[Percutaneous catheter dilatation of benign ureteral stenoses: indications, technic, results]. / Perkutane Katheterdilatation benigner Ureterstenosen: Indikation, Technik, Ergebnisse.

From June 1984 to December 1986 twenty-one benign ureteral stenoses were treated. After percutaneous nephropyelostomy an antegrade dilatation was performed by means of balloon catheters or increasing size of angiographic catheters. Subsequently an ureteral splinting with a F-12-catheter and a glucocorticoid therapy was followed. 13 strictures (61.9%) were treated successfully and in 3 cases (14.3%) an improvement of the obstruction and kidney function was obtained. In 5 patients (23.8%) the dilatation failed, in 2 of whom a nephrectomy was done. The failures occurred in cases with actinic and scarred-fibrotic strictures. The technical procedure, advantages and disadvantages of both dilatation methods were described. Treatment was complicated in 2 patients by the development of nephrolithiasis due to infection and in 2 further patients by acute pyelonephritis. Auxiliary measures of the dilatation therapy are a sufficient diuresis and an effective antibiotic therapy. In conclusion, the results are more dependent on the cause of stricture, than on the duration of disease and the used dilatation technique.

[Percutaneous nephropyelostomy--indications, complications, and various aspects of clinical use]. / Perkutane Nephropyelostomie--Indikationen, Komplikationen, Aspekte der klinischen Anwendung.

During almost 3 years in 100 patients the percutaneous nephropyelostomy was used as method of the supravesical discharge of urine 109 times. The X-ray-aimed puncture was performed on the basis of the fine needle puncture technique by means of a puncture set which we developed ourselves. When a urinary retention is present, the number of targets is great (96%), the rate of complications small. In 12 systematically exposed kidneys limited subcapsular haematomas were found, once a small perirenal haematoma. In one case a breaking off of the wire occurred. In 2 cases a septicaemia appeared, 4 punctures failed. Following the PNS 3 kidneys had to be exposed due to tamponage of the renal pelvis (2) and perforation of the renal pelvis, respectively. The percutaneous nephropyelostomy is a measure for the temporary or permanent supravesical discharge of the urine which is little stressing for the patient and simply to be performed. It represents a secure and effective alternative for the operative nephrostomy in patients with obstruction of the urinary tract of every genesis.

[Therapeutic effectiveness of CT-controlled drainage puncture in amebic abscesses of the liver]. / Therapeutische Wirksamkeit CT-gezielter Entlastungspunktionen bei Amöbenabszessen der Leber.

Amebic liver abscesses are the most frequent clinical manifestations of the extra-intestinal amebiasis and have to be considered as a serious complication in the course of disease. The abscesses have by their risk of rupturing and bacterial superinfection quoad vitam an unfavourable prognosis. CT-guided relief punctures can, as it is demonstrated by two cases of critical amebic abscesses, effectively improve the therapy with systemic amebicides, prevent imminent rupture and contribute to the healing of the abscesses. Thus a surgical treatment of the abscess was not necessary.

[CT-guided sclerosing therapy of kidney cysts. Report of experience with 100 patients]. / CT-gezielte Nierenzystenverödung. Erfahrungsbericht über 100 Patienten.

Due to its diagnostic accuracy as well as safe and accurate puncture technique CT can be used advantageously for percutaneous sclerosing therapy of renal cysts. CT-guided sclerosing therapy with pantopaque emulsions was carried out in 100 patients on an outpatient basis with altogether 107 solitary renal cysts. There were indications in all cases. Continuous follow-up of cyst involution in 96 patients with 103 cysts pointed out a reliable sclerosing effect in 95.1% of them. Major complications were neither registered in the puncture technique nor in the late urographic examinations.

[CT morphology of the splenic vessels in splenoportal fistula]. / CT-Morphologie der Milzgefässe bei splenoportaler Fistel.

CT examination of a 53-year-old patient with endocarditis and clinical signs of hepatosplenomegaly revealed an atypical vascular morphology in the hilum of the spleen, for which no diagnosis could be established. Angiography indicated the presence of a symptom-free splenoportal fistula, the histological study of which suggested its congenital genesis. The paper describes the morphology, as ascertained by CT, of the splenic vessels characterised by changed haemodynamics due to a hilar splenoportal fistula.

[Morphology and diagnosis of acquired bladder deformities]. / Zur Morphologie und Diagnostik erworbener Harnblasenverlagerungen.

