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Three radiological methods of examination can be used in phlebography of the upper extremity: screening (fluoroscopy) combined with on-target x-ray film examination; sheet film angiography; digital subtraction phlebography (DSP). Phlebography of the veins of the forearm performed preoperatively for selecting suitable veins for a dialysis shunt, should be done by screening with on-target x-ray film takes in several planes. DSP should be given preference if there is suspicion of thrombosis of the shoulder veins and the superior vena cava.

Die traditionellen bildgebenden Verfahren und ihre Stellung bei onkologischen Problemen im Bereich der Gynakologie sollen hier nicht behandelt werden. Laparoskopie, Zystoskopie, Rektoskopie und Koloskopie gelten als etablierte Untersuchungsverfahren, die in der Diagnostik von Ovarialtumoren, Zervixkarzinomen und Endometriumkrebs zum allgemein anerkannten pratherapeutischen Repertoire (und auch Staging) ebenso gehoren wie zur Tumornachsorge und Uberprufung des Therapieerfolges bzw. unerwunschter Nebenwirkungen der Behandlung (bei Operation und/oder Bestrahlung). In der aktuellen Diskussion stehen Sonographie, Computertomographie und Kernspintomographie hinsichtlich eines weiteren Gewinnes bei der pratherapeutischen Diagnostik und beim pratherapeutischen Staging gynakologischer Tumoren.

A total of 7 healthy volunteers and 31 patients have been examined clinically, by MRI, TRS, and biopsy. In those patients with established carcinoma, a CT examination was also performed. For the MRI study, a superconducting MR 2000 imager (Picker International) operated at 0.15 T was used with multiplanar SE and IR sequences. SE sequences with long echo times detected prostatitis, adenoma and carcinoma of the prostate with a high degree of sensitivity. However, at present, differentiation between adenoma, prostatitis and carcinoma is not possible with sufficient accuracy. In these studies we were unable to establish a correlation between the signal pattern and staging and/or grading of the carcinoma. Reliable diagnosis of a prostate carcinoma still requires a biopsy. Because of the high soft tissue contrast and the possibility of selecting any orientation for the plane under investigation, however, MRI represents an improvement in the preoperative diagnosis of local spread.

Correct positioning of the intra-arterial vascular catheter is essential for the technical execution of a fractionated, locally-acting (as far as possible) perfusion of medicaments with a minimum of side effects--now that selective chemotherapy has been introduced as part of a multi-method treatment of tumours in the head and neck region. For this purpose, angiographic imaging of the catheter topography with the relevant dependent vascular area is recommended. This procedure is relatively easy and allows immediate correcting of the catheter position, while taking into consideration the individual blood flow conditions. In a group of 70 patients subjected to this procedure by the author, no local complications were seen.

On the basis of x-ray-findings in 70 patients with tumours of the head and neck, who had intraarterial chemotherapy the authors demonstrate the varying approaches to an indirect catheterisation of the external carotid artery. Paying due attention to possible complications arising from i.a. catheterisation, they stress the need for x-ray checks of the correct position of the catheter before commencement of intraarterial chemotherapy.

The radiological changes in the kidneys and skeleton in primary oxalosis in a patient are described. Crystalline calcium oxalate deposits, which are a secondary phenomenon, are responsible for the findings, which are of great significance both functionally and prognostically. Hyperoxalaemia is due to an enzyme defect, which leads to hyperoxaluria; this causes a reduction in renal function and can lead to rapid progression of the condition.

The purpose of this study was to assess the contribution of digital subtraction angiography (DSA) to the quantification of aortic valve regurgitation in 21 patients undergoing heart catheterization. The digital image subtraction was used for densitometric evaluation. The regurgitation was derived from the distribution of contrast volumes during diastole in aortic and left ventricular "regions of interest". DSA-measurements were compared with results of conventional cineangiography. Results showed the following correlation between DSA measurements and cineangiographic estimates (grades I-III): regurgitation 1.7-9.8% in grade I (n = 11), 8.9-22.3% in grade II (n = 5), 31.7 and 32.5% in grade II-III (n = 2), 37-42.4% in grade III (n = 3). DSA and digital densitometry seem to be valuable methods for the quantification of regurgitation. Concerning quantitative measurements in left heart catheterization the digital subtraction aortography is superior to conventional cineangiography and will be helpful to characterize patients with aortic regurgitation more completely.

The clinical experience in diagnostic laparoscopy is dealt with under the conditions of the Department of Gynaecology and Obstetrics at Erlangen University. Among 700 cases the indications were infertility (34,4%), pelvic pain 27,4%), suspected ectopic pregnancy (7,9%), endocrinologic cases and malformations (18,9%), pelvic mass without symptoms (8,6%) and others (2,8%). The laparoscopic findings are shown. Important diagnostic clues otherwise missed were found in about half of the patients. In 122 women a laparotomy could be disregarded. One should be aware of diagnostic errors especially in ovarian tumors. Biopsy may help in assessment of ovarian function. In tumor diagnosis, however, it is rather dangerous. Difficulties of the methos (2,9%) and complications (1%) are discussed.

The 46-year-old woman was admitted with an acute inflammatory swelling of the left forearm. During the previous six months the patient had suffered from recurrent thromboses of the superficial veins associated with generalized physical weakness. The gynaecological history was remarkable for hypermenorrhea and metrorrhagia. On examination, the signs of an acute thrombophlebitis with concomitant lymphangitis were observed. In the lower right abdomen there was a palpable tumor. Laboratory findings showed a mild anemia and indices of inflammation. Subsequent procedures (abdominal sonography, gynaecological examination) further substantiated the suspicion of an underlying malignant process. Hysterectomy and histological examination revealed two different carcinomas of the right ovary and of the uterine cave. Already during the uncomplicated postoperative period the thrombophlebitis completely regressed.

Basing upon 77 patients examined the lateral cysturethrography with metallic bead chain is demonstrated as a special X-ray method in the diagnostic management of the female urinary incontinence in good reference to its diagnostic value in advance. A methodic limitation to the lateral voiding cysturethrography only means lack of information about the relations of the pathophysiologically important vesico-urethral connection in "relaxed" and "straining" state. The clinical graduation of stress urinary incontinence shows no proportionality in quantity according to the angles of the vesico-urethral connection revealable by roentgenogram.

Experiences in i.v. digital subtraction angiocardiography (DSAC) including so-called parametric imaging for morphological delineation of the right ventricle are illustrated. 32 patients with different anatomical and haemodynamic disturbances of the right ventricle were subjected to these examinations. Special emphasis is placed on pulmonary stenosis, particularly on its infundibular manifestations. For visualisation of muscular or fibrous bulging or other changes of the outflow tract of the right ventricle, analysis of the amplitudes is very suitable to produce cumulative pictures of ventricular wall motion during a cardiac cycle. Obstructive wall alterations within the infundibular part become visible even if they occur only during certain phases of the myocardial action, usually in late systole than otherwise.

The brains of 10 spider monkeys inoculated intracerebrally with brain suspension from kuru patients have been studied histologically and ultrastructurally. The animals were killed by perfusion of fixative from four to forty-one weeks after inoculation, when healthy and free of neurological signs. Definite histopathological changes had occurred as early as four weeks after inoculation, when moderate numbers of bi-nucleated neurons were found within the limbic cortex, striatum, the hypothalamus and amongst the Purkinje cells of the cerebellum. At later stages of incubation a moderate loss of neurons in the cerebral and cerebellar cortex and a mild to moderate proliferation of fibrous astrocytes here and also in the hypothalamus were the most striking features. None of our cases showed either status spongiosus or the generalized astrocytic proliferation and hypertrophy, characteristic of fully developed experimental kuru, in any region of the brain. The principal ultrastructural abnormalities consisted of the formation of membrane-bound intracytoplasmic vacuoles, predominantly within dendrites, and of concentric laminar arrays derived from the endoplasmic reticulum. The former were seen in all regions of the brain examined and at all stages of incubation. Concentric laminar arrays were confined to the cerebellar nodulus, where they were most numerous in dendrites and neuronal perikarya four weeks after inoculation. Both changes are interpreted as an indication that the kuru agent acts upon the plasma membrane from an early stage onwards and, by stimulating its growth, leads to the formation of complex, membrane-bounded vacuoles and to hyperplasia of the endoplasmic reticulum. The formation of vacuoles is further regarded as the first sign of status spongiosus on an ultrastructural level. Attention is drawn to the great similarities between the changes observed in the present material and those described in the brains of patients dying from kuru and of primates with fully developed experimental kuru. The significance of the relatively rapid spread of the kuru agent throughout the brain is discussed in relation to the concept of "slow virus" diseases.

