may be fine calcification of the aortic wall. A definitive diagnosis can be made only by thoracic aortography. Five patients had a congenital saccular aneurysm connected with a sinus of Valsalva. Three patients had acquired aneurysms of which two were leutic and one developed shortly after rheumatic fever. A diffuse aneurysms of the sinus of valsalva was found in fourteen patients with Marfan's syndrome. The radiological appearances are demonstrated. Indications for surgery are discussed; the indications must be considered for each situation separately.

[Importance of computed tomography in the diagnosis and differential diagnosis of primary adrenal tumors]. / Die Bedeutung der Computertomographie bei der Diagnose und Differentialdiagnose primärer Nebennierentumoren.

In the present study, 29 patients with primary adrenal tumours and one with an extra-adrenal paraganglioma were examined. With an accuracy of over 90%, computed tomography is the method of choice if there is clinical suspicion of a suprarenal tumour. Pathological changes greater than 8 to 10 mm can be demonstrated. Low absorption values, up to 25 HU, are found predominantly with hyperplasias and adenomas. Phaeochromocytomas, carcinomas and metastases, on the other hand, show significantly higher densities between 30 and 60 HU. CT also demonstrates neighbouring structures. Differentiation between benign and malignant processes is also possible by demonstrating tumour infiltration or metastases.

[Value of ultrasound in screening for liver metastases and liver involvement in malignant systemic disease]. / Die Wertigkeit der Ultraschalluntersuchung beim Screening von Lebermetastasen und von einer Leberbeteiligung bei malignen Systemerkrankungen.

The value of sonography as a primary screening method for the diagnosis of liver metastases or liver involvement by malignant lymphoma has been investigated in 163 patients. The following results were obtained: sensitivity 92%, specificity 80%, accuracy 85%. In 109 patients CT findings were also considered. The high proportion of correct positive and low proportion of low false negative findings makes sonography the method of choice for primary screening. The figures also indicate that if sonography is negative, other diagnostic procedures are unnecessary. If sonography is abnormal, but the findings are not clear, then computed tomography is indicated.

[Xeroradiographic studies on the capsule and ligaments of the knee joint. 1. Anatomy of the cruciate and lateral ligaments in the xerotomogram]. / Xeroradiographische Untersuchungen am Kapselund Bandapparat des Kniegelenkes

The suitability of xeroradiography for contrast arthrography was investigated by in vitro studies. Special attention was devoted to the cruciate and lateral ligaments on xero-ty lateral tomography. The anterior and posterior ligments can be evaluated and defined satisfactorily in the antero-posterior view. The lateral ligaments can be seen on xero-tomography without difficulty. The use of xero-tomography promises to improve the radiological diagnosis of injuries of the capsule and ligaments of the knee joint.

[Supravalvular aortic stenosis: Congenital and acquired changes in the ascending aorta near the valve (author's transl)]. / Zur supravalvulären Aortenstenose--angeborene und entzündliche Veränderungen der klappennahen Aorta ascendens.

Three patients with supravalvular aortic stenosis are described. One was a typical, sporadic-type supravalvular aortic stenosis, another a predominant aortic valve stenosis as part a complex heart lesion and the third inflammatory shrinking of the anulus fibrosus with an inflammatory aortic valve stenosis. The means of diagnosis are discussed. Angiocardiography and aortography are essential in order to demonstrate the pathology, haemodynamics, relation to the coronary arteries and the sinus of Valsalva, and in order to show other abnormalities. The aetiology and pathogenesis of various types of supravalvular aortic stenosis are discussed.

[Xero-radiographic examination of the capsule and ligaments of the knee joint. II. Demonstration of injuries to the cruciate and lateral ligaments and menisci (author's transl)]. / Xeroradiographische Untersuchungen am Kapsel- und Bandapparat des Kniegelenks. II. Mitteilung: Darstellung von Verletzungen an den Kreuz- und Seitenbändern sowie den Menisken im Xerotomogramm

The value of xero-radiography for demonstrating injuries to the capsule and ligaments of the knee has been investigated. A tomographic method was used in conjunction with arthrography of the knee. The results have shown that, in vitro, injuries of the cruciate and lateral ligaments and of the capsule are well shown by xero-tomography and that it is possible to evaluate their extent. Simultaneous demonstration of injuries to the menisci is less certain. In order to show these accurately, special methods would have to be employed. Despite the higher radiation dose which must be expected, and the greater complexity of this technique, we consider that a clinical investigation of the method is indicated.

