[Value of computerized tomography and magnetic resonance tomography in diagnosis of malignancies of the mouth cavity and oropharynx]. / Stellenwert von Computertomographie und Magnetresonanztomographie bei der Diagnostik von Malignomen der Mundhöhle und des Oropharynx.

PROBLEM: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer--some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. PATIENTS: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. RESULTS: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. CONCLUSION: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

[Intermittent bile duct obstruction as the first manifestation of a hepatocellular carcinoma]. / Intermittierende Gallengangsobstruktion als Erstmanifestation eines hepatozellulären Karzinoms.

HISTORY AND CLINICAL FINDINGS: For two months a 73-year-old woman had been suffering from intermittent colicky upper abdominal pain. She had also noted transient colourless stools and finally jaundice. Suspected cholelithiasis led to her admission for cholecystectomy. She had slight jaundice of skin and sclerae. Physical findings were unremarkable except for pain on epigastric palpation. INVESTIGATIONS: Sonography and computed tomography showed dilatation of the intrahepatic biliary passages and the proximal common bile duct, the latter containing a polycyclic mass that on endoscopic retrograde cholangiography appeared ovular and was surrounded by contrast medium. It was thought to be an intraductal bile stone. TREATMENT AND COURSE: Laparotomy, performed to remove the suspected stone, revealed a floating intraductal tumour, histologically a hepatocellular carcinoma. Further imaging discovered the primary hepatic tumour. CONCLUSION: Although a smooth-walled contrast-sparing mass in the common bile duct usually denotes a stone, other structures may rarely imitate this picture, in particular atypical tumour growth.

[Early pulmonary changes caused by amiodarone]. / Frühe pulmonale Veränderungen durch Amiodaron.

Confluent infiltrates and interstitial condensates with (sub)segmentary spreading are typical radiological findings in amiodarone pneumopathy. A case is presented where daily amounts of 200-600 mg and a total of 18.3 g amiodarone led to alveolitis with fibrosis within 4 weeks, which is uncommon in the early stage.

[Synchronous bilateral testicular tumor: embryonal carcinoma and Leydig cell tumor]. / Synchroner beidseitiger Hodentumor: Embryonales Karzinom und Leydigzelltumor.

Synchronous bilateral testis tumours of different histologic types are rare, especially the simultaneous occurrence of germ cell and contralateral stromal tumours. The case of an embryonal carcinoma and contralateral Leydig cell tumour is presented and discussed in consideration of the topical literature.

Attempted protection of spermatogenesis from irradiation in patients with seminoma by D-Tryptophan-6 luteinizing hormone releasing hormone.

Possible protective effects of D-Tryptophan-6 luteinizing hormone releasing hormone (D-Trp-6-LH-RH) against irradiation-induced testicular damage were investigated for the first time in patients with seminoma. After unilateral orchiectomy 12 men were allocated to receive the long-acting gonadotropin releasing hormone (GnRH) agonist D-Trp-6-LH-RH prior to and for the duration of radiotherapy. Eight patients with the same disease served as a control group. In contrast to several trials to protect spermatogenesis from chemotherapy by GnRH agonists, we first suppressed the pituitary-testicular axis before starting the treatment. As a new schedule this adjuvant GnRH agonist treatment was combined with cyproterone acetate for the first 20 days to diminish the amount and the duration of the initial stimulation of gonadotropins and testosterone. Irradiation started after suppression of the pituitary-gonadal axis. In all patients luteinizing hormone and testosterone were completely suppressed throughout the treatment compared to the controls, whereas the initial suppression of follicle-stimulating hormone was not completely maintained until radiotherapy was completed. At the follow-up at 18 months after completion of therapy, all patients reached their initial concentration of gonadotropins, testosterone, and motile spermatozoa independently of D-Trp-6-LH-RH treatment. With the dose and schedule investigated, the GnRH agonist showed no protective effects against testicular damage caused by radiotherapy.

[Computed tomography in orbital trauma]. / Zur Computertomographie beim Trauma der Orbita.

The results of CT in 104 patients with traumatic lesions of the orbits have been analysed retrospectively. Eighty-four fractures of the orbital skeleton were diagnosed in 58 patients; in 18 cases there was peri-orbital, retrobulbar or intrabulbar bleeding and two patients had a ruptured globe. A foreign body was demonstrated in 20 cases. Additional fractures of neighbouring paranasal sinuses were present in 22 cases. Mucosal swelling or bleeding in the sinus was found in 59 cases and orbital emphysema in 22 patients. The particular value of CT in the diagnosis of orbital trauma lies in the certainty with which bony injury of the orbit and peri-orbital structures can be demonstrated.

[The value of CT in carcinoma of the lung apex]. / Zur Wertigkeit der CT beim Lungenspitzenkarzinom.

The CT findings in 34 patients with histologically confirmed tumours at a lung apex are described. CT, compared with conventional methods, provides more comprehensive information regarding the localisation and extent of the tumour and of local metastases. On the basis of CT examinations, 28 patients were treated by radiotherapy and in six patients surgery could be carried out.

