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Purpose: To evaluate the combined use of extended field-of-view sonography and tissue harmonic imaging (THI) for assessment of the abdominal wall., Materials and Methods: In 32 patients (25 patients without and 7 patients with abdominal wall pathologies) extended field-of-view sonography of the abdominal wall was performed with and without THI using a 7.5 MHz ultrasound transducer. Images with a scan length of 60 cm were acquired above and below the arcuate line. The images were independently assessed by two observers regarding visibility of the anatomic structures and delineation of pathological changes using a 4-point grading scale. Furthermore, the influence of the extent of the subcutaneous fat on the image quality was assessed. For statistical analysis, kappa coefficients, Fisher"s exact test and a repeated measurement analysis of variance (ANOVA) were applied., Results: In all patients, delineation of the abdominal wall was possible with diagnostic image quality. Abdominal wall pathologies were concurrently diagnosed for extended field-of-view sonography with and without utilization of THI. Image quality was rated better with THI when compared to extended field-of-view B-Mode sonography. In comparison to extended field-of-view B-Mode sonography, the agreement between both readers regarding image quality was markedly improved using extended field-of-view sonography in combination with THI. With increasing thickness of the subcutaneous fat layer, image quality was rated significantly better using THI than B-Mode ultrasound., Conclusion: Combined use of extended field-of-view sonography and THI improves image quality and documentation of ultrasound examinations. Especially in obese patients, the use of THI is advantageous. Therefore, abdominal wall ultrasound gains additional value in the preoperative planning.

Unlabelled: BACKGROUNDS AND STUDY AIMS: At the time of diagnosis most patients with pancreatic cancer are still irresectable for cure. The aim of this study was to evaluate surgical palliation, in particular against the background of endoscopic stent placement., Patients and Methods: This retrospective study analyses the therapeutic results in 107 patients with an irresectable pancreatic carcinoma operated on between 1990 and 1998., Results: 104 patients showed primary therapeutic success with adequate bile drainage. In 97 % a simultaneous gastrojejunostomy was performed. The overall complication rate was 24 % and the hospital mortality 3.7 %. Median survival after surgical treatment was 201 days., Conclusions: Because of a decrease in perioperative morbidity and mortality, surgical palliation of irresectable pancreatic carcinoma still remains an effective therapy, especially for patients expected to survive 6 months or more. The surgical procedure offers the better chance for long-term palliation of obstructive jaundice and duodenal obstruction compared to the endoscopic approach. However, to consider both, the surgical and the endoscopic treatment, complementing each other, seems to be important to guarantee optimal palliation for the individual patient.

Purpose: To assess extended field-of-view sonography for delineation of the anatomic structures of the abdominal wall and for the diagnosis of hernia., Material and Methods: In 34 cases (24 probands, 10 patients with abdominal wall defects) extended field-of-view sonography of the abdominal wall was performed with a 7.5 MHz transducer. Dynamic alignment of real-time images allows for depiction of regions of up to 60 cm in a single extended field-of-view image. A standardized axial image was obtained above and below the arcuate line and at the level of the defect, respectively. All images were evaluated by two blinded readers regarding the visibility of the anatomic structures and the delineation and extent of pathological changes., Results: The abdominal wall was delineated with extended field-of-view sonography in all patients with a good image quality. The linea alba, the rectus muscle and the three lateral abdominal muscles, the rectus sheath, the peritoneum, and the subcutaneous fatty tissue were visible. In the patients with abdominal wall defects, the hernial sac with its contents, the extension of the defect, and the surrounding structures were clearly delineated., Conclusion: Extended field-of-view sonography allows for easily surveyed and reproducible documentation of the ultrasound examination of the abdominal wall. It is especially useful for the preoperative planning in patients with abdominal wall defects.

The significance of colonoscopic follow up is discussed controversially. Colonoscopy after resection of colorectal cancer offers the possibility of direct inspection and to take biopsies for the early detection of local recurrence or additional neoplasms. In a retrospective study we examined the benefit of regular colonoscopies. Between 1/1995 and 4/1996 237 colonoscopies were performed on 164 patients after resection of colorectal cancer. The evaluation was done due to the stage of the primary tumor, the age of the patients, the time after operation and the number of previous colonoscopies. 54 adenomas were found in 35 of 164 patients. 32% of the adenomas were diagnosed in the ascending colon or colon transversum. Additionally three carcinomas were found. There were two local recurrences and one metachronous neoplasm. Two patients were diagnosed without clinical symptoms and were able to undergo potential curative resection again. Because of the number and the localisation of diagnosed neoplasms colonoscopic surveillance should be performed every six months in the first two years after resection of colorectal cancer.

