Agreement between ultrasonography and computed tomography in detecting intracranial calcifications in congenital toxoplasmosis.

AIM: To evaluate the agreement between ultrasound (US) and computed tomography (CT) in detecting intracranial calcification in infants with congenital toxoplasmosis. MATERIALS AND METHODS: Forty-four infants referred for investigation of congenital toxoplasmosis were prospectively evaluated, and the diagnosis was confirmed or ruled out by serological testing and by follow-up in the first year of life. The investigation protocol included cranial US and cranial CT, and examinations were conducted and interpreted by two radiologists blinded to the results of the other imaging test and to the diagnostic confirmation. RESULTS: The diagnosis of congenital toxoplasmosis was confirmed in 33 patients, and agreement between US and CT findings was found in 31 of these cases. Both methods detected calcifications in 18 patients, and neither detected calcifications in 13 patients. Overall agreement was 94% and the kappa coefficient was 0.88 (95% confidence interval: 0.71, 1; p<0.001), which revealed almost perfect agreement between the two diagnostic methods. CONCLUSION: In this study, US and CT demonstrated equal sensitivity in the detection of intracranial calcification in infants with congenital toxoplasmosis.

[Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus]. / Endosonographie in der klinischen Routine beim Adenokarzinom des distalen Osophagus und Magens. Eine ernüchternde Bilanz.

PROBLEM: Endoscopic ultrasound (EUS) is an important diagnostic tool for determining the best therapeutic strategy (primary resection, neoadjuvant therapy or palliation only) to offer esophageal or gastric cancer patients. PATIENTS AND METHODS: In the present study (1992-2001),we evaluated the accuracy of EUS in adenocarcinomas of the distal esophagus and stomach and compared our results with pathologists findings as the gold standard. RESULTS: Of the 222 patients studied, the precise examination of 11% EUS was not completely possible due to severe tumor stenosis. The accuracy of EUS with respect to T, N+/- and TN+/- amounted to 51%, 65% and 34% in 131 patients with adenocarcinomas of the esophageal gastric junction and to 50%, 66% and 37% in 91 patients with adenocarcinomas located in the fundus, corpus or antrum of the stomach respectively. With respect to T-stage, the overstaging of tumors was more common than understaging, especially in pT2b-carcinomas. The subgroup analysis of the 131 EGJ adenocarcinoma patients showed that the results obtained by EUS were slightly better in type I (distal esophageal cancer) than in type II and III cardia carcinomas (proximal gastric cancer).When comparing two observation periods (1992-1996 and 1997-2001), the accuracy of endoscopic ultrasound staging was very similar in both periods for T-category (51% vs 49%) and N-category (63% vs 64%) as well as for combined TN-staging (36% vs 35%) respectively. CONCLUSIONS: In clinical routine examinations of adenocarcinomas of the stomach and the distal esophagus, the accuracy of EUS is not as good as the excellent results in the past--mostly obtained under study conditions--may suggest.

[Dependence of axis deviation in the esophagram on computerized tomography determined wall thickness and its value in assessing depth of invasion of esophageal carcinoma]. / Abhängigkeit der Achsdeformierungen im Osophagogramm von der computertomographisch bestimmten Wanddicke und deren Wertigkeit bei der Beurteilung der Invasionstiefe des Osophaguskarzinoms.

PURPOSE: In this study we compared the abnormalities of the esophageal axis seen in the esophagogram with the thickness of the esophageal wall measured by computed tomography. We have investigated, how exactly both methods assess the local tumor invasion according to the TNM criteria and whether there is a relation between the esophageal axis and the wall thickness. METHODS: In a retrospective study we examined the esophagograms of 65 tumor patients. Computed tomography examinations were available in 40 cases. Using a graphical method the wall thickness was transferred to the esophagograms under consideration of the different scales of the images. RESULTS: There is no correlation between the different types of distortion of the esophageal axis and the wall thickness in computed tomography. However, it can be demonstrated that the distortion results from specific fixation effects with the surrounding tissue. CONCLUSIONS: Both radiological methods cannot determinate the tumor invasion correctly.

Distal arterial occlusive disease in diabetes is related to medial arterial calcification.

In diabetes mellitus, peripheral arterial occlusive disease predominantly affects the lower leg (tibial and peroneal vessel disease). Our study suggests that this feature is related to the presence of forefoot medial arterial calcification.