[Computed tomography and conventional x-ray diagnosis of interstitial lung diseases]. / Computertomographie und konventionelle Röntgendiagnostik bei interstitiellen Lungenerkrankungen.

One hundred and sixty-four patients with pulmonary fibrosis were examined by CT and by conventional radiological methods. Sixty patients had asbestosis, thirty-nine silicosis, forty sarcoidosis and twenty-five had idiopathic pulmonary fibrosis. CT is superior to conventional radiography in evaluating interstitial pulmonary changes, particularly of the pleura and the lung parenchyma. Areas of fibrosis and of emphysema can be demonstrated without any overlap. In sixty-nine patients there were some findings which could only be demonstrated by CT. In asbestosis, silicosis and sarcoidosis the CT classification of the lung parenchyma which we have suggested produces significantly better correlation with vital capacity than can be achieved from conventional chest films, according to the guide-lines of the I.L.O.

[Radiation therapy of nasopharyngeal carcinoma. Retrospective study for the assessment of long-term results]. / Strahlentherapie des Nasopharynxkarzinoms. Folgestudie zur Beurteilung der Langzeitergebnisse.

During the years from 1967 to 1986, 90 patients with nasopharyngeal carcinomas were irradiated at the Radiologic Hospital of Bonn University. The median overall survival time was 4.3 years which corresponded to 23% of the statistical life expectancy of the patients. 66% were still alive after two years and 46.5% after five years. Compared to the overall group, the prognosis was significantly worse in case of highly differentiated, keratinizing squamous cell carcinomas, penetration of the primary tumor into the base of the skull, or certain symptoms as ophthalmo-neurologic troubles, headaches, loss of body weight, night sweat, or fever. After partial tumor excision performed prior to irradiation or complete remission following to radiotherapy, the therapy results were better than the average with median survival times of about eleven years.

[Echo morphology of testicular tumors]. / Echomorphologie der Hodentumoren.

The ultrasound and histological findings of 130 testicular tumours were compared; these included 56 seminomas, 49 teratomas, 16 mixed tumours, five Leydig cell tumours, three lymphomas and one metastasis. There was only a slight tendency to low echo homogeneous structure with seminomas and low echo irregular structure with teratomas and mixed tumours. Cystic components, or strongly echogenic structures, were found in 20 to 30% of primary testicular malignant tumours, but these findings were non-specific. Cystic lesions were found at histology to be due to necroses, haemorrhage or specific tumour cysts. Strongly echogenic appearances correlated with calcification, fibrosis or bone or cartilage development. There were no specific sonographic criteria suitable for the identification of specific tumour types.

[Therapeutic results in small-cell bronchial carcinoma after ACO II chemotherapy and adjuvant radiation]. / Therapieergebnisse des kleinzelligen Bronchialkarzinoms nach ACO II-Chemotherapie und adjuvanter Radiatio.

During the period from 1980 through 1984, 67 patients suffering from small-cell bronchial carcinomas were submitted to a complete ACO II treatment scheme combined with adjuvant irradiation. The complete remission rate was 12%, the partial remission rate 74%. Half of the patients with limited disease survived 12.3 months or more. The median survival time of patients with extensive disease was eight months. An irradiation of the tumor core had been found useful in cases where remote hematogenous metastases could not be demonstrated. It was shown that a prophylactic skull irradiation after the second chemotherapy series was applied too early, because persisting primary tumor residues formed late intracerebral metastases.

[Computed tomography and MR tomography before and after radiotherapy of primary and secondary CNS lymphoma]. / Computertomographie und MR-Tomographie vor und nach Strahlentherapie primärer und sekundärer Lymphome des ZNS.

CT scans were made prior to and following radiotherapy in eleven patients with primary or secondary malignant lymphomas of the CNS. Six patients were additionally submitted to MR tomography with calculated T1 and T2 images. Radiotherapy induced a very rapid regression of the lymphomas. A measurable quantitative influence of the irradiation could thus not be visualized in the MR scans. The survival curve of our patients was calculated, too. The median survival after radiotherapy is 17.4 months.

[Liver metastases of colorectal carcinoma: computerized tomographic follow-ups and prognoses in relation to therapy]. / Lebermetastasen kolorektaler Karzinome: computertomographische Verlaufskontrollen und Prognosen in Abhängigkeit von der Therapie.

Liver metastases of colorectal carcinomas were diagnosed by computed tomography in 116 patients. Several control examinations were made during the course of the disease. The therapeutic effect on the metastases is defined by measurements of the tissular density. Patients submitted to dearterialization or local chemotherapy showed a higher incidence of regressive tumor calcifications and necroses than untreated patients ans patients treated by systemic chemotherapy. The median survival of the untreated patients is 3.6 months, patients treated by systemic chemotherapy have a median survival of 7.9 months, and patients submitted to dearterialization and local chemotherapy show a median survival of 15.7 months. Patients treated by resection survived 36 months, which is about 10 months longer than the survival of patients treated by dearterialization, considering comparable metastatic stages. An increased survival after systemic chemotherapy was only observed in patients of stage 1.

