Doppler sonography of varicocele: long-term follow-up after venography and transcatheter sclerotherapy.

Sixty-eight patients with unilateral left-sided idiopathic varicocele who had not been treated previously were examined with Doppler sonography before and 1, 3, and 12 months after selective venography with balloon occlusion and transcatheter sclerotherapy of the internal spermatic vein. Varicocele and its persistence or recurrence was diagnosed by reflux only. Reflux was differentiated into stop-type and shunt-type by Doppler sonography. The resolution of varicocele was defined by absence of any reflux. The rate of resolution was greatest 3 months after sclerotherapy (49 patients, 72%). The diagnosis of persisting or recurring varicocele at this time does not seem to be justified, however, as in our study both further improvement and deterioration were observed up to 12 months after treatment. Twenty patients (29%) had a persisting or recurring varicocele 12 months after sclerotherapy. Reflux is the parameter of significance for diagnosing varicocele and its persistence or recurrence after therapy. Improvement of clinical aspects of varicocele (e.g., sperm count, sperm motility, and conception rates) depends on therapy of even subclinical varicoceles. Therefore, diagnosis and retreatment of persistent or recurrent varicoceles seems essential. The high sensitivity of Doppler sonography permits adequate assessment of the therapeutic result and evaluation of real rates of persistent or recurrent varicoceles after venography with balloon occlusion and transcatheter sclerotherapy.

Quantification of pleural effusions: sonography versus radiography.

PURPOSE: To develop a practical method of estimating the volume of pleural effusions with sonography. MATERIALS AND METHODS: Fifty-one patients underwent sonography of the pleural space while supine. Sonographic results and results of lateral decubitus radiography were compared with actual effusion volumes. The maximum thickness of the pleural fluid layer was measured with both modalities, while actual effusion volume was determined by means of complete drainage. RESULTS: Sonographic measurements correlated statistically significantly better with actual effusion volume (r = .80) than did radiographic measurements (r = .58) (P < or = .05). With sonographic measurement, an effusion width of 20 mm had a mean volume of 380 mL +/- 130 (standard deviation), while one of 40 mm had a mean volume of 1,000 mL +/- 330. Prediction error with sonographic measurement (mean, 224 mL) was statistically significantly less (P < or = .002) than that with radiographic measurement (mean, 465 mL). CONCLUSION: In quantification of pleural effusions, the sonographic measurement method presented is preferable to radiographic measurement.

[Rate of thrombosis after cava filter implantation. Long-term results]. / Thromboserate nach Kavafilterimplantation. Langzeitergebnisse.

Thrombosis of the access site and occlusion of the inferior vena cava after placement of an inferior vena caval filter are known complications of caval interruption. 30 patients were evaluated with colour-coded Doppler sonography 4 to 66 months (average 2.5 years) after percutaneous placement of either a Günther filter, a Bird's Nest filter or a Simon-Nitinol filter. One right internal jugular vein had post-thrombotic alterations. One inferior vena cava was found to be occluded 15 months after Simon-Nitinol filter placement. The long-term occlusion rates of access site and inferior vena cava after percutaneous filter introduction are low. These two factors need not be considered if implantation of a caval filter is contemplated.

[Ultrasound diagnosis of persistent varicocele after sclerotherapy]. / Sonographische Diagnostik persistierender Varikozelen nach Sklerotherapie.

252 consecutive patients with left-sided idiopathic varicocele were admitted into this prospective study. 30 patients did not receive a transcatheter sclerotherapy on account of their venous morphology on the selective phlebogram. Ultrasound examinations including Doppler sonography were performed before and 1, 3, and 6 to 12 (average 10) months after transcatheter sclerotherapy of the varicocele. For evaluation of therapeutic success the maximal diameter of the pampiniform plexus, the maximal diameter of the largest vein of the plexus, and, by means of Doppler ultrasound, reflux were measured. A continual decrease of these parameters was observed approximately one year after sclerotherapy. 9% of patients (20 patients) had a persisting varicocele. A premature decision for repeat sclerotherapy or operative correction of possibly persisting varicoceles can be avoided by employing a sonographical follow-up of more than 10 months.

Percutaneous angioscopy: improved technique.

Ten angioscopies with a pressure infusion set resulted in similar visualization times and irrigation volumes as 42 angioscopies with a specially constructed roller pump. Diagnostic image quality, however, was obtained almost exclusively with the roller pump. Three examinations were nondiagnostic. Total viewing time per patient was approximately 1 min with the roller pump and 2 min with the pressure infusion system. In the 30 patients examined, angioscopy changed the initially chosen form of therapy in 5 patients.

[Value of ultrasound in follow-up of biliary metal stents--initial results]. / Wertigkeit der Sonographie in der Kontrolle biliärer Metallstents--Erste Ergebnisse.

Self-expandable metallic biliary endoprostheses (= "stents") are an accepted therapeutic alternative in the palliative treatment of malignant biliary obstruction. The physiological direction of bile flow is re-established for a varying period of time. Sonography is an acutely available modality for the evaluation of symptomatic patients who are carriers of such endoprostheses. The cause of recurrent obstructive jaundice can be diagnosed quickly and a new intervention can be planned carefully.

Diagnosis of hyperparathyroidism with US after autotransplantation: results of a prospective study.

The best treatment for reactive hyperparathyroidism, a complication of chronic renal failure, consists of resection of all four parathyroid glands and subsequent autotransplantation of parathyroid fragments into the brachioradialis muscle of the forearm. These procedures normalize the elevated parathyroid metabolism in at least two-thirds of the patients. In this prospective study, the parathyroid transplant was examined at least once with ultrasound (US) during postoperative follow-up for a maximum of 84 months in 22 women and 13 men who were undergoing long-term hemodialysis for reactive hyperparathyroidism. In 32 of these 35 patients, the graft-bearing forearm had a normal appearance on US scans. Three patients had one or two hypoechoic lesions 5-11 mm in diameter. Graft-dependent recurrent hyperparathyroidism was verified in two of these patients by means of clinical, biochemical, and histologic examination. It is concluded that US is effective in the recognition and localization of graft-dependent recurrent hyperparathyroidism.

[The urethrocystogram and perineal sonography compared]. / Urethrozystogramm und Perinealsonographie im Vergleich.

Perineal sonography and urethrocystography were performed on 45 patients in the same sitting to evaluate the sonographical method with regard to its applicability as a routine examination method. Corresponding results were obtained 14 times (= 30%). In 31 patients (= 70%) urethrocystographic and ultrasonic measurements diverged. The urethrocystogram must therefore remain an integral part in the work-up of urinary incontinence.