[Sonographical diagnosis of pneumoretroperitoneum as a result of retroperitoneal perforation]. / Das sonografische Bild des Pneumoretroperitoneums als Folge einer retroperitonealen Perforation.

A retroperitoneal perforation is a rare incident. It can occur as a complication of ERCP with papillotomy (0.2-0.5%). Leakage of contrast agent during endoscopy raises the suspicion that this complication has occurred but doesn't always give sufficient information about the leakage extent. In the case of extreme gas emission, a plain abdominal X-ray shows classic pneumoretroperitoneum. The abdominal CT scan can display small amounts of free air which is why it is used for diagnosis in such cases. Ultrasonography also provides a reliable diagnosis and is a good method for monitoring the progression of the condition. Alternative causes of pneumoretroperitoneum can be: trauma, inflammation, infection, tumor as well as ERCP and other interventional procedures, especially endoscopies. Presacral retroperitoneal pneumoradiography was used for the diagnosis of retroperitoneal tumors in the 70 s but is no longer used today. Perforations into the retroperitoneal space come from several locations in the gastrointestinal tract. In the different types of lesions the gas can penetrate the compartments and reach as far as the mediastinum, the intraabdominal cavity, subcutaneum (cervical) or the scrotal compartment (compartment shift). Based on 11 cases (7 perforations during ERCP, 2 perforation during colonoscopy, 2 cases with damage of the distal esophagus), we show the most extensive presentation of the sonographical picture of pneumoretroperitoneum. Typical signs on abdominal ultrasound are an increased echogenicity around the right kidney ("overcasted" or "covered" kidney), air dorsal to the gallbladder, around the duodenum and the head of the pancreas and especially ventral to the great abdominal vessel which can lead to the picture of "vanishing" vessels. The extent of free air is easy to assess. Even very small amounts are detectable ventral to the right kidney. In most cases, a conservative approach with no oral intake, antibiotic coverage, and analgesia in close gastroenterological-surgical cooperation is indicated. Especially after ERCP abscess formation is repeatedly described, sometimes even with a lethal outcome. Sonography is a suitable method for detecting free air in the retro-peritoneum. Pneumoretroperitoneum following bowel-perforation can be effectively shown by ultrasound, it is possible to assess the extent of free air, and sonographic monitoring of the treatment is possible and successful.

[Epidemiology of gallbladder calculi in young females]. / Zur Epidemiologie von Gallenblasensteinen (GS) bei jungen Frauen.

In a population sample of nearly 900 women aged less than 25 years, prevalence of gallbladder stones (GS) was estimated by ultrasound and some risk factors were analyzed. GS were found in 4.8 percent. The prevalence of GS is significantly higher in females with GS in the family history as compared to persons without known GS in the family (11.8 vs. 2.6 percent); in women who have born as compared to nulliparae (10 vs. 3 percent); in obese women (BMI 26 or higher) as compared to lean women (15.1 vs. 4.2 percent). There was no significant correlation between intake of oral contraceptive and prevalence of GS.

[Prevalence of cholelithiasis in relation to use of hormonal contraceptives]. / Prävalenz der Cholelithiasis in Abhängigkeit von der Einnahme hormonaler Kontrazeptiva (HK).

UNLABELLED: 400 women in continuous care of a family planning clinic were examined for gallbladder stones by standard ultrasound technique. Gallstones (GS) are found infrequently in nulliparous women (3.1 percent). The prevalence of GS increases with number of births and with age: 11 percent of female under 25 years of age, who have ever born, have GS; women aged 45 years and older who have born two or more children have GS in 35 percent. Duration of use of HC increases with rising age and with number of births. There is no regular relationship between duration of use of HC or total dose respectively and prevalence of gallbladder stones. CONCLUSION: Intake of HC has no or only a marginal influence on prevalence of gallbladder stones.

