[Wrong diagnosis of a foreign body incorporation after a dog bite in the hand]. / Fehldiagnose einer Fremdkörperinkorporation durch Hundebissverletzung der Hand.

The case of a patient with foreign body incorporation after a dog bite is reported. The radiographic aspect and the density in CT was that of a fragmented tooth. The particle was visible in plain radiography. After operative extraction, the patient was discharged without any symptoms.

[Dysphagia as a symptom of a ventral cervical prolapsed disk]. / Dysphagie als Symptom eines ventralen zervikalen Bandscheibenvorfalls.

Ventral osteophytes, which occur frequently, usually cause no symptoms. They are sometimes identified as the cause of dysphagia. Cervical disc prolapses which cause symptoms of dysphagia are far less common. This paper describes a patient with dysphagia in whom ventral cervical disc prolapse was finally diagnosed by MR tomography, after she had been through a "diagnostic odyssey". The result was subsequently confirmed at surgery. The relevant literature is also reviewed.

[Liver angiography--technique, indications and significance in focal liver processes]. / Leberangiographie--Technik, Indikationen und Aussagen bei fokalen Leberprozessen.

Retrospective analysis of 155 liver angiographies and the literature data was carried out to appraise the current relevance of liver angiography in digital subtraction technique (i.a. DSA) for diagnosis of focal liver changes. A focal liver lesion was detected by angiography in 58 out of the 80 patients (72.5%) we investigated with a confirmed hepatic space occupation; an angiography correlate of the tumour type diagnosed was shown in 41 out of 69 (59.4%) of malignancies confirmed by surgery or biopsy histology; in the benign lesions, the angiographic diagnosis was consistent with the histological result in five out of six cases. DSA is thus usually clearly inferior to the tomographic sonography, CT and MRI in detection and qualification of the tumour type. However, it is still indispensable for planning operations or chemoembolization and for exact imaging of the portal perfusion conditions because of the frequent vascular anomalies in the anatomy of the liver.

[Fibromuscular dysplasia as a cause of cerebral infarct]. / Die fibromuskuläre Dysplasie als Ursache zerebraler Insulte.

Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory, segmental arteriopathy of unknown etiology. Fibroplasia of the tunica media is most common. After the renal arteries, the carotid arteries are most frequently affected. Angiographically beaded and tubular stenoses are seen. Complete occlusions and spontaneous dissection of the carotid arteries occur. The angiopathy causes general symptoms such as headache and vertigo, but also recurrent TIA and ischemic cerebral infarction. We examined 15 patients (12 female) suffering from FMD and stroke. The diagnosis of FMD was based on angiographic findings in all cases. 13 patients made a good recovery and seven of them could be discharged from hospital without any neurological deficit. Apart from conservative treatment, primary percutaneous or operative angioplasty may be necessary in some cases in spite of the mostly benign outcome of the disease. Acetylsalicylic acid should be given in all cases.

[The place of thoracic plain film in the assessment of left heart insufficiency]. / Zum Stellenwert der Thoraxübersichtsaufnahme bei der Beurteilung der chronischen Linksherzinsuffizienz.

The chest radiographs of 24 patients with chronic left heart failure (mean duration of cardiac disease 4.3 years) were compared with the haemodynamic findings. Before the initiation of intensive medical treatment haemodynamic parameters were measured invasively and followed up for a period of up to 16 months. The heart size and roentgenographic patterns of pulmonary congestion showed a weak negative correlation with both the ejection fraction and the cardiac index. During therapy changes of cardiopulmonary haemodynamics did not correlate with alterations of the radiographic findings. Therefore chest radiographs are not useful in the assessment of the therapeutic success in long-existing left heart failure; nevertheless, they are indicated to identify secondary pulmonary disease.

[Digital cineradiography (DCR) of the act of swallowing. The initial clinical experiences]. / Digitale Cine-Radiographie (DCR) des Schluckaktes. Erste klinische Erfahrungen.

