[The demonstration of the cruciate ligaments by xerotomography (author's transl)]

Demonstration of the cruciate ligaments by xerotomography was attempted in 54 patients after double contrast arthrography of the menisci. The best results of lateral tomography were achieved in showing the middle and caudal portions of the anterior ligament. The ligaments close to the femur are not well demonstrated. Twenty-six patients underwent operation; of these, 13 had ruptured cruciate ligaments. The correct diagnosis was made by xerotomography in only 46%. The reasons for this are discussed. The present results do not suggest that Xerotomography is valuable in the diagnosis of abnormalities of the cruciate ligaments.

[Transperitoneal fine needle biopsy of retroperitoneal lymph nodes in cancer diagnosis]

Preoperative lymphography was performed in 97 patients with urological malignoma. Fine needle punctions were performed of 458 suspicious as well as non-suspecious lymph nodes. In 22 cases lymphographic and cytological findings were compared with histological results after lymphadenectomy. It could be shown that of 15 cases with lymph node metastases lymphographic and cytologic findings were corresponding in 6 cases. In 9 cases tumor cells were found in lymph nodes even though the lymphogram was rated non-suspicious. It is concluded that fine needle biopsy of lymph nodes after lymphography is an important improvement in preoperative diagnosis of malignoma.

[Unilateral pulmonary artery aplasia with special reference to lung scintigraphy (author's transl)]

In a case of unilateral aplasia of one Arteria pulmonalis, i.e. proximal interruption, the diagnostic value of perfusion and ventilation scintigraphy is shown to be simple and non-invasive, exposing the patient to a lower radiation dose than other diagnostic screening methods. When an interruption of a main pulmonary artery is radiologically suspected the scintigraphic examination allows to distinguish between vascular and/or parenchymatous pulmonary diseases, thus clarifying the diagnosis of primary pulmonary malperfusion. The results of other examinations, the relevant literature, the pathogenesis and pathophysiology of unilateral pulmonary artery aplasia as well as therapeutical and prognostic aspects are reviewed.

[Indications and results of percutaneous transhepatic bile-duct drainage]

Percutaneous transhepatic drainage of the bile duct (PTCD) is a method that has few complications and can successfully relieve an obstructive jaundice. As a palliative drainage in malignancies of the liver and the porta of the liver it reduces the jaundice and prevents the accompanying troublesome pruritus, thus prolonging life. It reduces postoperative lethality and complications by reducing the jaundice preoperatively. Suppurative cholangitis with bile duct obstruction is quickly relieved by administration of antibiotics into the drainage.

[Lymph node metastases--diagnosis by lymphography and CT (author's transl)]

The value of lymphography and CT in the diagnosis of abdominal lymph node metastases was compared in 82 patients with various types of malignant disease. In the presence of systemic disease or testicular tumours, CT increased the recognition of lymph node metastases and their extent, particularly of high para-aortic deposits which were frequently underestimated by lymphography. Lymph nodes in the pelvis are more easily identified. CT is the first choice for the investigation of systemic disease and testicular tumours. This will, in addition, also demonstrate abnormalities of the organs and assist in radiation planning. CT is a simple procedure which is also very valuable in following the effect of treatment. For metastases from other origins, lymphography is often more valuable since CT is unable to identify metastases in lymph nodes if these are not enlarged. The two methods complement each other and their combination provides improved diagnostic information.

[Percutaneous fine needle biopsy of lymph nodes (author's transl)]

Following lymphography, 76 lymph nodes were punctured percutaneously using a fine needle in 23 patients and an aspiration biopsy was performed. This simple procedure provided cytological comfirmation in cases of doubtful lymphograms. Systematic puncture of representative lymph nodes in the area of metastatic spread may at times be able to replace a staging operation.

[Percutaneous transhepatic bile duct drainage for obstructive jaundice (author's transl)]

Palliative percutaneous bile duct drainage was carried out in five patients with obstructive jaundice due to inoperable tumours. In four patients drainage was continued for a long period, in one patient for only one day. The bile duct was punctured by transhepatic cholangiography. It was then catheterised and a drainage catheter introduced into the duodenum in order to produce both internal and external drainage. This procedure, which carries few complications, produces a rapid reduction of jaundice and disappearance of pruritus. It does not increase the expectation of life, which depends on the underlying disease. Experience with this method may be of value in benign stenoses or in pre-operative drainage.

