[Acute urogenital status]. / Urogenitale Akutsituationen.

The symptoms of a child indicating a urogenital emergency case are often unspecific. Clinical differentiation from a gastrointestinal disease may be impossible since typical clinical manifestations include vomiting, fever and acute onset of abdominal pain, sometimes with the symptoms of a colic. Efficient diagnostic work up is imperative with regard to these patients since a quick establishment of the correct diagnosis allows timely treatment which in turn may avoid irreversible damage. Clinical evaluation of externally visible changes of the genitals like reddening and swelling of the scrotum helps to limit the differential diagnosis to a certain extent. Congenital urogenital diseases should be diagnosed or assumed by means of routine sonography during pregnancy in order to avoid typical complications of a delayed diagnosis after birth. This article focuses on the description and discussion of an effective use of radiologic techniques in some of the common urogenital emergency cases.

Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings.

PURPOSE: To investigate if magnetic resonance (MR) enteroclysis can be performed routinely and to compare MR enteroclysis findings with those of conventional enteroclysis or surgery. MATERIALS AND METHODS: MR enteroclysis was prospectively performed in 30 patients with symptoms of inflammatory bowel disease or small-bowel obstruction (SBO). A methylcellulose-water solution was used to distend the small bowel. To monitor dynamic changes in the small bowel, a single-shot fast spin-echo T2-weighted sequence was applied. For morphologic assessment, breath-hold T2-weighted fast spin-echo and coronal T1-weighted gradient-recalled-echo MR images were obtained without and with gadolinium enhancement. Image quality and degree of small-bowel distention were graded. MR imaging findings and degree of SBO were compared with findings at conventional enteroclysis (n = 25) or surgery (n = 5). RESULTS: MR enteroclysis was well tolerated and provided adequate image quality and sufficient small-bowel distention. SBO grade based on MR enteroclysis images (n = 10) was identical to that based on conventional enteroclysis images (n = 6) or surgical findings (n = 4). There was exact agreement between MR enteroclysis and retrospective findings in all five patients who underwent surgery, and MR findings were identical to those at enteroclysis in 18 patients, superior in six patients, and inferior in one patient. CONCLUSION: MR enteroclysis can be performed routinely with adequate image quality and sufficient small-bowel distention. The functional information provided by MR enteroclysis is identical to that provided at conventional enteroclysis.

[Ultrasound mammography]. / Mammasonographie.

The development of high resolution technology ultrasound allows not only a simple differentiation between cystic and solid lesions. Palpable tumors and subclinical lesions can be detected and characterized with a high degree of accuracy. The specific sonographic appearances of the most common entities are described. The diagnostic criteria for the differentiation have been developed over many years. There is no single parameter which allows the differentiation of all lesions, and a number of criteria must be considered.

[MR mammography: current status and indications]. / MR-Mammographie: Aktueller Stand und Indikationen.

Several reports in the literature have demonstrated a promising role for MR imaging when used as an adjunct to mammography for the detection and diagnosis of breast cancer. There are many technical factors that must be considered, including dynamic imaging with subtraction, high resolution and fat suppression. Proven indications for MR mammography include patients suspicious of having cancer recurrence after breast conservation treatment and patients suspicious of having breast implant rupture. Potential clinical applications include differentiating benign from malignant lesions, detecting cancer when results of conventional imaging are equivocal, staging newly diagnosed breast cancer, detecting occult cancer in patients presenting with axillary node metastasis, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision. Several investigators have demonstrated that MR imaging can provide extremely high sensitivity for detection of breast cancer. There are pitfalls, however, secondary to false positive and false negative contrast enhancement. Awareness of the strengths and limitations of MR imaging of the breast will facilitate integration of this technique into the work-up of patients with suspicious breast lesions.

[Comparison of the clinical value of 2 frequently used indices of fetal blood flow analysis (pulsatility index PI and resistance index RI)]. / Vergleich der klinischen Wertigkeit zweier zur fetalen Blutflussanalyse häufig verwendeter Indices (Pulsatilitätsindex PI und Resistanceindex RI).

