[Therapy of acute traumatic vascular injuries using covered stents]. / Therapie akuter, traumatischer Gefässläsionen mittels ummantelter Stents.

PURPOSE: Evaluation of percutaneously implanted covered stents in acute vascular bleeding as therapeutic alternative to conventional surgical treatment. MATERIALS AND METHODS: 8 patients aged 26 to 83 years with acute vascular lesions caused by traumas, and subsequent haemorrhage, were transferred to our department. Because of general inoperability or difficult surgical access, interdisciplinary evaluation favoured an interventional treatment. In 6 patients stents could be placed percutaneously to the aorta, subclavian and iliac arteries. In one case we had to implant three stents into the thoracic aorta. RESULTS: In 7 interventionally treated patients the stents could be placed exactly on the lesions (88%). The bleeding could be stopped immediately in 6 cases (75%). In one patient we had to implant successfully two more stents in reintervention (12%). In another patient the available prosthesis was too short, so that the patient had to be referred to the OR for surgical treatment (12%). There were no complications during the treatment. CONCLUSION: First results in the use of covered stents as interventional treatment of acute vascular lesions are encouraging and may represent a possible alternative to surgical therapy in locally limited bleedings, presupposing that all different types and sizes of industrially produced covered stents are available. Further investigations to compare surgical and interventional techniques are warranted.

[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma]. / Superselektive intraarterielle Chemotherapie bei therapierefraktären Lymphknotenrezidiven von Mammakarzinomen.

PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.

[Percutaneous drainage of refractory necrotizing tumors: experience in 9 patients]. / Perkutane Drainage von therapierefraktären nekrotisierenden Tumoren: Erfahrungen bei 9 Patienten.

PURPOSE: The ranking of percutaneous drainage treatment in necrolytic advanced tumours was assessed. METHOD: 9 patients with refractory symptomatic necrolytic tumours were treated for alleviation by percutaneous drainage. Additionally, an attempt to sclerose the necrotic cavity was performed in 6 patients (6 x mitoxantrone 30 mg/24 hrs, of which 1 x additionally 98% alcohol). RESULTS: In 5 of the 9 patients symptomatic relief was obtained, but complete sclerosing of the necrotic cavity succeeded in only two patients. In two patients with necrotic tumours of the pelvis there was a bacterial superinfection of the tumour necrosis. CONCLUSION: Percutaneous alleviation is only occasionally successful in patients with necrolytic tumours. Therapy becomes effective probably only in case of successful sclerosing of the tumorous cavity.

[Intra-arterial treatment of therapy-resistant residual tumors of the pelvis]. / Intraarterielle Behandlung von therapierefraktären Tumorrezidiven des Beckens.

PURPOSE: Evaluation of intraarterial cancer treatment in recurrent pelvic tumors, which were resistent to other treatment modalities. PATIENTS AND METHODS: Ninety-seven patients suffering from pelvic recurrences originating from bladder (n = 40), rectum (n = 19), cervix (n = 21) oder other organs (n = 17) were treated by intraarterial chemotherapy (111 times) or transcatheter embolisation (52 times). RESULTS: Less than 20% of our patients had remission of the tumor burden but tumor symptoms (especially pain and bleeding) could be controlled in 35 to 87% of the patients. The main complication was a muscle necrosis after intraarterial chemotherapy because of recurrent bladder cancer. CONCLUSION: Intraarterial cancertherapy is a useful procedure for symptomatic treatment of tumor symptoms especially in case of bleeding. Local tumor control can only be achived in a minority of the patients.

Previously treated, locally recurrent breast cancer: treatment with superselective intraarterial chemotherapy.

