[Evaluation of sarcoid activity by radiological and scintigraphic methods (author's transl)]. / Die Beurteilung der Sarkoidoseaktivität anhand röntgendiagnostischer und szintigraphischer Methoden.

It is possible to evaluate the activity of sarcoidosis by means of 67 Ga scintigrams and radiographs. In known sarcoid with lung involvement, the scintigram can differentiate between the granulomatous and fibrous stage. The granuloma, which is reversible and requires treatment, must be distinguished from fibrosis, which causes permanent damage. In the early stages of treatment, the scintigram is more sensitive than the radiograph. When treatment is stopped, the scintigram is better than the radiograph in demonstrating the need for renewed therapy. Evidence of fibrosis on the radiograph, with increased activity on the scintigram, indicates the need for further treatment. 67Ga can also demonstrate enlarged hilar nodes and mediastinal nodes which are not visible on the radiograph.

[67Ga scintigraphy as an aid in the differentiation of fibrosis and granulomatosis in pulmonary sarcoidosis (author's transl)]. / Die 67Ga-Szintigraphie als Hilfe zur Differenzierung von Fibrose und Granulomatose der Lungensarkoidose.

Gallium scintigraphy enables the following statements: 1. It is possible to establish the existence of an active granulomatosis both in the acute and in the chronic stage I, as well as the granulomatous pulmonary infiltration of stage II. 2. A therapy-induced or spontaneous regression of granulomatosis is associated with a reduced and later on absent deposition of 67Ga. 3. Signs of fibrosis visible on x-ray film do not exclude the continued presence of granulomatous pulmonary infiltrations. Such a granulomatosis can progress and thus produce further fibrosing and hence functional disorders up to the development of pulmonary heart disease (cor pulmonale.) It follows from this that in such cases corticoid treatment must be continued or resumed. 4. Reduced or no longer apparent storage of 67Ga under therapy does not represent a safeguard against relapse. X-ray controls chould be performed after discontinuation of corticoid therapy in order to discover, if any, discrete signs of recurring granulomatosis. In such cases, gallium scintigraphy can clearly show the revival of granulomatosis. 5. In our opinion, gallium scintigraphy is mandatory in all pulmonary affections.

[Our experiences with the gallium-scintigraphy in case of sarcoidosis of the lungs (author's transl)]. / Unsere Erfahrungen mit der Gallium-Szintigraphie der Lungensarkoidose.

The comparing examinations of patients suffering from a sarcoidosis of the lungs by the help of roentgenograms, scintigraphies of lung perfusion of 67-gallium and bioptic examinations admit to conclude as follows: In the stages I and II the activity-accumulation of radioactive gallium corresponds nearly to the alterations becoming visible in the X-ray-graph. Consequently, increases of lymph nodes and active granulomatous interstitial or centriform infiltrations may be presented. In case of a successful treatment the activity-incorporation is not to be proved anymore. As to time the alterations also coincide with the radiogram. In single cases the epithelioid nodule may be proved bioptically and microscopically when the active process already has stabilized spontaneously or by a treatment. In these cases the radioactive gallium is incorporated no more. The proof of 67-Ga-activity has a special signification in case fibrotic alterations have already appeared. The examinations prove that a granulomatosis may continue to exist when already distinct X-ray-symptoms of a fibrosis are present. Consequently, the granulomas may appositionally develop and cause an additional fibrosis. Therefore, in case of an existing infiltration of the lungs the combination of a definite lesion in the form of a fibrosis and a persisting formation of granulomas rather means a rule than an exception. A perfusion scintigram may be altered pathologically by a granuloma as well as by a fibrosis. Disorders in perfusion caused by granulomas are reversible.

[Basic differentiation of granulomatosis and fibrosis in sarcoidosis (author's transl)]. / Differenzierung der Grundprozesse: Granulomatose und Fibrose bei der Sarkoidose

Active pulmonary granulomatosis due to sarcoidosis in stage I is characterized on chest films by well-defined enlarged hilar and mediastinal lymph nodes. In stage II a involved lymph nodes decrease in size. Interstitial infiltration causes ill-defined broadening of vessels and bronchi. Focal infiltrates correspond to just detectable or nodular lung shadows of up to several centimeters in size. Active granulomatosis is demonstrated by Gallium-67-scans in lymph nodes as well as in areas of interstitial and focal pulmonary infiltrates. Following spontaneous or therapeutically induced regression of granulomatosis the abnormal uptake is not seen anymore. X-ray findings of fibrosis include partial shrinkage of pulmonary lobes or segments along with displacement of vessels and bronchi and (fibrous) adhesions of interlobar, parietal and mediastinal pleura. Honeycombed, occasionally bullous emphysema are the most reliable findings suggesting fibrosis. In addition to the fibrosis demonstrated on chest films, the Gallium-67-scan often shows progressive granulomatosis. So stage III disease is often (almost regularly) associated with stage II disease. Such cases still need further treatment.

[The radiology of Egyptian mummies (author's transl)]. / Das Röntgenbild ägyptischer Mumien

The technique used for the radiological examination of a well preserved mummy is described. Problems of identification and determination of age, size and sex are discussed. Post mortem changes consist of subluxation of the cervical spine and fractures of the ribs and fibulae. Of medical interest, it was possible to diagnose definitely Scheuermann's disease with a scoliosis and marked reactive spondylotic and spondylo-arthritic changes. The radiological findings provided further information regarding the technique of mummification and the method of burial. Some findings of mythological significance could be demonstrated radiologically, such as the fact that the heart and kidneys had been left in the body, the presence of a scarab, various gold plates and amulets and a fayence-decorated shroud.

[Confluent pulmonary deposits from carcinoma of the breast under cytostatic therapy (author's transl)]. / Einschmelzende pulmonale Mammakarzinom-Metastasen unter zytostatischer Therapie. Beitrag zur Pathogenese

Cases of disintegrating pulmonary metastases are presented. Most interesting are cavitations which occur under cytostatic therapy. An increasing number of cavitous metastases might be seen under propagated cytostatic therapy.

[67Ga scanning in sarcoidosis]. / Die 67Ga-Szintigraphie bei der Sarkoidose

The value of 67Ga scans in selected cases of sarcoidosis was studied at various stages in order to assess its value as a supplement to clinical, radiological and perfusion studies. During stages I and II, radioactive gallium is taken up by the granulomatous nodes in the hilum and mediastinum and in the interstitial focal pulmonary infiltrates. After complete regression of the hilar and mediastinal lymphadenopathy or of the pulmonary infiltrates, radio-active uptake can no longer be demonstrated. Gallium scans are valuable in showing whether there is active granulomatous infiltration into the lungs when there is known scarring resulting in abnormal perfusion conditions. The gallium scan may indicate that further treatment is desirable. A comparison of serial radiographs and the 67Ga scan provides an indication of the activity of the granulomatous disease; a comparison of the radiological findings and of perfusion scans shows the severity of perfusion abnormalities caused by fibrosis. The investigation has shown that the granulomatous lesions persit even though radiological, clinical and functional investigations have indicated the presence of fibrotic scarring. Radiography, perfusion and gallium scans provide an understanding of the dynamics of this disease.