Digital subtraction sialography.

Digital subtraction sialography seems to provide a better display of glandular anatomy and pathological changes of parotid and submandibular gland. Further comparative studies are however necessary to better evaluate this simple and fast procedure.

Computed tomography of pharyngo-laryngeal carcinoma.

CT scans of 36 carcinomas of the laryngo-pharyngeal region were analysed retrospectively and the results compared with the endoscopic and operative findings. For the final tumour staging in 18 cases of carcinoma of the larynx equivalent results were obtained in 12 cases; CT scan offered a better evaluation in two cases and insufficient dates in four. Destruction of cartilagineous structures, submucosal tumour infiltration and the pre-epiglottic space are better shown on CT scans. Faulty evaluation of tumour presence of extent are due to superficial tumour growth or to motion artefacts. For the final staging of 18 carcinomas of the pharynx results of CT and clinical findings were comparable in nine cases. CT was less precise in five and superior to endoscopy in four. Evaluation of neoplastic infiltration of the parapharyngeal soft-tissue and of the skull base was the main advantage of CT scanning. Low grade tumours of the oro- and hypopharynx were not visible on CT and tumours of the base of the tongue were insufficiently displayed.

Biliary drainage by teflon endoprosthesis in obstructive jaundice--experiences in 69 patients treated by PTCD or ERCD.

In 69 patients with extrahepatic biliary obstruction a specially designed teflon tube, the endoprosthesis, was inserted across the ductal stenosis either by percutaneous or by endoscopic route to reduce jaundice. After gaining experience our success rate of stent placement was more than 90%. Compared with catheter drainage the endoprosthesis worked faster and more efficiently, while in palliative treatment the quality of life of the patient improved and secondary cholangitis was prevented. The rate of significant long-term stent obstruction can be tolerated in view of the expected life span of four months as average in our material.

[Endobronchial brush biopsy]. / Die endobronchiale Bürstenbiopsie

Bronchial brushing under fluoroscopy control is used in the diagnosis of pulmonary lesions which are beyond reach of the bronchoscope. A small nylon or steel brush is passed through a bronchial catheter and tissue material from the lesion is taken for cytologic and bacteriologic studies. The technique described is easy to learn, relatively safe, is well tolerated by patients and gives good diagnostic results.

[Dacryocystography. 2. Results of 125 studies]. / Die Dacryocystographie. 2. Mitteilung: Ergebnisse von 125 Untersuchungen

Results and X-ray findings of 125 dacryocystographies are discussed. Type II obstruction is the commonest pathological finding, Type I is caused often by a trauma. DCG gives a good morphological picture of tear drainage system and represents a very important method for planning surgical therapy.

[Algorithms in the radiological diagnosis of malignant disease (author's transl)]. / Algorithmen in der röntgenologischen Malignomdiagnostik.

Algorithms in the diagnosis of malignant disease have the aim to produce a diagnosis as quickly, as certainly and as simply as possible. The first phase consists of general non-invasive methods which should be as simple as possible. If the results are positive this should be followed immediately by percutaneous biopsy in order to produce cytological confirmation of the diagnosis as quickly as possible. If the original investigations were negative, those special methods of investigation should be used which are most likely to make a diagnosis. This is followed by investigations which throw light on the most appropriate form of treatment. This scheme has been illustrated by special algorithms for carcinoma of the bronchus, the pancreas and the breast.

[Dacrocystography. Paper I: A simplified catheter technique (author's transl)]. / Die Dacryocystographie. I. Mitteilung: Vereinfachung der Untersuchung durch die Kathetertechnik

By using a PE-catheter for catheterising the tear ducts, dacrocystography becomes a simple and rapid investigation. It permits excellent morphological demonstration of pathological changes, since films can be obtained under screening control. A water-soluble, low viscosity contrast medium is recommended. Amongst more than 100 dacrocystograms, there were no serious complications.

[Computer tomographic appearances of intra-abdominal abscesses (author's transl)]. / Röntgensymptomatik intraabdomineller Abszesse im Computertomogramm.

CT diagnosis of intraabdominal abscess was confirmed in 18 patients by laparatomy and in two by autopsy. In CT abscess is characterized by an expansive soft-tissue lesion with different density values, mostly with a central fluid collection and a thickened wall. The peripheral inflammatory reaction leads to obliteration of fat planes surrounding the adjacent organs. Further symptoms are contrast enhancement of the wall and extraluminal gas collection. The combination of all these signs together with a suitable history and clinical findings allow a reliable diagnosis of abscess formation. When only isolated signs are found, differentiation from tumor, pseudocyst or hematoma may be difficult.

