[Sonography and scintigraphy in the diagnosis of cystadenolymphomas (warthin tumor)]. / Wertigkeit der Szintigraphie und der Sonographie in der Diagnostik der Zystadenolymphome der Glandula parotis.

BACKGROUND: Is scintigraphy in the preoperative diagnosis of cystadenolymphomas dispensable? PATIENTS AND METHODS: In this prospective study 35 patients with tumors of the parotid gland were examined sonographically and scintigraphycally and the results were compared with the histological findings. RESULTS: By means of sonography 88 % (22/25) of the cystadenolymphomas were correctly diagnosed and by means of scintigraphy 80 % (20/25). CONCLUSIONS: Sonography is recommendable as the first-line diagnostic procedure in cystadenolymphomas because it is without radiation load, the free choice of the echographic plane, and it can be repeated as often as desired. Scintigraphy adds in selected cases, as in elder patients, additional informations. The combination of sonography and scintigraphy confirms the presence of cystadenolymphoma and allows the surgeon to make a decision and to avoid surgery especially in high-risk patients.

[Value of B-image ultrasound in diagnosis of paranasal sinus diseases in comparison with computerized tomography]. / Wertigkeit der B-Bild-Sonographie in der Diagnostik von Nasennebenhöhlenerkrankungen im Vergleich zur Computertomographie.

BACKGROUND: In diagnostic imaging of the paranasal sinuses, the A-mode technique is increasingly being substituted by B-mode ultrasonography. To assess the value of B-mode sonography we compared in a double-blind study computed tomography with our ultrasound findings. PATIENTS AND METHODS: Seventy-eight patients were examined by CT and subsequently by ultrasound, two-thirds before endonasal surgery and one-third for diagnosis of serious facial pain and swelling. RESULTS: Among 114 pathological maxillary sinus tomograms, 83 findings could also be diagnosed by ultrasound (sensitivity 72.8%). In the frontal sinuses only 12 of 52 of pathological findings could be detected (23.1%) and only 9 of 80 in the frontal ethmoid (11.3%). Except for circumscribed polyps and moderate general swelling of the mucosa, the detection rate by sonography was 97.4% for the maxillary sinuses, 31.5% for the frontal and 18% for the ethmoid sinuses. CONCLUSIONS: Ultrasound usually only demonstrates the presence of absence or unspecific findings. Differential diagnosis between tumors and sinusitis is generally difficult. The healthy individual is correctly assessed as healthy due to the total reflection of the air-filled healthy sinus. According to our findings ultrasound has a certain value in the diagnosis of maxillary sinuses. It can be used to obtain a preliminary diagnosis and as a screening method although a negative result never excludes a disease of the sinuses. As it does not involve radiation exposure, ultrasonography can be recommended as first step in diagnosis for children, pregnant women, and young women especially in acute sinusitis, because in acute sinusitis the maxillary sinuses are generally affected.

Stasis papillomatosis. Clinical features, etiopathogenesis and radiological findings.

Stasis papillomatosis can be divided into localized and widespread forms. Ten patients with this disease are discussed with emphasis on their clinical and lymphoradiological findings. Using isotope lymphography we were able to find an overall lymphostasis in only four patients. In all patients, local lymphatic disturbances were detected by means of indirect lymphography with intradermal lymph cysts as the most specific sign. Local dermal lymphostasis seems to be the common final pathogenesis in spite of different etiologies (ie, primary lymphedema, chronic venous insufficiency, trauma recurrent erysipelas, and local lymphangiodysplasia of unknown origin). A maximum variant was seen, following en-bloc resection of subcutaneous tissue in a patient suffering from congenital lymphedema.

[Angioarchitecture of the ileum and colon in Crohn disease]. / Angioarchitektur von Ileum und Colon bei Morbus Crohn.

Vascular changes in resected bowels of Crohn's disease were examined angiographically, microangiographically, micro-preparatorily and histologically. The proper angioarchitecture of the small and the large bowel is being destroyed in the course of the ongoing inflammatory process. Dilated capillaries, destruction of the primary angioarchitecture and its replacement by an irregular, partially bizarre pattern of scar vessels with bundling of the unchanged Vasa recta as varying vessel diameters caused by obliterating secondary fibroses can be seen in advanced Crohn's disease. The angioarchitecture of the pseudo-polyps in Crohn's disease is characterized by an increased number of vessels, bizarrely bended vessels and a radial pattern of veins. All these vascular changes in Crohn's disease are to be seen as secondary changes due to the inflammatory reaction.

