Gastroduodenal metastases--an unusual initial manifestation of bronchogenic carcinoma.

A 75-year-old woman with multiple polypoid lesions in the gastroduodenum , and one large gastric ulceration all representing large-cell type carcinoma is described. Radiologic and fiberbronchoscopic , together with other clinical findings suggested bronchogenic carcinoma as the primary tumor. Metastatic gastric involvement is an uncommon feature of primary bronchogenic carcinoma, rarely attaining clinical significance. In our patient, gastric symptoms represented the initial clinical manifestation of hitherto undetected bronchogenic cancer disease.

[Radiation therapy of endocrine orbitopathy. 1st communication: clinical results (author's transl)]. / Zur Strahlentherapie der endokrinen Orbitopathie. 1. Mitteilung: Klinische Ergebnisse.

Ten patients with serious endocrine orbitopathy underwent radiation therapy of the retrobulbar orbital tissue. Between the 2nd and the 13th week preceding radiotherapy, exacerbation of the clinical symptoms had appeared in all the patients, and distinct symptoms of infiltrative tissular processes were seen beside bulbar protrusion. Of the cases, 5 suffered from marked extra-ocular myopathy, 6 from corneal lesions, and one patient had lost his visual faculty. Index numbers for the degree of the orbitopathy (4-11, average 6.7) were established in all cases, and a total focal dose amounting to maximally 1000 cGy for each retrobulbar target volume was administered in one series. The pituitary gland was not included in the radiation field. Indices for the degree of ophthalmopathy were reduced by at least 3 points (average 3.7). Swelling of soft tissue and bulbar protrusion were decreased primarily. No improvement of myopathy was obtained but aggravation also did not occur. Recurrences appeared in 4 patients, at the earliest 4 months, at the latest 24 months after the end of the therapy. The present findings have shown orbital irradiation as an effective method for the treatment of endocrine orbitopathy.

[The value of computer tomography and sonography in the investigation of the pancreas (author's transl)]. / Wertigkeit der Computertomographie und der Sonographie innerhalb der Pankreasdiagnostik.

Three hundred and five patients were examined by computer tomography and sonography. In 117 patients no abnormalities were found in the pancreas. The accuracy of computer tomography was 87%, of sonography 85%. In 41 patients the presence of a carcinoma of the pancreas was confirmed histologically. In this group the sensitivity of computer tomography was 83%, of sonography 85%. Thirty-four patients suffered from acute pancreatitis. In this group sensitivity of the two methods was equal at 79%. 113 patients had changes of chronic pancreatitis. Sensitivity of computer tomography was 84%, of sonography 70%. Computer tomography is better at demonstrating calcification in the pancreas. Atrophy of the pancreas cannot be diagnosed by sonography.

[Computer-assisted irradiation planning by means of computed tomography (author's transl)]. / Rechnergestützte Bestrahlungsplanung mit Hilfe des Computertomographen.

Operation of the computer tomograph combined with a computer for irradiation planning leads to an optimization of radiotherapeutic efforts. By means of a careful carrying-over of computed tomographic data into the computing system the demanded homogeneous dose distribution with a deviation rate of +/- 10% may be accomplished to a large extent for any given target volume. At the same time this method achieves an optimal sparing of the sound or else critical organs. An evaluation unit independent of the diagnostics ought to be available, as this renders possible the adaptation of the CT cross-sections of interest under individual aspects.

[Fertility in patients with testicular seminoma (author's transl)]. / Fertilität bei Patienten mit Seminom des Hodens.

In view of the excellent prognosis and the desire for children frequently expressed after post-operative healing, fertility studies were performed in 234 patients with seminoma of the tests. There already was a reduced sperm count before therapy in 39 out of 46 patients. The damage to spermatogenesis induced by radiotherapy can lead to azoospermia, cryptozoospermia and severe oligozoospermia in the first two years. The different irradiation techniques with the resulting burden on the residual testis are described. By appropriate irradiation adapted to the stage of the disease as well as by application of a testis guard, the damage to the residual testis can be reduced to the extent that restitution can be expected after two years. Four fathers produced healthy children within three to five years after the end of treatment.

[Percutaneous puncture of renal cysts for diagnostic and therapeutic purposes (author's transl)]. / Perkutane Punktion zystischer Raumforderungen der Niere zur Diagnostik und Therapie.

Percutaneous needle puncture of space-occupying lesions is an innocuous procedure in the differential diagnosis of renal masses. In conjunction with intravenous urography, ultrasonography and CT-scan it is a method of considerable diagnostic value, which will lead to a nearly complete accurate diagnosis. In this study we will report our experiences with diagnostic and therapeutic puncture of renal cysts. The instillation of Lipiodol has been given up, since a follow-up study became impossible due to radiological problems. The diagnostic procedure to differentiate expanding lesions of the kidney and the technique of percutaneous needle puncture are described as well as indications for surgical exploration.

[Hematologic toxicity of total body irradiation (author's transl)]. / Zur hämatologischen Toxizität der Ganzkörperbestrahlung.

