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The rate of contrast injection during i.v. urography may vary considerably (bolus injection or drip infusion). The effect of 5 rates of injection (6, 12, 18, 36 and 72 ml/min) on the contrast density in the renal collecting system was examined over a period of 30 minutes. Measurements showed an inter-individual difference of more than 200% in each group. The intra-individual variations for different rates of injection were very slight; individual concentration in the kidney for a given dose depends only slightly on the rate of injection. There is no statistically significant improvement in contrast values as a result of a bolus injection. The reduced incidence of side effects justifies the use of bolus injections but pressure injections are unnecessary from a diagnostic point view.

Neuropeptides are found in both mammals and invertebrates and can modulate neural function through activation of G-protein-coupled receptors (GPCRS). The precise mechanisms by which many of these GPCRs modulate specific signaling cascades to regulate neural function are not well defined. We usedDrosophila melanogasteras a model to examine both the cellular and behavioral effects of DPKQDFMRFamide, the most abundant peptide encoded by the dFMRF gene. We show that DPKQDFMRFamide enhanced synaptic transmission through activation of two G-protein-coupled receptors,Fmrf Receptor(FR) andDromyosupressin Receptor-2 (DmsR-2). The peptide increased both the presynaptic Ca2+response and the quantal content of released transmitter. Peptide-induced modulation of synaptic function could be abrogated by depleting intracellular Ca2+stores or by interfering with Ca2+release from the endoplasmic reticulum through disruption of either the ryanodine receptor or the inositol 1,4,5-trisphosphate receptor. The peptide also altered behavior. Exogenous DPKQDFMRFamide enhanced fictive locomotion; this required both theFRandDmsR-2. Likewise, both receptors were required for an escape response to intense light exposure. Thus, coincident detection of a peptide by two GPCRs modulates synaptic function through effects of Ca2+-induced Ca2+release, and we hypothesize that these mechanisms are involved in behavioral responses to environmental stress.

Regenerative medicine encompasses “tissue engineering” – the in vitro fabrication of tissues and/or organs using scaffold material and viable cells – and “cell therapy” – the transplantation or manipulation of cells in diseased tissue in vivo. In the cardiovascular system, tissue engineering strategies are being pursued for the development of viable replacement blood vessels, heart valves, patch material, cardiac pacemakers and contractile myocardium. Anecdotal clinical applications of such vessels, valves and patches have been described, but information on systematic studies of the performance of such implants is not available, yet. Cell therapy for cardiovascular regeneration, however, has been performed in large series of patients, and numerous clinical studies have produced sometimes conflicting results. The purpose of this chapter is to summarize the clinical experience with cell therapy for diseases of the cardiovascular system, and to analyse possible factors that may influence its outcome.

Maintenance of synaptic transmission requires regulation of intracellular Ca2+in presynaptic nerve terminals; loss of this regulation at elevated temperatures may cause synaptic failure. Accordingly, we examined the thermosensitivity of presynaptic calcium regulation in Drosophila larval neuromuscular junctions, testing for effects of disrupting calcium clearance. Motor neurons were loaded with the ratiometric Ca2+indicator Fura-dextran to monitor calcium regulation as temperature increased. Block of the Na+/Ca2+exchanger or removal of extracellular Ca2+prevented the normal temperature-induced increase in resting calcium. Conversely, two treatments that interfered with Ca2+clearance—inactivation of the endoplasmic reticulum Ca2+-ATPase with thapsigargin and inhibition of the plasma membrane Ca2+-ATPase with high pH—significantly accelerated the temperature-induced rise in resting Ca2+concentration and reduced the thermotolerance of synaptic transmission. Disrupting Ca2+-ATPase function by interfering with energy production also facilitated the temperature-induced rise in resting [Ca2+] and reduced thermotolerance of synaptic transmission. Conversely, fortifying energy levels with extra intracellular ATP extended the operating temperature range of both synaptic transmission and Ca2+regulation. In each of these cases, Ca2+elevations evoked by an electrical stimulation of the nerve (evoked Ca2+responses) failed when resting Ca2+remained >e 200 nM for several minutes. Failure of synaptic function was correlated with the release of intracellular calcium stores, and we provide evidence suggesting that release from the mitochondria disrupts evoked calcium responses and synaptic transmission. Thus the thermal limit of synaptic transmission may be directly linked to the stability of ATP-dependent mechanisms that regulate intracellular ion concentrations in the nerve terminal.