[Tumor form of lymphostatic papillomatosis of the skin]. / Tumorform einer Papillomatosis cutis lymphostatica.

The case of a patient with two plantar papillomatous tumours that had had a relapsing course over 10 years is presented. The tumours were located on the right forefoot and the left great toe. Several operations were performed for different diagnoses, i.e. plantar verrucae, verrucous carcinoma and pyoderma vegetans. Histologically, the papillomas proved to be pseudocarcinomatous hyperplasias with multiple ectatic dermal lymph plexuses. Indirect lymphography revealed a circumscribed lymphatic dysplasia with cystic-ectatic cutaneous vessels within the tumour area. Draining lymphatic collectors were conspicuously reduced in number. Isotope lymphography showed a normal lymph transport rate from the foot to the groin. It is concluded that the circumscribed disturbance of lymphatic drainage is the decisive cause of the reactive papillomatous hyperplasia. Thus, these papillomas clinically resembling verrucous carcinoma represent the tumour variant of a papillomatosis cutis lymphostatica.

[Isotype lymphography findings in sclerotherapy, varicose exeresis and excision of autologous venous transplants for arterial reconstructions]. / Isotopenlymphographische Befund bei Sklerotherapie, Varizenexhairese und Entnahme von autologen Venentransplantaten für arterielle Rekonstruktionen.

In an isotope lymphography study on 24 patients (38 legs), the influence of complete sclerosation therapy of trunk varicosis of the great and small saphenous veins according to Tournay is examined before and, on average, four weeks after treatment. The isotope lymphography parameter was defined as the ratio of the outflow from the foot to the influx to the groin area (quotient Q). The results showed no significant change in Q after treatment compared with the starting values. Thus, sclerosation therapy did not result in any impairment of lymphatic transport. In contrast, of the 9 patients (12 legs) treated by varicose exeresis who were referred for isotope lymphography there were 8 cases (i.e. 9 legs) of impaired lymphatic transport. However, this was a pre-selected patient group. Three further patients were examined by isotope lymphography after resection of a saphenous segment for arterial reconstruction. These revealed excessive lymphatic transport disturbances which were quantified for the first time. Vascular surgeons should include this complication in their explanatory talks with patients.

[Detection of lymph vessel changes in venous diseases of the leg using imaging procedures]. / Nachweis von Lymphgefäss-veränderungen bei Venenerkrankungen der unteren Extremitäten durch bildgebende Verfahren.

Chronic venous insufficiency reveals both functional correlations with the lymphatic system of the limbs as well as pathological-anatomical. The functional correlation initially consists in an enhancement of function as a manifestation of a compensation mechanism of lymphatic drainage in relation to the insufficient venous system. Finally, if the lymphatics are themselves damaged in their further course, a safety valve insufficiency occurs with resulting lymphostasis. Apart from this participation, regional damages to the lymphatic fascicles play a role in chronic venous insufficiency in trophic disorders, as for example leg ulcer and atrophy. However, these are far less significant for the overall function of lymphatic drainage. As a role, they show a pronounced collateralization, and thus good possibilities of functional compensation. In particular indirect lymphography with water-soluble contrast medium is suitable as imaging technique in diagnostics with regard to the morphology. Isotope lymphography is suitable with regard to investigating the function of lymphatic drainage and for circumscribed local disorders. As native techniques, xeroradiography and computed tomography are very suitable to analyse tissue damage of the cutis and subcutis resulting from chronic venous insufficiency and from lymphostasis and to make indirect inferences from this with regard to the chronicity of this disease process.

[Multiple lipomas of the colon. Case report with clinical, roentgenologic, angiographic and histologic findings]. / Multiple Lipome des Kolons. Fallbericht mit klinischen, röntgenologischen, angiographischen und histologischen Befunden.

Case report on a 26 year old woman with multiple lipomas of the colon and rectum and a neurofibromatosis simultaneously. Description and discussion of clinical data and differential diagnosis. The vascularisation of the lipomas and of the overlying mucosa was proved to be good angiographically. This is the reason for the frequent bleeding of the lipomas of the colon. The coincidence of multiple lipomas and neurofibromatosis is rare. Therefore conclusions for a possible common etiology of the two diseases should be drawn only after further reports.

[Sonography of the neck--indications and value]. / Sonographie im Halsbereich--Indikationen und Wertigkeit.

