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Purpose: Evaluation of the relationship between ethanol concentration in expired air and the amount of absorbed irrigation fluid in patients who undergo a transurethral resection of the prostate., Methods: 76 patients were evaluated in a prospective study. The irrigation fluid contained 1.92 w/w% of ethanol. The ethanol concentration in breath was measured at least every 10 minutes with a Alcotest 7410 (Dräger) or a Biomed 3010 (Biotest). Documented values: breath ethanol concentration, mean arterial pressure, heart rate, haemoglobin concentration, serum sodium concentration, the amount of irrigation fluid, the time of operation, special events, therapeutic interventions. A modification of the Widmark formula was used for calculating the amount of absorbed irrigation fluid from the breath ethanol concentration., Results: A rise of the ethanol level above 0.2/1000 was observed in 10 patients. No clinically significant difference in heart rate and blood pressure during surgery between the 24 patients with no alcohol in breath and the 10 patients with more than 0.2/1000 was observed. Prolonged duration of resection and greater amount of used irrigation fluid correlated with higher ethanol concentration in breath. During the study period no patient developed the clinical features of a transurethral resection syndrome., Conclusions: If 2 w/w% of ethanol is added to the irrigation fluid, breath ethanol concentration under 0.2/1000 may be considered harmless, while values above 0.2/1000 are predictors of massive absorption of irrigation fluid. In our patients, the addition of ethanol to the irrigation fluid has been a suitable and easy way to monitor the absorption of irrigation fluid, if the ethanol concentration in the breath is measured every ten minutes. If 2 w/w% of ethanol have been added to the irrigation fluid, the absorbed volume (E) can be estimated using the formula: E = 37.5 x body weight (kg) x ethanol concentration (/1000).

A 35-year old woman showed gastrointestinal bleeding right after normal pregnancy. With endoscopy of the GI-tract with biopsy, ultrasound, conventional radiology of the stomach and computed tomography a gastric leiomyoma was diagnosed. After en-bloc resection of tumor, part of the stomach and spleen, histologic examination and size of tumor changed diagnosis in gastric leiomyosarcoma. Patient died 15 month postoperatively on systemic metastasis. Case report and review of the literature show difficulties in diagnosis and prognosis of gastric leiomyosarcoma.

Purpose: To study the ranking of CT in the diagnosis of sigma diverticulitis. Comparison of results of the colon monocontrast enema with those obtained via CT and histopathology as gold standard., Material and Methods: 32 patients were included who were operated on for sigma diverticulitis. In 30 patients both CT and monocontrast enema were performed and in two patients CT only., Results: Acute inflammatory wall alterations are identified by CT with a sensitivity of 89.7% vs 96.3% via contrast enema. Pericolic reactions of the environment were seen via CT with 89.7% sensitivity. In case of covered perforations CT yielded a sensitivity of 76.5% vs 46.7% via contrast enema. Sensitivity for abscesses and fistulas was in each case 100% with CT., Results: CT may help to identify extraluminal inflammatory changes and complications in diverticulitis. The degree of the inflammation can be classified and the surgical approach suitably influenced, respectively modified.

Leiomyosarcoma of the stomach is a rare occurrence, amounting to only 0.5-3% of all stomach malignancies. Because of its extragastral growth, it produce clinical symptoms, mostly with bleeding, only at a late stage. The decisive method of examination is computed tomography which demonstrates the extraluminal tumor lying apparently in the mesenterium with contrast medium up-take at the borders and central necrosis. A secure differential diagnosis to leiomyoma is not possible by angiography or by computed tomography; this distinction is even difficult by histology.

Pars plana or pars plicata lentectomy was introduced for congenital cataract at the University Eye Clinic of Freiburg 12 years ago. Records of 32 patients (48 eyes) who were operated on during a period of 7 years were retrospectively analyzed to determine the anatomical and functional results in comparison to previous methods of treatment for congenital cataract. The documented follow-up was at least 5 years long (maximum 11 years, mean 7.3 years). Seventeen patients had bilateral, 15 patients monolateral cataract operations. Thirteen eyes were operated on during the first 2 months of life, and 31 of the 48 eyes during the first year. Sixteen of the 48 eyes had additional malformations, like microphthalmus, different stages of persistent hyperplastic primary vitreous, or anterior chamber malformation. Visual acuity was at least 20/50 at the last visit in 3 of 15 eyes after monolateral lentectomy and in 19/33 eyes after bilateral lentectomy. Twenty-four children are now able to attend a regular school; only one child is attending a school for the visual handicapped; another child attends a school for deaf children. Postoperatively, secondary cataract or a retropupillary membrane was found in two eyes. Glaucoma developed in two eyes, requiring additional surgery. Postoperative retinal detachment caused by a giant tear complicated the postoperative course in one case. The anatomic results turned out to be better than after discission and aspiration with fewer postoperative complications like secondary cataract, glaucoma, or retinal detachment. The functional outcome is mainly dependent on good postoperative orthoptic and pleoptic management of the children.