Modulation of neuromuscular transmission at invertebrate neuromuscular junctions has been studied in detail mainly in arthropods, particularly in decapod crustaceans and in two orders of insects. Alterations in neurotransmission most often reflect changes in the presynaptic motor nerve terminal of the neuromuscular junctions. Invertebrate motor nerve terminals typically possess numerous small synaptic contacts with group-specific characteristics. Changes in synaptic performance may involve altered probability of neurotransmitter release at individual synaptic contacts, increases or decreases in the number of responsive synapses, or both. Modulation of synaptic performance can be initiated in several ways. The most significant inducing agents are alterations in nerve impulse activity in the transmitting motor neuron, synaptic transmission from another neuron that affects the neuromuscular junction (especially presynaptic inhibition), and circulating neurohormones or local neuromodulators, in particular amines and neuropeptides. Many forms of modulation are linked to regulation of intracellular Ca2+ in the presynaptic nerve terminal, but in some cases second-messenger pathways are activated without significant changes in presynaptic Ca2+.

Drosophila Frequenin (Frq) and its mammalian and worm homologue, NCS-1, are Ca2+-binding proteins involved in neurotransmission. Using site-specific recombination in Drosophila, we created two deletions that removed the entire frq1 gene and part of the frq2 gene, resulting in no detectable Frq protein. Frq-null mutants were viable, but had defects in larval locomotion, deficient synaptic transmission, impaired Ca2+ entry and enhanced nerve-terminal growth. The impaired Ca2+ entry was sufficient to account for reduced neurotransmitter release. We hypothesized that Frq either modulates Ca2+ channels, or that it regulates the PI4Kβ pathway as described in other organisms. To determine whether Frq interacts with PI4K. with consequent effects on Ca2+ channels, we first characterized a PI4Kβ-null mutant and found that PI4Kβ was dispensable for synaptic transmission and nerve-terminal growth. Frq gain-of-function phenotypes remained present in a PI4Kβ-null background. We conclude that the effects of Frq are not due to an interaction with PI4Kβ. Using flies that were trans-heterozygous for a null frq allele and a null cacophony (encoding the α1-subunit of voltage-gated Ca2+ channels) allele, we show a synergistic effect between these proteins in neurotransmitter release. Gain-of-function Frq phenotypes were rescued by a hypomorphic cacophony mutation. Overall, Frq modulates Ca2+ entry through a functional interaction with the voltage-gated Ca2+-channel subunit; this interaction regulates neurotransmission and nerveterminal growth.

The lymphographic findings in 20 patients with AIDS-most in clinical stage IV-can be divided into four categories. In six there were no specific changes and in a further six the storage pattern was that of sinus histiocytosis. One patient showed transition to malignant lymphoma and another patient had atypical mycobacterial infection of the retroperitoneal lymph nodes. Six patients showed a lymphographic pattern of scarring. The results of this study show that lymphography is a sensitive method that can provide important additional information.

We examined the thermosensitivity of calcium regulation in Drosophila larval neuromuscular junctions, testing effects of prior heat shock and Hsp70 expression. Motor neurons were loaded with either the ratiometric indicator Fura-dextran or the nonratiometric indicator Oregon Green bis-( o-aminophenoxy)- N,N,N′,N′-tetraacetic acid to monitor parameters of calcium regulation as temperature increased. Nerve terminals treated to a prior heat shock, and those of transgenic flies expressing higher than normal levels of Hsp70, were better able to maintain near-normal resting calcium concentrations, calcium influx, and calcium clearance at higher temperatures. Synaptic transmission was also protected by prior heat shock and by higher than normal Hsp70 expression. Thus the thermal limit of synaptic transmission may be directly linked to the stability of calcium regulation.