The anatomical structures of the neck as shown by ultrasound are described. The B-scan technique is of primary importance for evaluation of the thyroid gland and the major salivary glands too. B-scan ultrasound is the premier method of diagnosis of thyroid gland disease. Therefore the otolaryngologist interested in this region needs profound knowledge of the ultrasound findings of thyroid disease including lymphomas, other types of tumor and vascular lesions. At the moment ultrasound is the "missing link" between palpation of the neck and endoscopy because of its ability to display the underlying structures.

[Lymphoscintigraphic studies of regional lymph vessels in patients with head and neck tumors]. / Lymphszintigraphische Untersuchungen der regionalen Lymphwege bei Patienten mit Kopf-Hals- Tumoren.

Lymphatic drainage was followed with Tc lymphoscintigraphy. Micrometastases in head and neck cancer cases cannot be detected. The drainage pattern is highly variable and does not allow prognostic conclusions in tumors as demonstrated for the parasternal pathways. The method helps to determine the side and extent of a neck dissection prior to surgery as well as follow-up postoperatively. The development of lymphedema can be detected early in order to start treatment by manual lymph drainage.

[Pulmonary microlithiasis following iodine lipiodol lymphography?]. / Mikrolithiasis pulmonum nach Jod-Lipiodol-Lymphographie?

Pulmonary fibrosis with marked calcifications in an 83 year old female patient is reported. Following previously inconspicuous thoracic x-ray findings (1975 and 1978) a bipedal oil lymphography was carried out for diagnosis of a systemic malignant lymphoma. The calcifying pulmonary fibrosis was investigated with the help of tomography, computed tomography, xeroradiography and scintigraphy of the lung and the skeletal system as well as magnetic resonance imaging. A biopsy was refused by the patient. The etiological possibilities of an idiopathic disease as well as an induction by the oil contrast medium and a concomitant malignant lymphoma are discussed.

[Studies on the angioarchitecture of polypoid colonic processes]. / Untersuchungen zur Angioarchitektur polypöser Kolonprozesse.

Portions of the colon removed at operation were studied angiographically after arterial or venous injection with a barium-gelatin mixture. The aims of the investigation were: To study the differences between tumour and inflammatory angiographic appearances and the clinical value of in vivo angiography of the mesenteric arteries. A comparison of the micro-angiographic appearances of benign and malignant polypoid lesions of the colon. Adenomas and carcinomas showed patterns which are easy to distinguish and permit classification in uncertain lesions. Pseudopolyps in Crohn's disease resemble adenomas in the early stages, but later assume features characteristic of tumours.

Relationship between the venoconstrictor activity of dihydroergotamine and its pharmacokinetics during acute and chronic oral dosing.

In a double-blind, interindividual comparative study 30 healthy volunteers were randomly allocated to oral treatment with 5 or 10 mg of dihydroergotamine (DHE) or placebo once daily for 16 days. Regional basic venous blood volume (BBV), pressure dependent venous capacitance (CV) of the calf, resting heart rate and blood pressure were determined on Days 1 and 15 of treatment. Plasma concentrations of DHE were monitored on Days 2 and 16. Due to spontaneous vasodilation BBV varied considerably, showing that it is an inappropriate parameter for investigating the venoconstrictor activity of DHE. CV remained unchanged after the first dose of DHE but it had declined significantly on both dosage regimens at the end of the treatment phase. In contrast, the blood concentration profiles of DHE were comparable at the beginning and the end of the trial. The discrepancy can best be explained by the existence of an effect compartment, e.g. smooth vascular musculature, which slowly becomes filled with DHE and/or its active metabolites. The venoconstrictor activity of DHE exhibited a significant dose-response relationship.

An autoradiographic study of bone grafts in small animals.

Bone remodelling was studied in allografts and isografts by means of autoradiography. Collagen and proteoglycans of the organic bone matrix were labelled with H-3 amino acids and S-35 sodium sulphate. The principles of primary bone formation are followed in graft remodelling as well. Matrix breakdown and reformation are carried out by mononuclear cells. Components of the original matrix can be seen in osteoclasts, perivascular cells, osteoblasts, young osteocytes, and in new bone. The label allows tracing of these components and proves their reuse.

Advanced periampullary carcinoma: endoscopic palliation by sphincterotomy.

We have described a 50-year-old woman with periampullary carcinoma with extensive infiltration of the duodenal wall arising from advanced tumor of the pancreatic head. Endoscopic sphincterotomy induced complete relief from jaundice and pruritus before definitive surgical therapy was done. This procedure should not be restricted to small tumors confined to the ampulla itself, since it may also be of palliative or preoperative value in certain patients with advanced cancer of the pancreatic head.