Twenty-seven patients with different swallowing disorders were studied by employing digital cineradiography (DCR) for rapid imaging of the pharynx with a temporal resolution of up to 50 frames per second and a maximum spatial resolution of .8 per/mm. To facilitate therapy planning, the DCR study can be transferred to the otorhinolaryngologist via videotape. DCR is capable to substitute analog cine or video techniques in the pre- and postoperative examination of patients with swallowing disorders.

[Magnetic resonance tomographic diagnosis of vascular processes in the vertebrobasilar system--analysis of 35 of our own cases and a literature review]. / Kernspintomographische Diagnostik von Gefässprozessen im vertebrobasilären Stromgebiet--Analyse von 35 eigenen Beobachtungen und Literaturübersicht.

35 patients with abnormalities of the vertebrobasilar system were studied via magnetic resonance imaging (11 saccular aneurysms, 10 vascular malformations, 9 basilar arteries with dolichoectasia, 5 thromboses of the vertebral or basilar artery). The two smallest aneurysms of the basilar top had a diameter of 2-3 mm. Most vascular malformations could be differentiated by typical MRT symptoms. All 5 cavernous angiomas were negative in angiography (cryptic). The shape and size of the basilar artery and its relationship to the third ventricle were best demonstrated on coronal slices. Flow-related intraluminal loss of signal allows a differentiation between vascular perfusion and thrombosis already on plain images (partial) thrombosis and artery dissection can be differentiated from flow effects based on identical findings in at least two planes or additional gradient echo images.

[The effect of the imaging geometry of angiographic equipment on the measurement of vessel diameters: the significance for PTA and stent implantation]. / Einfluss der Abbildungsgeometrie von Angiographie-Anlagen auf die Messung der Gefässdurchmesser: Bedeutung für PTA und Stentimplantationen.

The diameter of arteries in the angiogram is determined by the geometry of the angiographic unit and the position of the vessel in the body section. The position of the arteries in the middle portion of the pelvis is subjected to a wide variability due to their curved course, and cannot be precisely predicted even if the individual body diameter is known. Magnification of the pelvic arteries on a.p. angiograms typically ranges between 30 and 40%, and increases with patient thickness. Therefore, PTA of the pelvic arteries produces overdilatation, even if the balloon diameter is smaller than the vessel diameter measured on the a.p. film. If the balloon diameter exceeds the measured vessel diameter by 1 or 1.5 millimetres, vessel overdilatation may reach up to 70% of the original size.

[Techniques, results and risks of chemoembolization of malignant liver tumors]. / Techniken, Ergebnisse und Risiken der Chemoembolisation von malignen Lebertumoren.

This is a report on 55 chemoembolizations (ChE) in 31 patients with primary (n = 10) and secondary (n = 21) liver malignomas. Probing of the segmental arteries was always possible by means of a coaxially placed 3F catheter system. Chemoembolization was effected with a mixture of ivalon particles, 20 mg mitomycin or 40-60 mg epirubicin and an ethibloc solution. More than 75% of the patients showed a decrease in tumour size and/or tumour density. The proportion of surviving patients was 80.6% after 6 months. Within this period, extrahepatic metastases were seen for the first time in 19.4% of the patients. References in literature on techniques and results of chemoembolization are discussed.

[Pulmonary lymphangiomyomatosis]. / Pulmonale Lymphangiomyomatose.

The case of a woman of 48 years of age suffering from pulmonary lymphangiomyomatosis is presented. Chest radiographs showed the reticular infiltrate of diffuse interstitial lung disease, whereas high resolution CT illustrated multiple, well-defined cystic lesions distributed diffusely through the lungs without fibrotic changes or nodular densities. The patient underwent open lung biopsy and pleurodesis because of recurrent pneumothorax. Treatment with medroxyprogesterone was initiated.

Evaluation of adrenal masses in oncologic patients: dynamic contrast-enhanced MR vs CT.