We found that using more than one parameter derived from optical tomographic images can lead to better image classification results compared to cases when only one parameter is used.. In particular we present a multi-parameter classification approach, called self-organizing mapping (SOM), for detecting synovitis in arthritic finger joints based on sagittal laser optical tomography (SLOT). This imaging modality can be used to determine various physical parameters such as minimal absorption and scattering coefficients in an image of the proximal interphalengeal joint. Results were compared to different gold standards: magnet resonance imaging, ultra-sonography and clinical evaluation. When compared to classifications based on single-parameters, e.g., absorption minimum only, the study reveals that multi-parameter classifications lead to higher classification sensitivities and specificities and statistical significances with p-values

Although it has been postulated that vesicle mobility is increased to enhance release of transmitters and neuropeptides, the mechanism responsible for increasing vesicle motion in nerve terminals and the effect of perturbing this mobilization on synaptic plasticity are unknown. Here, green fluorescent protein-tagged dense-core vesicles (DCVs) are imaged inDrosophilamotor neuron terminals, where DCV mobility is increased for minutes after seconds of activity. Ca2+-induced Ca2+release from presynaptic endoplasmic reticulum (ER) is shown to be necessary and sufficient for sustained DCV mobilization. However, this ryanodine receptor (RyR)-mediated effect is short-lived and only initiates signaling. Calmodulin kinase II (CaMKII), which is not activated directly by external Ca2+influx, then acts as a downstream effector of released ER Ca2+. RyR and CaMKII are essential for post-tetanic potentiation of neuropeptide secretion. Therefore, the presynaptic signaling pathway for increasing DCV mobility is identified and shown to be required for synaptic plasticity.

Hypoxic preconditioning was shown to improve the therapeutic efficacy of bone marrow-derived multipotent mesenchymal stromal cells (MSCs) upon transplantation in ischemic tissue. Given the interest in clinical applications of umbilical cord blood-derived MSCs, we developed a specific hypoxic preconditioning protocol and investigated its anti-apoptotic and pro- angiogenic effects on cord blood MSCs undergoing simulated ischemia in vitro by subjecting them to hypoxia and nutrient deprivation with or without preceding hypoxic preconditioning. Cell number, metabolic activity, surface marker expression, chromosomal stability, apoptosis (caspases-3/7 activity) and necrosis were determined, and phosphorylation, mRNA expression and protein secretion of selected apoptosis and angiogenesis-regulating factors were quantified. Then, human umbilical vein endothelial cells (HUVEC) were subjected to simulated ischemia in co-culture with hypoxically preconditioned or naïve cord blood MSCs, and HUVEC proliferation was measured. Migration, proliferation and nitric oxide production of HUVECs were determined in presence of cord blood MSC-conditioned medium. Cord blood MSCs proved least sensitive to simulated ischemia when they were preconditioned for 24 h, while their basic behavior, immunophenotype and karyotype in culture remained unchanged. Here, “post-ischemic” cell number and metabolic activity were enhanced and caspase-3/7 activity and lactate dehydrogenase release were reduced as compared to non-preconditioned cells. Phosphorylation of AKT and BAD, mRNA expression of BCL-XL, BAG1 and VEGF, and VEGF protein secretion were higher in preconditioned cells. Hypoxically preconditioned cord blood MSCs enhanced HUVEC proliferation and migration, while nitric oxide production remained unchanged. We conclude that hypoxic preconditioning protects cord blood MSCs by activation of anti-apoptotic signaling mechanisms and enhances their angiogenic potential. Hence, hypoxic preconditioning might be a translationally relevant strategy to increase the tolerance of cord blood MSCs to ischemia and improve their therapeutic efficacy in clinical applications.

The synaptic vesicle-associated cysteine-string protein (CSP) is important for synaptic transmission. Previous studies revealed multiple defects at neuromuscular junctions (NMJs) ofcspnull-mutantDrosophila, but whether these defects are independent of each other or mechanistically linked through J domain mediated-interactions with heat-shock cognate protein 70 (Hsc70) has not been established. To resolve this issue, we genetically dissected the individual functions of CSP by anin vivostructure/function analysis. Expression of mutant CSP lacking the J domain atcspnull-mutant NMJs fully restored normal thermo-tolerance of evoked transmitter release but did not completely restore evoked release at room temperature and failed to reverse the abnormal intraterminal Ca2+levels. This suggests that J domain-mediated functions are essential for the regulation of intraterminal Ca2+levels but only partially required for regulating evoked release and not required for protecting evoked release against thermal stress. Hence, CSP can also act as an Hsc70-independent chaperone protecting evoked release from thermal stress. Expression of mutant CSP lacking the L domain restored neurotransmission and partially reversed the abnormal intraterminal Ca2+levels, suggesting that the L domain is important, although not essential, for the role of CSP in regulating intraterminal Ca2+levels. We detected no effects ofcspmutations on individual presynaptic Ca2+signals triggered by action potentials, suggesting that presynaptic Ca2+entry is not primarily impaired. Both the J and L domains were also required for the role of CSP in synaptic growth. Together, these results suggest that CSP has several independent synaptic functions, affecting synaptic growth, evoked release, thermal protection of evoked release, and intraterminal Ca2+levels at rest and during stimulation.

