[Direct determination of free thyroxine in two simultaneous radioimmunoassays with different test principles: validity of test research derived from an area of marked iodine deficiency (author's transl)]. / Direkte Bestimmung des freien FT4 in zwei simultanen Radioimmunoassays mit unterschiedlichen Testprinzipien: Validität der Testergebnisse in einem Jodmangelgebiet.

Serum FT4 was measured simultaneously by the commercial FT4 kits of Amersham-Buchler and Corning Medical in 4 groups with defined thyroid function as follows: 57 euthyroid subjects with and without goitre, 27 patients on T4 supplementation, 12 subjects on oral contraceptives and 26 subclinically hyperthyroid patients. All patients underwent physical examination, thyroid scintigraphy and additional in-vitro tests (total thyroxine T4, total triiodothyronine T3 and TRH/TSH assay). Both assays generally correlated well with the defined thyroid functional status except for the patients on oral contraceptives. Contrary to the FT4-test (Amersham-Buchler) in this group the FT4-test (Corning Medical) produced a significantly increased mean for FT4 as compared to the euthyroid groups thus indicating a probably insufficient compensation for high but not necessarily abnormal levels of TBG concentration. Using the FT4-assay (Amersham-Buchler) the normal range of FT4 values of euthyroid subjects from the area of Bamberg with marked iodine deficiency agrees well with recently published results of a multicentre trial thus confirming the assumption of serum FT4 not being strongly dependent on iodine intake. The results of the FT4-test (Corning) showed a wider scatter of normal ranges of FT4 values for all groups and concomitantly reduced discrimination compared to the corresponding simultaneously obtained FT4-test (Amersham-Buchler) results. Though cost and time saving, the commercial radioimmunoassays will require further critical evaluation of normal range validity on larger populations of defined abnormalities of thyroid function to elucidate inherent deficiencies of the new FT4 methods and of their diagnostic efficiency.

[Computed tomography of cranio-facial injuries (author's transl)]. / Computertomographie bei frontobasalen Schädelhirnverletzungen.

For the detection of the finest changes in bone structure--like arrosions, porotic alterations, small fracture and fissure lines--computed tomography (CT) is yet surpassed by X-ray tomography: The current resolving power of CT is smaller, our Delta Scanner's layer thickness of 13mm is too large. Nevertheless, the advantages of CT in fronto-basal injuries augment essentially the diagnostic possibilities: with few layers and without great problems in setting projections, most of the possible injuries may be easily surveyed. The traumatized patient ist only minimally discomforted by the whole-body scanner. The lens dose is far less than the values of X-ray tomography reaches. Dislocated fracture fragments, brain traumatisation with and without hemorrhage, defects of the cribriform plate with concimitant brain prolaps, trauma of intraorbital structures, injuries to the nasal cavity and paranasal injuries may easily be detected. These findings influence importantly the surgical intervention and enable one to set up a planning of time and intercollegiate treatment. The postoperative care ist improved and inflammatory complications may be pointed out. In diagnosis of frontobasal injuries we therefore recommand: 1. X-ray survey and eventually X-ray radiograms of the nasal cavity and paranasal sinuses. 2. Computed-tomography (CT). 3. For fine detailed study of bone structures like fissures and smalles fractures X-ray tomography will still remain indispensable.

[Diastematomyelia--a harmless finding or cause of late neurological disturbance? (author's transl)]. / Diastematomyelie--ein harmloser Zufallsbefund oder Ursache später Rückenmarksschäden?

Diastematomyelia is said to produce neurological lesions. Several new cases of diastematomyelia are reported without any neurological defect. They are discussed and compared with similar cases from the literature. Apparently the fixation of the spinal cord by diastematomyelia seems not to be the primary cause of the "tethering cord syndrome". Other conditions which are sometimes associated with diastematomyelia (myelodysplasia, dysraphia of the spinal cord etc.) may be the primary cause of progressive neurological lesions.

The diagnosis of congenital spinal disorders in computed tomography (CT).