[Algorithms in the radiological diagnosis of malignant disease (author's transl)]

Algorithms in the diagnosis of malignant disease have the aim to produce a diagnosis as quickly, as certainly and as simply as possible. The first phase consists of general non-invasive methods which should be as simple as possible. If the results are positive this should be followed immediately by percutaneous biopsy in order to produce cytological confirmation of the diagnosis as quickly as possible. If the original investigations were negative, those special methods of investigation should be used which are most likely to make a diagnosis. This is followed by investigations which throw light on the most appropriate form of treatment. This scheme has been illustrated by special algorithms for carcinoma of the bronchus, the pancreas and the breast.

[Value and results of computer tomography in diseases of the pancreas (author's transl)]

In a joint study carried out by the radiological university clinics of Bonn, Hamburg, Cologne, Leuven and Munich, 483 computer tomographs of the pancreas were evaluated. A correct histological diagnosis, or one confirmed at surgery, was obtained in 74.5% of 168 cases; in a further 9% an abnormality was seen in the pancreas or in its immediate vicinity, but was wrongly interpreted. The computer tomographic criteria of inflammatory processes and of tumours of the pancreas are given, and the not uncommon difficulties in distinguishing between these are discussed.

Die einseitige Lungenarterienaplasie unter besonderer Berücksichtigung der nuklearmedizinischen Lungendiagnostik

Am Beispiel eines Falles einer unilateralen Aplasie der Arteria pulmonalis (sog. proximal interruption) wird der Stellenwert der Lungenperfusions- und Ventilationsszintigraphie als technisch einfache und nicht-invasive Methode mit vergleichsweiser geringer Strahlenbelastung in der Vorfelddiagnostik aufgezeigt. Beim röntgenologischen Verdacht erlaubt ihr Einsatz durch die mögliche Unterscheidung zwischen vaskulärer und/oder parenchymatöser Lungenerkrankung bereits die Klärung in Richtung einer primären pulmonalen Perfusionsstörung herbeizuführen. Unter gleichzeitiger Berücksichtigung der übrigen Untersuchungsergebnisse und der einschlägigen Literatur werden auch Pathogenese und Pathophysiologie der einseitigen Lungenarterienaplasie sowie therapeutische und prognostische Gesichtspunkte besprochen.

[The radiological findings in septic Candida arthritis (author's transl)]

There are very few reports of bacteriologically proven Candida arthritis. With the increasing number of cases of immune deficient infants being treated now, one must expect an increase in frequency of fungus infections, including Candida arthritis. We have observed three cases of fungus arthritis in infants with reduced resistance. The radiological changes were indistinguishable from bacterial arthritides. During the acute phase the accumulation of pus and exudate showed widening of the joint space on the radiograph, with increase of the peri-articular soft tissues. In two patients a central bone abscess was seen in the metaphysis which later showed a sclerotic margin. In one patient with a gonarthritis there was complete healing, but in two fungus infections of the hip there was persistent late demage. One patient developed a deformed hip joint with subluxation, which had to be treated surgically after ineffective medical treatment. In the other case there was considerable flattening of the femoral head.

[Standard report forms in radiological diagnosis (author's transl)]

Standard report forms have been designed for excretion urography, gastro-intestinal examinations, cholecystography, myelography, trauma and surgical emergencies; the findings, which are printed on the form, are marked and the conclusion is then written by hand. If used for a limited number of examinations with recurring problems, these report forms results in a considerable reduction in effort and simplifies routine diagnosis.

[Magnification technique in peripheral angiography (author's transl)]

Fourteen exactly similar conventional and magnified serial angiograms were compared and the advantages and disadvantages of magnification angiography are discussed. Particular attention was paid to exact comparability of the series in order to make the analysis valid. In three patients small end-vessels and collaterals were visible on the magnification angiogram which could not be seen on the ordinary series even in retrospect. Macro-angiography was also valuable in cases of microsurgery, both before and after operation. Considering the well-known disadvantages of magnification angiography, such as increased radiation and cost, its use appears to be indicated only for the elucidation of special problems.

[Angiographic findings due to malfunction of Cimino shunts in haemodialysis patients (author's transl)]

Both the arterial and venous limb of a Cimino shunt can be well demonstrated by injection of contrast medium into the shunt vein during transient arterial and venous ccompression with a blood pressure cuff. Twenty-four angiograms in patients with shunt malfunctions carried out in this way were analysed with respect to various vascular changes.