[Computed tomography and angiography in aortic dissection]. / Computertomographie und Angiographie bei der Aortendissektion.

The authors report on 32 patients with dissecting aneurysm examined via computed tomography, 21 of whom were also additionally examined by means of angiography. Whereas CT with contrast medium bolus resulted in a diagnosis in dissecting aneurysm in all the cases, aortography failed in 2 patients because of a thrombosed dissection. Aortography offers clear advantages over CT, besides better spatial representation, in respect of clarification as to which aortic branches are involved, especially in the region of the aortic arch. On the other hand, the advantages of CT are lower invasiveness, high sensibility and the possibility of including concomitant complications when establishing the diagnosis.

[Lung parenchymatous changes following mustard gas poisoning]. / Lungenparenchymveränderungen nach Schwefellostvergiftung.

The authors present a late sequel of poisoning with dichlorodiethyl sulphide, also known as mustard gas or Ypérite, in a patient of 22 years of age--a late sequel not described in the literature to date. After the poisoning, a severe pulmonary fibrosis with pulmonary artery hypertension developed. A mediastinal emphysema that had so far been observed only during the acute intoxication phase, was evident even two years after the intoxication. Perivascular collections of air in the left lung communicating via the left hilus with the mediastinal air point to the existence of bronchus or lung parenchyma fistulas.

[A procedure for taking into account scattered radiation and scattered light in the densitometric determination of intravascular iodine content]. / Ein Verfahren zur Berücksichtigung von Streustrahlung und Streulicht bei densitometrischer Bestimmung des intravasalen Jodgehaltes.

Scattered light and scattered radiation are two significant sources of error during video densitometry and lead to local under-estimation of iodine concentration. A procedure is described using digital subtraction angiography which largely eliminates both factors. The measured intravascular iodine concentration is close to the true value throughout the entire intensifier field and quantitative evaluation is independent of local factors. The reduction of the artifacts improves diagnostic certainty during visual evaluation also.

[Diagnosis of sarcoidosis using MR tomography]. / Zur Diagnostik der Sarkoidose im MR-Tomogramm.

One hundred and thirty-three patients with lymph node enlargement from various causes were examined by MR tomography, using 0.5 and 1.5 Tesla. Amongst these, there were 27 patients with chronically enlarged lymph nodes and histologically confirmed sarcoidosis; these showed characteristic T1 intervals. Enlarged lymph nodes due to chronic inflammatory conditions can be differentiated from lymph nodes with malignant lymphoma, or from lymph node metastases from carcinomas. Although there are problems with the determination of relaxation times on MR tomography, this may be a valuable method for the differential diagnosis of sarcoid.

[Digital subtraction angiography and large-film angiography of the pelvic and leg arteries]. / Digitale Subtraktionsangiographie (DSA) und Blattfilmangiographie der Becken- und Beinarterien.

The diagnostic information and image quality of 1153 DSA studies of pelvic and lower limb arteries and of 104 conventional large film angiograms have been analysed. Using intra-arterial contrast, all large film angiograms and all DSA studies of the iliac, femoral, popliteal and upper calf arteries were satisfactory. For demonstrating the distal calf vessels and vessels in the foot, intra-arterial DSA was superior to large film angiography. Using intravenous DSA, 98% of the iliac, femoral and popliteal arteries were adequately demonstrated, although image quality was reduced.

[Malignant tumors of the mouth and pharynx--MR tomography with surface coils]. / Malignome der Mundhöhle und des Pharynx--MR-Tomographie mit Oberflächenspulen.

The place of MRT, using surface coils, has been evaluated retrospectively in 27 patients with clinically confirmed malignant tumours of the mouth and pharynx. The extent of the tumour and its relationship to neighbouring structures is well demonstrated. The resolution obtainable by using surface coils is almost as good as that of CT. Soft tissue contrast is better in showing the spread and size of the tumour. A disadvantage of MRT is the inability in most cases to demonstrate bone destruction. Differentiation between residual tumour, recurrence and scarring is possible only occasionally. Quantitative MRT may be expected to lead to improved diagnosis during the course of following up.

[Parametric visualization of cerebral perfusion by intravenous digital angiography]. / Parametrische Darstellung der Hirnperfusion mittels intravenöser digitaler Angiographie.

Intravenous digital subtraction angiography is often used for evaluation of the extracranial and major intracranial vessels. The information obtained by this examination concerning cerebral perfusion is usually judged visually. In 50 patients a time-density curve at a specific point was analysed using 128 X 128 matrix. The level of grey scale at the moment of arrival of the bolus permits estimation of the haemodynamics of the intracranial vessels and provides a simple demonstration of differences of perfusion.