[Can pharmaco-DSA of the kidney replace intraoperative rapid biopsy diagnosis?]. / Kann die Pharmako-DSA der Niere die intraoperative Schnellschnittdiagnostik ersetzen?

QUESTION: Can primary nephrectomy be performed without preliminary sample excision of the tumor if pharmaco-angiography of the kidney has demonstrated the typical tumor vascularization? MATERIAL AND METHOD: To clarify this question in 32 patients with "displacing mass" of the kidney, verified in sonography and computer-tomography, or hematuria of unknown origin, we prospectively performed and additional pharmaco-angiography of the respective kidney. RESULTS: In 18 patients with tumor vascularization in the pharmaco-angiography, intraoperatively we found 15 malignant renal cell carcinomas, 1 patient with transitional cell carcinoma of the renal pelvis, 1 leiomyosarcoma, and 1 high-differentiated tumor of only 2 cm in diameter with unclear dignity, which was treated by enucleation. CONCLUSION: In case of an intrarenal lesion of more than 3 cm in diameter and additional tumor vascularization seen in selective pharmaco-angiography, the kidney undoubtedly can be removed by primary nephrectomy without a preliminary sample excision to confirm the diagnosis. For tumors with a diameter of less than 3 cm and additional tumor-vascularization, the option should be enucleation. If there is a "tumor" without typical malignant vascularization, the exploration by sample excision should be performed. Depending on the histological result the tumor should be removed by enucleation or nephrectomy.

[Results of selective kidney DSA in suspicious computerized tomography findings--retrospective evaluation of 122 cases]. / Ergebnisse der selektiven Nieren-DSA bei suspektem computertomographischen Befund--retrospektive Auswertung von 122 Fällen.

The superiority of computer tomography in the detection and staging of renal malignomas has been proven in numerous studies. In this retrospective analysis, the significance of the pre-surgically still widely and routinely performed, selective kidney angiography was investigated. The written computer tomographical and angiographic findings of 122 patients were classified according to malignancy stage urgency. They were then compared to progression, and surgical finding respectively. Angiography had the greatest influence on the therapeutic procedure in those patients having only a slight computer-tomographical suspicion of tumor. An operation was waived by 12 patients. A small hypernephroma (pT 2 showing typical tumor vessels was found in two patients. Inoperability excepted, a surgical denudation was performed in all patients with computer tomographical tumor typical, or suspicious finding, irrespective of the angiographic result. The diagnosis was surgically confirmed in all patients having a tumor-specific angiogram. Yet besides benign tumors, 4 hypernephromas and 5 other malignomas were found in those patients showing an angiographically classified, vessel-free formation.

[A combination of conventional single contrast arthrography with arthro-CT of the shoulder--an evaluation of 78 cases]. / Kombination von konventioneller Einfachkontrastarthrographie mit Arthro-CT der Schulter--Auswertung von 78 Untersuchungen.

For the diagnosis of traumatic shoulder lesions, 78 patients have been examined by conventional single contrast arthrography with subsequent CT. For 26 patients, it was possible to compare the radiological diagnosis with the arthroscopic or surgical findings. The combination of both diagnostic methods provided a high sensitivity (94%) and specificity (100%) for lesions of the ventral or dorsal limbus. Ruptures of the rotator cuff showed a sensitivity of 60% and a specificity of 89%. An unsatisfying sensitivity (60%) with high specificity (95.6%) was observed in the diagnosis of the ventral capsula. A retrospective screening of the roentgenography showed a good detectable leak of contrast medium, which was misinterpreted as being an artefact. All in all, the combination of conventional arthrography in mono-contrast and CT in daily routine should be recommended the diagnosis of traumatic shoulder lesions since it is easy to use, is of low inconvenience for the patient, and provides a high level of information.

[The end stage of a rheumatoid arthritis presenting as a tumorous space-occupying lesion of the left axilla]. / Endstadium einer rheumatoiden Arthritis unter dem Bild einer tumorösen Raumforderung der linken Axilla.

In this paper we report on a 67-year old woman suffering from long-term rheumatoid arthritis. She was admitted to hospital because of a hard tumour with the size of a fist in her left axilla. The supposed tumour was proved by conventional radiological and CT examination as an excessive manifestation of the basic disease in the left shoulder joint.

[A large asymptomatic renal hemangioma as a chance radiologic finding]. / Grosses asymptomatisches Nierenhämangiom als radiologischer Zufallsbefund.

The author reports on a large asymptomatic renal haemangioma that was found accidentally in the course of a preoperative CT examination. The radiological visualisation in plain CT, in serial CT as well as in selective angiography is presented. The finding is discussed and compared with the observations reported so far in the literature in respect of this rare benign tumour.