[Value of the esophagogram in preoperative assessment of esophageal carcinoma]. / Stellenwert des Osophagogramms bei der präoperativen Einschätzung des Osophaguskarzinoms.

PURPOSE: In this study we utilized barium swallows exhaustively in each patient. After that we compare the results with the intraoperative findings. The goal is to select those criteria which contribute to the preoperative clinical staging of esophageal carcinoma. METHODS: In a retrospective study we examined the esophagograms of 65 tumor patients. We evaluated the location and length of the tumor, the deformation of the esophageal axis, stenosis, dilatation, and the radiological type of the tumor. All characteristics were correlated with the pathologically determined TNM-criteria, the stage of the tumor, and the palliative or curative type of resection. RESULTS: We found the following significant correlations: localisation/T-criterion, radiological type/T-and M-criteria, stenosis/type of resection, deformation of the axis, stenosis and radiological type/tumor stage. CONCLUSION: In the sense of a checklist the stenosis, the deformation of the esophageal axis and the radiological type of the tumor should be carefully evaluated and included in the report. With these data, the clinical stage of the tumor can be estimated.

[Gastrointestinal metastasis of malignant melanoma]. / Gastrointestinale Metastasierung des malignen Melanoms.

In this paper we present a case study of a patient suffering from a gastrointestinal metastasis of a malignant melanoma. Normally in this location multiple and solid metastases were observed in the submucosa. Extraordinary in this case is the fact, that a polycystic tumor with more than 15 cm diameter has been found.

[Intraarterial digital subtraction angiography (i.a. DSA) of the lower limb using fine needle technique]. / Intraarterielle digitale Subtraktionsangiographie (i.a. DSA) der unteren Extremität in Feinnadeltechnik.

PURPOSE: Severe peripheral arterial occlusive disease (pAOD) requires adequate diagnostic imagery of poststenotic and postocclusive vascular regions. This study was designed to evaluate the validity of i.a. DSA using fine-needle technique (FNA) especially concerning the vascular area of the lower limb. MATERIAL AND METHODS: 206 FNA of the lower limb wer evaluated retrospectively. Besides evaluation of the image quality of the 1119 angiographic image series, main points of interest were the determination of accuracy of the FNA in comparison to the operative findings, the average radiocontrast agent consumption and the rate of complication. RESULTS: In all cases the image quality was rated either very good or good in the pelvic, femoral and popliteal vessels. 94% of the image series of the lower leg and foot could be rated as well as very good/good although 75% of all patients demonstrated an advanced stage of pAOD. Accuracy of FNA compared to operative findings came up to 82%. The average radiocontrast consumption amounted to 69 ml per examination. Overall, two major complications were seen. CONCLUSION: I.a. DSA of the lower limb using fine-needle-technique is an easily applied angiographic method of low radiocontrast agent consumption and a low complication rate. Essential information can be acquired preoperatively in planning far peripheral bypass anastomoses. Postoperative vascular complications can be safely assessed.

Association of below-knee atherosclerosis to medial arterial calcification in diabetes mellitus.

In diabetes mellitus, peripheral arterial occlusive disease (PAOD) more often affects the lower rather than the upper leg. It is hypothesized that peripheral medial arterial calcification (MAC) may be related to this phenomenon. In 42 diabetic patients subjected to arteriography for PAOD, forefoot roentgenogrammes were also obtained for assessment of MAC, e.g. of the metatarsal arteries. The distribution of PAOD (number of partial and total arterial stenoses per leg) was assessed according to the coexistence of MAC. A total of 242 partial and complete stenoses was found in 35 MAC-positive legs and 28 MAC-negative legs. MAC-positive legs displayed 4 (3-6) stenoses per leg (median with 95% confidence interval), vs. 3 (2-5) stenoses per MAC-negative leg. MAC-positive legs had more than twice as many stenoses located in the lower (2.6 (2.3-2.8) stenoses below knee) as compared to the upper leg (1.3 (1.0-1.7) stenoses above knee; P < 0.05), whereas stenoses were equally distributed above and below the knee in MAC-negative legs. The prevalence of stenoses in the truncus tibiofibularis and in the foot arteries (e.g. arteria dorsalis pedis) was unaffected by MAC-status. In conclusion, the predominance of PAOD in the lower leg of diabetic patients appears to be related to the presence of forefoot medial arterial calcification. The underlying pathogenesis remains to be elucidated.

