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AIM Analysis of the effects of pharmacological stress echocardiography using dobutamine on left ventricular function in patients with and without evidence of coronary heart disease. METHOD During dobutamine stress echocardiography, aortic flow and transmitral velocities, left ventricular end-diastolic and end-systolic diameters, wall thickness and fractional shortening were determined in 124 patients. RESULTS 36% of the patients showed a pathological wall motion response during echo, which indicates relevant coronary artery disease (group II). After dobutamine stress these patients had significantly lower peak (1.71 m/s) and mean (1.29 m/s) aortic outflow tract velocities compared to patients with normal stress echo (group I; 64%; 2.24 res. 1.67 m/s). Peak transmitral diastolic filling velocity increased significantly less among patients with abnormal stress echo compared to those with normal stress echo. E/A-relation remained unchanged. In addition there was a significantly decrease of the left ventricular end-diastolic and end-systolic diameter and of the fractional shortening in group I compared to group II. CONCLUSION Dobutamine stress testing leads to different haemodynamic and left ventricular changes in patients with and without coronary heart disease. The frequency of false negative and false positive stress echocardiographies may be reduced especially by evaluating aortic Doppler parameters, left ventricular diameters and fractional shortening.

The clinical use of the duplex methods in the abdominal space is at present partly based on case study and partly systematic. Established ranges of application exist for the portal circulation and the kidney transplant. This method enables for the first time a noninvasive diagnosis of mesenterial disturbances of blood flow. The future of the method in the abdominal space will be mainly determined by continued technical development and results of practical clinical application. Results achieved so far lead us to expect that the Duplex methods are a valuable addition to the sonographic palette.

In a retrospective study of our hospital of the years 1983 to 1989 we diagnosed a hepatocellular carcinoma (HCC) in 30 patients. The diagnosis was confirmed by histology or cytology, ultrasound and clinical symptoms. The tumours presented sonomorphologically different patterns. Some were hypoechoic (n = 9), some hyperechoic (n = 16) and 5 had a mixed pattern. Nine of the hyperchoic lesions looked like a metastasis with a halo. 13 patients had multiple tumours or diffuse infiltration of the liver. Due to the variable sonomorphology only 16 patients were assumed to have a HCC, no definite diagnosis by ultrasound being possible. The concomitant cirrhosis of the liver was sonomorphically detected in 19 patients and was suspected in 2 further patients. Four patients had no cirrhosis; in 3 patients, the available information was insufficient. Because of the variable sonomorphology of HCC no definite diagnosis by ultrasound can be achieved. The combination of liver tumour and cirrhosis or elevated serumfetoprotein leads to the diagnosis. The diagnosis of HCC must be confirmed by histology.

From 1976 to March 1987 intraabdominal or retroperitoneal abscesses were confirmed by ultrasound in 40 patients. 13 patients had surgical drainage with zero-mortality. 3 of 27 patients were treated with antibiotics (only systemically). 24 patients were treated by percutaneous catheter drainage or needle aspiration. Elective cholecystectomy was performed later in 3 patients. Nonsurgical treatment was successful in 22/27 cases. 3 patients died despite percutaneous drainage. Failure of percutaneous drainage required surgical intervention in 3 patients. The considerably poorer primary condition of the patients receiving nonsurgical treatment allows no comparison with the surgical group. Advantages of percutaneous drainage and needle aspiration are a high success rate and low mortality. These techniques can be used even in critically ill persons.

The successful collaboration among Ultraschall in der Medizin/ European Journal of Ultrasound (UiM/EJU), DEGUM, ÖGUM and SGUM as well as Thieme Verlag was confirmed in the respective general meetings in Davos recently, and it was agreed that such cooperation should continue in coming years. Last year, in discussions with the previous DEGUM board of directors the issue of orientation of the content of UiM/EJU, among other things, was an essential topic. Briefly stated, the constructive criticism was: too much science, too little continuing education. It is worthwhile and necessary to address this criticism.The purpose of our clinically-oriented journal is to present the state of the art of multidisciplinary ultrasound in medicine, consistent with the objectives of scientific organizations as well to promote the analysis and communication of this medical technology to the user. This balancing act is difficult for our journal; the limited scope and high number of manuscript submissions result in a rejection rate of over 80 %. Consequently it is hardly possible to cover all special fields in every edition. Nevertheless, in almost 20 years of editorial activity, we have received fewer than five letters from readers criticizing our selection of content.As a journal with German roots, the bilingual diversified CME contributions represent the core of our continuing education opportunities, including pictorial essays and case reports, as well as consensus papers and articles on quality control. In conjunction with the EFSUMB, a series of guidelines has been published, available to everyone - not just subscribers of UiM/EJU. Guidelines are important, since they have an influence on the practice and quality of ultrasound applications in diagnosis and therapy. Calculated in terms of pages and percentages, this is more than just a little, since clinically-related scientific articles also represent the requirement for continuing education within the rules of the medical profession.Considered retrospectively, contents of recent volumes of UiM/EJU - apart from the large block of obstetrical articles - were dominated by CEUS, elastography, the breast and "small parts".Although CEUS has been established scientifically 1 2 3 4, but not really employed everywhere, additional articles are needed in order to help integrate the use of contrast agents in routine practice apart from examination of the liver 5 6 7 8 9 10. Likewise, we have endeavored to support elastography as a new technical feature of sonography. Examples of this are publications regarding its use in diagnosing diseases of the liver 11 12 13 14 15, breast 16 17 18 19 and the thyroid 20, as well as its use in examining the pancreas 21 and gastrointestinal tract 22.In addition, for the benefit of sonographers, who are used to observing associated fields from the sidelines, we have presented unexpected highlights, such as articles on peripheral nerves 23 24 25.The contents of this year's final edition present the common interdisciplinary perspective of the editorial team. In addition to a CME article on elastography in the diagnosis of breast cancer 26, we would particularly refer you to two prospective articles: on the importance of CEUS in the aftercare of colon cancer 27 and the value of high-frequency examination of the liver surface compared to elastography and laparoscopy when cirrhosis is suspected 28.Further articles on elastography 29 30 31 32 indicate that the possibilities and limitations of this technology have yet to be reached.As editors, we will be satisfied if the publication interests as many readers as possible, be it online or in the print version, and that they are able to read about new as well as established techniques. We are certain that the societies for ultrasound in medicine, UiM/EJU, and "our sonographic community" are excited to learn about scientific advancements, and we are pleased when, thanks to submissions by our active and innovative authors together with reviewers and our advisory committee, we can set our sights on new topics.

