[Peripartum aortic dissection]. / Peripartale Aortendissektion.

A 29-year-old primagravida developed severe chest pains during labor. An emergency caesarean section was performed as the symptoms persisted. Imaging diagnosis immediately after delivery revealed an acute proximal (type A) aortic dissection. The patient was transferred to the nearest cardiothoracic surgery centre and successful emergency surgical aortic repair was performed. The perioperative course of a type A aortic dissection during pregnancy and labor is complicated by time pressure, diagnostic restrictions until delivery and potentially fatal uterine bleeding during cardiopulmonary bypass and hypothermic cardiac arrest. This case report describes the diagnosis and the surgical, anesthesiological and gynecological management of this life-threatening peripartum complication.

Renal masses--evaluation by amplitude coded colour Doppler sonography and multiphasic contrast-enhanced CT.

OBJECTIVE: To assess the efficacy of amplitude coded colour Doppler US (aCDS) in the evaluation of renal masses as shown by multiphasic contrast-enhanced CT. MATERIAL AND METHODS: Eighty patients (155 kidneys) with suspicion of renal masses underwent aCDS and spiral CT. The findings were classified into normal kidneys, kidneys with tumours, kidneys with cysts, and those with "other findings" (i.e. bleeding, calcifications, inflammation, parenchymal hypertrophy). The aCDS findings were compared to CT results and to histological findings or clinical, laboratory and follow-up data. RESULTS: Eighteen renal cell carcinomas and 8 other tumours were found; 78 kidneys had cysts, 12 polycystic kidneys and 10 fibrotic kidneys were detected, 20 kidneys showed other findings. Diagnostic aCDS data were obtained in 129 kidneys (83.2%) showing pathology with an accuracy of 94%. CT adequately showed pathology in all patients with some diagnostic uncertainty in the evaluation of complicated cysts. CONCLUSION: Though contrast-enhanced multiphasic spiral CT is the method of choice for evaluating renal masses, US including aCDS can provide valuable information, particularly in differentiating vascularized from non-vascularized lesions and in the evaluation of complicated renal cysts.

[Combined ultrasound-urodynamic study in paraplegic patients]. / Kombinierte Ultraschall-Urodynamik-Untersuchung beim Querschnittpatienten.

Over a period of 2 years (1989-1991), combined urodynamic and ultrasonic investigations of the lower urinary tract were performed in 80 patients with spinal cord injuries. The main advantage of this procedure proved to be the lack of irradiation to both patient and investigator. Besides the real-time image of the bladder, bladder neck, prostate, pelvic floor and urethra, functional conclusions were possible, especially when urodynamic pressure curves were also considered.

Ultrasonography of urinary tract and micturition as an alternative to radiologic investigations in the spinal-cord-injured patient.

Over a period of 1.5 years (July 1989-Jan. 1991), a total of 504 patients, 442 of them suffering from spinal cord injuries with subsequent voiding disorders, were investigated by ultrasonography of the genitourinary tract. Ultrasonography of the upper urinary tract as well as the bladder and prostate provided and accurate image of the pathomorphological changes which go along with this kind of malfunction of the lower urinary tract in this group of patients. The application of rectal ultrasonography using a linear array rectal transducer was able to provide equal or even better images of the micturition process than micturition cystourethrography (MCU). An adequate and accurate real time image of the bladderneck, the prostatic urethra and the external rhabdosphincter could be obtained in all instances. Combined micturition cytourethrosonography (MCUS) with urodynamic evaluation has also been performed, which made the observation and judgement of the bladder outlet as well as the position of the catheter possible throughout the procedure without the interference of X-rays.