The aim of the present study was to investigate the epidemiologic evolution of fluoroquinolone resistance of E. coli clinical isolates from patients admitted to a hematology-oncology service where fluoroquinolone prophylaxis during neutropenia was recommended as the standard of care for many years but was then discontinued in a trial conducted in patients with acute leukemia. Fluoroquinolones had been shown to decrease the incidence of gram-negative bacteremia in cancer patients with neutropenia, yet it was thought that the emergence of resistance in Escherichia coli and other gram-negative bacteria may have caused a progressive lack of efficacy of fluoroquinolone prophylaxis. Epidemiologic surveillance of fluoroquinolone resistance of E. coli clinical isolates at our cancer center since 1992 showed a continuing influx of new clones not previously observed in the population of cancer patients, an increase in the number of cancer patients per year colonized and/or infected by fluoroquinolone-resistant E. coli (1992-1994, 10-16 patients; 1995-1997, 24-27 patients), and a resistance rate of50% among E. coli bloodstream isolates of hematology-oncology patients. A 6-month fluoroquinolone prophylaxis discontinuation intervention trial in 1998 suggested that despite increasing resistance among E. coli isolates, fluoroquinolone prophylaxis in acute leukemia patients was still effective in the prevention of gram-negative bacteremia (incidence rates, 8% during the pre-intervention period vs. 20% after discontinuation; p0.01). The resumption of fluoroquinolone prophylaxis in acute leukemia patients thereafter decreased the incidence of gram-negative bacteremia to the pre-intervention level (9%; p=0.03), while the proportion of in vitro fluoroquinolone resistance in E. coli bacteremia isolates again increased (from 15% during the intervention period to50% in the post-intervention period). Relative rates of resistance thus were a poor indicator of the potential clinical benefits associated with fluoroquinolone prophylaxis in cancer patients.

SUMMARYIntracellular symbiosis requires that the host satisfy the symbiont's metabolic requirements, including the elimination of waste products. The hydrothermal vent tubeworm Riftia pachyptila and the hydrocarbon seep worm Lamellibrachia cf luymesi are symbiotic with chemolithoautotrophic bacteria that produce sulfate and protons as end-products. In this report, we examine the relationship between symbiont metabolism and host proton equivalent elimination in R. pachyptilaand L. cf luymesi, and the effects of sulfide exposure on proton-equivalent elimination by Urechis caupo, an echiuran worm that lacks intracellular symbionts (for brevity, we will hereafter refer to proton-equivalent elimination as `proton elimination'). Proton elimination by R. pachyptila and L. cf luymesi constitutes the worms' largest mass-specific metabolite flux, and R. pachyptilaproton elimination is, to our knowledge, the most rapid reported for any metazoan. Proton elimination rates by R. pachyptila and L.cf luymesi correlated primarily with the rate of sulfide oxidation. Prolonged exposure to low environmental oxygen concentrations completely inhibited the majority of proton elimination by R. pachyptila,demonstrating that proton elimination does not result primarily from anaerobic metabolism. Large and rapid increases in environmental inorganic carbon concentrations led to short-lived proton elimination by R. pachyptila, as a result of the equilibration between internal and external inorganic carbon pools. U. caupo consistently exhibited proton elimination rates 5-20 times lower than those of L. cf luymesi and R. pachyptila upon exposure to sulfide. Treatment with specific ATPase inhibitors completely inhibited a fraction of proton elimination and sulfide and inorganic carbon uptake by R. pachyptila, suggesting that proton elimination occurs in large part via K+/H+-ATPases and Na+/H+-ATPases. In the light of these results, we suggest that protons are the primary waste product of the symbioses of R. pachyptila and L. cf luymesi, and that proton elimination is driven by symbiont metabolism, and may be the largest energetic cost incurred by the worms.