Acquired displacements of the urinary bladder refer to intrapelvic pathological anatomy. These alterations of the bladder are predominantly detected via an initial radiologic study with intravenous urography or suprapubic pelvic ultrasonography. According to their clinical incidence displacements of the bladder can occur in: pelvic space-occupying lesions; displacements in musculo-fascial defects of supporting structures as well as in extirpation cavities of the small pelvis; extrapelvic space-occupying lesions. Herniation, prolapse and descensus of the bladder can be accurately diagnosed by correct examination via intravenous urography. The diagnostics of pelvic and extrapelvic pathogenetic causes require the complex application of all methods of diagnostic imaging, the value of which is determined by clinical diagnosis and by the choice of an appropriate therapy.

[Results and assessment of ventilation and perfusion scintigraphic studies following left-sided homologous lung transplantation in the dog]. / Ergebnisse und Wertung ventilations- und perfusionsszintigraphischer Untersuchungen nach homologen linksseitigen Lungentransplantationen am Hund.

Left-sided homologous lung transplantations (LTP) were carried out in 18 mongrel dogs. Exhalation and perfusion scannings took place for interpreting the ventilation and perfusion in the postoperative course. The per cent Xe133 storage and the exhalation per minute show the significant reduction of the ventilation in the transplants dependent on the duration of the postoperative interval. The compensation behaviour of the ventilation of the non-operated lung shows the compartment analysis. The perfusion index QL/QR with Tc99m decreased progressively in the postoperative course.--These investigation methods are slightly invasive. They allow the synoptic recording of the relationships between ventilation and perfusion. A differential diagnosis of complications after lung transplantations is not possible, however.

Determination of dental age in adopted non-European children.

Adoption and immigration have brought about a considerable number of non-European children living in Sweden. Frequently the date of birth and age of the child are estimates of some uncertainty. In order to find out whether dental age could be useful in these cases a determination of dental age, according to methods described by Gustafson & Koch (1974) and by Liliequist & Lundberg (1971) was carried out in 44 non-European adoptive children, 23 with certain and 21 with uncertain date of birth. The results showed good agreement between the two methods and for children whose date of birth was certain, dental age determination was reliable, regardless of sex and race. For almost half of the children of uncertain age, however, dental age differed by a year or more. This may be seen as evidence of the difficulty in estimating the correct age in the native country and to asses the correctness of this estimate at the routine medical checks at present carried out upon arrival in Sweden. It can be concluded that in order to assign a reliable year of birth all adoptive or immigrant children whose age is at all uncertain should also be subjected to adequate odontological age determination.

[The significance of pulmonary artery angiography in the early postoperative phase following unilateral homologous lung transplantation]. / Die Bedeutung der Pulmonalis-Angiographie in der frühen postoperativen Phase nach unilateraler homologer Lungentransplantation.

In animal experiments there was carried out the homologous left-sided lung transplantation in quest of possibilities in therapy of the respiratory failure. Postoperative angiographies of the pulmonary artery took place in general anesthesia in 14 operated dogs to disclose vascular changes in the transplant at the early postoperative phase qualified by operation and rejection. The evaluation of the anastomosis of the pulmonary artery succeeded very well whereas the assertation about the venous anastomoses remains uncertain. A lengthening of the hemodynamic time phases by rejection was intimated previously in the early postoperative phase; statistical significance existed, however, only for the first venous filling. Furtheron, the perception of vascular morphological changes is possible in more distant advanced rejection processes. The angiography of the pulmonary artery in connection with the chest X-ray film and scintigraphic methods is of great importance for the evaluation of the transplant function especially for complications which result from the vascular system of the transplant.

[Diagnostic value of chest x-ray film in recognizing complications following homologous lung transplantation in the dog]. / Diagnostischer Stellenwert der Thoraxnativaufnahme zur Erkennung von Komplikationen nach homologer Lungentransplantation am Hund.

The postoperative controls of the course after unilateral homologous lung transplantation were interpreted by chest X-ray films of 86 dogs. Radiomorphologic findings in the transplanted lung had developed 69% of the surviving animals in the end of the 5th and 80% on the 9th postoperative day. The descriptive phenomena of the chest X-ray films were compared with the post-mortem findings concerning their etiology. Phenomena caused by rejection, by operation, and in a third group by rejection and operation could be separated statistically as to the temporal occurrence. - In that manner the partial or total shadow of the graft is a sign of rejection after the 5th postoperative day and the pneumothorax is a sign for a postoperative complication before the 5th day, on the other hand a phenomenon for the rejection after this time. - The radiologic findings are restricted by imperfect position of the animals during the radiograph and by overshadowing bony parts of the thorax. The diagnostic value of the chest X-ray film is reduced much, because the differential diagnosis to the radiomorphologic findings requires additional diagnostic methods for instance scintiscanning, angiography, bronchospirometry, and biopsy.