[To the differential diagnosis of bronchiolo-alveolar-cell carcinoma in early state (author's transl)]. / Zur Differentialdiagnose des Bronchiolo-Alveolarzell-Karzinoms im Frühstadium

Prompt surgical treatment of the solitary form of bronchiolo-alveolar-cell carcinoma offers a good survival rate in comparison with bronchogenic carcinoma; the prognosis of the diffuse form is poor. Review of 28 cases of solitary BAC showed an airbronchogram in 36% and a tail sign in 85% of cases; both features were found in 32% of tumors. The air bronchogram seems to be specific for this type of tumours, the tail sign is found with granulomatous or inflammatory diseases as well. In the differential diagnosis of a peripheral coin lesion with air bronchogramm and tail sign, without calcifications and atelectasis, a BAC should be taken into serious consideration.

[Value and possibilities for the improvement of hysterosalpingography]. / Stellenwert und Optimierungsmöglichkeiten der Hysterosalpingographie.

The diagnostic results of hysterosalpingography and laparoscopy were compared (30 patients). Agreement between the methods was found in 73%. In 17% of the women, findings seen on hysterosalpingography, could not be confirmed at laparoscopy. Conversely, in 10% of negative hysterosalpingograms, adhesions were found at laparoscopy. Possible causes for these differences are discussed. At present three different methods are used for hysterosalpingography. Compared with a metal cannula or a Foley catheter, the use of a baby's feeding tube resulted in a reduction of tubal spasm. A reduction in screening time and consequent decrease in gonadal radiation is possible without loss of diagnostic information.

[Ambulant transbrachial 4-French arteriography with particular reference to the aortofemoral vascular system]. / Ambulante transbrachiale 4-French-Arteriographie unter besonderer Berücksichtigung der aortofemoralen Strombahn.

Arteriograms were carried out on 176 patients using 4-F catheters through a transbrachial approach. Criteria for exclusion from the series were injuries to the upper limb, hemiparesis or poor pulses in the presence of a normal femoral pulse. There were no local vascular complications requiring treatment. On two occasions the brachial artery could not be punctured. Acute posterior cerebral infarction was the only serious complication (0.5%). 67% of the patients were examined on an outpatient basis and this did not appear to increase the risk of complication. We regard this as a suitable method for demonstrating the pelvic and lower limb arteries on ambulant patients.

[The mucoid impaction and the "mucous bronchogram" (author's transl)]. / Die mucoid impaction und das "Schleimbronchogramm".

Intrabronchial retention of large plugs of inspissated mucous in cases of disturbed bronchial secretion and impaired clearing mechanism leads often to chronic inflammation and to formation of "proximal" bronchiectasis. Mucoid impaction may occur in many bronchial diseases and is radiologically characterized by the so-called "mucous bronchogram".

[Computer tomographic findings in pelvic and abdominal trauma (author's transl)]. / Computertomographische Symptomatologie des Becken- und Bauchtraumas.

Twenty-two patients with trauma to the pelvis and abdomen were examined by computer tomography. Subcapsular haematomas, haematomas and rupture of organs, intra- and retroperitoneal haematomas and pelvic fractures could be reliably diagnosed in this way. Serial observations on the tissue density of an haematoma allows one to judge its age. Lack of contrast enhancement of an haematoma makes the injection of contrast a useful test. Computer tomography has reduced the indications for angiography in blunt abdominal trauma.

[Extramedullary haematopoiesis as a cause of a paravertebral mass in the thorax (author's transl)]. / Extramedulläre Hämatopoese als Ursache paravertebraler Tumorbildungen im Thorax.

The radiological due to extensive extramedullary haematopoiesis taking place in the posterior mediastinum in two patients are described, and the literature is reviewed. Characteristic features are a polycyclic or spindle-shaped configuration of the mass, with bilateral paravertebral localisation in the caudal and middle third of the thorax. There is absence of inflammatory or neoplastic changes in the neighbouring skeleton, but in thalassaemia there may be changes in the paravertebral portion of the ribs. Computer tomographically, the combination of a solid paravertebral tumour, with adjacent rib changes, is characteristic of thalassaemia with extramedullary haematopoiesis. In the absence of other skeletal changes, computed tomography is valuable for differential diagnosis. Lymphomas occur considerably more often and may appear identical but, because of the well know fat content of myolipoma, the scan shows contrast values between -15 and + 40 HU. Because of their high vascularity, there is a marked increase in density following intravenous contrast medium.

