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Based on our three years experience with about 200 transcutaneous real-time sonographies of the tongue and the floor of mouth, an assessment of the determination of size and site of 38 pretherapeutically examined malignant tumours (35 squamous cell carcinomas) was made. The patients were examined in reclined position, the head retroflected. Curved array transducers of 5 or 7.5 MHz and a silicon elastomer block as interface turned out to be optimal. All tumours could be detected by sonography as hypoechoic, more or less homogeneous, ill-defined areas. Two thirds of the tumour ulcerations could be seen as hard hyperechoic reflexes within the hypoechoic areas. When comparing the maximal diameter of tumours of the 20 operated patients, we found an agreement (5 mm tolerance) of sonography with the surgical specimen in 14 of 20 tumours (70%), of sonography with the clinically estimated diameter in 10 of 20 tumours (50%), whereas the clinically estimated diameter was in agreement with the surgical specimen in only 8 of 20 tumours (40%). A peritumoral inflammatory infiltration can simulate a larger tumour size in sonography. The extent of tumours within the tongue, to the floor of mouth, the lateral pharyngeal wall and the preepiglottic space was documented correctly in most cases. In three cases a previously unknown spread across the midline was found sonographically. Including the sonographic findings in the TNM classification, 5 T1 tumours would have been staged as T2 and one T3 tumour as T4. Inflammatory diseases of the tongue can show the same sonomorphology as malignant tumours.

The effects of abdominal decompression applied over a period of several weeks (mean 4 weeks) in late pregnancy on biochemical and haemodynamic parameters as well as fetal growth and cardiotocogram patterns were studied in a group of 64 pregnant women with identified placental insufficiency. A statistically significant improvement was demonstrated in the following findings after treatment: placental perfusion measurements 113mIn and unconjugated oestriol and human placental lactogen, both in serum. A positive influence on antepartum cardiotocogram was observed only immediately after therapy. An acceleration of fetal growth (biparietal diameter) could not be demonstrated. Frequency and severity of EPH gestosis did not change after abdominal decompression. Abdominal decompression seems to be a valuable aid in the still unsatisfactory treatment of placental insufficiency.

102 pregnant women, suspected of placental insufficiency, according to their physical findings, were regularly monitored by various techniques which were related to the birth of a small-for-date infant (less than 10th weight percentile), and assessed by calculations of recognition, occurrence, and exclusion probabilities. High reliability was given by ultrasonic biometry, by human placental lactogen (HPL) and estriol both in serum, and placental perfusion measurements (113mIn) if they were within the normal range. Antepartum non-stressed cardiotocogram revealed probability rates similar to HPL in serum. Combination of monitoring methods augmented the prognostic value, nevertheless a problem of relatively high numbers of false-positive findings remained. For large departments all methods are recommended; for smaller ones particularly antepartum cardiotocogram in combination with ultrasonic biometry is recommended.

92 sonographic examinations performed in 62 patients were evaluated to determine the possible application of sonography in the diagnosis and follow-up of malignant tumours of the tongue. Squamous cell carcinomas were by far dominant and proved to be hypoechoic, mainly inhomogeneous and ill-defined masses. In most cases, they ranged between 2 and 4 cm. in diameter. In 50% of the lesions an infiltration of the pharynx wall was confirmed, and exulcerations were correctly detected by sonography in 75%. In preoperative determination of the size of the tumour, sonography correctly detected the size in 93% of the cases and was thus markedly superior to the clinical palpatory examination, which determined a mere 43% correctly. Sonography should be included in the pretherapeutic staging of tumours of the tongue to objectify the clinical findings. It is also adequate to document tumour behaviour during radiation.