[Transabdominal ultrasonography in pancreatic diseases]. / Transabdominelle Sonographie bei Erkrankungen des Pankreas.

Transabdominal ultrasound renders complete imaging of the pancreas possible in 90% of cases. Ultrasound is very sensitive in diagnosing acute pancreatitis. Peripancreatic edema and fatty necrosis are both hypoechoic and cannot be differentiated by ultrasound but by dynamic computed tomography. Complications of pancreatitis and biliary obstruction in the case of biliary acute pancreatitis are well detectable. Focal dense parenchymal echoes and an irregularly dilated pancreatic duct are characteristic of chronic pancreatitis. Biliary and duodenal obstruction, portal vein thrombosis and pseudocysts as complications of chronic pancreatitis are clearly demonstrable by ultrasound. Pancreatic ductal carcinomas of more than 10 mm in diameter can be detected with a high degree of accuracy. Resectability can be judged reliably.

[Ultrasound diagnosis of hepatocellular carcinoma]. / Sonographische Diagnostik des hepatozellulären Karzinoms.

From 1983 to 1992 we found in 50 patients a hepatocellular carcinoma (HCC). The diagnosis was confirmed by histology (n = 34), cytology (n = 4) or clinical symptoms together with ultrasound findings and laboratory signs. 41 of the tumors occurred in cirrhotic livers. 29 patients had singular tumors, 21 had multiple tumors or diffuse tumor spreading in the whole liver. The singular tumors ranged in size from 1.1 to 15 cm. 8 of these tumors were smaller than 3 cm in diameter. The sonomorphological tumor pattern was hyperechoic in 24 cases, 14 of them had a halo sign. 14 tumors were hypoechoic. In the 12 cases with a mixed sonomorphologic pattern, a mosaic of hyperechoic and hypoechoic areas seemed to be very characteristic. Biopsies of the different parts of such a tumor in 1 patient showed different degrees of fat. By color Doppler-sonography, in 8 of 12 investigated patients an increased tumor perfusion was detected. In conclusion, HCC has different sonomorphologic patterns. The so-called mosaic pattern is characteristic, but rare. A focal lesion in a cirrhotic liver is highly suspicious for HCC. Ultrasound is effective as a screening method for risk groups with liver cirrhosis, hemochromatosis or chronic hepatitis.

[Sonographic imaging of lung emboli. Results of a prospective study]. / Sonographische Darstellung von Lungenmbolien. Ergebnisse einer prospektiven Studie.

UNLABELLED: From 8/90 to 9/91 the lungs of 100 consecutive patients (35 male, 65 female) were examined sonographically. INDICATIONS: 1. tentative diagnosis of pulmonary embolism by clinical signs (n = 47) 2. only chest pain in breathing (n = 32), 3. deep vein thrombosis without signs of pulmonary embolism (n = 21). In 67 cases perfusion lung scans ware available. The typical sonographic sign is a wedge-shaped echo-poor lesion with or without a local effusion. In the first group, both methods coincided positively in 28 cases, whereas only the scan detected pulmonary embolism in 6 cases. In the second group, 8 cases were found by ultrasound, only 3 by scan. 6 patients from the third group showed pulmonary embolism sonographically. Multiple pulmonary embolism can be shown by both methods in a comparable percentage. False negative findings by ultrasound are to be expected in perfusion lesions of nearly one lobe of the lung or more, whereas contrariwise small signal embolism causes more often negative scans. Ultrasound is a additional, easily available and even alternative method of detecting pulmonary embolism, especially in case of doubt or if lung scan is not feasible.

Lymphoepithelial cyst of the pancreas. Clinical, morphological, and immunohistochemical findings.

Lymphoepithelial cyst of the pancreas, formerly also termed branchial cyst, is an extremely rare tumor of uncertain histogenesis. Our case, that of a 53-year-old man, is the fourth to be described. Fluid aspirated from the cyst exhibited a very high concentration of carcino-embryonic antigen (CEA; 5000 ng/ml), and a high level of carbohydrate antigen 19-9 (CA 19-9; 187 U/l), suggesting a diagnosis of carcinoma of the pancreas. However, the serum CEA and CA 19-9 levels were only slightly elevated (5.5 ng/ml and 125 U/l, respectively). Histologic investigation revealed a cyst lined by squamous epithelium with closely associated lymphoid tissue, without cellular atypia. Numerous lymphocytes, mainly T cells (UCHL1 positive), were present in the lining epithelium. The lymphoid tissue surrounding the lining epithelium was composed of germinal centers and T regions. Epithelial cords contiguous with the squamous epithelium lining the cyst radiated out through the lymphoid tissue towards the pancreatic parenchyma, which suggests that lymphoepithelial cyst of the pancreas is a true pancreatic cyst. Since the excretory ducts of the normal pancreatic tissue and some of the epithelial cells lining the cyst were immunoreactive for CEA and CA 19-9, it can be concluded that CEA and CA 19-9 in the cyst contents are probably produced by cells derived from the exocrine pancreas. The histogenesis of lymphoepithelial cyst of the pancreas remains unclear, but it is probable that it derives from the duct system of the pancreas.

