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Background: The purpose of this study was to provide information concerning the performance of selective transarterial chemoembolization (TACE) as a palliative treatment in patients with hepatocellular carcinoma (HCC), also in the case of multifocal lesions., Patients and Methods: We reviewed prospectively collected data on 43 patients with cirrhosis and HCC who underwent selective TACE as a palliative treatment. Patients were assigned to one of two groups: (1) those with one to three HCC lesions, and (2) those with four or more HCC lesions., Results: One hundred and two TACE sessions were applied in 43 patients. There were 39 men and 4 women with a mean age of 65.5 +/- 8.273 years. Alpha fetoprotein levels were elevated to a median value of 73.8 U/mL prior to first TACE (range, 1.5-25615 U/mL). Fourteen patients underwent one session, and 29 patients from two to eight TACE sessions. Bilobar HCC distribution prior to initial TACE was evident in 40% of the patients. Solitary HCC was radiologically diagnosed in 14 patients. Twenty-seven patients were assigned to group 1 and 16 patients to group 2. No significant differences were found between the two groups concerning the number of TACE sessions and the severity of liver cirrhosis. Currently 12 patients are alive after a median follow-up of 25 months (range, 3-84 months). Three- and 5-year survival rates according to patient groups were 45% and 19%, and 42% and 11% for the patients' groups 1 and 2, respectively (P = .87)., Conclusions: HCC patients without a curative therapy option may benefit from palliative TACE, also in the case of multifocal lesions.

Background: The purpose of this study was to show the practicability of a new algorithm in the management of polytraumatized patients based on Advanced Trauma Live Support (ATLS) and using mobile whole body multislice CT (MMDCT) as the primary imaging system., Patients and Methods: A series of 120 trauma patients referred to the Würzburg University Hospital Trauma Emergency Room were categorized into suspected polytrauma and suspected non-polytrauma groups. The polytraumatized patients were investigated using the Würzburg polytrauma-algorithm including whole body multislice CT with a 16-row-scanner. The algorithm is described. The time for the diagnostic procedure was measured and compared with data from the Trauma Registry of the German Society of Trauma Surgery., Results: From 120 patients 78 (66%) underwent whole body CT. The diagnostic procedure was quick with significant advantages especially for cranial and trunk diagnostics., Conclusion: The Würzburg polytrauma algorithm worked well. There was excellent cooperation within the interdisciplinary leading team consisting of anaesthesiologists, surgeons, and radiologists. The principles of ATLS could be respected. Mobile whole body multislice CT was an effective tool in the diagnostic evaluation of polytrauma patients.

Clinical findings and the correct assessment of the morphology and degree of stenosis is a decidant point in the conservative and operative therapy of carotid stenosis. Diagnosis should be reached fast, sure and cost-effective with a high sensitivity and specifity.One hundred and fifty-nine patients with cerebrovascular disease underwent digital subtraction angiography (DSA), color flow Doppler (CFD) and CT angiography (CTA).We detected 213 severe (> 80%) stenoses (ICA: 151, ECA: 45, CCA: 17), and 32 occlusions (ICA: 27, ECA: 3, CCA: 2). The 3 methods showed all occlusions (sensitivity: 100%). D SA failed in 7 stenosis (sensitivity 96.7%), CTA in 3 cases (98.6%), CFD in 19 stenoses (sensitivity: 92.2%).Morphology of plaques were detected by CTA, which was superior to CFD or DSA. Ulcerations were demonstrated more exactly by CFD and DSA; CTA needs the reformation. Most questions can be answered by CFD, special information should be got by CTA and DSA.

Objective: We assessed the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to conventional cholecystectomy., Subjects and Methods: Upper abdominal sonography was performed (according to a checklist) in 75 consecutive patients before laparoscopic cholecystectomy. Sonographic findings were verified by the surgeon in the operating room., Results: Conversion from laparoscopic surgery to laparotomy was performed in five patients (6.7%). Of 75 patients, 19 had sonograms revealing gallbladder wall thickening (>4 mm); surgical preparation difficulties in 16 of these patients led to laparotomy in four patients. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of technical difficulties were 66.7%, 94.1%, 84.2%, and 85.3%, respectively. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of surgical conversion were 80.0%, 78.6%, 21.1%, and 78.7%, respectively. Technical difficulties at laparoscopy occurred in all five patients with pericholecystic fluid on sonography (sensitivity, 20.8%; specificity, 100%; positive predictive value, 100%; accuracy, 74.7%) and led to laparotomy in three patients (sensitivity 60.0%, specificity 97.1%, positive predictive value 60%, accuracy 94.7%). The accuracy of sonography for cholecystolithiasis was 100%., Conclusion: On sonography, gallbladder wall thickening is the most sensitive indicator and pericholecystic fluid is the most specific indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.