[Post-traumatic hematoma simulating a left-sided adrenal gland tumor]. / Vortäuschung eines linksseitigen Nebennierentumors durch posttraumatisches Haematom.

Typical signs of posttraumatic adrenal gland haematoma in computer-tomography are, besides an enlargement of the adrenal gland, a stripy infiltration of surrounding tissue and a thickening of the homolateral crus of the diaphragma, located primarily in the right adrenal gland. We report a case of an isolated enlargement of the left adrenal gland with normal surrounding tissue, which histologically proved to be a posttraumatic hematoma within the adrenal gland medulla.

[Chordoma as osteolytic space-occupying lesion of the anterior lumbar spine]. / Chordom als osteolytische Raumforderung der oberen LWS.

A case of a 78-year old woman with a chordoma destroying the second lumbal vertebra is reported. Radiologic and histologic feature of this rarely diagnosed tumor is demonstrated. An overview about the therapeutic modalities is given.

[Quantitative serial computed tomography. Kidney and tumors]. / Quantitative Seriencomputertomographie. Niere und Tumoren.

Density-time-functions after intravenous contrast medium injections are simultaneously taken by a computer tomograph in the region of the aorta and the cortex of the kidney or the region of the aorta and a tumor respectively. The differential equation system resulting from this is solved explicitly on the basis of a compartment model. The resulting functions are related to the density-time functions. These functions include the constants of distribution velocity and discharge velocity. They are modified by application of an iteration procedure (computer programme) to ensure the adequate correspondence between the curves and the density-time-trends. Between the constants of inversion velocity and eversion velocity of the cortex of the kidney, there is a linear as well as allometric relationship, the correlation amounts to r = 0.99. In the case of all tumors, only an allometric relationship (r = 0.92) could be found as regards the conversion constants.

Automated measurements of cerebral atrophy in multiple sclerosis.

An automated method of measuring cerebral atrophy is introduced. Using this method we studied patients with multiple sclerosis and a control group showing premature cerebral atrophy in multiple sclerosis (P = 1,32 x 10(-8) for male and P = 3,6 x 10(-14) for female). There was only a weak correlation between cerebral atrophy and psychological deficits. Multivariate analysis did not show any significant correlation between cerebral atrophy, duration of disease, clinical manifestations and progression of disease. We conclude that our method to measure cerebral atrophy is more accurate and less time-consuming than the use of linear indices. It might be appropriate for further investigations in evaluating atrophic processes in cerebro-vascular, degenerative and exogen-toxic disease of brain.

[Spongiocytic adenoma of the adrenal cortex--risk of misinterpretation as a cyst in computerized tomography]. / Spongiozytäre Nebennierenrindenadenome--Gefahr einer Fehldeutung als Zyste im CT.

A report on two cases where solid benign tumours of the adrenals (spongiocytic adrenocortical adenomas) were misinterpreted as adrenal cysts due to water-equivalent density values. The CT scans are compared with the microscopic cuts.

Combination of 5-fluoro-uracil and Co60 irradiation in the treatment of carcinoma of the oro-facial region. A follow-up investigation of 30 patients.

During the years from 1974 to 1977, 30 patients were treated for carcinoma of the oro-facial region with a combination of 5-fluoro-uracil and telecobalt under the care of the Institute of Radiotherapy, Knappschafts-Krankenhaus, Recklinghausen. 13 of these patients were inoperable and had primary irradiation therapy, and the remaining 17 patients were irradiated postoperatively. The main effect that treatment showed was a rapid response in the inoperable tumors, while the 4- to 5-year survival rates of 1:13 of the inoperable cases and 6:17 of the operated patients are in accordance with generally accepted results. The possible radio-biologic relation to this is discussed.

[Five-year recovery of case of carcinomas of the uterus after conventional irradiation and after telecobalt therapy (author's transl)]. / 5-Jahres-Heilungsergebnisse bei Uteruskarzinomen nach konventioneller Bestrahlung und nach Telekobalttherapie.

Two part collectives of patients with carcinomas of the uterus - one consisting of 525 conventionally irradiated patients, the other consisting of 577 patients irradiated with telecobalt - are compared with respect to their five-year survival recovery rate, the frequency of recurrences and metastases and the radiogenic complications. After having introduced the telecobalt therapy - intracavitary radium therapy remaining unchanged - the five-year survival recovery ameliorated by about 10% for carcinomas of the cervix as well as for carcinomas of the body of the uterus. The evaluation according to tumor stages showed that the telecobalt irradiation was particularly advantageous for operated and non-operated patients with a carcinoma of the cervix of stage II as well as for non-operated patients with a carcinoma of the body of the uterus. The authors discuss the possible reasons for the increase of recurrence rate and radiogenic complications observed in patients treated with telecobalt.