[Medically indicated termination of pregnancy in giant uterine myoma and mono-amniotic twin pregnancy: a case report]. / Medizinisch indizierter Schwangerschaftsabbruch bei riesigem Uterus myomatosus und monoamnioter Zwillingsschwangerschaft: eine Fallvorstellung.

We report the rare combination of a monoamniotic twin pregnancy with giant uterine leiomyomas in a 33-year-old para 0, gravida 1. Considering the restricted capacity of uterine expansion during pregnancy and the known complications associated with myomas, as well as the elevated morbidity and mortality of monoamniotic twin pregnancies, we opted for a medically indicated abortion at 12 weeks' gestation. After abortion the patient developed fever and abdominal pain. In differential diagnosis we considered endomyometritis and necrosis of the myomas. Despite adequate conservative treatment the symptoms persisted and myomectomy was performed in view of the patient's desire to maintain fertility.

[Bouveret syndrome--a rare gallstone complication]. / Das Bouveret-Syndrom--eine seltene Gallensteinkomplikation.

A 62 year old woman presented with the symptoms of a gastric outlet obstruction together with severe metabolic hypochloremic alcalosis. A gallstone in the duodenum with gastric outlet obstruction was diagnosed by abdominal ultrasonography. In a one-stage surgical procedure, cholecystectomy, enterolithotomy and repair of the cholecytoduodenal fistula were performed. The postoperative course was uneventful. Pathogenesis, clinical findings, diagnostic procedures and therapeutic options of gastric outlet obstruction secondary to a gallstone impacted in the duodenal bulb (Bouveret's Syndrome) are discussed.

[Imaging of abdominal hernias by herniography. Imaging technique, results and tolerance in 67 patients]. / Die Darstellung abdominaler Hernien durch die Herniographie. Untersuchungstechnik, Resultate und Verträglichkeit bei 67 Patienten.

PURPOSE: Role of herniography in patients with unexplained pain and/or clinically doubtful hernia of the abdominal wall, especially after previous operation (for hernia). Patient tolerance and side effects of herniography. MATERIAL AND METHODS: After puncture of the linea alba caudal of the umbilicus water soluble low osmolar contrast medium is injected into the peritoneal cavity. 8 radiographs of the inguinal region are taken. In order to visualize umbilical and cicatricial hernias tangential projections of the anterior abdominal wall are taken in ventral decubitus. In 67 Patients herniography was performed with the following indications: groin pain in 47, groin swelling or anterior abdominal wall swelling in 7, pain in the groin combined with swelling or other indications in 6, other indications in 12. 20 Patients had previously been operated for an inguinal hernia. In order to evaluate possible side effects 57 patients filled out a questionnaire. RESULTS: 66 herniographies were performed successfully. In 31 Patients a total of 51 hernias was found: 18 indirect, 21 direct inguinal hernias, 1 femoral hernia, 4 umbilical hernias, 1 epigastric and 6 incisional hernias. In the group with recurrent hernias, direct inguinal hernias predominated. Subsequently 12 patients were operated. In 11 cases the presence and type of the radiologically diagnosed hernias was confirmed. 1 Patient had a false negative result. No serious side effects were noted. 9 Patients had slight abdominal discomfort during or shortly after the examination. One patient with a persistent open tunica vaginalis testis experienced painless scrotal swelling. CONCLUSION: Hernias of the abdominal wall can be well demonstrated and classified by herniography with little side effects.

[Use of ultrasound, ultrasound-directed fine needle puncture and aspiration in amebic abscess of the liver. Case report and short overview]. / Einsatz von Ultraschall, ultraschallgezielter Feinnadelpunktion und -aspiration bei Amöbenabszess der Leber.

Case report on a 48-year-old Swiss male living in Burundi who suddenly fell ill with vomiting and anorexia, followed by pappy stools, weakness and impotence. He presented with hepatomegaly, while sedimentation rate and alkaline phosphatase were both elevated. Stool examination revealed cysts and vegetative forms of Entamoeba histolytica, while amebic serology was negative. Treatment with ornidazole and later with diloxanide furoate was given. Sonography showed two cystoid areas in the right lobe of the liver. In the third sonographically guided fine-needle puncture both lesions were fully aspirated. Amebic serological tests were now positive for the first time. Six weeks later the sonogram showed a normal liver feature. The symptomatology and diagnosis of hepatic amebic abscess are discussed, with special reference to the important role of sonographically guided fine-needle puncture and drainage. Sonographic technique and differential diagnosis are briefly demonstrated.

[Enteroclysis: improved and simplified contract media imaging of the small intestine]. / Die Enteroklyse: verbesserte und vereinfachte Kontrastmitteldarstellung des Dünndarms.

Enteroclysis as a routine procedure is a major advance in the field of radiological small bowed examination. Its most important features are the duodenal infusion of a barium contrast fluid of low specific gravity (less than 1,32), good preparation of the patient and demonstration of all loops in various phases of contraction.