[Thromboses of the subclavian vein and jugular vein and superior vena cava: sonographic diagnosis and control of treatment using tissue-type plasminogen activator therapy]. / Thrombosen von Vena subclavia und Vena jugularis sowie Vena cava superior: Sonographische Diagnostik und Therapiekontrolle bei TPA-Lysetherapie.

In the suspected diagnosis "superior influx congestion" sonography performed with the 5 MHz linear scanner is suitable as a non-invasive method for the primary diagnosis of thrombotic occlusions of the vena subclavia and vena jugularis interna, and for follow-up monitoring under thrombolytic therapy. In successful lysis it is possible to verify a sonomorphological and Doppler sonographic sequence of stages from the freshly formed, stratified stage via the high-echo to the low-echo thrombus with formation of lacunae, as well as the recanalisation that is seen at first only at the margins and eventually becomes complete with a flow that varies with the respiration.

[Results of sonographic diagnosis of choledochal calculi]. / Ergebnisse der sonographischen Choledochussteindiagnostik.

To evaluate sonographic accuracy in the diagnosis of choledochal calculi 44 patients were examined prospectively with a mechanical sector scanner before endoscopic retrograde cholangiography (ERC). Calculi with a diameter of more than 1.5 cm could be detected in all cases. Smaller stones (less than 1 cm) were missed in 50% of cases. To quantitate sensitivity in daily clinical practice, the data of 229 patients, suspected to have common bile duct stones, were analysed retrospectively. The overall accuracy was 76%, 90% when an experienced sonographer performed the examination and 47% if the examiner was less experienced. From these data it is concluded that the sonographic detection of choledochal calculi is influenced by the examination technique, experience of the examiner and diameter of the stones.

[Sonographic detection of embolic masses in the ventricular passage]. / Sonographischer Nachweis von embolischen Massen während der Ventrikelpassage.

Using echocardiography, we succeeded in identifying thromboembolic masses in the heart of 5 patients suffering from massive pulmonary or arterial embolism. In another case we found a thrombus in the right ventricular outflow tract. Premonitorial pulmonary embolism preceded in all cases. One thrombus in arterial embolism was found by tm-echocardiography, five thrombi by sector-echocardiography. The examinations were performed after acute worsening of the clinical condition. In four patients, death resulted from the embolism, whereas two survived, one old patient without thrombolytic or operative therapy.

Morphologically different biopsy specimens of the human gastric mucosa. II. Adenylate cyclase activity in response to prostaglandin E2 and histamine.

Adenylate cyclase (AC) in response to prostaglandin E2 (PGE2) and histamine was studied in morphologically different biopsy specimens from human gastric mucosa. The activities of the enzyme were log-normally distributed and did not differ between males and females. PGE2 activated AC in a concentration-dependent manner in normal gastric mucosa (n = 57), chronic superficial gastritis (GI, 18), chronic gastritis with beginning atrophy (GII, 10), chronic atrophic gastritis (GIII, 24), gastric ulcer (GU, 39), duodenal ulcer (DU, 32), and biopsies of patients operated according to Billroth II (BII, 20) and was most efficacious in GIII and BII. Histamine, which was studied in normal gastric mucosa (n = 27), DU (n = 20), GU (n = 13), and BII (n = 18), stimulated AC most efficaciously and potently in DU, was less effective in normal gastric mucosa and GU, and had no effect at all in BII. Cimetidine treatment of DU patients did not change the PGE2 action, while the degree of stimulation by histamine was reduced. The data indicate characteristic differences of the PGE2- and histamine-sensitive AC in the mucosal samples of these patients.

[Groove pancreatitis--its pathological anatomy and sonographic findings]. / Rinnen-Pankreatitis--Pathologische Anatomie und sonographische Befunde.