PIP: 400 women regularly using oral contraceptives (OC) were examined by standard sonography for signs of gall stones (GS). In the 61 (15.25%) who had GS, the prevalence was age dependent: up to age 24 the rate was 5.9%, it was almost 20% in the 25-44 age group, and it reached 30.2% in the 45-54 age group. Among 130 nulliparous women, 4 had GS (3.1%); among 71 with 1 delivery, 11 had GS (15.5%); and among 199 of those with 2 or more deliveries, 47 had GS (23.1%). Nulliparous women in all age groups had a much lower rate of GS incidence. GS prevalence was highest in women who had had multiple deliveries and were of a more advanced age (45-54). 19.6% of those up to age 24 used OCs for 1 year, and 3.6% used OCs 5 years, while in the 45-54 age group, 81.1% used OCs for 5 years. The number of GS carriers increased in proportion to duration of OC use. 4 of 130 mostly young nulliparas used OC for 1-5 years. All 11 (15.5%) GS carriers among the 71 women with 1 delivery used OCs for 1 year, and 7 used them for 5 years. 23% of multiparous women had GS (46 out of 199), and 36 used OCs 5 years. The effect of pregnancy is very clear when the nulliparous GS rate (3.1%) is compared to the rate of all parous women (15.9%, or 43 out of 270). None of the 61 women with GS had taken OCs for 1 year, 70.5% had taken them for 5 years, and 29.5% had taken them for 2-5 years. However, after taking other factors into consideration, it must be stated that OC use affects the incidence of GS not at all or only marginally.

[Prevalence of cholelithiasis. Results of an epidemiologic study using sonography in East Germany]. / Prävalenz der Cholelithiasis. Ergebnisse einer epidemiologischen Studie mittels Sonographie in der DDR.

In two middle-sized towns in the northern part of the German Democratic Republic, a random sample of the population and unselected subjects, respectively, were examined for gallbladder stones (GS) by ultrasound. The prevalence of cholelithiasis (sum of GS detected by ultrasound and history of cholecystectomy for GS) ist higher than in other European populations screened by similar methods. It is suggested that dietary habits are responsible for this finding. About one third of subjects with GS had complications of GS and about one third gave a history of cholecystectomy for GS. The frequency of nonspecific dyspeptic complaints was the same in persons with GS as in persons without GS.

[Familial incidence of gallstones]. / Familiäre Häufung von Gallensteinen.

From March 1986 to June 1988 ultrasound examinations for gallstones were performed on 1616 symptom-free persons (982 females and 634 males, aged 12-93 years). They were also asked about gallstones and (or) cholecystectomy among blood relatives. Gallstones were discovered or a previous cholecystectomy was reported in 316 persons (19.6%). The prevalence of gallstones was age-dependent and increased with age. Prevalence was higher in females than in males. There was, in this group of 316, a significant increase in family prevalence of gallstones among six of nine age-groups (P less than 0.05 and P less than 0.01, respectively) compared with those without gallstones. These data suggest a genetic disposition towards cholelithiasis, while dietary factors could not be definitely excluded.

[Quantitative and qualitative investigations on human pericardial fluid]. / Quantitative und qualitative Untersuchungen der humanen Perikardflüssigkeit.

The quantity and the quality of the pericardial fluid (PF) were investigated in patients after cardiosurgery and thoracic surgery. The quantity of the pericardial fluid was described independent of the disease and dependent on the age of the patient. The behaviour of the concentration of the immunoglobulins was verified as independent of the illness. A passive distribution mechanism of the observed parameters in the pericardial fluid was discussed.

[Experimental coronary stenoses and occlusions]. / Experimentelle Erzeugung von Koronargefässstenosen und -verschlüssen.

A constrictor for experimentally inducing stenoses and obstructions of the coronary artery is described. Smallness, good adaptability to every vascular diameter, atraumatic insertion, and slow swelling are its advantages. Within 12 months a coronary artery could be constricted by two thirds. In one third of the cases the lumen was narrowed by more than 75 per cent. Just 50 per cent of the cases showed chronic infarction after coronary obstruction, the other half developed differently marked myocardiac fibrosis. At high-degree narrowing of the arteries, 75 per cent of the cases showed disseminated myocardiac fibrosis. The occlusion of the vessel is caused by constrictor, by fibroplastic alteration of the vascular wall, and by thrombosis. Different degrees of myocardiac ischemia are sequelae of different development of collaterals. The constrictor may be used for studies on the development of collaterals as well as on therapeutic measures in chronic ischemia of the myocardium.