Radiological and ultrasonographic investigations with respect to patient selection and monitoring for chemical gallstone dissolution.

786 consecutive patients with suspected gallstones investigated radiologically and ultrasonographically, 231 (33.0%) were found to have stones. Radiological examinations showed that 59.3% of these were suitable for chemical dissolution with cheno- or ursodeoxycholic acid. The percentage of treatable patients fell from age 20 to age 65 from 71% to 48% (p less than 0.05) and then rose again to 61% (not significant). The benefit of litholysis is greater, the earlier it is begun. The results are in disagreement with those of two studies in operated patients. Here only 19-24% were suitable for stone dissolution. Comparative ultrasonographic and radiological studies in 23 patients have shown that monitoring of patients during litholysis can be carried out ultrasonographically. Stone size measured ultrasonographically corresponds sufficiently accurately with that obtained radiographically.

[Combined irrigation and endoscopy in the treatment of biliary duct stones (author's transl)]. / Spülbehandlung und Endoskopie im kombinierten Einsatz bei der Therapie von Gallengangssteinen.

In ten patients with biliary duct stones reoperation was not indicated and endoscopical stone extraction after papillotomy had failed due to the size of the concrements. As in some patients cholecystectomy had been performed several years ago and in others had not been done yet, treatment was commenced via an endoscopically inserted nasobiliary tube using media dissolving cholesterol and calcium bilirubinate stones. Results of treatment were satisfactory and side effects were tolerable. Results were compared with those after treatment with glycero-1-monooctanoate (Capmul 8210). In four patients distribution in the intra and extrahepatic biliary duct system was investigated by admixture of radiographically opaque media with both irrigation fluids. It was shown that both the oily and watery phase of the irrigation media were distributed homogeneously in the duct system and that the stone surface was covered adequately.

[Nonocclusive mesenteric ischemia (author's transl)]. / Die nichtokklusive mesenteriale Ischämie.

This report intends to emphasize the importance of selective angiography in nonocclusive mesenteric ischemia (NMI). In a 67-year-old male with abdominal pain and weight loss the diagnosis of NMI was made angiographically after enteroclysis had shown extensive ulcerative jejunitis. In this condition, where constriction and obliteration of vasa recta of the superior mesenteric artery are present, operation is contraindicated. Current status of still incomplete understanding of the disease is discussed.

[Radiological appearance of neoplastic and inflammatory changes of the small intestine. A case report (author's transl)]. / Die neoplastischen und entzündlichen Dünndarmveränderungen im Röntgenbild. Ein kasuistischer Beitrag.

Accuracy and efficiency of small bowel enteroclysis by means of a roller pump is demonstrated in patients with neoplastic and inflammatory small bowel disease.

[Diagnosis and treatment of chylopericardium (author's transl)]. / Diagnose und Therapie des Chyloperikards.

In a 22-year-old patient without clinical symptoms, a chylous pericardial effusion was found as cause of pericardial enlargement persisting over 7 years. Ultrasonic echocardiography, diagnostic pericardial puncture and the demonstration of chylomicrons enabled the diagnosis to be made. Lymphography showed lymphangiectasis of the thoracic duct. At operation two fistulous connections between pericardium and lymphatic system were found. Surgical ligature of the thoracic duct and the lymphatic fistulae and pericardial fenestration resulted in rapid normalisation of all findings.

[Supra renal metastases. The rôle of angiography (author's transl)]. / Nebennierenmetastasen--Stellenwert der Angiographie.

Fifteen cases of metastatic involvement of the adrenal glands are described. There are three groups of metastatic lesions: 1. metastases of distant tumors 2. metastases of malignant tumors of the ipsilateral kidney 3. direct extension of tumor to the adrenals Neovascularity was angiographically demonstrated in all cases. 13 of 15 patients had hypervascular metastases and 12 showed enlarged adrenal arteries. The angiographic findings are discussed and compared to those found in the literature.

[Angiographic appearance of intravenous tumor growth in the portal and hepatic veins ("thread and streaks sign") (author's transl)]. / Angiographischer Nachweis intravenöser Tumorexpansion in Vena portae und Vena hepatica ("thread and streaks sign").

Report of two cases with the angiographic signs of tumor growth in the portal and hepatic veins in hepatocellular carcinoma. Discussion of the angiographic and pathologic-anatomic findings and review of the literature.

[The radiological diagnosis of peptic ulcer of the oesophagus (author's transl)]. / Zur Röntgendiagnose des peptischen Osophagusulkus.

In the two years 1974--1976, the radiographic diagnosis of peptic ulcer of the oesophagus was made in 14 patients. All these patients showed oesphagogastric reflux at fluoroscopy, 13 had an axial hiatus hernia. The ulcer lay at the oesophagogastric junction in 13 patients, in one patient it was located 5 cm. above the cardia. Endoscopy was performed in 11 patients and confirmed the X-ray diagnosis. The authors believe the best technique for this purpose to be "hypotonic oesophogography" and that this is essential for the differential diagnosis between benign and malignant ulcers.

[Clinical-radiological evaluation of barium sulfate suspension in double contrast examination (author's transl)]. / Klinisch-radiologische Beurteilung von Barium-sulfatsuspensionen für die Doppelkontrastuntersuchung des Magens.

In four selected, commercial barium sulfate preparations, viscosity, surface tension and particle size were measured; examined were agglomeration, sedimentation and homogeneity in vitro. For the clinical-radiological examination, an evaluation scheme has been developed containing the following criteria: uniformity and thickness of contrast medium layer, demonstration of the areae gastricae, clearness of gastric contour, and vesiculation. A blind study, encompassing about 100 double contrast examinations of each preparation, ascertained the usability of this scheme. Significant differences could be detected among the four contrast media. The barium sulfate suspension which was rated the highest lay within a viscosity range of 50-90 cP, had a particle diameter of 0.2-1.6 micrometer and showed the least degree of agglomeration. Results of the in vitro examinations, when compared to the clinical tests, lead to the conclusion that both, gastric mucous and contrast medium additives, may exert considerable influence on the pictorial quality of the above defined criteria.