Atypical facial pain is generally an unclearly defined pain syndrome. We tested in 35 patients (31 women, 4 men) with a mean age of 53.2 +/- 14.9 years and a chronic facial pain syndrome the quality of the new diagnostic criteria of the International Headache Society (IHS), at the same time using the SCL-90-R (Self-Report Symptom Inventory), to identify any associated psychopathology. In accordance with the literature there is a marked female preponderance, an altogether vague description of symptoms and a long history of incorrect diagnoses. Of note is the high number of invasive procedures (3.5 +/- 3.0). In agreement with the IHS commentary, an operation or injury to the face was a suspected cause in 43%. In contrast to the IHS criteria, we found in our patient sample dysaesthesia (63%), bilateral occurrence (37%), remission periods (57%), pain attacks (23%) and presence of superficial as well as deep pain. Depression is by no means the only psychopathological abnormality in atypical facial pain; a broad spectrum of complaints is seen. The IHS classification appears insufficient to separate atypical facial pain from other primary headache and facial pain syndromes. We therefore suggest a modified version of the IHS criteria for atypical facial pain.

The validity of computer-assisted radionuclide angiography was assessed in 189 patients with cerebrovascular disease including TIA (transient ischemic attack), PRIND (prolonged reversible ischemic neurological deficit), completed stroke and a-v. angioma. Time-activity curves were derived from regions of interest established over the right as well as the left side vascular supply territories of both middle and anterior cerebral arteries. Employing Fortran programs, parameters (right to left) A (ratio of maximal count rates), B (ratio of mean count rates) and C (relative perfusion efficiency) were computed. In patients with completed stroke, C revealed 85% and combined evaluation of A and C, 93% correct positive findings as compared with clinical and/or angiographic findings. In patients with asymptomatic stenoses, TIA and PRIND, C revealed an overall sensitivity of 83%, but was correct positive in unilateral extra- and intracranial vascular abnormalities in 96%. Out of seven a-v. angioma, five were diagnosed correctly by parameter C. These high success rates indicate the usefulness of computer-assisted radionuclide angiography (CARNA) supplementary to visual evaluation in patients suspected of having stenoses or occlusion of the major extra- or intracranial cerebral arteries.

During the last there years (from May 1981 to March 1984) we performed 1368 CT examinations of the spine, 447 of the cervical, 264 of the thoracic and 657 of the lumbar vertebral column. 30% of the CT examination of the lumbar spine revealed a prolapse of an intervertebral disk. In 38% of the cases involving the thoracic spine metastases were seen. We diagnosed fractures in 10% of the cervical spine and 11% of the thoracic spine examinations. Posttraumatic or postoperative intravertebral haemorrhage was hardly ever diagnosed in our patients (1.9% of the cases). Spinal trauma: The anterior-posterior and lateral plain films continue to be the mainstay of radiographic screening in spinal injury. Nevertheless, the degree of injury is underestimated in a significant number of patients with spinal trauma if conventional radiography is the only diagnostic approach. For further clarification CT proved to be the fastest and best method to recognise the causes and extent of compression of the vertebral canal. CT has attained a high degree of accuracy in the diagnosis of prolapse of intervertebral disks, replacing myelography if the findings are unequivocally established. CT should also be preferred to myelography in suspected recurrent prolapse. Localisation, shape and density are criteria for differentiating between scarification and prolapse via CT. The results show that CT has opened up new possibilities in the diagnosis of spinal diseases and has resulted in a reorientation of the diagnostic approach.

Using a prototype of an electronic, universal examination unit equipped with a special x-ray TV installation, spotfilm exposures and digital angiographies with high spatial resolution and wide-range contrast could be made in the clinic for the first time. With transvenous contrast medium injection, the clinical results of digital angiography show excellent image quality in the region of the carotids and renal arteries as well as the arteries of the extremities. The electronic series exposures have an image quality almost comparable to the quality obtained with cutfilm changers in conventional angiography. There are certain limitations due to the input field of the 25 cm x-ray image intensifier used. In respect of the digital angiography imaging technique, the electronic universal unit is fully suitable for clinical application.

The usefulness of digital subtraction angiography of the venous system, which we have termed "digital subtraction phlebography (DSP)" was demonstrated in the region of the vena cava, the pelvic veins and the veins of the arms. DSP is especially of diagnostic value in the region of the vena cava and pelvic veins and offers no advantage in the veins of the lower extremities compared to conventional phlebography. DSP is a time--and cost--saving method, furthermore minor concentrations of contrast media are needed.

Two patients (mother and son) with Hallervorden-Spatz's syndrome were examined both via CT and Nuclear Magnetic Resonance (NMR), using different measuring modes. In the patient with progressing disease pathological findings were seen in the right and left putamen with CT and NMR. All examinations in the mother with a less progressive syndrome were without any result. Information obtained via NMR did not yield significantly more relevant data than computed tomography.

