[Diagnosis of fibrolamellar cancer].

A fibrolamellar carcinoma (FL-Ca) is a primary malignant tumor of the liver of unknown etiology, without cirrhosis and usually without an increase in tumor markers; it occurs mainly in young patients. As it can simulate malignant and benign tumors, particularly focal nodular hypoplasia (FNH), the diagnosis is difficult. Ultrasound and angiography show mostly uncharacteristic features, so ultrasound only has to ascertain that the tumor is there.

Two different manifestations of botryoid sarcoma (embryonal rhabdomyosarcoma) of the biliary tree.

A 16-month-old girl and a 5-year-old boy with botryoid sarcoma of the biliary tree are presented. The girl's tumor infiltrated the liver, whereas the boy's tumor was confined to the extrahepatic biliary tree. Computed tomography not only enabled the evaluation of the tumor-surrounding structures, but also indicated the tumorous nature of the lesion following intravenous administration of a contrast agent.

Rudimentary second stomach as adrenal incidentaloma.

We present the case of an adrenal incidentaloma of considerable size which turned out to be a stomach-like diverticular mass, probably a malformation arising from the embryonic foregut. We discuss whether results possibly obtained by extensive and costly investigative techniques would have changed the management.

Pulmonary nodules in spiral volumetric and single slice computed tomography.

Single slice acquisition of conventional CT and volume scanning of spiral volumetric CT are compared in terms of detection and assessment of pulmonary nodules. Spiral CT is supposed to be superior to conventional CT in detecting all lung nodules by scanning the complete lung volume, while conventional CT may miss nodules due to inconsistent levels of inspiration for single slices. Different technical procedures of spiral CT may change the imaging of nodules and other findings.

[Computed tomography of the paranasal sinus prior to endonasal surgery].

In a retrospective study 170 computed tomographies recorded in patients with chronic sinus disease were evaluated. The extent of sinus disease and the involvement of the different paranasal sinuses were well seen. Up to now 50 patients have undergone surgical treatment.

[Therapeutic bilateral renal artery embolization in the nephrotic syndrome].

Amyloidosis with renal involvement was diagnosed in a 52-year-old man with Crohn's disease for 15 years. A severe nephrotic syndrome developed (proteinuria 40 g daily) with oedema and arterial hypotension (80/60 mm Hg). As adequate substitution treatment was not possible an attempt at medical renal ablation was made with a combination of captopril (25 mg daily), frusemide (80 mg daily) and indomethacin (200 mg daily).

[Radiation sensitivity of the normal bile duct during high dose rate afterloading irradiation with Iridium 192. Experimental studies in pigs].

This animal study was designed to assess the tolerance of the normal bile duct to a single intraluminal high-dose-rate afterloading irradiation. This information is essential for treatment recommendations in irradiation therapy of malignant bile duct stenoses. In 16 pigs bile duct catheters were inserted surgically.

[The value of the AMBER system in demonstrating intrathoracic space-occupying lesions. A comparative ROC study of the AMBER and conventional technics for postero-anterior views of the thorax. Advanced Multiple Beam Equalization Radiography].

Since October 1991 the AMBER technique has been used for the diagnosis of chest diseases in about 4,000 patients. The ability of this technique, compared with conventional methods, for demonstrating intrathoracic masses on p.a.

[The role of embolization treatment of acute hemorrhage].

137 arteries of 95 patients were treated by transcatheter embolization for massive haemorrhage using Ethibloc, Gelfoam, wire coils and Tissucol (Fibrinogen + Thrombin). The bleeding was secondary to trauma in 23 patients, to neoplasms in 16 patients and to vascular malformations or chronic inflammatory processes in 41 cases. 15 patients were treated for iatrogenic bleeding following surgery.

[Intraductal ultrasound of the bile ducts].

Intraluminal ultrasound with 12.5 and 20 MHz transducer allows precise analysis of the extrahepatic bile ducts and the adjacent structures. Inflammatory and malignant thickening of the bile duct wall can be assessed without difficulty.

[Percutaneous intraductal ultrasound of the bile ducts].

Miniaturization of ultrasound probes (6 F, 20 MHz) enables to perform intraluminal sonography of the bile duct in patients in whom a percutaneous transhepatic access has been achieved for diagnostic or therapeutic reasons. Initial experiences in 13 patients with malignant bile duct obstruction and in 8 patients with benign bile duct disease are described. Intraluminal ultrasound displays the normal anatomy and pathologic processes of the bile ducts and reveals information on therapeutic procedures within the bile ducts.

[Biliary cystadenoma].

Biliary cystadenomas are rare biliary ductal neoplasms of congenital origin. There is an excellent correlation between CT and sonographic findings for number, size and location of the lesions. However, sonography can demonstrate better morphologic features such as thickened wall, mural nodules and septations.

[Modified implantation of a Wallstent in bile duct obstruction].

The self-expanding Wallstents are increasingly applied in malignant biliary obstructions. The deployment of the stent from the covering membrane is a relatively complicated mechanism susceptible to trouble. Sometimes the deployment of the stent from the catheter fails and the incompletely deployed stent has to be removed and rejected.

Pancreatic and ampullary carcinoma. Ultrasound, computed tomography, magnetic resonance imaging and angiography.

Ultrasound remains the most readily available and least expensive of the imaging techniques used in assessment of the upper abdomen. Ultrasound is very useful in the detection of pancreatic tumors as well as in the evaluation of the extent of the disease. If ultrasound fails technically or is inconclusive, CT is recommended.

[Differential diagnosis of angiodysplasias using angiography and CT with special reference to the MR tomographic aspects].

The basic prerequisite for a rational therapy of angiodysplasia is differentiated diagnostics, especially the differentiation between arteriovenous malformations, haemangiomas, and venous malformations. Angiography reveals the arterialisation, arteriovenous fistulas, CT infiltrations of bone and soft-tissue. MRT demonstrates completely the extent of haemangiomas because of its bright signal intensity in the T2-weighted images.

[Percutaneous transhepatic cholangioscopic color laser lithotripsy in bile duct calculi].

Tunable dye laser lithotripsy is an effective and low risk treatment in patients with bile duct stones in which transpapillary maneuvers failed. The percutaneous approach allows to introduce small caliber endoscopes (10.5 F) to fragment the calculi under vision.

[The potentials and limits of blood-flow quantification in the peripheral arteries with MRT using a phase-mapping procedure].

MRT is able to demonstrate arteries while MR angiography can quantify blood flow by a noninvasive method. In the present paper blood flow measurements were carried out in four selected cases on the basis of phase mapping. In 3 patients with lesions in the pelvis or thigh, angiography was performed in order to localise the stenosis or occlusion and this was followed by quantitative blood flow measurements.

[Bile duct endoprostheses in tumor disease: when is the expense justified?].

Percutaneous transhepatic catheters should be reserved for the minority of palliatively treated tumor patients because of the chronic complications and the discomfort to the patients. Plastic biliary endoprostheses relief malignant obstructive jaundice in most patients sufficiently. Late complications such as occlusion and displacement occur relatively often.

[Acute diverticulitis--radiological and endoscopic studies].

In patients with suspected acute diverticulitis, plain abdominal radiographs may demonstrate free gas in the abdomen. Ultrasound can indicate the nature of disease but is not sufficient to assess the extent of the inflammation. If perforation is suspected, a water-soluble contrast agent should be used to demonstrate diverticulitis and peridiverticular abscess.