[Percutaneous endovascular aneurysm repair without arteriotomy (Perclose system)]. / Perkutane endoprothetische Therapie des Aortenaneurysmas ohne Arteriotomie.

BACKGROUND AND OBJECTIVE: It is common clinical practice to perform an arteriotomy for the endovascular treatment of infrarenal and thoracic aortic aneurysms. Instead we used the percutaneous endovascular Perclose device to perform the aneurysm repair without arterial cut-down. PATIENTS AND METHODS: The Perclose device contains four needles with two suture loops for closing the femoral artery access site. The sutures were deployed after the arterial puncture, before introduction of sheaths (diameter 12 - 27 F = 4 - 9 mm). After the procedure the sutures were used to close the puncture site. We attempted to achieve hemostasis with the Perclose system in 104 femoral arteries in 60 patients (7 females, mean age 69 +/- 12 years). The mean vessel diameter was 10 +/- 2 mm. RESULTS: The percutaneous graft implantation was successfully achieved in 58 of 60 patients. The graft could not be forwarded into the aorta in two cases because of calcified iliac arteries. The Perclose suture technique was successfully used in 97 femoral arteries. In one case a false aneurysm developed and in another case a secondary hemorrhage occurred. Seven patients needed additional manual compression to achieve complete hemostasis. A surgical repair was not necessary. The time to hospital discharge ranged from 4.5 hours to 32 days (median: 18 hours). 20 patients stayed longer than 24 h in the hospital, only 2 of them for reasons related to the puncture site. CONCLUSION: Closing the access site with the Perclose system is technically feasible and effective, even with large sheaths up to 27 F = 9 mm. This technique reduces the invasiveness of the endovascular repair of aortic aneurysms and decreases the length of hospital stay, i. e. it allows treatment in outpatients.

[Sneddon syndrome: vasculitis or thrombotic disorder?]. / Sneddon-Syndrom: Vaskulitis oder thrombotische Vaskulopathie?

BACKGROUND: Livedo reticularis generalisata (LR) in combination with affection of CNS is referred to as Sneddon's syndrome (SNS). Latest data suggest chronic progressive systemic disorder with occlusion of small and medium sized vessels (e.g., cutis, brain, kidneys, heart, eyes). No conclusive etiology is known, though there are correlations to the antiphospholipid syndrome, systemic secondary vasculitis and coagulopathies. Hereditary and toxic factors seem to play a role in pathogenesis in some cases. CASE REPORT: Diagnostic procedure and clinical course of a 56-year-old woman with dementia and hemiparesis proceeded by LR is reported. MRI-, SPECT- and TCD-findings were congruent with diffuse ischemic lesions of the brain due to affection of small- and medium-sized vessels. Histopathological specimens of the brain, meninges and cutis were non diagnostic. Some laboratory findings suggested vasculitis as an underlying cause. LR improved under immunosuppressive therapy with prednisolone and azathioprin. CONCLUSION: SNS does not seem to be a nosological entity. A differentiation between primary (idiopathic) and secondary SNS is useful for different therapeutical approaches.

A new classification of proximal humeral fractures.

Neer's classification of humeral fractures was proved on 657 patients. This classification enables the radiologist to estimate the risk of avascular necrosis of the head of the humerus. The problematic group is that of four part lesions, which has a 19% incidence of humeral head necrosis. Since in this group minimal osteosynthesis produces better functional results than extensive osteosynthesis, a detailed pre-operative radiological description of the fracture type is necessary in order to spare the patient from extensive surgery which could have unsatisfactory results.

[Diagnosis and therapy of pseudo-obstruction of the colon]. / Diagnose und Therapie der Pseudoobstruktion des Kolons.

Pseudo-obstruction of the colon (Ogilvie's syndrome) occurred in 18 patients as an acute abdominal emergency. It was characterized by massive distension of the caecum or the entire colon in the absence of any organic cause. Usually there was an underlying extraintestinal disease. Diagnosis of this entity depends on careful radiological investigation of the abdomen, whereby barium enema reveals the absence of organic obstruction. Increasing distension in untreated patients may lead to spontaneous perforation of the caecum.

[Aneurysms of the abdominal aorta: possibilities and limits of sonography]. / Das Bauchaortenaneurysma: Möglichkeiten und Grenzen der Sonographie.