[Radiological observations on bone changes in women after bilateral ovariectomy with and without oestrogen prophylaxis (author's transl)]. / Radiologischer Nachweis von Knochenveränderungen bei beidseitig ovariektomierten Frauen mit und ohne Ostrogenoprophylaxe.

A retrospective study was carried out on 69 women who had hysterectomies and bilateral ovariectomies carried out during puberty for non-malignant disease. The effect of oestrogen prophylaxis on bones was studied by various radiological methods (1. Miminal combined cortex thickness in the proximal radius according to Meema; 2. Biconcavity index according to Nordin; 3. Osteoporosis stage in the lumbar spine according to Saville; 4. The Singh index in the proximal femur and 5. Absorption coefficient and relative cortical thickness of the phalanges). It was found the the hormone-treated group (33 cases) showed significantly greater bone density than the control group (36 cases). It is therefore suggested that women undergoing ovariectomy before the menopause, or those with low bone density at the natural menopause, should be treated by long-term oestrogen therapy, provided there are no specific contraindications.

[Morphometric and densitometric assessment of left ventricular function in the digital subtraction angiocardiogram]. / Zur morphometrischen und densitometrischen Beurteilung der Funktion des linken Ventrikels im digitalen Subtraktionsangiokardiogramm.

The paper deals with the early clinical experience, using a new DSA installation with a specially programmed cardiological module. DSA provides very good contrast and special resolution and morphometric estimation of the ejection fraction and regional movement of the left ventricular myocardium derived from DSA. This is as good as the results of the left cardiogram. The significant advantage of DSA ist the ability to make a rapid and simple diagnosis. In addition, it is possible with densitometric methods to calculate ventricular volume curves and to provide phasic indications of the amplitude to contraction of the left ventricle. These investigations have so far proved valuable and provide new scope for the radiological evaluation of left ventricular function.

[Digital video subtraction angiography of the abdominal aorta, the pelvic and leg arteries]. / Digitale Videosubtraktionsangiographie (DVSA) der Bauchaorta, der Becken- und Beinarterien.

The arterial system can be demonstrated after intravenous contrast injection by means of DVSA. The abdominal aorta, pelvic and lower limb arteries were examined in this way in 152 patients. Occlusions, stenoses and areas of dilatation could be recognised. In 8% of the patients the aortic bifurcation or common iliac arteries were not adequately visualised. In other respects, the results of DVSA were comparable with conventional arteriography. Because of limited image size, DVSA is particularly indicated where the vascular changes can be localised accurately by clinical means. The method is well suited for observing the results of surgery or percutaneous angioplasty. The indications for arteriography have been reduced as a result of DVSA.

[The value of radiographic examinations of the thorax in acute myocardial infarction (author's transl)]. / Zum Stellenwert der Röntgenaufnahme der Thoraxorgane bei akutem Myokardinfarkt.

The degree of pulmonary congestion seen on chest radiographs taken in the intensive care unit was compared with the end-diastolic pulmonary artery pressure in 65 patients with recent transmural myocardial infarcts without cardiogenic shock. There was good correlation between the radiographic appearances and the end-diatrolic pulmonary artery pressure, so that the severity of left heart insufficiency could be diagnosed radiologically at an early stage. Errors were due to the time interval which must pass before the radiographic appearances approximate the haemodynamic changes. This resulted in a diagnostic "phase lag" (following a rise in end-diastolic pulmonary artery pressure) or in a post-therapeutic "phase lag" (after a fall in end-diastolic pulmonary artery pressure). Repeated examinations allow one to recognize changes in the haemodynamics. One should pay particular attention to the features of pulmonary venous and pulmonary arterial hy