[Carotid-cavernous fistula. Diagnosis by angiography and scintillation camera (author's transl)]

Four patients with post-traumatic and one with a spontaneous carotid-cavernous fistula are described. Perfusion scintigraphy made the diagnosis in three patients and in the other two strongly suggested it. Exposures in ventral and lateral projections are able to make the correct diagnosis. Sequential scintigraphy is also valuable for post-operative follow-up. Cerebral angiography can localise the fistula and the adequacy of the circle of Willis can be determined pre-operatively. In addition to the major venous flow from the cavernous sinus into the superior ophthalmic vein, other characteristic pathways may be demonstrated. Knowledge of the pathological and anatomical situation is a prerequisite for treatment planning.

[Computed tomography of the pancreas (author's transl)]

The computed tomography gives direct visualisation of the pancreas in a transverse section. Form, size, and changed consistency of the organ can be diagnosed. Being a non-invasive technique it does not stress the patient, and can be applied to the severly ill with acute haemorrhagic pancreatitis. Other indications are chronic pancreatitis, pancreatic abscess, pseudo-cyst and cancer. The differential diagnosis of cancer, especially from chronic pancreatitis, may be difficult. Further methods of investigation such as arteriography or endoscopic retrograde pancreatography may also have to be used.

[Ectopic course of the internal carotid artery in the tympanic cavity-value of angiography and tomography]

The rare case of an internal carotid artery crossing the tympanic cavity is reported. By means of angiography and proper positioned tomography a diagnosis can be made before any operation is attempted. A biopsy of the clinically appearing "tumor" can be disastrous for profuse arterial bleeding.

[Contra-lateral selective hip angiography (author's transl)]

A new method for the selective demonstration of the larger and smaller vessels which supply the hip is described. A curved catheter is introduced into the opposite femoral artery, it is advanced into the common iliac artery and a guide wire is then introduced into the femoral artery on the side to be examined. The catheter is withdrawn and a second, soft, catheter is introduced over the remaining guide into the femoral artery. The appropriate vessels can then be selectively catheterized by means of the catheter and guide wire. Good selective demonstration was achieved in 14 patients with various types of hip disease.

[Pancreaticography and its correlation with angiography and ultrasonography in diagnosis of the pancreas (author's transl)]

The endoscopic retrograde pancreaticography demonstrates - when suspecting "pancreas anulare" - the part of the pancreatic duct system that forms a ring around the duodenum, helping to recognize this anomaly. In chronic pancreatitis deformities of the pancreatic ducts may be visualized 2-3 years after the onset of the disease. There are deformities of the outlining and the course of the ducts as well as solitary and multiple stenosis and -most important- dilatation of the main duct and its branches. In pancreas abscess, necrotic cavities, and pseudocysts the retograde pancreaticography visualizes solitary or multiple perforations of the duct and pooling of contrast medium in cavities. Carcinoma of the pancreas presents stenosis, occlusion and deviation of the main duct and its branches and sometimes with lakes of contrast medium in ares of necrosis. Pancreaticography following trauma demonstrates similar to chronic pancreatitis laking of contrast medium following perforation. The endoscopic retrograde pancreatico-cholangiography has - like angiography and ultrasound - its special indications in diagnosis of the pancreas. They are important in cases which have affected primarily or secondarily the duct system. Its reliability in confirming and differentiating a disease increases with more accurate indication. In this journal in 1965 a critical review of roentgenologic examinations of the pancreas presumed that development of a valid preoperative pancreaticography would lead to priority of this method. This priority has become true in chronic pancreatitis, calculous pancreatitis and visualization of necrotic cavities. In those examples the endoscopic retrograde pancreatico-cholangiography is still not dominating all cases.

[Carotid-cavernous fistula. Treatment with a balloon catheter (author's transl)]

A relatively simple method for the intra-vascular treatment of a carotid-cavernous fistula is described and illustrated in one case. It consists of proximal ligation of the internal carotid artery and occlusion of the carotid syphon with a balloon catheter above the fistula. In this way, the carotid segment with the fistula is isolated from the circulation and therefore undergoes thrombosis. Close co-operation between radiologist and surgeon is required.