[The preoperative marking of nonpalpable breast lesions: the technic and results]. / Präoperative Markierung nicht-palpabler Mammaläsionen: Technik und Ergebnisse.

189 non-palpable breast lesions in 182 patients were localized using conventional mammographic apparatus, a wire grid compression plate and a cannula with a hooked mandrin. The technique of the examination for defining the lesion in three planes and fixation of the lesion with the wire is described. In 173 instances (91.5%), the lesion was found at the first biopsy and subsequent biopsies were necessary on only 24 occasions. One lesion (0.5%) was missed completely. 47 carcinomas were found (24.9%) and the incidence of malignancy increased from 14.3% to 33.3% during the series. The mean ratio defining the size of the biopsy and the size of the lesion was 3.3 and indicates good preservation of breast tissue. Radiographs of the specimen taken with compression showed 186 lesions (98.4%). The method, which is comfortable for the patient, provides satisfactory detection and localization of the lesions; results are similar to those of stereotactic methods but this method is quicker and much less expensive.

[CT for staging of systemic lymphatic diseases (author's transl)]. / Die Bedeutung der CT für die Stadieneinteilung lymphatischer Systemerkrankungen.

In 75 patients with lymphoma (46 Hodgkin's disease, 29 non-Hodgkin lymphomas) computed tomography was performed in order to detect neoplastic invasion of the abdominal organs (55 new cases) or to control the results of treatment (20 cases). In 30 cases enlarged retroperitoneal or mesenteric lymphnodes and/or liver or spleen enlargement were found. Neoplastic involvement of lymphnodes without enlargement was missed in two cases. CT failed also to demonstrate microscopic malignant invasion of liver and spleen. The false-negative rate in our series was 10.9%. Computed tomography is a non-invasive method which is very well suited for staging malignant lymphoma.

[X-ray transparency of common orthopedic casts]. / Die Röntgenstrahlentransparenz gebräuchlicher stabiler Stützverbände.

X-ray permeability is one of the important criterions which qualify a material as orthopedic cast. By using a phantom (amputated human lower leg) standardized conditions were created to compare the five customary casts: Cellamin, Lightcase II, Hexcelite, Neofrakt and Baycast. For judging the perceptibility of osseous structures, especially the details of the fracture, the lower and the upper number of clinically used layers were considered. The blank tested valuation showed the well-known advantages of the plastic materials in comparison with plaster of Paris. Within the group of the plastic materials distinct differences were also found.

[Effects of stereotaxic puncture biopsy on breast diagnosis in a general hospital]. / Auswirkungen der stereotaktischen Stanzbiopsie auf die Mammadiagnostik an einem Versorgungskrankenhaus.

PURPOSE: To inform about the experiences by introducing this method, concerning feasibility, indication, procedure, histologic analysis, changes in admission of patients, consequences for the diagnostic work-up of breast lesions. MATERIAL AND METHODS: In 80 patients, 84 lesions were biopsied. The patients were chosen according to the "Breast Imaging Reporting A Data System", recommended by the American College of Radiology, with slight modifications. The examinations were performed on a mammographic unit with a special equipment for stereotactic biopsy, using a biopsy gun. RESULTS: Histologic assessment was possible for all the cores provided. 12 of 84 lesions (14.3%) contained carcinoma, 53/84 (63.1%) mastopathic changes, 19/84 (22.6%) other benign findings. The percentage of out-patients was constantly high with 55%, the number of gynecologic in-patients increased slightly from 24 to 27%. The number of open biopsies decreased from 9 to 6 per month with a considerable decrease (30%) of negative biopsies. CONCLUSIONS: Co-operation with the admitting physicians, who are also doing mammography, should set a new course towards stereotactic core breast biopsy already before the patients are admitted to the hospital. An increasing acceptance by the gynecologists doing open biopsies could lead to a further decrease of unnecessary operations. The effect by direct histologic feedback improves the quality of mammographic diagnostic.