[Sonographic diagnosis of parathyroid carcinoma].

Prognosis and survival of patients suffering from parathyroid carcinoma are completely dependent on correct surgical therapy in form of an en-bloc resection of the tumour. A correct preoperative diagnosis of this rare carcinoma is therefore absolutely mandatory in order to perform a curative operation. We demonstrate a case of parathyroid carcinoma in which scintigraphy and CT diagnostics did not produce the right diagnosis.

Sonography of the thyroid and parathyroid glands.

Sonography is the first line modality for assessment of thyroid and parathyroid pathologies. Sonographic and color Doppler patterns of diffuse and focal pathologies of the thyroid are presented in this article. The accuracy of sonography in the localization of enlarged parathyroid glands is also discussed.

Ultrasound of the neck.

Sonography, when performed by an experienced examiner, can be used for evaluation of many pathologies in the head and neck area. Some benign neck lesions, such as cysts, lipomas, carotid body tumors, and hyperplastic lymph nodes, have typical sonomorphology. Sonography has an accuracy rate of about 90% in cervical lymph node staging and can delineate subclinical lymph node recurrences.

[High resolution small parts sonography (7.5 MHz) of the head and neck region].

Frequently, sonography of the head and neck serves only for assessment of the thyroid and arteriosclerotic lesions of the extracranial vessels. This article gives a review of ultrasound of the remaining cervical structures, particularly spaceoccupying lesions. The differentiation between malignant and benign lymphadenopathy or between intraglandular and extraglandular abnormalities of the salivary glands is possible with an accuracy between 90 and 95 %.

Ultrasound of the neck.

In many institutions sonography still is used for evaluation of the thyroid gland and for assessment of sclerotic lesions of the carotid arteries only. The aim of this article is to summarize the potentials and limitations of sonography in the investigation of the extrathyroidal cervical soft tissues. The knowledge of the anatomy of this complex region is mandatory for the investigation of cervical soft tissue lesions.

[Correlation of scintigraphic and x-ray findings in Marie-Bamberger secondary hypertrophic osteoarthropathy].

The radiological and scintigraphic findings in the rare condition of hypertrophic osteoarthropathy (Marie-Bamberger) were followed up for a period of two years. They are described and compared. Skeletal scintigraphy shows the abnormalities in the skeleton at an earlier stage than does radiology and also shows more extensive manifestations.

[Intraoperative sonographic demonstration of intraspinal tumors].

Four examples are given to demonstrate the problems, methods and advantages of intra-operative sonography for intra-spinal tumours. The value of intra-operative sonography for localising the tumours and for judging their extent is demonstrated and related to other imaging methods, such as myelography, CT and MR.

[Experiences with a modified nephrostomy instrument kit in ultrasound-guided kidney fistulization].

During a period of 24 months, ultrasound-guided percutaneous nephrostomies were performed in 51 patients in the Hospital at Köln-Merheim. The procedure was carried out with a modified nephrostomy instrument manufactured by Angiomed, Ettlingen, according to our own design. The procedure was successful in 49 patients.

[Sonography and computed tomography before and after liver resection and transplantation].

The diagnostic value of sonography and CT was studied in 259 patients. In the diagnosis of solid tumours, CT is superior to sonography, whereas ultrasound is more useful in the investigation of cystic lesions. In estimating the extent of intrahepatic tumours, the falciform ligament is more useful than a line from the cava to the gall bladder, both for CT and ultrasound, although in this case CT shows the extent of tumours more accurately.

[Intraoperative sonographic localization of brain tumors].

Twenty-six patients with mostly small intracranial space-occupying lesions were examined sonographically during surgery. In all patients, accurate localisation and complete delineation of the intra-cerebral lesion proved possible. The extent of the lesion could be determined accurately and surrounding cerebral structures were identified unequivocally.

Cardiac metabolism of 15 (p-I-123 phenyl-) pentadecanoic acid after intracoronary tracer application.

Myocardial turnover of omega-(p123I-Phenyl-) pentadecanoic acid and release of its metabolites into the coronary sinus and peripheral blood has been studied in patients with coronary artery and valvular heart disease. After intracoronary tracer injection myocardial extraction fractions of 45-53% in control subjects were observed. In patients with coronary artery disease (CAD) normal to reduced values (34-61%) were established.