249 blood-flow measurements were carried out with pulsed Doppler-ultrasound in the umbilical arteries and the descending aorta of 188 fetuses. The PI and the RI of the recorded flowpatterns were calculated. In a retrospective study we then calculated the validity of the prediction of a pathological fetal outcome, i.e. a SGA-fetus and/or perinatal morbidity, for both indices. The sensitivity of the PI is 63%, the specificity was 98%, the sensitivity of the RI was 40%, and the specificity 98%. Therefore the sensitivity of the PI is significantly higher than that of the RI (p less than 0.05). In the second, prospective part of the study these results could be verified by means of an equivalent number of measurements to the first group (n = 249) with 178 fetuses. All the jeopardized fetuses with IUGR and perinatal morbidity (n = 13) were detected by an increased PI, but even in this group the sensitivity of the RI was only 54%. The possible reasons for these results are discussed, taking into account the different characteristics of the two indices and the influence of the heart rate on both of them.

[Clinical value of fetal flow measurements with pulsed Doppler ultrasound]. / Die klinische Aussagekraft fetaler Flow-Messungen mittels gepulstem Doppler-Ultraschall.

326 fetal flow-measurements with Doppler ultrasound were carried out in the umbilical arteries and fetal aortas of 236 newborn babies. The pulsatility index and the resistance index were used for the flowprofile analysis. The dystrophy rate and the rate of serious perinatological problems of newborn babies with pathological flow (n = 26) are compared with those of newborn babies with a normal flow. It appears that in the group with pathological flowindices, the dystrophy rate is 7.8 times and the morbidity rate 17 times higher. Most important, however, was the fact that all endangered SGA fetuses were diagnosed with flowmeasurements while SGA fetuses with a normal flow had no perinatological problems at all. Enddiastolic flow reductions, based on an increased placental resistance, are provable relatively early, whereas a beginning centralization of the fetal circulation is only recognizable in a closer temporal connection with the fetal imperilment on account of pathological flowprofiles.

[Ultrasonographic picture of the pylorus in infants]. / Odzwiernik w obrazie ultrasonograficznym u niemowlat.

The assessment of pylorus in the diagnostic procedure of causes of vomiting in infants is very important. The differentiation between organic and functional changes is principal. The survey covers 65 infants aged from 2 weeks to 12 months. In this group there are 14 vomiting neonates, in 6 of them the hypertrophic pyloric stenosis by ultrasound examination was diagnosed and by operation confirmed. Ultrasongraphy in presented children was performed on TOMOSONIC EUB--22 Hitachi (real time) provided with a 3 MHz transducer. The pylorus in children is localized near to the middline in the right epigastrium. In normal pylorus the walls of the canal widen the lumen opens. The diameter of normal pylorus amounts 10 to 15 mm, the thickness of muscular wall about 2 mm. In infants with the hypertrophic pyloric stenosis the three components: the muscle, the wall and the lumen of the canal are exceptionally visualized. The hypertrophied muscle forms a regular cylindrical sleeve around the canal and sometimes the pyloric lumen disappears. The diameter of the pyloric mass amounts about 15 to 30 mm and the thickness of the pyloric wall about 5 to 9 mm. The ultrasound examination let to assess the normal pylorus as well as with great probability to diagnose the hypertrophic pyloric stenosis eliminating also in many cases the conventional x-ray examinations.

[Bursa omentalis hernia through Winslow's foramen]. / Bursa omentalis-Hernie durch das Foramen Winslow

The case of a 61 year old female patient suffering from an incarerated hernia through the foramen of Winslow into the lesser sac is discussed. The hernia contained the terminal ileum (20 cm) with caecum, part of the appendix, the ascending colon, hepatic flexure and the first third of the transverse colon. This type of hernia is one of the rarer forms which may occur. After surgical reposition of the hernia contents and closure of the foramen of Winslow, the patient recovered completely and was discharged.

[Spontaneous bilateral carotid-cavernous-fistula (author's transl)]. / Beidseitige spontane Carotis-Sinus-cavernosus-Fistel

There is reported about the rare case of a spontaneous bilateral carotid-cavernous-fistula. We have to deal with a 61-aged woman with insignificant troubles taking a good-natured course. The bilateral carotid-cavernous-fistula-cases stated in the literature has got assembled, where it is remarkable that 60% of these cases occured spontaneously. In the contrary the spontaneous unilateral carotid-cavernous-fistulae are present in 16-23% of cases.