Search

Gorham syndrome, also known as massive osteolysis or vanishing bone, is a rare disorder (135 cases reported) leading to extensive loss of bony matrix, replaced by proliferating thin-walled vascular channels. Three histologically proven cases of the disease are reported, including the clinical presentation and modern imaging features with CT (with 3D reconstruction) as well as T1- and T2-weighted MRI. Two cases in young women were located in the pelvis with extensive osteolysis reaching to the acetabulum. The third case in a 2-month-old boy is the youngest case ever reported and involved the humerus. The radiological appearance of the disease is discussed and the importance of the modern imaging methods debated.

Due to the flexibility and an external control mechanism of our thin calibrated cholangioscope (10.2 F) an inspection of the bile ducts via percutaneous transhepatic access is possible without too much discomfort for the patient. A 3.6 F working channel enables target-specific biopsies under optical control. It does not only enable histological diagnosis of the tumour itself but above all the exact definition of the proximal and distal tumour borders. This is a decisive criterion of operability and operation planning especially in tumours of the hepatic bifurcation. Expansion of the compressive lesion may be determined for palliative treatment. Percutaneous stone extraction by contact lithotripsy or with a Dormia basket is technically possible via the working channel under endoscopic view. An inspection of the peripheral branches of the same and the other liver lobe from one access only is made possible by easy maneuverability and flexibility of the endoscope.

This is a follow-up study of 171 patients concerning the patients' care and complications following biliary drainage. Complications caused by puncture and drainage are considered separately. External biliary drainage resulted in 39%, internal in 26% with complications. The influence of advantages and side effects upon the indications of biliary drainage is discussed. Prognosis concerning the survival rate depends on the underlying pathology: In obstructive jaundice caused by metastases the patients only survived two months while the mean survival rate in carcinoma of the biliary ducts is 18 months.

A new cutting biopsy needle has been used to obtain histologically useful material while causing the minimum of trauma. It permits biopsies of organs, but its small external diameter of 0.8 or 0.95 mm makes it possible to carry out transperitoneal puncture of the stomach, colon or liver and of the retroperitoneal space, using a ventral approach. Tissue samples were obtained in 96% of 63 patients. The risk of complications is no higher than for conventional needles used for cytology. The accuracy with which the material can be obtained is therefore the most important problem. The position of the area to be biopsied should determine whether the biopsy is to be aided by sonography or CT. Biopsies of organs can be appropriately carried out under ultrasound control, but processes in the pelvis and in retroperitoneal-paravertebral and extra-peritoneal positions are best biopsied under CT control.

Investigations have been carried out on the endothelial damage produced by diatrizoate (Angiografin) during the course of endotoxin shock. A single injection was given directly into the aorta of 1 ml of the contrast medium, with an iodine content of 300 mg/ml. The increased proliferation of the aortic endothelium could be shown to be due to the endotoxin shock, but was not further increased by administration of the contrast medium.

Nach stumpfem Bauchtrauma kann die Sonographie schnell und sicher intraperitoneale Flussigkeit als Hinweis auf eine Organruptur nachweisen. Die modernen transportablen Gerate ermoglichen die Untersuchung auch im Schockraum. Von 779 seit 1980 untersuchten Patienten zeigten 27% pathologische Befunde; bei 92 Patienten war eine sofortige Operation notig. Die Fehlerquote lag bei 1%. Um eine Korrelation zwischen intraperitonealer Blutmenge und sonographischem Befund herstellen zu konnen, haben wir Peritonealdialysepatienten nach Gabe definierter Flussigkeitsmengen uber den liegenden Dialysekatheter untersucht. Besonders interessierten nur schmale Flussigkeitsansammlungen subhepatisch, da hier chirurgischerseits unter sonographischen Verlaufskontrollen abgewartet werden kann.

Cross-sectional studies using diffusion tensor imaging (DTI) suggest decline of the integrity of intracortically projecting fiber tracts with aging and in neurodegenerative diseases, such as Alzheimer's disease (AD). Longitudinal studies on the change of fiber tract integrity in normal and pathological aging are still rare. Here, we prospectively studied 11 healthy elderly subjects and 14 subjects with amnestic mild cognitive impairment (MCI), a clinical risk group for AD, using high-resolution DTI and MRI at baseline and after 13 to 16 months follow-up. Fractional anisotropy (FA), a DTI measure of fiber tract integrity, was compared across time points and groups using a repeated measures linear model and tract based spatial statistics. Additionally, we determined rates of grey matter and white matter atrophy using automated deformation based morphometry. Healthy elderly subjects showed decline of FA in intracortical projecting fiber tracts, such as corpus callosum, superior longitudinal fasciculus, uncinate fasciculus, inferior fronto-occipital fasciculus, and cingulate bundle (p < 0.05, corrected for multiple comparisons). MCI subjects showed significant FA decline predominantly in the anterior corpus callosum (p < 0.05, corrected for multiple comparisons). Grey and white matter atrophy involved prefrontal, parietal, and temporal lobe areas in controls and prefrontal, cingulate, and parietal lobe areas in MCI subjects and agreed with the pattern of fiber tract changes. Our findings indicate that DTI allows detection of microstructural changes in subcortical fiber tracts over time that are related to aging as well as to early stages of AD type neurodegeneration. The underlying mechanisms for these changes are unknown.