Seven patients had a percutaneous transluminal removal of catheter fragments using a Dormier stone-basket within the last 14 months. An immediate intervention should be performed because serious complications are expected from catheter embolization. The percutaneous transluminal catheter retrieval as a method of low risk and of little discomfort to the patient should always precede surgical procedures. The Dormier-basket proved to be a successful and easy handling catheter instrument in all our cases.

The contrast-to-noise ratio, known from the theory of imaging methods, is applied to magnetic resonance imaging. This ratio is proportional to the product of relative image contrast and the signal-to-noise ratio. After predetermining all intrinsic (T1 and T2 times, proton density) and extrinsic (pulse sequence, layer thickness, number of averagings) parameters, the signal-to-noise and contrast-to-noise ratio can be computed to a proportionality constant for all possible pulse sequences. Studies in six voluntary test subjects and 11 patients with a 0.35 T-unit showed that the measured values for the signal-to-noise ratio and the contrast-to-noise ratio are in good agreement with the computed values. The contrast between gray and white brain matter was used as an example for this. The method is applied in order to gain a better understanding of tissue contrast. However, by using diagrams it can be particularly useful for determining the optimal pulse sequences for answering particular clinical questions. It should thus be possible to enhance the effectiveness of magnetic resonance imaging considerably.

25 patients in whom a carcinoma of the urinary bladder had been confirmed, were examined preoperatively by means of computerised tomography, and the local size of the tumour was determined. These findings were compared postoperatively with the histopathological staging. The degree of tumour spread was verified exclusively via cystectomy. CT does not yield very relevant data in respect of the therapeutically important differentiation of the low tumour stages. However, CT is very well suited in the diagnosis of tumours which have penetrated the bladder wall; however, diagnostic relevance in respect of organ infiltration can be definitely limited by the overlapping of other organs.

100 patients were evaluated by DSA after vessel reconstructions by surgery or percutaneous transluminal angioplasty (PTA). The visualization of the proved vessels was very good or good in 92%, sufficient in 6% and without diagnostic value in 2%. Patency of grafts and postoperative vascular abnormalities like stenoses, occlusions or aneurysms were well demonstrated. According to our results, DSA is an excellent semi-invasive method with a high accuracy for postoperative evaluation of vascular reconstructions.

NMR tomography, which is based on nuclear magnetic resonance, enables the production of sectional images of the human body without ionising radiation. In particular, the field of urology places great hopes on this new procedures, since the contrast in soft tissue is considerably better than that of computer tomography. Our first clinical results confirm the advantages of the soft tissue differentiation as well as the possibility to judge the large vessels safely and simultaneously without contrast medium, which is advantageous in the detection of tumours in the retroperitoneum and in the region of the kidneys. An improvement of the preoperative staging of urological tumours can be achieved by means of primary three-dimensional images. Only after several years of experience with NMR tomography and all its variations will it be able to evaluate properly, to what extent clinically relevant diagnostic possibilities are offered by the analysis of relaxation values.

NMR tomography is a new imaging method based on nuclear magnetic resonance. It is possible to obtain sectional views of the human body in all three planes without ionizing radiation. NMR can differentiate soft tissue better than CT, and large blood vessels can be simultaneously evaluated without using contrast medium. The pathological process could be imaged exactly in every examination. Due to the lack of image clarity caused by breathing movement, NMR is not superior to CT when using contrast medium in the epigastrium. Calculation of relaxation times T1 and 2 shows clear differences between tumor and normal tissue. However, contrary to initial expectations. NMR did not permit a type-specific diagnosis to be made. Three-dimensional images improve the process of staging tumors, especially in the retroperitoneal space and in the pelvis. As with CT, metastatic lymph nodes can only be demonstrated when they have reached a size of at least 1 cm. Further studies will be necessary to evaluate the validity of this new imaging method.

The term "Digital Radiography" covers all x-ray techniques which produce a projected image with the help of digital imaging techniques, which are very similar to a conventional x-ray film image. The advantage of "Digital Radiography" is the possibility of digital image processing, like the subtraction technique, the selective material filtering technique and the quantitative image plotting technique. With the equipments now in use, the digital projected image is produced by the line or on an even level. One example of the in-line projected image is the so-called "topogram", produced via computed tomography equipment. With the help of an x-ray video chain, it is possible to produce digital images on an even level. This technique is used, for example, for "digital video subtraction angiography" (DVSA). Today, digital radiography is clinically used only in the "DVSA" and the "topogram" systems. A survey of the clinical use and the improved future possibilities of digital radiography is given, and the special features of the method are discussed.

Magnetic Resonance Imaging (MRI) and CT were performed in a patient suffering from carcinoma of the larynx with swollen cervical lymph nodes. MRI images in coronal planes give new diagnostic information about the spatial extension of pathologic findings and about the question of compression or infiltration of vessels. Exact topographic knowledge will be necessary. A subject of research is the differentiation between scar formation and tumour relapses.