Purpose: Evaluation of CT cholangiography compared to i.v. cholangiography concerning its diagnostic value before laparoscopic cholecystectomy and optimisation of CT cholangiography., Method: I.v. and CT cholangiographies of 54 patients were retrospectively evaluated by two radiologists. The time interval between contrast infusion and CT was correlated with the assessment of CT cholangiographies to detect the optimal timing for CT scanning., Results: CT cholangiography was judged to be generally better than i.v. cholangiography. The optimal time interval for CT scanning is between 30 min and 60 min post contrast infusion., Conclusion: CT cholangiography should replace the conventional tomograms if i.v. cholangiography does not yield sufficient depiction of the biliary tree. It should be performed within 60 min post contrast infusion. Complete abolishment of i.v. cholangiography is not warranted. This is due to the fact that conventional cholangiography can sufficiently delineate the biliary tree and thereby reduce x-ray exposure and cost compared to initial performance of CT cholangiography.

253 consecutive patients with bleeding gastroduodenal ulcers were treated in a prospective protocol from Jan/1986 to Dec/1993. All underwent emergency endoscopy and injection therapy. In ulcers with a high risk of rebleeding (Forrest Ia, Ib, and IIvisible vessel) we performed an early elective operation (n = 126). Operative mortality was 9% (11/126). No patient died after endoscopic treatment, therefore the over-all mortality was 4% (11/253).

The potential of the generic kaopectate (Upjohn) as a negative rectal contrast agent in MR imaging was investigated in the assessment of colorectal disease. 45 MR examinations in patients with colorectal disease (colorectal carcinoma 25 patients, inflammatory disease 12 patients, miscellaneous disorders of the colon 8 patients) were evaluated. All examinations were performed with T1 and T2 weighted SE sequences after rectal application of kaopectate. Gd-DTPA enhanced T1 SE sequences were obtained as well. Kaopectate revealed a signal void of the lumen of the large intestine in T1 and T2 weighted SE sequences. Intravenous administration of Gd-DTPA enabled good differentiation of contrast-enhanced malignant or inflammatory tissue and the low signal lumen of the bowels. No side effects were noted.

A multimodal therapeutic concept of choledocholithiasis with endoscopic and surgical procedures is presented. Between January 1986 and December 1990 106 patients with choledocholithiasis were operated. These patients are retrospectively analyzed. The success rate is 95.3%, the morbidity 18.7% and the mortality 0. These results are compared with the published data of the surgical or endoscopic therapy of the choledocholithiasis.

Based on the data of 56 patients undergoing elective cholecystectomy the value of subhepatic drainage is evaluated in a randomized controlled clinical trial. The design of the study and the perioperative management of the patients are described in detail and the results analyzed according to clinical course, blood tests and abdominal ultrasound.

Radioimmunoscintigraphy (RIS) with 111In-and 131I-labelled monoclonal antibodies (MAbs) against CEA and/or CA 19-9 was performed in 83 patients with various gastrointestinal carcinomas. A total of 276 body regions could be examined. The results of planar scintigraphy and SPECT were compared intraindividually. Using 111In-labelled MAbs the sensitivity of RIS was significantly improved by SPECT (88.9 vs. 52.4% with planar scintigraphy, p less than 0.01). For 131I-labelled MAbs the effect was smaller (83.9 vs. 65.6% with planar scintigraphy, n.s.). This finding can be explained by different kinetics and biodistribution of the used MAb preparations. 111In-labelled MAbs with long whole-body retention and rapid blood clearance reveal ideal qualities for SPECT; on the other hand, the short whole-body retention of 131I-labelled MAbs leads to small count rates and therefore long counting times that make delayed SPECT unsuitable in clinical practice.

Lethality of bleeding peptic ulcer has been reduced to about 15 per cent in recent years by therapeutic endoscopy in combination with differentiated surgical tactics. Intensity and activity of bleeding as well as additional criteria, such as localisation, recurrence of bleeding, and age of the patient, are some of the parameters for surgical indication which are used in decision-making, with due consideration of the spontaneous course. Endoscopic haemostasis should be intensively used to avoid emergency operations and action of early recurrence. Selective early surgery should be performed whenever possible. Surgical techniques should be chosen with two objectives in mind, localised haemostasis and definitive ulcer treatment. Extraluminal and intraluminal ligation and additional vagotomy should be the optional approach to bleeding peptic ulcer. Billroth's I operation should be applied to ventricular ulcer.

32 patients suffering from rectal carcinoma were examined by endorectal sonography. The preoperative staging by sonography was compared with digital palpation, colon enema and computertomography of the pelvis. In 90% of the cases the sonographic determination of the grade of invasion was identical to the histopathological examination. The efficiency of local destruction methods of rectal carcinoma (cryotherapy) can be controlled by this method.

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.