One hundred and thirty-six patients with various cardiac abnormalities that had been diagnosed by standard methods, were examined by I-V DSA; images of the left and right ventricles during a representative cardiac cycle were submitted to amplitude and phase analysis, using a Fourier transformation. Temporal differentiation of ventricular function was derived from the best available right anterior oblique projection; the amplitude of cardiac movement of abnormal areas in the myocardium were obtained from a grey scale or colour coding at a fixed point. Comparison with a control group of 35 individuals showed the following pathological findings: hypokinetic segments (33 cases) showed delay, dyskinesias (20 cases) showed complete separation of maximal phases, frequently with a double peak in the phase histogram; disturbances of cardiac rhythm (14 cases) showed atypical localisation of initiation of contraction: in Wolfe-Parkinson-White syndrome this is basal-anterior, in left bundle branch block and VVI stimulation it is apical inferior; in hypertrophic obstructive cardiomyopathy (eight cases) it is postero-basal inferior with high, narrow peaks on the phase histogram. Differential phase analysis on I-V DSA enables one to define cardiac contraction in a simple manner.

A 66 year old patient with chest pain and exertional dyspnea is described. Auscultation and physical examination showed signs of aortic stenosis combined with aortic insufficiency. Electrocardiography revealed left ventricular hypertrophy with associated ST-segment and T-wave abnormalities. Color blood flow imaging confirmed severe combined aortic stenosis and regurgitation, the hemodynamic evaluation demonstrated the indication for aortic valve replacement.

At defined times prior and following a Wertheim operation for cancer of the uterine cervix the patients were investigated for the functional parameters of the lower urinary tract. The residual urine was determined. Stress incontinence and urgency incontinence were measured with urethrocystometry. The sensitivity and the micturition were evaluated from subjective data. The results of 237 investigations in 192 operated women are described and compared to previous papers on the subject. Stress incontinence increased to double the pre-operative incidence following the Wertheim operation. An urgency incontinence was quite rare. A lack of feeling of fullness to the bladder as a sign of disturbed bladder sensitivity was present 5 months post-operatively in 6 of 45 patients (13%). This was present in only 1 of 119 patients (1%) after five years. 1/3 of the women had difficulty with spontaneous micturition five months following the operation. 1/10 of the women had difficulty with spontaneous micturition 5 years after the operation. There was no residual urine five months after the operation in 9/10 of the patients and five years following the operation almost 100% of the patients had no residual urine. It was noted that difficulty with spontaneous micturition with residual urine and urgency incontinence did not necessarily result in concomitant bacteriuria. Suggestions are presented how future investigations with similar questions may lead to comparable results.

The measurement of residual urine is important for bladder training in cases with neurogenic bladder dysfunction, especially in multiple sclerosis and in non-neurogenic retention. It is possible to measure the bladder volume precisely enough for even small amounts of residual urine by means of the ultrasound B-mode technique. A sector scan was used since with a linear array scan, the caudal part of the bladder cannot be visualized in female patients because of the pubic bone. The 144 volume data taken by ultrasound from normal persons and from patients without residual urine and the 19 measurements made in patients with residual urine more than 20 ml were compared with the urine volume determined by micturation or catheterization. The bladder volume was calculated from the maximum sagittal and transversal planes using an ellipsoid formula. The regression coefficient was 0.75. The correlation coefficient was 0.94 for bladder volumes between 0 and 200 ml. The standard deviation of the calculated residual urine as compared to the measured urine was 10.5 ml for a volume between 0 and 100 ml and 16.2 ml for a volume between 101 and 200 ml. Thus, ultrasound determination of residual urine may be recommended as a simple and reliable method when using a sector scan.

Our study of the synaptic organization of the baboon subthalamic nucleus has revealed at least nine different types of synapses. Most frequently encountered is the type I (F) axo-dendritic or axo-somatic synapse. It is characterized by scattered flat vesicles and many large mitochondria. The axon terminal is either elongated, tubule shaped (type IF en passant), and undergoes many short button-like en passant junctions with a parallel running dendrite, or it is spindle shaped with similar synaptic contacts (type IFa). In other cases a more compact bouton forms many short junctions at the same time with a dendrite and a beak-shaped spine springing from it. A smaller bouton with flat vesicles, which show a tendency to fuse together (type IIF) usually undergoes slightly asymmetric contacts with two vesicles-free dendrites between which they frequently appear wedged. Three types of boutons with small, round vesicles have extended asymmetric contacts forming elongated (type III), star-shaped (type IV), or oval (type V) synapses. The latter form contacts mostly with dendritic terminals or spines. Another type of synapses contain larger, pale, pleomorphic vesicles (VI (SO)): The bouton is more compact and often in contact with a dendritic terminal. Type VII (LO) shows a looser arrangement of vesicles intermingled with more dense core vesicles. Type VIII (F) is a dendritic terminal with loosely arranged, flat vesicles and is in contact either with a type VI or with a type VII P bouton. Finally, there is an axo-spinous microsynapse type IX, which partly degenerates after contralateral pallidum externum coagulation. A few axon preterminals filled with dense core vesicles do not undergo synaptic contacts.

The diagnostic value of computed tomography was examined in 34 patients by the clinical diagnosis of an ovarial tumor established immediately before the operation. In 78,9% of all cases, a carcinoma could be surely recognized, often only by indirect signs of malignancy. Benign processes were correctly recognized in 83,3% of all cases. The staging of carcinomas was correct in 57,9%. A disadvantage of CT lies in the fact that it does not show peritoneal disseminations of smallest metastases as well as metastatic formations in not enlarged lymph nodes, which often leads to an understaging.

We carried out replacement of the oesophagus by transposing the stomach in 87 patients, 64 with carcinoma of the oesophagus. There is an immediate operative mortality of 20-30%, but this is followed by a relatively low morbidity, which is well demonstrated radiologically (stricture at the anastomosis, which can be mechanically dilated, about 22%; external fistula with a tendency to spontaneous closure about 25%; ectasia of the thoracic stomach, 15-25%). Average survival time is eight to ten months. There is a 24% risk of post-operative pulmonary oedema and daily chest x-rays are indicated.

Sonography is firmly established in obstetrics as the method of choice for the localization of fetus and placenta. However, for the determination of pelvic dimensions sonography does not suffice. Thus, for a few strictly selected indications conventional x-ray pelvimetry is used. This has the disadvantage of the relatively high radiation dose for the fetus and the maternal gonads. Since the introduction of digital radiography, there is the alternative of digital pelvimetry. We performed dosimetry comparing digital and conventional radiography with the new high amplifying screens (Quanta III, Dupont) using an ionization dosimeter and a wax phantom. The radiation dose of digital radiography was 24 mu Gy. This corresponds to about 15% of a comparable conventional exposure (177 mu Gy). A further advantage of digital radiography is a standardized and rapid exposure technique; furthermore pelvic dimensions can be measured directly. The disadvantages are the poorer spacial resolution and poor image quality in obese patients. Digital radiography because of its lower radiation dose is suitable for pelvimetry for special indications.

The subtotal hysterectomy is no longer indicated for the treatment of female genital disease with rare exceptions. It has been known for a long time that the remaining cervical stump has very few advantages but many potential risks. Among our patients who had cervical stumps removed 32 of 69 cases had malignant changes in the cervical stump. Decensus and prolapse was the next common abnormality. If adnexal tumors or cervical cancers do not indicate an abdominal approach for the removal, the vaginal approach for the removal of the cervical stump ist preferred since this is easier and less risky.

From 1962 to 1975 severe stress incontinence or recurrent stress incontinence was operated according to Marshall-Marchetti In 64 cases. Sixty patients were followed up. More than 2/3 of the patients were satisified with the result. Objective follow-up with urethrocystotonometry showed that only slightly more than 50% of the patients were cured. It was possible to divide the cases in 4 groups to elucidate the discrepancy between subjective and objective cure. The operative and postoperative complications were minor. The recurrence rate was the same with follow-up from 3 to 14 years. The results can probably be improved by precise pre-operative diagnosis regarding intrinsic urinary tract disease and by an extension of the indication for this operation or risk cases. The patients must be warned that the result also depends on their cooperation.

It was shown that a spectrophotometric investigation of the amniotic fluid for the determination of fetal lung maturity can be achieved with a photometer of the wave length 644 nm (CD) and 623 nm (HG) in conjunction with a count of superficial cells. In a small number of investigations the combination of spectrophotometry and fetal cell count is a sufficiently accurate method to determine fetal lung maturity.

Quantitative investigations were made on the effect of convulsant doses of pentamethylenetetrazol (PMT) on the neurones of the supraoptic nucleus in rabbit. In contrast to results reported by other workers, the present investigation yielded statistical evidence for an increase in the number of “Gomori-positive” elements in the supraoptic nucleus following epileptic seizures induced by PMT. The factors that might be responsible for this phenomenon are discussed. It is pointed out that a satisfactory interpretation cannot be given on the basis of histological findings alone. The problem requires further investigation with other techniques, such as electron microscopy and biochemical methods.

An interesting and unusual histologic variant of ameloblastic fibroma is reported in a 15-year-old Negro girl. The case represents the first published report of papilliferous ameloblastic fibroma. The available follow-up suggests that the biologic behavior of this variant is identical to that of the ameloblastic fibroma.

Professor Christ’s pioneering contributions to econometrics, monetary and fiscal policies and the government’s budget constraint are thoroughly covered in this volume. Other areas addressed include monetary economics, monetary policy, macroeconomic model building, and the role of the economist in economic policy making. The book also features an original new introduction by the author and a detailed bibliography.