9 patients (8 girls, 1 boy) with dysraphic disorders of the spinal column were examined by CT. In 6 cases no diastematomyelia was established. Among the 8 girls, an intraspinal bony septum was identified in 7 instances and a splitting of the cord without identifiable septum was seen in 1 girl. In 6 patients with symptoms dysplastic changes of the cord independent of the segmental level could be identified, such as variable thickness and a heterogenous absorption pattern of the cord. Three girls with symptomless diastematomyelia showed no striking absorption pattern of the spinal cord. Asymptomatic diastematomyelia indicates that frequently concomitant orthopaedic and neurological disorders cannot be referred to a mechanically obstructed ascent of the cord alone, but infer complex etiologies, probably including abnormal medullary vascularization Dural sac and subarachnoid fixation of the spinal cord cannot be identified by CT. Unless there is a possibility of a low lumbar medullary conus or of spinal cord dysplasia or intraspinal lipoma, cyst or fistula, one can assume that the normal ascent of the cord is obstructed with subsequent pull on the cord elements. From our preliminary experience which takes into account conventional radiological procedures, the appropriate task of CT consists of identifying even a minimally calcified septum in radiologically suspected diastematomyelia. Further, with CT one can exclude a splitting of the cord without a calcified septum. CT provides a noninvasive method for assuring diagnosis of diastematomyelia at an early stage and enables one to make the differential diagnosis from pseudodiastematomyelia.

[CT in the diagnosis, treatment planning and follow-up in craniopharyngeoma (author's transl)]. / Computertomographische Diagnostik, Therapieplanung und Verlaufskontrolle beim Kraniopharyngeom.

The axial computed tomography of the skull has become an important part of the neuroradiologic diagnostics. The intracranial CT diagnosis is completed by the coronal sections which is used in particular in case of processes in the posterior cranial fossa and its differentiation of the supra- and infratentorial dimensions and in order to localize tumors in the sella region. The accurate determination of the tumor volume and the para-, supra-, and retrosellar dimensions makes possible an exact operation and irradiation planning. Solid, cystic and calcified tissues of the craniopharyngioma can be delimited. The quantitative evaluation by means of a computed tomogram of a tumor reduction obtained by surgery and irradiation with ultrahard X-rays (42 MV) with a target volume dose of about 5000 rd is illustrated by two examples. Under the above mentioned radiotherapeutic conditions, one partially resected craniopharyngioma with cystic, calcified and solid tissues showed a diminuation of the tumor volume of 60%, whereas the volume of a craniopharyngioma consisting of solid and calcified parts which had not been operated upon was reduced by about 40% two weeks after the end of the radiotherapy.

Computed tomography of trauma involving brain and facial skull (craniofacial injuries).

Among head injuries, frontobasal fractures play an important role due to frequently concomitant intracranial complications. Intracranial hematomas, cerebral contusions, depressed fractures, and intracranial air are readily detected by computed tomography (CT). Traumatization of intraorbital structures often associated with blowout fractures and herniation of cerebral parenchyma into the ethmoidal, frontal, or sphenoidal sinuses are best demonstrated by CT. In assessing soft tissue structures, CT is superior to multidirectional tomography, which tends to be more suitable for fine detail study of bony structures. Furthermore, CT is helpful for diagnosing inflammatory processes due to bacterial invasion not infrequently following traumatic communication between the paranasal sinuses and the cranial cavity. Sequelae of head trauma such as posttraumatic porencephaly are clearly demonstrated by CT.

[Computerized tomographic diagnosis of the brain: addition of frontal and clivo-parallel cuts to the transverse standard cuts (author's transl)]. / Computertomographische Diagnostik des Gehirns: Ergänzung der transversalen Standardschichten durch frontale und clivo-parallele Schichten.

The data of now available transverse cut are insufficient for spatial orientation. Using a special technique, frontal and clivo-parallel cuts will provide satisfactory diagnostik detail. The often difficult differentiation between vertically adjoining or commmunicating structures will be facilitated by frontal tomography. Clivo-tangential cuts show the maximum of clivus and dorsum sellae, also the brainstem with axis-parallel transverse cuts. An approximately clivo-parallel cut in the aqueduct the 4th ventricle is longitudinally cut with influx and limited only partially in axis-parallel tomograms because of weak definition in the direction of the Z axis and the variable anatomic and geomtric relations. Pneumo-encephalography and ventriculography cannot be done without. So far in space-occupying lesions clivo parallel cuts are diagnostically valuable near the brainstem, the aqueduct and the 4th ventricle.

[Computerized tomography of the facial skeleton (part II). Pathological changes (author's transl)]. / Computertomographie des Gesichtsschädels. Teil II: Pathologische Veränderungen.