The authors regret that an error appeared in the above article. When reading the manufacturer’s certificate of the Luminex cytokine/growth factor screening assay, a comma (thousand separator) was mistaken for a decimal separator. Hence, the analyte concentrations given in the article as pg/ml are in fact ng/ml. The paragraph of the subsection ‘Growth factors and cytokines in conditioned medium’ under RESULTS should read: In fibroblast-conditioned medium, the total protein content was 26 ± 10% lower than in CBMSC medium (CBMSC 27 ± 2 vs fibroblasts 20 ± 2 μg/ml, P < 0.05). The concentrations of selected growth factors and cytokines are shown in Fig. 2. The concentrations of VEGF (CBMSC 6.0 ± 0.9; fibroblast 4.9 ± 0.7 ng/ml), EGF (CBMSC 0.83 ± 0.09; fibroblast 0.65 ± 0.06 ng/ml), and Angiopoetin-2 (CBMSC 0.44 ± 0.04; fibroblast 0.49 ± 0.06 ng/ml) were similar, CBMSC medium contained more HGF (CBMSC 0.36 ± 0.05 vs fibroblast 0.04 ± 0.01 ng/ml, P < 0.001), and fibroblast medium more bFGF (CBMSC 0.08 ± 0.02 vs fibroblast 0.59 ± 0.14 ng/ml, P < 0.05) and IL-6 (CBMSC 0.15 ± 0.03 vs fibroblast 5.8 ± 1.0 ng/ml, P < 0.001). IL-10 and TNFα were not detectable in either medium. In addition, the Y-axis in Figure 2 should indicate ng/ml rather than pg/ml.

A knowledge of the microanatomy of the cochlear nucleus complex and its variations is essential for successful implantation and for the design of stimulation devices. One hundred cerebellopontine angle specimens were dissected under surgical conditions using the Zeiss NC31 surgical microscope. The topographical anatomy of the exit of the vestibulocochlear nerve, the cochlear nucleus and the surface of the medulla and their relation to the surrounding structures was recorded and measured. The mean distances between the exits of the VIIth and VIIIth cranial nerves were 4.7 +/- 0.9 mm, between the VIIth and IXth 6.3 +/- 1.2 mm and between the VIIIth and IXth 5.5 +/- 1.0 mm. The visible area of the cochlear nucleus covered a square of 10.0 +/- 2.9 by 3.3 +/- 1.0 mm. A major AICA-loop had to be re-routed in 17 per cent of specimens. The taenia of the choroid plexus was present in 92 per cent and had to be cut in 51 per cent in order to enter the foramen of Luschka, that had a mean size of 3.5 by 2.0 mm. It was wide open in 24 per cent, open only after incision of the arachnoid in 53 per cent, functionally closed but opened by extensive dissection in 18 per cent and anatomically occluded in five per cent of the specimens. The typical straight vein at the cochlear nucleus leading to the entrance of the foramen of Luschka was found in 76 per cent of specimens. Constant anatomical landmarks are very helpful for finding the cochlear nucleus, but variations may endanger dissection and implantation in a remarkable number of cases.

This paper presents a rationale for using videotape records in evaluation research. Although videotaping is commonly used in ethnographic and sociometric analysis, the evaluation literature does not show the application of these recording techniques to program evaluations. The authors outline a model for exploring the effectiveness of video in qualitative program evaluation.

The rate of contrast injection during i.v. urography may vary considerably (bolus injection or drip infusion). The effect of 5 rates of injection (6, 12, 18, 36 and 72 ml/min) on the contrast density in the renal collecting system was examined over a period of 30 minutes. Measurements showed an inter-individual difference of more than 200% in each group. The intra-individual variations for different rates of injection were very slight; individual concentration in the kidney for a given dose depends only slightly on the rate of injection. There is no statistically significant improvement in contrast values as a result of a bolus injection. The reduced incidence of side effects justifies the use of bolus injections but pressure injections are unnecessary from a diagnostic point view.

The CT clearance in a number of urological patients (39 patients, 25 with normal renal function) was studied by means of an "area under curve" (AUC) method, using a region of interest. 31 patients were given meglumine ioxithalamate and 8 patients Iopamidol as a contrast medium. Both for total and partial function there was highly significant correlation with isotope clearance with good reproducibility. The difference in the pharmacokinetics of the contrast media affected the absolute clearance values.