[Value of isotope diagnosis in diseases of the ENT area. Status, development and trends]. / Der Stellenwert der Isotopendiagnostik bei Erkrankungen im HNO-Bereich. Stand, Entwicklung und Tendenzen.

The nuclear medical diagnostic procedures listed in this article demonstrate the continual change in the significance of modern and recent techniques. The definition of the current status may be as short-lived as some radioisotopes. The tendencies are determined by aspects of radiological hygiene and the development of new technical procedures and the preference of in-vitro-examinations over in-vivo-diagnostic. On the other hand progress in immunology using labelled antibodies opens new possibilities in diagnosis and therapy. Although these possibilities are still somewhat visionary, they have already been translated into reality by experiment. For examination of thyroids further progress in sonography can be expected. In special problems tests using iodine isotopes with short half-lives and consequently lower radiation exposure will be used. At the moment the combination of technetium scintigram with sonography seems optimal and should if possible applied by the same hand. Scintigraphy of salivary gland and of cerebrospinal fluid have their unquestioned position. Brain scintigraphy has lost its importance but may reappear as an examination method using specially labelled agents for research of cerebral metabolism. The position of bone scintigraphy is similar. Its use is still justified when searching for skeletal changes which may not be seen in classical radiology. The knowledge of disturbance of local osseous metabolical disturbances does not give a specific information on the cause but demonstrates the site of disorder. Contrary its present ranking, important developments are to be expected from tumour scintigraphy. Isotope angiography, isotope lymphography and ventilation scintigraphy are to be employed when special questions arise, especially in fundamental research and for controls of therapeutic concepts.

[Appearance of fresh vertebral body fractures on the bone scintigram]. / Das Verhalten frischer Wirbelkörperfrakturen im Skelettszintigramm.

Based on observations on 27 patients technetium-99m-diphosphonate scintigram is recommended as two-stage-investigation. During the first 12 hours no activity and up to 48 hours only slight activity can be seen in contrast to a marked take-up of the tracer after 6 to 8 days. This enables a timing of the fracture, which can be of importance in compensation and legal disputes.

[Intratympanic course of the internal carotid artery as an accidental finding of ear surgery and as a roentgen diagnostic problem]. / Der intratympanale Verlauf der Arteria carotis interna als otochirurgischer Zufallsbefund und röntgendiagnostisches Problem.

The rare anomaly of an intratympanic course of the internal carotid artery is, like the equally rare aneurysm of this artery, a differential diagnosis of tumours of the middle ear. A biopsy would lead to obvious complications. Petrous bone tomography, even using the most modern spiral type of movement, is of limited value because of the difficulty in interpretation and plays little part in the diagnosis as compared with arteriography.

[Paranasal sinusitis in children]. / Zur Sinusitis paranasalis bei Kindern.

Sinus x-rays were taken of all children admitted for surgery to the ENT Department of Bochum for one year. 43.9% of 273 children and 29% of 14 healthy control children showed opacities of the maxillary sinuses. As described previously, sinusitis in childhood produces few symptoms. Patients with nasal obstruction due to adenoids did not show a higher incidence of pathological changes on sinus x-rays. Children with sinusitis did not have a higher rate of combined chronic otitis media, chronic bronchitis and chronic tonsillitis than the patients without pathological changes on the sinus x-rays.

[Micromorphological and clinical aspects of angiodysplasias]. / Aspects micromorphologiques et cliniques des angiodysplasies.

As is known, 1900 Klippel and Trenaunay summarized naevus teleangiectatisuc lateralis, vein ectasias and isolated gigantism to a triad. Seven years later Weber described the same syndrom adding the symptom of arterio-venous fistulas, that he clinically diagnosed. Some authors deduce from this symptomatology two syndroms ; on one hand the Klippel and Trenaunay syndrom and on the other the P. F. Weber-syndrom. As it is shown, in spite of an immense variability of symptoms, arterio-venous short circuits can regularly be demonstrated-clinically, arteriographically or histomorphologically. In addition to this some casuistical examples are presented. Referring to this reports the authors do not agree on separation of Klippel-Trenaunay and Weber syndrom. Considering to therapeutical consequences -- namely surgical -- it should be always cleared up angiographically if hemodynamically relevant arterio-venous fistulas are present. (Due to this fact a divergence to Weber's characterization is given). Relative to the authors opinion the presence of hemodynamically and so therapeutically relevant or obviously hemodynamically non-relevant arterio-venous fistulas does not allowed the separation in two syndroms. Out of this reason the authors nomenclature the described symptomatology as Klippel-Trenaunay-Weber-Syndrom.