[Quantitative ultrasound (ultrasonometry) in the diagnosis of osteoporosis. State of the art]. / Quantitativer Ultraschall (Osteosonometrie) in der Osteoporosediagnostik. Wo stehen wir heute?

The importance of ultrasound-based measuring methods in the diagnosis of osteoporosis has increased during the last few years. Measuring speed of sound (SOS) and broadband ultrasound attenuation (BUA) also allows assessment of density and elasticity of bone. Values measured show significant age dependence and correlate well with osteoporotic bone deterioration. The various ultrasound methods are quite equal and allow an adequate prediction of fracture risk comparable to the radiologic dual energy X-ray absorptiometry (DEXA) method. At present, standardization of cutoff points and criteria to determine osteoporosis among the different devices is unsatisfactory. The suitability of the method for a general screening is growing.

[The value of shockwave therapy in treatment of humero-radial epicondylitis]. / Zum Stellenwert der Stosswellentherapie in der Behandlung der Epicondylopathia radialis humeri.

Numerous therapies exist for the treatment of radial Epicondylitis. A new treatment, Extracorporal Shock-Wave Therapy (ESWT) has recently been proposed. Based on a review of the medical literature various mechanisms of action are presented. Except for the treatment of conditions of the urinary system, ESWT is controversial. Scientific proof of enhanced efficacy of ESWT compared to other treatments of radial Epicondylitis is still lacking. Prospective, randomized follow-up studies of large patient populations under standardized technical conditions are needed. Based on current knowledge, ESWT of radial Epicondylitis should only be applied if three conditions are fulfilled: 1) the diagnosis of radial Epicondylitis has been ascertained, 2) conservative therapies for at least one year failed, and 3) the only alternative is surgery.

[Ultrasound study of the shoulder]. / Die sonographische Untersuchung der Schulter.

The sonographic examination of the shoulder joint is nowadays a matter of the daily routine. A standardized way of examination permits to evaluate all sonographic visible regions of the shoulder joint statically and dynamically as well. Pathologic findings in the shape of the humeral head, the joint (except of the joint pan and parts of the labrum), the rotator cuff, the long biceps tendon, the bursa subacromialis and the acromio-clavicular joint can be seen and assessed. A qualified examinator with excellent knowledge of the anatomy and the current diseases and injuries, and an adequate apparative condition as well, is of eminent importance. In comparison with MRI the advantage of the sonography is a higher resolution, the possibility of dynamic examination and an easy comparison with the opposite side. Availability is better and the price is lower. A disadvantage is the impossibility to judge the subacromial space and parts of the glenoid rim. Furthermore the skill of the sonographer limits the evidence of the examination. Sonographic examination should belong, together with the conventional x-ray to the first imaging procedures in shoulder diagnostics.

[When is laryngectomy indicated in hypopharyngeal carcinoma?]. / Wann ist die Laryngektomie beim Hypopharynxkarzinom indiziert?

INTRODUCTION: We studied the histories of 121 patients with hypopharyngeal carcinoma treated at our clinic from 1990-1998. From 1990-1993 all patients with curable hypopharyngeal carcinoma were treated by surgery. Radiotherapy was used for those in whom surgery was impossible or who refused laryngectomy. In 1994 we changed our therapy and only patients in whom the voice could be preserved were treated surgically. All others received radiotherapy as primary treatment. The goal of this study was to ascertain whether and how this shift in therapy was influenced by T and N stage. METHODS: From 1990-1993, 57 patients with hypopharyngeal carcinoma were registered at our clinic. Surgery was performed in 32, 16 received radiotherapy and 9 only palliative treatment. During this time there was no difference in diseased specific survival between the radiotherapy and surgical groups. Therapy was therefore changed in 1994 to preserve voice function. From 1994-1998, 64 patients were diagnosed. Only 10 were treated surgically. 40 received radiotherapy and 14 no curative therapy. Age, N and T stage were comparable in both groups. To show differences we performed Kaplan Meier survival rates for both groups and for the N and T stage of patients undergoing surgery or radiotherapy respectively. RESULTS: 3-year survival was 68% in patients treated from 1990-1993 and 38% from 1994-1998. The difference was statistically significant (p-value 0.02). Survival for nodal stages 0 and 1 was much better in patients undergoing surgery than those receiving radiotherapy. Multivariant analysis was highly significant. T-category showed no tendency for either treatment modality. DISCUSSION: After a switch in the treatment of hypopharyngeal carcinoma in 1994 there was a significant change in survival. For patients with nodal stage 0 and 1 surgery brought much better survival. We conclude that surgery should be the primary treatment for all patients in these small nodal stages, even if total laryngectomy is necessary.