The CT examinations, precontrast gradient echo MR images, and fast contrast enhanced dynamic MR studies were evaluated in 44 patients with 52 adrenal masses and known malignant disease of different origin. Morphologic features (size, shape, attenuation, contour, and enhancement) on CT scans, signal intensity on T2-weighted MR images, and patterns of enhancement on Gd-DTPA enhanced dynamic MR studies were analyzed in all patients. With dynamic contrast enhanced studies with prolonged imaging up to 15 min after Gd-DTPA, masses with moderate enhancement and complete washout after 10 min were considered as adenomas. Computed tomography and plain MR had a sensitivity of 0.71 and 0.96, a specificity of 0.75 and 0.88, and overall accuracy of 0.56 and 0.71, respectively. Simultaneous use of precontrast MR and dynamic contrast enhanced studies led to an accurate diagnosis in 88% (sensitivity = 1.0, specificity = 0.91) and thus should be considered in oncologic patients with undetermined adrenal masses.

[Diagnosis and differential diagnosis of a peritoneal carcinosis. Conventional techniques, sonography, computed tomography, magnetic resonance tomography]. / Diagnostik und Differentialdiagnostik einer Peritonealkarzinose. Konventionelle Techniken, Sonographie, Computertomographie, Kernspintomographie.

Based upon the results obtained in 346 patients, the diagnostic value of conventional techniques, ultrasonography, computed tomography and magnetic resonance imaging in the detection of peritoneal tumor spread is analyzed. Since such signs as ascites, mesenteric and omental infiltration and peritoneal masses are non-specific, various conditions have to be considered in the differential diagnosis. None of the imaging modalities can exclude intraperitoneal tumor spread.

[Simulated stenosis of the common femoral artery in intravenous digital subtraction angiography by palacos following hip joint endoprosthesis implant--a possible source of error in videodensitometry determination of the degree of stenosis]. / Vorgetäuschte Stenose der A. femoralis communis in der i. v. DSA durch Palakos nach Hüftgelenkendoprothese--Eine mögliche Fehlerquelle bei der videodensitometrischen Stenosegradbestimmung.

Radiation absorbing foreign material in the patient's body, such as palacos, may mimic significant vascular stenoses in DSA. The potential pitfalls of geometric and videodensitometric quantification of stenosis are discussed.

[The importance of i.v. DSA in the diagnosis of acute pulmonary embolism]. / Bedeutung der i.v. DSA für die Diagnostik der akuten Lungenembolie.

The high mortality rate of pulmonary embolism requires rapid and rational diagnosis especially with regard to the necessary decision about the best possible treatment. Analysis of data published in the literature, and of our own data, show that angiography of the a. pulmonalis according to the i.v. DSA technique is of central importance. This involves fewer hazards than conventional pulmonalis angiography while being comparatively satisfactory in respect of reliability of the results (more than 90%). It is, therefore, a safe basis for deciding on the appropriate treatment: lysis or surgery.

[Radiologic diagnosis of hemorrhages of the gastrointestinal tract]. / Radiologische Diagnostik bei Blutungen des Gastrointestinaltraktes.

In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations.

[Assessment of the grading of cartilaginous tumors of the long tubular bones from the radiologic and pathologic viewpoint]. / Zur Problematik der Dignitätsbeurteilung von Knorpeltumoren langer Röhrenknochen aus radiologischer und pathologischer Sicht.

Based on 46 enosteal cartilaginous tumours of the long tubular bones (43 patients) the established radiological and Mirra's histopathological criteria of tumour status are assessed independently and compared retrospectively. In lesions of Lodwick's type I B (37 cases) with mineralisation of the cartilaginous matrix and facultatively cortical arrosion, lack of periosteal reaction, destruction of the corticalis and parosseal tumour extension none of Mirra's histopathological criteria of malignancy was found. It may be expected that biopsy and histopathological examination will not give valuable additional information in this radiological constellation, because there are no known definite histopathological criteria of benignity. Suspicious radiological findings should prompt complete resection of the lesion. Biopsy and histopathological classification are always crucial when matrix mineralisation is lacking and therefore the diagnosis of a cartilaginous tumour cannot be established radiologically.