[Accuracy in the diagnosis of renal masses. Computed tomography, sonography, urography, angiography].

One hundred and twelve renal masses, whose histology was confirmed at operation, as well as renal vein thrombosis and renal infiltration, were examined by urography, sonography, CT and angiography. In general the results showed good agreement. For the diagnosis of the type of tumour, its size, infiltration into the renal capsule, demonstration of regional lymph node metastases and infiltration into neighbouring organs and for the diagnosis of liver metastases, CT was superior to the other methods.

[Radiological detection of the Medina worm (Dracunculus medinensis)].

Atypical linear or convoluted calcification in the subcutaneous tissues of patients from tropical areas in Africa and Asia may be caused by D. medinensis. The radiological appearances and differential diagnosis are described.

[Primary tumors of the mesentery and greater omentum].

Diseases of mesentery and greater omentum are commonly the result of lymph node metastases from an abdominal carcinoma, or lymph node involvement as part of a general lymphatic malignancy. Primary tumours are rare. Cysts occur predominantly in children.

[Pseudocysts of the adrenal gland].

Diagnosis, clinic and therapy of adrenal pseudocysts are described by means of three cases. The three characteristic signs of this rare diseases are: 1. traumatic anamnesis, 2.

[Computer-tomographic findings in portal hypertension caused by liver cirrhosis. 2. Analysis of results].

The results of a discriminant analysis for the objective diagnosis of cirrhosis of the liver are reported. Eight quantitative parameters seen on CT which, by themselves, are not diagnostic, were studied, and three relationships found to be of discriminatory significance; they are the diameter of the superior mesenteric vein, the ratio of the diameter of the caudate lobe and the right lobe of the liver and a quotient derived from the splenic and hepatic index. Cirrhosis of the liver with portal hypertension could be distinguished with a specificity of 100%, an accuracy of 96% and a sensitivity of 94%.

[Computer tomographic findings in portal hypertension caused by liver cirrhosis. 1. Morphologic changes--qualitative and quantifiable parameters].

The CT findings in 80 patients with confirmed portal hypertension due to intrahepatic block were analysed retrospectively. The findings included ascites, hypo-dense areas in the liver, nodular or irregular liver contour, the inability to define intrahepatic portal vessels with narrow window settings, the so-called "kissing" sign and evidence of hepato-fugal collaterals and thickening of the wall of the oesophagus. Electronic measurements of various organs (liver, spleen) and vessel diameters (portal vein, superior mesenteric vein) provide parameters which permit classification of patients into the cirrhotic group, as compared with a control group.

[Aneurysm of the ascending aorta with aortic valve insufficiency].

Nine cases are reported who had aneurysms of the ascending aorta and aortic valve incompetence and in whom aortic valve prostheses and aortic prostheses had to be implanted. Two patients had dissecting aneurysms. In five patients, the origins of the coronary arteries were involved, and these had to be implanted into the prostheses.

[Skin and bone findings in mastocytosis].

The syndrome of mastocytosis extends from cutaneous urticaria pigmentosa through systemic mastocytosis to the rarely occurring mast cell leukaemia. Our investigations with a large patient collective have shown that systemic forms of the disease occur more often than is generally supposed. In particular the incidence of bone marrow manifestations deserve more attention.

[Sonographic assessment of the portal system in portal hypertension].

Three hundred and thirty-seven patients with portal hypertension and recurrent bleeding from oesophageal varices were examined by sonography. The situation was correctly elucidated in 17 out of 21 patients (81%) with pre-hepatic blocks, in 275 out of 313 cases (88%) with intra-hepatic blocks and in two out of three cases with post-hepatic blocks. The relevant findings consisted of stenoses and occlusions of the portal venous system and collaterals in pre-hepatic blocks, dilatation of the portal venous system and hepato-fugal collaterals in intra-hepatic blocks and occlusion of the hepatic veins in post-hepatic blocks.

[Coronary artery aneurysms (author's transl)].

Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed.