[Gastric secretory inhibitors improve the visibility of gastric mucosal detail in barium studies of the stomach: a controlled clinical trial (author's transl)]. / Die Verbesserung der radiologischen Schleimhautdarstellung durch Magensekretionshemmer. Eine kontrollietre klinische Studie.

In a controlled randomized clinical trial the effect of the secretory inhibitors Cimetidine and pirenzepine on the visibility of the areolar gastricae in barium studies of the upper gastrointestinal tract was examined. Both drugs improved the radiological imaging of the areolar tidine reduced the amount of radiologically visible fasting gastric contents. Thus, factors other than the volume alone of gastric secretions appear to play a major role in the quality of imaging of the gastric fine relief.

[Massive lung necrosis in klebsiella pneumonia (so-called massive lung gangrene)]. / Ausgedehnte Lungennekrose bei Klebsiellen-Pneumonie (sogenannte massive Gangrän der Lunge).

In the literature only 13 cases of voluminous necrosis of lung tissue, generally referred to as massive pulmonary gangrene, could be found. This disease constitutes an unusual, very severe complication of lobar pneumonia, mostly due to Klebsiella. This type of pneumonia generally affects old or otherwise debilitated persons, quite often chronic alcoholics. It has a high lethality of 20%. Our own observation in a 48-year-old man is presented. He suffered from recurrent massive hemoptysis in relation with a huge cavity of the right lung, filled with necrotic lung tissue. Following right pneumonectomy empyema developed, also due to Klebsiella; it was successfully treated with thoracic fenestration according to Clagett. Knowledge of this severe infrequent complication of pneumonia is necessary since it requires early operative treatment: Out of the 14 patients four were treated medically only and died, while the remaining ten underwent surgery and were all cured.

[A urologic-radiological view of perinephric abscesses (author's transl)]. / Der paranephritische Abszess aus urologisch-radiologischer Sicht

Perinephric abscess is a rare condition; it may be acute, but can take a chronic and atypical course as a result of incomplete treatment with antibiotics. In this case the diagnosis is often delayed. The most common cause is primary renal disease, with perforating ureteric stones, abscess-forming pyelonephritis, renal carbuncle and pyonephrosis as the most important factors. Diagnosis depends on a varying combination of clinical signs, any of which is not necessarily present and which is not pathognomic, but nevertheless, in their totality, are fairly typical. Characteristic are pain on percussion and pressure, resistance in the renal angle and fever. Laboratory investigations do not contribute to the diagnosis. These only show findings typical of any infection, and frequently a marked anaemia. An infected urine may be suggestive. The traditional clinical and radiological methods may well indicate a space-occupying lesion, but its further elucidation depends on angiography. Renal and perinephric abscesses must be distinguished from other space-occupying renal lesions. Abscesses can usually be distinguished from cysts because they are generally less clearly demarkated and often show a hypervascular margin with a "blush". A further differential diagnosis of perinephic abscess is a peri-renal haematoma. Radiologically, an haematoma also produces a perirenal mass with displacement and compression of the kidney. As with perinephric abscesses, the angiogram shows dilatation and displacement of the capsular arteries. Differences in the neovascularity, as well as in the clinical symptoms, permit differentiation between abscesses and hypovascular carcinomas in most cases, or at least suggest the probable diagnosis.

Esophageal function in progressive systemic sclerosis.

A prospective study was performed in 13 consecutive patients with systemic progressive sclerosis (PSS). For the diagnosis of impaired esophageal peristalsis cineradiography and manometry are equally useful. Esophageal suction biopsy allows the diagnosis of esophagitis but not of scleroderma. Mild to severe esophageal involvement was observed in 12 patients. In only one patient the esophagus was virtually normal. Dysfunction of the esophageal body may occur early in the course of the disease while incompetence of the lower esophageal sphincter is observed on an average after 7 to 8 years. Both impairment of peristalsis and pressure of the lower esophageal sphincter may lead to delayed esophageal clearance. Relaxation of LES is normal even in the absence of primary peristalsis. Extensive esophageal damage including severe gastroesophageal reflux may be present in the absence of esophageal symptoms.

[Carotid angiography with subtraction for glomus tumours of the middle ear (author's transl)]. / Karotisangiographie mit Subraktion bei Glomustumoren des Mittelohres

Four patients with glomus tumours of the middle ear are described, in whom carotid angiography with subtraction was carried out. In three patients the tumour could be clearly demonstrated by using the subtraction method. In a fourth case, in whom the diagnosis was made at operation, angiography was unsuccessful.