[Sympathetic reflex dystrophy. Effectiveness of physical therapy treatment of Sudeck's syndrome]. / Sympathische Reflexdystrophie. Wirksamkeit physiotherapeutischer Behandlungsmassnahmen des Sudecksyndroms.

To investigate the impairment of patients with reflex sympathetic dystrophy syndrome (RSDS) and to establish the effectiveness of two physiotherapeutic regimens in the treatment of this entity, 54 RSDS patients were examined clinically, radiologically and scintigraphically an average of 112 days after the triggering event. The patients were assigned to either of two treatment groups in accordance with the results of preliminary scintigraphic examinations. After physiotherapy comprising exercises and cryotherapy either with or without galvanic stimulation, a significant therapeutic effect on clinical and scintigraphic parameters was found in both treatment groups. Scanning, in combination with clinical diagnostic measures proved a valuable tool in the diagnostic evaluation, selection of treatment and follow-up in patients with RSDS.

[The diagnostic value of scintigraphy and x-rays in unclear arthralgias of the hands]. / Der diagnostische Wert von Szintigraphie und Röntgen bei unklaren Arthralgien der Hände.

33 patients presenting with arthralgia of wrists and finger joints were examined by radionuclide imaging and radiography. In 22 patients clinical symptoms turned out to be caused by inflammation, 11 patients suffered from degenerative joint disorder. Radionuclide imaging proved once more to be nonspecific albeit very sensitive; plain film radiography exhibited good specificity. The combination of both methods resulted in an increase in accuracy as compared to scintiphotography alone (0.88 vs. 0.79). Radionuclide imaging and radiography should therefore always be done and interpreted simultaneously. Radionuclide imaging is mandatory to confirm or to rule out inflammatory joint disorder in case of an inconclusive x-ray (absence of erosions or degenerative changes). A negative radionuclide study rules out inflammation, even when juxta-articular demineralisation is suspected on the x-ray.

[Sonographic detection of osteodestruction of the mandible]. / Sonographischer Nachweis von Osteodestruktionen der Mandibula.

32 patients with osseous destruction of the mandible were examined sonographically. The results were compared with those of plain radiographs. In 30 patients, discontinuation of the cortex was clearly evident. Sonography could detect osteolytic lesions in the corpus region, in the angle and on the buccal side of the rami of the mandible. 2 cases of osteodestruction on the lingual side could not be seen.

[B-mode and color-coded Doppler sonography in irradiation planning in klippel-Trenaunay syndrome with Kasabach-Merritt symptoms]. / B-Bild und farbcodierte Dopplersonographie zur Bestrahlungsplanung bei Klippel-Trenaunay-Syndrom mit Kasabach-Merritt-Symptomatik.

A patient with intravascular coagulation caused by the Klippel-Trenaunay syndrome is presented; this is a rare phenomenon. The patient was treated with fast electrons. Sonography is a suitable method for determining the extension of the haemangiomas occurring in Klippel-Trenaunay's syndrome. This is important for therapy planning. With colour-coded Doppler sonography, arteriovenous fistulas can be ruled out, this allowing to distinguish the Klippel-Trenaunay syndrome from the Parkes-Weber syndrome.

[Sudeck syndrome--a combined clinico-roentgenologic-nuclear medicine study]. / Das Sudeck-Syndrom--eine kombinierte klinisch-röntgenologisch-nuklearmedizinische Studie.

147 patients with clinical suspicion of a Sudeck syndrome were submitted to X-ray and nuclear medical examinations. The clinical suspicion was confirmed in 122 patients. In six cases showing no X-ray symptoms, the diagnosis could only be confirmed by scintigraphy. A new classification of stages was necessary for therapeutic reasons: I = early stage, II = acute/subacute stage, III = healing stage, IV = defective recovery. Modifications due to therapy were demonstrated early by 100 scintigraphic check-up examinations, whereas the evidence of such modifications in X-ray pictures was delayed. The study describes the X-ray morphology as well as the scintigraphic manifestations of the Sudeck syndrome. The study shows that scintigraphy is a valuable examination method. It is useful in diagnosing early stages often not detected in X-ray examination, in the assessment of the evolution of a disease, and in the classification of stages.

[Histiocytosis X: scintigraphic and roentgenologic findings]. / Histiozytosis X: Szintigraphische und röntgenologische Befunde.

The aim of this study was to compare the roentgenological and scintigraphic osseous changes in 25 resp. 18 patients with histiocytosis X and to analyse them. In particular, it was also interesting to discuss the divergent reports in the literature in respect of scintigraphic storage behaviour. In all the patients examined before initiation of therapy (39 osseous foci) high activities were found scintigraphically. The extension of the scintigraphically active zone was much greater than the corresponding translucencies on the x-ray film. On the other hand, patients after therapy still showed foci on the x-ray film whereas the scan had already become inactive. This striking discrepancy between scan findings before and after therapy could be one of the reasons for divergent literature reports on this problem.

[Bone scintigraphy in high-voltage injury to the skull]. / Skelettszintigraphie bei Starkstromverletzung des Schädels.

This is a report on the use of skeletal scintigraphy in skull injury caused by power current (heavy current). Nuclear medicine offers the advantage compared with x-ray technique of early and safe assessment of the vitality of the injured bone. This is of course of great value for selecting the appropriate therapy.

[Optimum surgical staging and rational use of radiodiagnostic methods in case of ovarian carcinomas (stages III and IV)]. / Optimales chirurgisches Staging und rationelle Anwendung radiodiagnostischer Verfahren bei Ovarialkarzinomen (Stadium III und IV).