Complications following caval interruption.

Caval interruption is widely regarded as the treatment of choice for the prevention of recurrent pulmonary embolism (PE). The safety, ease of insertion and "convenience" of the devices are the main arguments for filter placement. Today many filters are placed for prophylactic reasons, sometimes without an established diagnosis of pulmonary embolism or underlying deep venous thrombosis. Early and late complications have been published but the rate is reported to be low, although only limited numbers of patients have been followed. In an 18-year period 11 patients with problems following caval interruption were treated, 10 with acute complications, one with chronic caval occlusion. Six were treated conservatively, five underwent venous thrombectomy and a.v.-fistula. The device was removed in four. During the same period only three permanent filters were placed in our hospital (two with complications). Caval interruption is useful in selected high-risk patients and is the least invasive but not necessarily the best treatment. Provided stringent criteria are applied, the early and late complications can be accepted in order to prevent sudden death in patients with threatening massive PE. Extended or more liberal indications for caval interruption are neither necessary nor justified.

[The computed tomographic diagnosis of inflammatory abdominal aortic aneurysms]. / Computertomographische Diagnostik des inflammatorischen Bauchaortenaneurysmas.

Amongst 1599 patients undergoing surgery for abdominal aortic aneurysm, there were 89 patients (5.6%) who showed typical features of inflammatory aneurysms of the abdominal aorta (IAAA). 37 of the 89 patients had been examined preoperatively by CT. In 73% of the cases (27/37) a correct diagnosis had been made. Localisation, width and extent of the IAAA was correctly diagnosed in all patients. Involvement of the renal arteries by the inflammatory process, the extent of thrombus and of mural calcification were accurately shown. The inflammatory tissues were typically ventral and lateral to the aorta. Frequently, there were adhesions to neighbouring structures. Aortic rupture, aortic dissection and retroperitoneal lymphoma may produce similar CT appearances; nevertheless, CT remains at present the method of choice for the diagnosis of IAAA because of its high sensitivity.

Serological diagnosis of Aujeszky's disease: a comparison between reactions of blood samples from sows and their offspring.

Blood sera from sows and their piglets were compared for their suitability for the serological diagnosis of Aujeszky's disease. Within a few days after parturition, blood and colostrum samples were collected from a total of 104 sows from 8 different gI-vaccinated breeding herds. Three piglets of each litter were bled simultaneously with their mother and again 3 weeks later. All 416 sera reacted positively in the screening for vaccination-induced antibodies. Using the gI ELISA, the sera of 16 sows and their offspring reacted positively, while 86 sows and their piglets reacted negatively and 2 sows and their piglets showed reactions near the test-cutoff. By testing piglets from another 1,300 sows in 37 farms, the practicability of the proposed method was proved. Blood samples were taken at intervals of 4 to 6 weeks from piglets of all sows, which had farrowed in the meantime. Within a six to nine months period, the serological status of a breeding herd could be established.

Constancy of Aujeszky's field virus antibody titres in sows repeatedly vaccinated with a gI-negative vaccine.

A breeding herd repeatedly vaccinated with a gI-deleted vaccine was regularly tested serologically for Aujeszky's field virus antibodies over a period of up to 35 months. Of the 100 sows tested, 18 animals reacted positively with constant titers during the whole period of the investigation. On the other hand, there was no serological evidence that any of the contact animals contracted field virus infection.

[Hypodense oral intestinal contrasting for the diagnostic optimization of abdominal computed tomograms in children]. / Hypodense orale Darmkontrastierung zur diagnostischen Optimierung des abdominellen Computertomogramms im Kindesalter.

37 children were examined for diagnostic improvement of the oral intestinal contrasting images in abdominal computed tomography with a hypodense solution of mannitol (n = 23) in comparison with a suspension of BaSO4 (n = 14). Because of the hypodense intestinal contrasting images the artifacts of the images induced by the bordering surface could be reduced, the condition of fullness of the intestine and the judgement of the intestinal wall improved. The parenchymatous organs and points of abdominal lymph nodes could be defined and judged more easily through the hypodense contrasting images. On the whole the picture quality of the computed tomography of the young child could be increased with the hypodense solution of mannitol.