Objective: We describe the use of helical CT cholangiography or helical CT after administration of biliary i.v. contrast material to verify and localize bile duct leakage., Conclusion: Helical CT cholangiography revealed bile leaks in seven patients after penetrating trauma or liver or gallbladder surgery and excluded bile leaks in two patients with blunt liver trauma. Endoscopic retrograde cholangiography was performed in only one of seven patients with bile leakage and was avoided in an additional two patients in whom CT cholangiography excluded leakage. The method is a feasible, noninvasive tool for the detection and localization of bile leaks and may help avoid endoscopic retrograde cholangiography.

In portal venous spiral CT there is no visible renal contrast excretion within the usual period of scanning. To opacify collecting systems additional delayed scanning is required. We administered an extra pre-dose of contrast medium before the main portal venous bolus in order to opacify the urinary tract and studied its effects on liver attenuation. In 32 patients examined first by non-contrast spiral CT 20 ml of a non-ionic IV CM were injected. Five minutes later, orientating cuts in the liver and along the urinary tract were obtained. Immediately thereafter, a 120-ml bolus was administered at 3 ml/s for portal venous phase helical CT (60-s delay craniocaudad). The quality of renal excretion was graded visually (excellent, fair, poor, none). Hepatic attenuation measurements were performed at comparable regions of interest. In all patients 20 ml CM opacified the renal pelvis after 5 min. Depiction of the ureters was excellent in 14, fair in 11 and poor or none in 7 cases. There was little effect on mean hepatic attenuation by the 20-ml pre-bolus after 5 min: mean enhancement 2.3 HU (range -0.6 to 7.8 HU). Mean hepatic enhancement after the 120-ml portal venous bolus ranged between 23.6 and 74.1 HU (mean 51.5 HU). When opacification of the urinary tract is necessary, pre-administration of a 20-ml bolus 5 min before portal venous scanning may save an extra delayed spiral. The effects on hepatic enhancement are negligible.

Optimal liver enhancement during portal venous-phase helical CT is crucial in the detection of parenchymal liver lesions. In the prospective study reported here we investigated the effects of a real-time bolus-tracking system on mean and maximal liver enhancement. In 79 patients referred to us for abdominal CT we injected 120 ml of non-ionic contrast (300 mg I/ml) at a rate of 3 ml/s. After a nonintravenous contrast upper abdominal scan a portal venous phase was performed. In 39 patients (mean weight 72.6 +/- 18.7 kg, range 48-139 kg) real-time bolus tracking was performed using the CARE Bolus software (Siemens, Erlangen, Germany). The software performs repetitive low-dose test scans in a preselected region of interest and measures the Hounsfield attenuation and liver enhancement in real-time. After a critical threshold (we selected 31 HU) is surpassed, the software starts diagnostic spiral scanning. Our control consisted of 40 patients weighing 51-100 kg (mean 73.2 +/- 11.1 kg) who were scanned with a fixed, preselected start delay of 80 s. Mean hepatic enhancement was 54.0 +/- 9.9 HU (range 33.3-74 HU) in 37 automatically triggered patients, mean peak hepatic enhancement 64.6 +/- 12.6 HU (range 42.0-91.8 HU). In 2 patients of the study group scanning had to be started manually. In the control group with fixed delay mean enhancement was 48.3 +/- 9.2 HU (range 33.8-71.6 HU) and peak enhancement 55.5 +/- 9.7 HU (range 39.7-81.0 HU). Differences were significant (p < 0.05, Student's t-test). Real-time bolus tracking significantly increased mean hepatic enhancement and may improve portal venous hepatic CT scanning.

Cytologic-nucleolar grading of carcinomas includes mitotic frequency, mean nuclear size, nuclear variability, degree of chromasia and nucleolar frequency, and the occurrence of singular or multiple, small or large nucleoli in the central or peripheral location. A total of 186 renal cell carcinomas were analyzed cytologically in this respect. The results were correlated to the histologic pattern, tumor stage, and grading. Renal cell carcinomas of low malignancy and stage possess a low nucleolar frequency and small solitary nucleoli in the central location. Highly malignant carcinomas (T3 or T4) are characterized by high nucleolar frequency and multiple prominent nucleoli in the eccentric position. There is no correlation to the histologic pattern. Therefore, the nucleolar status is helpful in grading and determination of prognosis of renal cell carcinomas.

Cytological-nucleolar grading of carcinomas includes mitotic frequency, mean nuclear size, nuclear varibility, degree of chromasia and nucleolar frequency, the occurrence of singular or multiple, small or large nucleoli in central or peripheral location. 186 renal cell carcinomas were analysed cytologically in this respect. The results were correlated to the histological pattern, tumor stage, and grading. Renal cell carcinomas of low malignancy possess a low nucleolar frequency and small solitary nucleoli in central location. Highly malignant carcinomas are characterised by high nucleolar frequency and multiple prominent nucleoli in eccentrical position. There is no correlation between nucleolar grading and histological pattern as well as tumor stage. Therefore, the nucleolar status is helpful in grading and determination of prognosis of renal cell carcinomas.