The lymphographic findings in 20 patients with AIDS-most in clinical stage IV-can be divided into four categories. In six there were no specific changes and in a further six the storage pattern was that of sinus histiocytosis. One patient showed transition to malignant lymphoma and another patient had atypical mycobacterial infection of the retroperitoneal lymph nodes. Six patients showed a lymphographic pattern of scarring. The results of this study show that lymphography is a sensitive method that can provide important additional information.

In comparison with endoscopy, computed tomography can produce excellent results with respect to the endobronchial spread of central bronchial carcinomas. Used for the same purpose, conventional tomography of the central bronchial system is greatly inferior. With respect to an evaluation of the endobronchial tumour growth configuration, computed tomography of the chest showed agreement with the endoscopic findings in only 56 per cent of all cases. This would seem to indicate that for the planning of palliative bronchological measures, such as, for example, laser therapy and afterloading treatment, prior endoscopic inspection is indispensable. By themselves, the results obtained with the imaging procedures described in this article are not adequate.

In a prospective study of 20 cases, the importance of nuclear magnetic resonance as a diagnostic tool in cervix carcinoma was investigated. The results were compared with those of the Computer tomography as well as with those of the clinical examinations. The histology served as "Standard". In the evaluation of the local tumor invasion the gynecological examination appeared to be the most important. The involvement of regional lymph nodes was detected more accurately by the NMR as compared to CT. The exact clinical staging was not achieved by either method; thus these new diagnostic methods do not alter the planning and the technique of the operation.

Partial and total trans-catheter embolisation of the spleen with butyl-2-cyanoacrylate-lipiodol in 23 dogs lead to partial necrosis and cicatrisation of the spleen after 3 to 5 weeks. The embolised vessels do not recanalise, but are by-passed by extra- and intra-splenic collaterals. In five animals there was a reduction in the number of erythrocytes; after embolisation there was increase in the number of leucocytes, whereas the thrombocytes were unchanged. The most common complication which occurred in five animals was a 1.5 to 2.5 cm. splenic abscess. The procedure was employed without success in one patient with bleeding oesophageal varices. The procedure was complicated by extensive necrosis of the gastric mucosa. Trans-catheter embolisation of the spleen has significant complications, despite strict asepsis and antibiotic cover. The main indication of the procedure is hypersplenism which cannot be treated surgically.

Transrenal ureteric embolisation with the tissue adhesive butyl 2-cyano-acrylate mixed with lipiodol and tantalum powder produces rapid and effective occlusion of the ureter. This can be combined with the use of a Gianturco spiral. In an experimental series of eight dogs observed for 54 days, the adhesive disappeared partly in three animals and totally in a further three. Fibrotic ureteric stenosis was observed in three animals. Clinical results were rather better because of the presence of external urinary drainage. Twenty-one ureters in eighteen patients were occluded either unilaterally or bilaterally, and sometimes combined with percutaneous contralateral renal embolisation. After one to four months, the ureter was still occluded in three out of six cases; after five to 17 months, three out of five cases were no longer totally occluded, but in two cases they were still blocked. The procedure is new and suitable for the treatment of otherwise untreatable conditions, such as extensive urinary fistulae, bladder tenesmus and haematuria due to extensive tumours of the minor pelvis.

Between 1978 and 1983 fifty-two abdominal abscesses in 44 patients were drained percutaneously. 79% of the abscesses occurred as postoperative complications. The overall success rate was 60%, whereas only 42% of left subphrenic abscesses were cured. Complications were encountered in 4.5%. Reasons for drainage failures were: liver sequestration, loculation, fistulae and recurrences. Percutaneous abscess drainage is an alternative, and valuable addition, to surgery.

As a side effect after radical lymphonodectomy in the pelvic lymphatic cysts may occur on one or both sides. Only when they are big clinical signs will arise by compression. For diagnostic ultrasonic and computer tomography are superior to other radiological methods.

The value of magnetic resonance tomography in the diagnosis of carcinoma of the cervix was studied in a prospective series of 20 patients. The results were compared with those of computed tomography and with the clinical findings. The diagnosis depended on the postoperative histology. Gynaecological examination proved superior to imaging methods in determining the extent of local tumour spread. Tumour involvement of the regional lymphatic system was better demonstrated by MRT than by CT. Exact staging proved inadequate with both these methods and the new imaging methods have not produced any changes in operative planning or technique.

