[A young patient with multiple arterial occlusions]. / Junge Patientin mit multiplen arteriellen Verschlüssen.

BACKGROUND: Mild hyperhomocysteinemia due to genetic causes and nutrition factors is well known as an independent strong risk factor for premature arterial occlusive disease. CASE REPORT: A 27-year-old female with a history of two episodes of small bowel ileus due to vascular causes presented with subacute pain in the left lower extremity. Angiography revealed a short segmental occlusion in the P III segment of the popliteal artery with small vessel collateralization and proximal occlusion of the superior mesenteric artery und the coeliac trunk. Vascular risk factors in this patient included smoking over a duration of 10 years, use of oral contraceptives (estrogen and gestagen combination) and elevated levels of homocysteine in the fasting state and after methionin loading. The patient was treated conservatively with intravenous application of prostaglandins, additionally she underwent training to improve her walking capability. After 4 weeks of the fasting state as well as after methionin loading were normalized by an oral substitution with folate and B vitamins. So far it was not possible to prove a genetic defect of the enzymes participating in the metabolism of homocysteine. CONCLUSION: This clinical conference of a young female patient with occlusion of several arteries illustrates the differential diagnosis of premature occlusive vascular disease with special regard to mild hyperhomocysteinemia as an independent risk factor.

[Instrumental diagnosis for therapy decision making--what is possible and desirable, what is essential and what is superfluous--in vascular surgery]. / Apparative Diagnostik zur Therapieentscheidung--was ist möglich und wünschenswert, was unverzichtbar und was überflüssig--in der Gefässchirurgie.

It is impossible to give a paper on the whole of vascular surgery, which represents a broad surgical specialty; so we will concentrate on three typical vascular procedures, namely Carotid surgery, abdominal aortic aneurysm, and varicose veins. Ultrasound examinations in carotid artery disease are inevitable because they are screening examinations. CCT or MRT are necessary, but not angiography, particularly in symptomatic patients. In asymptomatic patients, DSA may be of value for forensic documentation; MR angiography is now better, but is still not so evident as conventional DSA. CBF should be carried out in multiple vessel disease. Intraoperatively, quality control can be assured by Doppler or flowmetry; other techniques like DSA, EEG, SEP or transcranial Doppler are not necessary when a temporary shunt is routinely applied. In AAA, sonography and CT (or MRT) are absolutely necessary; angiography may reveal accessory visceral and renal vessels. In treatment of varicose veins, sonography (color-coded) is indispensible; phlebography can reveal more details, but is not absolutely necessary.

[Possibilities of conventional intravenous subtraction angiography]. / Möglichkeiten der konventionellen intravenösen Subtraktionsangiographie (ISA).

Basing on the experiences collected with 127 patients, the pros and cons as well as the indications for intravenous angiography with conventional photographic subtraction technique (ISA) are discussed in comparison with rival procedures. ISA can be performed in every angiography unit without any additional investment, and its possibilities of use are identical with those of the DSA. As a matter of fact, it is a simple and safe method for visualising the renal arteries in the course of intravenous urography in the diagnostic evaluation of hypertension. For the first time, it has become possible to perform transvenous determination of the complete status of the arteries of the pelvis and legs, using a new technical system (simultaneous use of two film changers in the frontal plane--ISA aortoarteriography.

[Very rapid bolus injection as routine method in excretion urography (author's transl)]. / Bolus - Kurzinjektion als Routinemethode bei der Ausscheidungsurographie.

The authors report on a comparative examination of the tolerance and diagnostic value of excretion urography using a standard dose of 50 ml of a 77% solution of the meglumine-sodium salt of ioxythalamic acid (Telebrix 390) at conventional injection speed (60-90 sec.) compared with a very rapid bolus injection (less than 10 sec.) Although the risk of severe side effects is probably the same in both cases, the rate of mild or so-called non-specific side effects is significantly lower with the more rapid type of injection. At the same time, it is possible to improve the diagnostic value with a slightly greater effort (vascular early nephrogram).

[On the technique of examination in ERCP, EPT with stone extraction and PTC from the radiologist's viewpoint (author's transl)]. / Zur Untersuchungstechnik bei ERCP, EPT mit Steinextraktion und PTC aus radiologischer Sicht.

Based on the empirical data of more than 2500 examinations we report on the technique of the endoscopic retrograde cholangio- and pancreaticography (ERCP), the endoscopic papillotomy (EPT) with calculus extraction and also the percutaneus transhepatic cholangiography (PTC) from the radiologic point of view. The essential tasks of the radiologist are the clarifying of the position of the probe, the quick diagnosis and the making of valid x-ray photographs. For this purpose the knowledge about an optimal technique of examination is the prerequisite. By this the experienced radiologist is an important partner of the gastroenterologist. He helps to avoid complications for the patient.