The value and main task of computerized tomography in the diagnosis of benign and malignant processes in the middle and upper facial skeleton lies in its accurate demonstration of the extent of the disease; this is important in relation to the planning of treatment, prognosis and to other complementary procedures. CT is a new and potent method for the TNM classification of tumours of the nose, paransal sinuses and nasal pharynx. The ability of the CT to demonstrate deeply situated structures in the face, without disturbing overlying shadows, makes precise staging of deep tumours possible, eg. stages T2-T4. The consequences in terms of pre-treatment TNM classification are discussed. In cases of fronto-basal fractures, the CT will show particularly trauma to the orbital contents, intracranial displacement of bone fragments and cerebral trauma with or without bleeding. Suspicion of orbital involvement by benign or malignant disease is a definite indication for a CT examination. As regards the middle and upper facial skeleton, computer tomography provides information of a morphological and quantitative nature and aids in the localisation of lesions. It should be properly integrated into the conventional clinical, endoscopic and tomographic methods employed in the diagnosis of lesions of the facial skeleton.

[Computer-tomography of the facial bones (part I). Demonstration of various structures and deeply placed regions (author's transl)]. / Computer-Tomographie des Gesichtsschädels (Teil I). Darstellbarkeit bestimmter Strukturen und tiefliegender Regionen

Conventional diagnosis of facial structures by endoscopy and conventional tomography often meets with the following difficulties: 1. Deeply placed areas cannot be seen, or are only partly visible by endoscopy. 2. Conventional tomography produces a two-dimensional section of a three dimensional object which may be confused by out of focus tomographic shadows. Our first attempts at computer tomographic examination of the facial structures in 41 patients have shown that this technique, working with parallel rays and without confusing shadows, is able to provide an accurate morphological demonstration of various structures and organs in the facial region.

[Computertomography of the parotid gland (author's transl)]. / Computertomographie der Parotis

In the first computer-tomographic investigations of the parotis epithelial and mesenchymal tumours histologically ascertained were examined as well as a sialadenitis. For the first time the non invasive computer-tomography allows to demonstrate directly the glandular body morphologically-quantitatively in the macroscopic area and topographically clear in the transverse tomogram. In the face of tumours of the lateral part of the gland, easily to access from the clinical diagnostic point of view, the computer-tomogram can improve pretherapeutically the differential diagnosis to a great extent by additional morphological-quantitative information about the macroscopic possibility to palpate the borders of a tumour, depth of expansion, and tissue structure, the mixed tumour, in particular, seems to have an absorption pattern relatively appropriate to computer-tomography as a result of its different tissue formation, calciferous histopathologic in part, often sealed off macroscopicly. The case observed displays a well-developed annular capsule structure with massive deposits of calciferous substance as a prominent computer-tomographic feature (histological: fibrohyaline capsule). The degree of correlation between the histopathologic and computer-tomographic appearance and its differential diagnostic value is to be checked by further investigation. The hidden tumours of the deep tissue parts, of the processus parapharyngeus, in particular, will be realized earlier by computer-tomography than by conventional diagnostic methods. In order to exclude deficiency symptoms of the nervus facialis a computer-tomography of the parotis is indicated in neurological and otological cases of doubt for a direct demonstration of the deep tissue part with processus parapharyngeus. By means of computer-tomography a growth of parotid tumours affecting other organs can be realized directly in the macroscopic area, and even in good time in the direction of the spatium parapharyngeum. In view of parotid tumour diagnosis orientated topographically and based on the TNM system computer-tomography makes a more exact realization of the T categories possible; therefore, a further subordination of the key of localisation for clinical trials is suggested.

[Extra-thoracic sarcoidosis of the retroperitoneal lymph nodes and of the spleen with ascites. Comments on the problem of lymphatic obstruction (author's transl)]. / Extrathorakale Sarkoidose der retroperitonealen Lymphknoten und der Milz mit Aszites. Uberlegungen zur Frage der Lymphablussstörung

Sarcoidosis without radiologically demonstrable intrathoracic changes is described, in which there was involvement of the retroperitoneal lymph nodes and of the spleen, together with ascites. Contrary to descriptions in the literature of the lymphographic findings in sarcoidosis, there is evidence of lymphatic obstruction and at operation fluid was found in the peritoneal cavity. The relationship between the lymphatic obstruction which was associated with low-grade peritoneal involvement and the increased amount of peritoneal fluid is discussed.