PURPOSE: To evaluate the effectiveness of intraarterial infusion chemotherapy (IAC) with mitoxantrone hydrochloride in patients with previously treated, locally recurrent breast cancer. MATERIALS AND METHODS: Thirty-nine women (aged 31-82 years) with recurrent breast cancer underwent superselective IAC (25 mg/m2 mitoxantrone hydrochloride every 24 hours) through the subclavian artery branches after heparin administration. The extent of tumor perfusion was monitored with computed tomography during the intraarterial administration of contrast medium. IAC was repeated one to nine times. Patients had previously undergone radiation therapy (n = 39), surgery (n = 20), or systemic chemotherapy (n = 23). RESULTS: The overall response rate was 77% (n = 30). Eight patients had complete remission. Progression occurred in three patients. Remission was observed in cases of lymph node involvement (n = 9). Seven patients are still undergoing treatment. Side effects were usually moderate. Nine patients died of systemic tumor spread. In 14 patients, distant metastases developed during the first 18 months of treatment. CONCLUSION: IAC is an effective, well-tolerated therapy in patients with locally recurrent breast cancer.

[DIL vena cava filter. Initial experiences in 15 patients]. / DIL Vena-Cava-Filter. Erste Erfahrungen bei 15 Patienten.

DIL filters were permanently inserted through the cubital vein, using a 7-F catheter, in 15 patients and were followed up for six months in 12 patients. One filter could not be opened and 4 others were only partly open. Clinically there were no recurrences of pulmonary emboli. There were no complications from the correctly placed filters. Amongst the 4 incompletely expanded filters, two caused perforation of the cava, in one the cava thrombosed and in another the filter migrated to the bifurcation of the pulmonary artery. It follows that unexpanded filters should not be placed in the cava. Measurements in 10 patients showed the cava reduced to less than 10 mm lumen. In two cases the reduction of lumen was only slight, measuring more than 15 mm. The effect of the reduction in the lumen remains to be compared with that achieved by other filters.

[Hemophiliac arthropathy of the knee joint. Gd-DTPA-enhanced MRI; clinical and roentgenological correlation]. / Hämophile Arthropathie des Kniegelenkes. Gd-DTPA-verstärkte MRT; klinische und röntgenologische Korrelation.

17 patients with hemophilic arthropathy of the knee joint were studied with static and dynamic MRT before and after i.v. bolus injection of Gadolinium-DTPA (0.1 mmol/kg body weight). After contrast enhancement, synovial proliferations exhibited an increase of signal intensity (SI) on FFE and SE images of 47.7% and 37.4% respectively, whereas muscle and fatty tissue, tendons, bone marrow and joint effusion revealed only minor increase in SI. The gradient of signal intensity (ratio SI/time) of pannus was 39.6%/min. Gd-DTPA enhanced MRI studies delineate and quantify the synovial proliferations in hemophilic arthropathy. Dynamic studies in hemophilic arthropathy do not provide qualitative assessment of the inflammatory process.

[Magnetic resonance tomography with fast spin-echo sequences--the results in the ENT area]. / Magnetresonanztomographie mit schnellen Spinecho-Sequenzen--Ergebnisse im HNO-Bereich.

UNLABELLED: The use of T2-weighted spin-echo sequences is mandatory for identifying tumours in the ENT region and for differential diagnosis of pathological findings. A highly promising alternative to time-consuming conventional SE sequences is now available in the fast-spin-echo sequences (FSE). FSE was compared with the conventional SE (CSE) basing on 100 assessments of examinations of 20 patients. RESULTS: Conventional SE = TR/TE = 1800/90 ms with one average (NEX), FSE = TR/TE = 3200/120 ms with 4 averages (NEX). Measurement time CSE 6:59 min, FSE 3:12 min. Analysis was performed in analogy to on ROC analysis by 5 radiologists as a blind study. The anatomic differentiation and contrast performance were compared as well as the differentiation and definition of lesion and lymphatic node and a subjective overall assessment. Differentiation of pathological findings was the same with both sequences. FSE was superior to CSE in the visualisation of normal tissue, lymph nodes and also in the subjective overall assessment. The following criteria were employed in the subjective overall valuation: sum total of impressions gathered from contrast behaviour or performance, susceptibility to artifacts, and signal-to-noise ratio. Due to the definitely improved parameters of image quality and the markedly reduced scanning time--which is reduced to 50%--FSE will replace the conventional spin-echo sequence in routine diagnostics.