Groove pancreatitis is a special type of segmental pancreatitis. Its morphological aspects with participation of the peripheral dorsal and cranial parts of the pancreatic head, the pancreatic soft tissue, and the duodenal wall with frequent narrowing of the distal common bile duct and suprapapillar stenosis of the duodenum can be detected by means of sonography. If this type of seqmental pancreatitis is known, the suspicion of a carcinoma of the pancreatic head can be removed.

[Accumulation of risk factors before acute gastroduodenal hemorrhage: analgesic/antirheumatic drugs, alcohol and ulcer anamnesis]. / Kumulation von Risikofaktoren vor der akuten gastroduodenalen Blutung: Schmerz-/Rheumamittel, Alkohol und Ulkusanamnese.

72 patients with acute hemorrhage from gastroduodenal peptic lesions were asked about their drug and alcohol consumption as well as about their smoking habits, 43 of them (60%) had used analgetic or antiinflammatory drugs on at least 3 days during the week preceding the gastrointestinal (g. i.) hemorrhage, 20 patients had used more than on drug, 4 patients an overdose of one drug. During a therapy with corticosteroids alone only one thrombopenic patient bled. 21 patients (29%) had an abnormal high alcohol consumption. In the control group significantly fewer patients had such a drug and alcohol history (p less than 0.01 and p less than 0.05, respectively). The relative risk of a g. i. hemorrhage following an exposition with analgetic/antiinflammatory drugs was RR = +7.41 +/- 5.8. Strikingly, 43 patients (60%) had an ulcer history or a g.i. hemorrhage in the past. In 46 per cent of all patients the risk factors analgesic/antiinflammatory drug, alcohol and ulcer history accumulated before the acute hemorrhage. A more careful indication and dosage of analgesic and antiinflammatory drug therapy might reduce the frequency of g.i. hemorrhage. Most of the patients were male (76%). 39 patients (54%) were older than 60 years. The average age of the 6 patients who died was 73 +/- 6.3 years. After analgesic/antiinflammatory treatment the clinical course was by no means better than in the case of spontaneously occurring lesions. Endoscopically, following exposition with analgesic/antiinflammatory drugs more frequently erosions (p less than 0.05), multiple ulcers and gastric ulcers (no statistical significance) were observed.

[The size of the gallbladder in acute viral hepatitis]. / Die Gallenblasengrösse bei der akuten Virushepatitis.

We investigated sonographically the gallbladders of 22 patients during the course of acute viral hepatitis. The size of the gallbladders in the fasting state varied characteristically. When the illness was at its severest, the gallbladder was slightly filled or empty. Later on in the course of the illness, the volume increased until the gallbladder was tightly filled. The area of the gallbladder was measured repeatedly with the same patient and individually correlated inversely with the values of aminopeptidases, but not in a strictly linear manner. This is in fact an easily detectable, sonographical marker of the clinical development of a severely disturbed liver function. When a gallbladder is seen empty, slack or with an apparently thickened wall in the fasting state, the diagnosis of a parenchymal jaundice may be considered.

[Gallbladder sludge: a sonographically recognizable stage of lithogenesis]. / Gallenblasen-"Sludge": ein sonografisch erkennbares Stadium der Lithogenese.

The appearance and the natural course of gallbladder sludge were studied by ultrasonography in 82 patients. Sludge was found in conditions with a functional or organic disturbance of gallbladder emptying: alcoholic cirrhosis and an atonic gallbladder in the fasting state, e.g., extrahepatic ductal obstruction and obstruction of the cystic duct. No clinical complaints could be attributed to sludge. After the normal bile flow had re-established the sludge disappeared in many cases. In 9 of 82 sludge-positive patients (10,9 per cent) ultrasonography revealed gallstone formation. Newly-formed stones obtained from 2 patients had the aspect of pigment stones and were analyzed by infrared spectroscopy. They consisted of calcium bilirubinate. This material constitutes the pigment granules which are suspended in the sludge. It was concluded that sludge was an early phase of stone formation. Alcoholic cirrhosis, obstruction of the biliary tract, gastrectomy, celiac sprue and prolonged fasting may predispose to lithiasis secondary to the precipitation of sludge in a large, atonic or distended gallbladder. Ultrasonography is instrumental to detect an early state of gallstone formation in those patients who carry a risk.

Sonographical detection of free gas in the peritoneal cavity.

Using suitable examination technique free gas in the peritoneal cavity can be as reliably detected by sonography as by x-ray. The identical sensitivity of both methods is experimentally proved up to a gas-volume of 1 ml.