Pretherapeutic informations furnished by surgery and histopathology are of special importance for the local high voltage therapy of the operated ovarial carcinoma. The intraoperative state does not only confirm the diagnosis, but also reveals the full biologic extension of the tumor and, thus, the correct staging. Extensive supplementary radiodiagnostic examinations are necessary if the informations furnished by the surgeon are not complete. Between February 1977 and February 1981, we treated 55 patients suffering from ovarial carcinomas with a combined simultaneous radio-chemotherapy (45 patients with stage III and 10 with stage IV). The first operations had been performed at gynecologic departments of other hospitals in 60% of all cases, at surgical departments of other hospitals in 20% of all cases and at the II. Gynecologic Clinic of the University of Vienna in only 20% of all cases. The definitive staging was established by postoperative analyses of X-ray views of the chest, liver-spleen scintigrams, ultrasonic examination, computed tomography, lymphoscintigraphy and lymphography. 36 women were submitted to an early therapeutic second operation. It turned out that in most of all cases the retroperitoneal manifestations were correctly recognized by the different radiodiagnostic methods; histopathology was superior in only 8% of all cases. The rate of retroperitoneal metastases is 45% out of the total collective and 40% out of patients in stage III. With the therapy method applied, the survival time does not depend upon the retroperitoneal state as long as there are no tumor manifestations with a maximum diameter of more than 2 cm. The liver metastases described after the first operation do not necessarily correspond to such manifestations; often they are rather tumorous peritoneal layers. More attention should be given to the state of the subdiaphragmatic region, because manifestations in this region are an unfavorable diagnostic factor. Patients in stage III have possibly still curative chances. A careful surgical exploration and a close co-operation between surgery, histopathology, radiodiagnosis and clinical examination are not only a basis for a rational treatment but will also exempt patients from unnecessary or cumbersome examinations.

Vertebra plana Calvé.

The differential diagnostic problems of a case of vertebra plana Calvé having a rare location in the cervical spine are discussed. The various theories of aetiology and pathogenesis are considered briefly. The differentiation from inflammatory and tumourous diseases of the vertebral column is of great importance for therapeutic reasons. Skeletal scintigraphy was used for the first time for differential diagnosis in the case presented.

[Investigation of inflammatory paranasal sinus diseases with scintigraphy (author's transl)]. / Szintigraphische Untersuchungen bei entzündlichen Nasennebenhöhlenerkrankungen.

In the course of inflammatory diseases affecting the paranasal sinuses, a number of complications may occur. One of those is the involvement of neighbouring skeletal portions. By this study evidence is given, that there is a high rate of inflammation, spreading to adjoining bone areas. This applis also to early stages and first manifestations. Especially in cases of surgery, complete recovery is rare. The pattern of chronic recurrent osteomyelitis may develop.

[The esophagogastral transitional region--localization of acute and chronic hemorrhages (author's transl)]. / Die ösophagogastrale Ubergangsregion Lokalisation akuter und chronischer Blutungen. Ein Beitrag zur Differentialdiagnose.

Various diseases which can be associated with hemorrhages are located in the esophagogastral transitional region. Emergency endoscopy can contribute significantly to the detection of an acute source of hemorrhage. Roentgenologic examination can make significant contributions toward the further clarification of acute and especially chronic hemorrhages, by assessment of the topographic, morphologic, functional and angiologic conditions. The relevant diseases in this respect are discussed with regard to clinical pattern and significance of the roentgenologic and endoscopic methods of examination, namely, reflux disease, hiatal hernia, cardial tumors, esophageal varices and Mallory-Weiss syndrome. Differential diagnostic problems are demonstrated by means of relevant cases. Brief reference is also made to "operated cardia" and the associated possibility of hemorrhage.

[Skeletal scinitgraphy in neuroradiological diagnostics (author's transl)]. / Die Skelettszintigraphie in der Neuroradiologischen Diagnostik.

From a review of 52 selected cases showing neurologic symptoms, the possible use of skeletal scintigraphy for the purpose of neuroradiologic diagnostics is reported. The close relationship of the nervous system and surrounding structures with the skeletal system means that the skeletal system is often involved in nervous pathologic processes. Such involvement can be detected by skeletal scintigraphy which thus provides a vital aid to diagnosis and therapeutical planning. The basic methods and technical equipment in the field of scintigraphy are discussed.

[Scintigraphic studies of skeletal abnormalities during childhood (author's transl)]. / Szintigraphische Studien bei Skeletterkrankungen in der Pädiatrie.

An extensive application of nuclear medical examination in the field of pediatric diagnostics was only made possible by introduction of short-lived radionuclides. On the one hand, they cause low radiation exposure, on the other they allow short-term check-ups. Analysis carried out on examination results of 47 children revealing various skeletal disorders showed a combination of radiologic-nuclear medical examination methods to produce maximal information suitable for both diagnostics and therapeutical planning. Specific questions such as termination of pathologic alteration process within the skeleton, can be answered only by the use of the scintigraphy. With reference to 4 cases the wide range of possibilities and limitations of skeletal scintigraphy in pediatrics are shown.

[Skeletal scintigraphy in otolaryngology (author's transl)]. / Die Skelettszintigraphie im HNO-Bereich.

Close relation of non osseus facial skull portions to the skeleton cause rapidly the bone to become co-involved in presence of various diseases. Early diagnosis is of decisive importance for therapeutic measures. For localisation scintigraphy has proved particularly reliable in aids to early determination. This can be shown clearly in inflammatory diseases and tumour infiltrations with various tumour affections. Technical requirements and the use of skeletal scinitgraphy are demonstrated on hand of 6 cases.