Role of computed tomography in the diagnosis and radiotherapy planning of recurrent rectal carcinoma.

The incidence of local recurrences after surgical treatment forms one of the main problems in the treatment of rectal carcinoma. Computer tomography is of great help in these cases not only for diagnosis, but also in radiotherapy planning procedures. Diagnostic and radiotherapeutic aspects will be discussed.

The bedside determination of extravascular lung water: a non-invasive double indicator technique using 123I-antipyrine, 113mIn-transferrin and external counting.

Using the formulae of Fazio and coworkers, we calculated the extravascular lung water per unit of blood volume (ELW/V) and per unit of blood flow (ELW/F) after intravenous injection of 113In-transferrin as the blood label, and 123I-antipyrine as the diffusible, i.e. water label. Time-activity curves were recorded over the right anterior upper chest wall using a mobile detector. The curves were digitalized and fitted to a gamma-variate using a GAMMA-11 computer. Area over height calculations gave the mean transit times (t). Sixteen control subjects, without evidence of cardiac or pulmonary disease, and 10 patients, with clinical and radiological evidence of left heart failure, were examined. In the control group ELW/V was 0.37 plus or minus 0.17 and ELW/F 3.39 plus or minus 1.56 (mean plus or minus 1 SD). In the patients ELW/V was 0.71 plus or minus 0.26 and ELW/F 13.10 plus or minus 5.67. The difference between both ELW/V and ELW/F for the control group and the patient group is statistically significant. Our values for ELW/V both in patients and control subjects are very similar to those obtained by Fazio and coworkers using H2 15O. However, our values for ELW/F differed from those of Fazio; this could be partly due to dependence of this parameter on the cardiac output.

Effect of pyloroplasty on gastric emptying: long term results as obtained with a labelled test meal 14-43 months after operation.

The mean gastric transit time (t) and the half-time of gastric emptying (t/2) of a labelled test meal have been studied in 18 patients more than 1 year after gastric surgery for peptic ulcer and compared with those in 18 healthy controls. Of the patients, 6 had undergone proximal gastric vagotomy alone (PGV), L had had proximal gastric vagotomy and pyloroplasty (PGVP) and in 6 truncal vagotomy and pyloroplasty (TVP) had been performed. The t and t/2 of patients with PGV alone did not differ significantly from the values of the control group. The t and t/2 in patients after PGVP and TVP, however, were significantly lower than in both controls and patients after PGV alone. There was no statistically significant difference between the groups with PGVP and TVP. The results of this study suggest that the lasting effects of vagotomy operations on gastric emptying are due to the drainage procedure rather than the vagotomy.

[Aneurysm of the abdominal aorta. Diagnostic, prognostic, and the therapeutic knowledge after review of cases and the literature]. / Das abdominelle Aortenaneurysma. Diagnostische, prognostische und therapeutische Erkenntnisse nach Durchsicht der eigenen Fälle und der Literatur

Report on 80 patients with aneurysm of the abdominal aorta seen in this clinic during the period January 1968 to December 1974. They are divided into three groups, viz. asymptomatic, symptomatic and ruptured. The indication for and urgency of surgery are discussed and the results in 62 surgical cases are compared with those in 18 where surgery was not performed. The difficulties encountered in the diagnosis of ruptured aneurysm of the abdominal aorta are outlined. Only in these cases can the prognosis still be decisively improved by early recognition and immediate treatment.

[Radiologic diagnosis of abdominal aortic aneurysm. Value of abdominal radiography, ultrasonic tomography and abdominal aortography]. / Die radiologische Abklärung beim abdominalen Aortenaneurysma. Wertigkeit der Abomenübersichtsaufnahme, Ultraschalltomographie und abdominalen Aortographie

Radiological diagnosis of arteriosclerotic abdominal aortic aneurysm is discussed. This review is based on the evaluation of 70 abdominal plain films and 58 aortograms. In addition, 11 aneurysms have been examined by ultrasound tomography (grey-scale technique). In 15% of patients referred with suspicion of aneurysm, the diagnosis could not be confirmed radiologically or operatively. The diagnosis of abdominal aortic aneurysm can be established in 80% of patients on the basis of the abdominal plain films. Ultrasonography gives better results as a screening method, since it renders a definite diagnosis possible in about 98% of cases and unnecessary arteriography can thus be avoided. However, preoperative abdominal aortography remains indispensable for demonstration of the exact anatomic details and pathologic changes in the large abdominal and pelvic arteries. The risk involved in this examination are minimal. Suprarenal or combined supra- and infrarenal aneurysm were found in 9% (5 patients), and renal artery stenosis or obstruction in 12% (7 cases). Obstruction or stenosis of the celiac artery and the superior mesenteric artery were present in only 2 patients with suprarenal expansion of the aneurysm. The angiographic-anatomic correlation is excellent, and only very infrequently is it impossible to determine exactly the distal extent of the aneurysm (2 patients).