Eleven patients with malignant lymphoma were treated with total body irradiation. This therapy was performed during 3 weeks with a midline dose of 70 to 100 rd. Two patients were treated two times after an internal of 3 months. The authors studied the hematologic side effects of this therapy. The irradiation caused a diminution of leucocytes of 73% of the initial value (range 16,7 to 98,4%), the neutrophilic granulocytes were reduced by 60% (24-95%), the thrombocytes were reduced by 57% (12-73%). The lowest values were seen during the fourth and sixth week of observation or one to three weeks after the end of therapy. In patients with hypoplastic anemia the number of reticulocytes was reduced to zero with a further fall of hematocrit and replacement therapy was necessary. The pool of circulating CFUc was reduced to zero in nine of twelve observations up to six weeks after therapy.

[The diagnosis of hydatid disease of the liver by ultrasound (author's transl)]. / Sonographische Diagnostik der Leberechinokokkose.

Demonstration and localisation of hydatid disease in the liver by ultrasound was successful in 41 patients (35 with cystic and 6 with alveolar disease). In cystic hydatid disease the demonstration of a cyst which contains a daughter cyst (5 of 35 cases), as well as a cystic conglomerate enclosed in a smooth capsule (17 of 35 cases), is typical for the disease. In 22 patients ultrasound alone provided the correct diagnosis. In the alveolar form the ultrasound findings were not typical for the parasite and could not be differentiated from solid or necrotising malignant tumour of the liver. The ultrasound method is thus of great value in the diagnosis of cystic hydatid disease, but if the findings are unclear--especially if the alveolar type of disease is suspected--further studies of the disease, in particular angiography, must be undertaken.

[Haemophilic pseudo-tumours and iliac haematomas: radiological and clinical findings (author's transl)]. / Hämophiler Pseudotumor und Iliacushämatom; radiologische und klinische Befunde.

Between 1971 and 1977, 648 patients with haemophilia were seen; of these 38 had pseudo-tumours and 163 iliac haematomas. Amongst the latter 153 were cured by the administration of the appropriate factor. In ten the symptoms persisted. In the early stages the diagnosis cannot be made radiologically. Large haematomas produce indirect evidence of their presence by displacing the bladder. Particularly with small haematomas, computer tomography has proved a reliable and accurate diagnostic measure. Without treatment, a haemophilic pseudo-tumour may develop. Its radiological differential diagnosis includes malignant and benign bone tumours, inflammatory and parasitic disease. Therapy includes conservative measures (factor concentrates) or operative intervention (removal of the haematoma).

[Computer tomographic demonstration of an intramuscular haematoma in haemophilia (author's transl)]. / Computertomographischer Nachweis von Muskelhämatomen bei Hämophilie.

Anatomical localisation of intramuscular haematomas can be achieved more accurately by computer tomography than by clinical examination in conjunction with conventional radiography. Computer tomography is able to demonstrate fresh haematomas before they become diagnosable clinically, and before secondary changes, such as calcification or bone erosions, make them visible on conventional radiographs. In this way the diagnosis is made more certain and the choice between conservative or surgical treatment is simplified. Ther period of treatment with clotting factors can, in some cases, be shortened as a result of serial examinations by computer tomography.

[Complications due to migration of a Kirschner wire from the clavicle (author's transl)]. / Komplikationen durch Drahtwanderungen nach Kirschnerdraht-Spickungen an der Klavikula.

The complications due to migration of a Kirschner wire from the clavicle are described. The major complication of a vascular and pulmonary kind were found in five cases. Migration of the wire into major vessels (aorta, subclavian artery) were seen twice and in three cases, the wire entered the lung. Removal of the wire from the aorta had a fatal result. Before removing displaced fixation wires, accurate localisation is necessary, if necessary using angiography in order to plan the subsequent operation. To avoid migration of the wire, one end should be bent to form a walking-stick shape, and the arm should be immobilised.

[A comparison of intravenous and infusion cholangiography with intraoperative and tomocholangiography (author's transl)]. / Vergleich der Wertigkeit von intravenösem bzw. Infusionscholangiogramm sowie intraoperativem und Tomocholangiogramm.

Seventy-four patients are described who were examined by various cholangiographic methods. 1. In the diagnosis of stenosis of the papilla, intraoperative cholangiography was found to be the most reliable. Intravenous and infusion cholangiography were of equal value and provided less information than the intra-operative examination. 2. For stones, intravenous and infusion cholangiography is significantly better than the intro-operative cholangiogram. Tomography provides no additional information. 3. For stones in the papilla, the intra-operative method is best and is superior to intravenous and infusion cholangiography. Pre-operative tomography resulted in a loss of information.

Experiences with the echo midliner in children.

Three hundred eighty-five children were examined with the Midliner echoencephalography unit. In examinations termed adequate, correct interpretations were made in 94.6% of healthy children versus 78% ill children. The incidence of adequate examinations increases with the child's age, but 58% of children with hydrocephalus had inadequate examinations, regardless of age. For the measurement of the infantile ventricle system the midliner is not appropriate.