[Value of magnetic resonance tomography for diagnosis of bone tumors]. / Stellenwert der Magnetresonanztomographie für die Diagnostik von Knochentumoren.

Primary bone tumors are well investigated with magnetic resonance imaging (MRI). Depending on the tumor site and localization the examination technique has to be tailored to the particular situation. Using MRI, the delineation of extraosseous tumor spread and the intramedullary extension of malignant bone tumors is superior as compared to other imaging modalities.

[Rheumatoid arthritis of the wrist. Dynamic Gd-DTPA enhanced MRT]. / Rheumatoide Arthritis des Handgelenkes. Dynamische Gd-DTPA-verstärkte MRT.

21 patients with rheumatoid arthritis of the wrist diagnosed according to the criteria of the American Rheumatism Association were examined by dynamic MRT before and after the i.v. injection of Gd-DTPA (0.1 mmol/kg). The results were correlated with the clinical and radiological findings. The increased signal intensity of the pannus was 1.17 +/- 0.45%/sec and this differed significantly (p < 0.001) from bone marrow (0.16 +/- 0.11%/sec) and from muscle (0.25 +/- 0.16%/sec). Blood sedimentation rate correlated with the gradient of synovial proliferation (p < 0.05). There were no further statistically significant correlations between the clinical, radiological and MRT findings and the change in signal intensity from synovial proliferation as shown by dynamic MRT.

["Metastasizing" Echinococcus alveolar of the liver]. / "Metastasierender" Echinococcus alveolaris der Leber.

We report a case of metastatic alveolar echinococcosis of the liver. There were calcifications of the liver parenchyma, and a large tumour adjacent to the porta hepatis infiltrated neighbouring structures. In addition, haematogenous metastases to the spine and foot were found. This extensive haematogenous "metastasis" is rare and may complicate diagnosis, but the typical findings in the liver should permit the correct conclusion.

[Time-dependent changes in signal intensity in neoplastic and inflammatory lesions of the musculoskeletal system following intravenous administration of Gd-DTPA]. / Zeitabhängige Anderungen der Signalintensitäten in neoplastischen und entzündlichen Läsionen des Bewegungsapparates nach i.v. Gabe von Gd-DTPA.

In 48 patients with primary and secondary bone and soft tissue tumors and in 6 patients with inflammatory diseases of bone, the increase in signal intensity after i.v. administration of Gd-DTPA (0.1 mmol/kg body wt) was assessed in pathologic and normal tissues of the musculoskeletal system by means of a FLASH sequence (TR = 40 ms, TE = 10 ms, tip angle 90 degrees). In normal tissues the increase of signal intensity was slower and less pronounced than in lesions. Malignant tumors showed a more pronounced and rapid increase in signal intensity than benign tumors and inflammatory tissue. It was possible to differentiate necrotic areas and peritumorous edema from tumorous and inflammatory tissue. The increase in signal intensity was perceptibly slower and less pronounced in malignant tumors exposed to cytostatic therapy than in malignant tumors without therapy.

[Computerized tomography and magnetic resonance tomography in soft tissue tumors]. / Computertomographie und magnetische Resonanztomographie bei Weichteiltumoren.

The modern cross-sectional imaging techniques, e.g. CT and MR, have brought about a significant improvement in the diagnosis of soft tissue tumors. CT allows these neoplasms to be detected with relatively high sensitivity and their extension to be assessed. MR has proved to be superior to CT owing to the high soft tissue contrast it provides and its multi-planar imaging capabilities. Gadolinium-DTPA, a paramagnetic agent, can be utilized to good advantage as contrast material in MR; it yields further information as to the malignancy or otherwise of particular tumors. In addition, differentiation of tumor recurrences from other postoperative alterations seems to be feasible.