A percutaneous catheter which can be looped by means of a nylon thread was used in 32 patients for percutaneous biliary drainage. The catheter can be fixed in this way and is thereby prevented from migrating from the biliary system. The catheter is not suitable for proximal obstructions. Problems may arise during the removal of the nylon thread and loss of looping of the point of catheter.

37 cases of skull fractures with involvement of the orbit were reviewed retrospectively. The value of plain films, tomography and computed tomography was analysed. Combined use of 28 degrees Caldwell and water views revealed 96% of all orbital floor fractures. Orbital emphysema in facial bone fractures nearly almost (in 14 of 15 cases) indicated involvement of the medial orbital wall. CT--performed on a biplane basis--showed best diagnostic accuracy in evaluating orbital fractures. Axial CT scans revealed only 70% of all orbital floor fractures. Because of that coronal scans are especially necessary for evaluating the orbital floor and the orbital roof. CT is necessary for evaluating the medial orbital wall since conventional radiology only shows 15% of all medial orbital wall fractures.

Of 29 patients examined operation revealed a malignant tumor in 9 and a benign insulinoma in 18, 2 insulinomas were not found. The problems of preoperative tumor localization were limited to small insulinomas (size 7-35 mm). Ultrasound detected all of 3 insulinomas as low echogenic structures (size 7, 8, 17 mm). Computed tomography demonstrated 4 of 5 insulinomas (size 7, 8, 15, 17 mm) due to contrast enhancement following bolus injection. Arteriography localized 12 of 18 insulinomas preoperatively and 14 of 18 retrospectively. Selective transhepatic venous sampling for insulin assay identified 7 of 8 tumors. Real-time ultrasound and dynamic CT are promising in the diagnostics of insulinomas over 7 mm and should precede arteriography. Selective transhepatic venous sampling as the last diagnostic step is a major procedure and most specific, but not always without problems in interpretation.

In 57 patients undergoing endoscopic retrograde cholangiography (ERC) the magnification of the endoscope was determined by measurement of its diameter depicted on the X-rays. A magnification of 30.2 +/- 10.6% (mean +/- SD) ranging from 8 to 58% in individual patients was recorded. The clinical reliability of the method was confirmed by comparing the diameters of 13 bile duct stones assessed in-situ and after removal respectively. Although the magnification tended to be higher in obese patients, no correlation between body weight and the degree of the magnification could be established. Our data add further doubt to the reliability of the radiologic bile duct measurement if not referred to a reliable standard which can be easily provided by the endoscope. This is particularly important whenever therapeutic interventions are planned which critically depend on exact determination of diameters, like bile duct stone removal with or without endoscopic papillotomy, lithotripsy or introduction of transpapillary enthoprothesis.

Carcinoma of the common hepatic bile duct or common bile duct were treated by interstitial irradiation with gold seeds using the percutaneous transhepatic drainage partly boosted by external irradiation. The interstitial dose of 50 Gy was given in two applications and 40 Gy by linac. Twice histological examination showed wide tumor destruction of local irradiation, but also much more tumor extension than seen before by diagnostic investigation. Mostly the therapy is only palliative because of the infiltration of liver and lymph nodes.

Sonography was performed in 206 patients with space-occupying processes in the region of the lateral soft parts of the neck, of the parotid gland or the submandibular gland (3.5; 7.5 and/or 8-10 MHz real-time contact field scanner). This sonographic examination enabled differentiation of 166 solid from 40 cystic space-occupying masses: 102 lymphatic node enlargements, 12 primary tumours of the neck, 24 neck cysts, one thymus and epidermoid cyst, on carotid aneurysm, diseases of the salivary glands (35 neoplasias, 8 cysts, 9 inflammatory tumours, 6 cases of sialolithiasis, 5 abscesses, 2 intracapsular lymphomas). The following valuable additional information was gained from sonography in respect of surgical treatment: 1. In the region of the lateral soft parts of the neck, it was possible to effect a clear differential diagnosis of the original findings based on palpation; differential diagnostic clarification of the tumour volume; spatial location of fixed tumours of the neck in relation to the adjacent soft parts of the neck, such as vessels, musculature etc.; quantification of tumour regression subsequent to chemotherapy or radiotherapy. 2. In case of diseases of the salivary glands, differentiation between salivary calculi, neoplasia, inflammation and cyst; extension of tumour; localisation of processes in the immediate vicinity; preoperative localisation of salivary calculi.