[Ultrasound detection of pneumoperitoneum based on typical ultrasound morphology]. / Sonographischer Nachweis des Pneumoperitoneums anhand typischer Sonomorphologie.

The correspondence of sonography and radiography to figure out a pneumoperitoneum was studied in a group of 140 patients having undergone abdominal surgery. Sonography revealed 14 (82.4%) out of 17 radiographically positive patients. Because of the predominant collection of free air in the right upper quadrant, the ventrolateral liver surface represents the most important region in search of a pneumoperitoneum. In another 3 patients free peritoneal gas was diagnosed which was not revealed radiographically. The possibility to observe motion in real-time sonography repeatedly proved to be decisive for the certain diagnosis of free air (the shifting air under patient's movent and the immobility of the gas reflex under respiration). An observed "step" between the air in the costophrenic sinus and the abdominal gas reflex is considered to be an additional sonographic sign. These results justify combined evaluation of a suspected pneumoperitoneum by both plain film radiography and sonography prior to other imaging modalities.

[Idiopathic facial paralysis and magnetic resonance tomography (MRT)]. / Idiopathische Fazialisparese und Magnetresonanztomographie (MRT).

We investigated 15 patients with unilateral facial paralysis using gadolinium(Gd)-DTPA (diethylenetriamine pentaacetic acid) enhanced (magnetic resonance imaging (MRI). Eleven were idiopathic and 1 each was due to basal skill trauma, Lyme's disease, Foville's syndrome and herpes zoster oticus. Ten of 11 Bell's palsies showed a significant enhancement of the facial nerve on the paralysed side. In all cases enhancement was shown in the labyrinthine segment, in 9 in the meatal segment, in 8 in the mastoid segment and in 7 in the tympanic segment also. Follow-up Gd-enhanced MRI investigation was performed 3-11 months later in 8 patients. In 1 case with incomplete return of function after 3 months MRI enhancement was decreased. We could not find any correlation between the intensity of the Gd enhancement and the course, severity or outcome of Bell's palsy, or stapedius reflex audiometry. The mechanisms and aetiology of the Gd enhancement in Bell's palsy seem to be non-specific phenomena which are also found in post-traumatic facial lesions, for instance. Nevertheless, the ability to image the facial nerve in Bell's palsy provides a new means of examination in this disorder. In our opinion Gd-enhanced MRI is recommended in cases of recurrent or "atypical" Bell's palsy and in cases with total loss of electrical excitability, to exclude tumours. It is further suggested that MRI may provide valuable information concerning areas which may require surgical exploration or decompression.

[Differential diagnosis of the "fat leg"--a case report]. / Zur Differentialdiagnose des "Dicken Beins"--ein Fallbericht.

This is a report about a patient, who came to our hospital because of a painful thickening of her left calf. She was treated with Heparin 48,000 IU/24 hours. A crural vein thrombosis was suspected. Instead of improvement of the symptoms the diameter of the leg grew until the state of a complete Compartment-syndrome. After exact inspection (Sonography, Computertomogramm) we found a hematom of the calf, caused by a rupture of the tibial part of the gastrocnemius muscle. Fasciotomies and evacuation of the blood brought a restitutio ad integrum. Diagnostic methods and faults are discussed.

Surveillance strategy for intratesticular cysts: preliminary report.

We treated 15 patients with all sonographic criteria of a simple testicular cyst. Of the patients 6 were operated on and the diagnosis was confirmed histologically, while 9 did not undergo an operation but are under close observation (mean surveillance 11 months). All patients are without any detectable malignancy. The possibility of a surveillance strategy in simple intratesticular cysts is discussed.

Has ultrasound influenced the therapy concept of blunt scrotal trauma?

We present the ultrasonic diagnoses and treatment of 44 patients with blunt scrotal trauma (rupture of the testis, hematocele, intratesticular hematoma and hematoma of the scrotal layers). Purely intratesticular hematoma without any other accompanying injury also can be detected sonographically. When massive scrotal swelling is present ultrasound is valuable to determine the status of the underlying testis even if discrete fracture planes of the tunica cannot always be detected. To achieve best long-term results early surgical intervention should be performed in cases of rupture of the testicle and hematocele, while hematoma of the scrotal layers and purely intratesticular hematoma can be treated conservatively.

Sonographic appearance of benign intratesticular lesions.

58 patients with a purely intratesticular lesion were investigated with scrotal ultrasound. A pathognomonic echo pattern could be found for simple parenchymal cysts and hemangiomas only. The nature of all other lesions (chronic orchitis, hematoma, epidemoid cyst, testicular necrosis, abscess and tuberculosis) could not be defined solely on sonographic grounds.

Impact of sonography on diagnosis of scrotal diseases: a multicenter study.

Scrotal ultrasound was carried out since 1980 in five centers. 1,971 cases presenting with pathological conditions of scrotal content were reviewed to asses limitations and possibilities of the method. Scrotal sonography was found to be a highly reliable method to distinguish between intra- and extratesticular lesions. The data presented reveal that sonography is not capable of differentiating reliably between benign and malignant lesions. In the decision-making process ultrasound is sometimes of great help to the urologist but surely no substitution for careful examination and history taking.

[Renal venous thrombosis in the newborn (author's transl)]. / Nierenvenenthrombose im Neugeborenenalter.

The renal venous thrombosis is mostly produced by severe dehydration. The following, however, are also predisposing factors: infections, birth traumata, paranephritic processes, lack of oxygen, diabetes of the mother and cyanotic heart defects. The diagnosis is correctly made by means of the palpable flank tumor, the macrohematuria, together with the urogram and sonography. The most urgent therapeutic measure is the balancing of the water and electrolyte deficit to eliminate the dehydration, i.e. the existing oliguria or anuria. The therapy is primarily always conservative. In the event of a consumption coagulopathy, a therapeutical attempt can be undertaken with heparin but if this is unsuccessful, an immediate nephrectomy must be performed. A further nephrectomy will be necessary if hypertony persistent infection and renal atrophy occur. Two infants with renal venous thrombosis were used for this study on the causes and diagnosis of, and the therapy for the illness.

[Ultrasound diagnosis of the kidneys and the retroperitoneal space]. / Ultraschalldiagnostik der Nieren und des Retroperitonealraumes.

In addition to well known topics of nephrosonography, e. g. space occupying lesions, malformations, renal obstruction and transplantated kidneys, also lesser known topics such as nephrosonography in pregnancy and blunt renal trauma, and also sonographic findings in pathological changes of the retroperitoneum, are discussed. Consequently, the high diagnostic value of ultrasonography, is emphasized.

[Nephrosonography during pregnancy (author's transl)]. / Nephrosonographie in der Gravidität.

In a consecutive series of 128 pregnant patients with sound kidneys the physiological changes of the renal cavity during gravidity with regard to primiparae and multiparae as well as to the stage of pregnancy have been investigated ultrasonographically. We found a dilatation of the renal cavity based on mechanical as well as on hormonal factors with the ultrasonographic picture of obstruction. The aim of this study is to identify border-line conditions in order to avoid false positive findings and to distinguish pathological stages from physiological changes. The ultrasonography represents an excellent technique to recognize macromorphologic changes of the kidney during pregnancy.