Sonography has proved successful as an excellent method to diagnose an aneurysm of the abdominal aorta with an accuracy of 98%. Diameter of the aneurysm can be determined via sonography with the same exactitude as with CT. The difficulties arising with sonography concern the exact determination of longitudinal spread. If an aneurysm starts on the level of the hilus of the kidney, the information supplied by sonography on an involvement of the renal arteries is not sufficiently safe, whereas the distal end of the aneurysm can often be determined correctly. The angiogram remains indispensable for assessing adjacent vascular regions in asymptomatic aneurysms. Sonography allows good identification of perforated and penetrating aneurysms. This fact emphasises the value of this method also in acute diagnostics.

Computed tomographic findings in myogenic gastric tumors.

Computed tomographic findings in leiomyoma, leiomyosarcoma and benign leiomyoblastoma of the stomach are discussed. Gastroscopic biopsy was unsuccessful in every case, but CT was able to show the extragastric extension in all tumors. In one case, gastric leiomyoma and renal hypernephroma occurred simultaneously. Both tumors showed similar contrast medium enhancement, leading to a misdiagnosis.

[Giant-cell reaction of the short tubular bones of the hand and foot]. / Die riesenzellige Reaktion der kurzen Röhrenknochen von Hand und Fuss.

Giant cell reactions in the short tubular bones comprise mainly enchondromas, aneurysmal bone cysts and giant cell tumours. In both cases a history of trauma can be related. We therefore agree with Aegerter and Lorenzo that an intra-osseous haematoma due to minor trauma is likely to be of pathogenic significance.

Adenosine and diltiazem. A new therapeutic concept in the treatment of intestinal ischemia.

To determine the therapeutic effect of two vasodilators, adenosine and diltiazem, in mesenteric ischemia, 13 dogs were treated with an intra-arterial perfusion of the drugs after digitalis intoxication. Blood flow was restored to the control value after a dose of 2 micrograms/kg/minute adenosine or 5 micrograms/kg/minute diltiazem. The advantage of adenosine is that its effect begins and ends very rapidly, but because doses of more than 2 micrograms/kg/minute may cause a drop in blood pressure, strict pressure control is mandatory when the drug is applied clinically. Its limited use is appropriate, for example, when operative measures cannot be excluded. Diltiazem can be used for long-term therapy with a reduced risk of a drop in blood pressure.

[Soft-tissue changes in the chest wall area after contusion trauma. The findings in conventional x-ray diagnosis]. / Weichteilveränderungen im Bereich der Thoraxwand nach Kontusionstrauma. Befunde bei der konventionellen Röntgendiagnostik.

Six cases of posttraumatic hematomas in areas of the chest wall are reported, four of them were found subpleural and two extrapleural. Radiological signs and differential diagnostic possibilities are discussed.

Value of angiography, sonography, and CT in renal infarction.

The value of angiography, sonography, and computed tomography as diagnostic methods for renal infarction is discussed. In all cases the infarct could be demonstrated angiographically, but not by sonography. In the case of a former infarct, the involved area appeared as a tumour mass by sonography and enhanced CT-scan showed contrast enhancement of the mass.

[Effect of contrast media on glycoside-induced mesenteric ischemia]. / Kontrastmitteleffekte bei der glykosidinduzierten mesenterialen Ischämie.

Experiments in 12 dogs have shown that intra-arterial injection of hyperosmolar contrast into the superior mesenteric artery normally produces a 52% increase in blood flow lasting more than two minutes. Following digitalis-induced mesenteric ischaemia, vaso-dilatation is equally marked, but lasts two and a half times as long. In view of the prolonged vaso-dilator effect of hyperosmolar contrast, arterial spasm could be missed during angiography.

Evidence for coronary spasm during flushing in the carcinoid syndrome.

In this report we present the history of a patient with symptomatic carcinoid syndrome. During flushing he suffered from variant angina. The observation of coronary spasm due to excess 5-hydroxytryptamine (5-HT) is discussed with regard to the discharge of 5-HT from clotting platelets in the coronary arteries.

[Pulmonary fibrosis in histiocytosis X]. / Lungenfibrose bei Histiozytose X.

This paper reports on a 23-year-old man suffering from pulmonary fibrosis caused by localised histiocytosis X. Although chest film examination shows diffuse pulmonary involvement the patient is asymptomatic. No other organ systems are involved. The different forms and prognosis of histiocytosis X are discussed.

[Computertomographic findings in pigmented villonodular synovitis]. / Computertomographische Befunde bei der pigmentierten villonodulären Synovitis.

The CT findings in two patients with synovitis of the knee joint were analysed. Angiography is a non-specific method for the differential diagnosis of synovitis; CT, however, can be pathognomonic by showing a strikingly thick and hyperdense synovial membrane because of the iron content of the hyperplastic synovia. This is not found in non-specific synovitis.