AIM Between cytology of pleural effusion and thorascopy there is a gap for another non invasive biopsy method to diagnose pleural diseases, especially since Adam's and Ramel's blind pleural biopsy is uncommon. Therefore it is suggestive to test feasibility and usefulness of pleural forceps biopsy. METHOD It is possible to take biopsies under ultrasound guidance with the help of a biopsy-forceps from the diaphragmatic pleura or pleural appositions through a 2.5 mm canula with a stop cock and a rubber vent. The specimen can be used for histological or immunohistochemical examinations. The procedure is coducted in a closed system to avoid pneumothorax. The puncture was done in 12 patients with a puncturable pleural effusion. RESULTS In 11 of 12 patients it was possible to get the final diagnosis. In one of three cases of mesotheliomas a rebiopsy was necessary. In 9 cases a malign tumor was diagnosed, effusion cytology was negative in 4 of 7 tumors. In 5 patients with a history of a former tumor pleural carcinosis was related three times correctly to the former cancer and twice to a secondary cancer. In one case a fibrous plaque was found. There were two patients with pleuritis, in one case a pulmonary tuberculosis was found 8 weeks later. In one patient with a mesothelioma inoculated metastasis were present in the sites of the punctures. In all pleural forceps punctures we got enough biopsy material for histological and immunohistochemical diagnosis. CONCLUSION The ultrasound guided forceps biopsy of the pleura is a very promising less invasive method to diagnose pleural tumors. Additional improvements of the equipment are possible. Definitive evaluation of the procedure especially in infectious pleural diseases requires a higher number of cases.

The sonographic detection of fistulas in Crohn's disease has been almost impossible up to now and had therefore not been attempted. Two findings of an enterocutaneous and a blind-ending colohepatic fistula are demonstrated. Probably sonographic diagnosis of fistulas is better than has been believed so far, due to the high contrast of tiny gas bubbles; the "compression technique" to bypass meteoristic intestinal loops, which is been increasingly employed, and the improved physical resolution that allows to distinguish between different layers of the intestinal wall, are further contributing factors to the increasing use of sonography in this category of diagnostics.

Chronic alcohol consumption may lead to a variety of diseases and may deteriorate a great number of existing health problems. Among all these diseases the development of certain types of cancer is of major concern. Since decades it has been known that chronic alcohol consumption is a risk factor for cancer of the upper aerodigestive tract (oral cavity, pharynx, larynx and oesophagus), the liver and the female breast. Data with respect to alcohol and cancer concerning other organs do not show such clear correlations. In February 2007 an international group of epidemiologists and alcohol researchers met at the International Agency for Research on Cancer (IARC) in Lyon, France, to evaluate the role of alcohol and its first metabolite acetaldehyde as potential carcinogens in experimental animals and humans. The working group has concluded from the epidemiological data available that the occurrence of malignant tumours mentioned above is related to the consumption of alcoholic beverages. In addition, at this time epidemiologic and experimental data showed that alcohol is also a risk factor for colorectal cancer (Baan et al., 2007). Worldwide a total of approximately 389,000 cases of cancer presenting 3.6 % of oral cancers (5.2 % in men and 1.7 % in women) derive from chronic alcohol consumption (Rehm et al., 2004). Besides the fact that alcohol is a co-carcinogen and may act as a promoter alcohol can also accelerate tumour spread as exemplified for liver metastases of colorectal cancer possibly due to immune suppression and induction of angiogenesis by the expression of vascular endothelial growth factor (VEGF) (Seitz & Stickel, 2010). In addition, it is important to know that ethanol also interacts with the metabolism of chemo-therapeutic drugs which can result in a decreased respond to medication and increased side-effects (De Bruijn & Slee, 1992). This review focuses solely on the effect of chronic alcohol consumption on colorectal cancer, a cancer which is wide spread in Western societies and is No. 3 cancer in men and women in Germany. The present review will, therefore, discuss epidemiology of alcohol and colorectal cancer, will briefly address possible mechanism by which alcohol stimulates colorectal carcinogenesis and may finally give some suggestions and recommendations with respective to earlier detection and identification of high risk groups.

BACKGROUND: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. METHODS: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. FINDINGS: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p

The contributions to sonography of the abdomen and retroperitoneum approximately equaled those of the previous years with respect to quantity and quality. CEUS received the greatest amount of attention as evidenced by the increase in the number of studies presented. However, the organizations and convention committees should make a serious effort to improve the scientific program. It was conducted largely by seminar leaders of the German Society for Ultrasound in Medicine, indicating a lack of new academics.