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It is the considered opinion of the authors that meniscus sonography can largely replace arthrography. This opinion is based on their detailed examinations and studies. Sonographic visualisation of all lesions produced by a scalpel was demonstrated using knees of corpses. Even cracks having the fineness of a human hair were visualised by sonography. A comparison between sonographic and surgical findings in meniscus lesion yielded in 82 patients an agreement of 95.1%. In 47 patients it was possible to prove that sonography was more accurate than arthrography as far as diagnosis was concerned. A comparison of 94 sonographically and arthrographically established findings yielded agreement in 89% of the cases. Sonography is suitable for meniscus imaging especially on account of the good imaging reproducibility of meniscus morphology; through safe detection of a pathological process in the meniscus; through the safe presentation of lesions; through the accurate imaging of all parts of the meniscus; and, furthermore, through the invaluable advantage of noninvasiveness, freedom from pain and hazards; and, last but not least, rapid manipulation and unlimited repeatability.

Objectives: To assess whether it is possible to measure tooth vitality using magnetic resonance imaging (MRI). Methods: Signal intensity measurements were conducted using T1 and T2 sequences at the region of interest in 211 teeth (35 patients). Results: Clinical findings showed that 17.3% of the teeth were avital, whereas 82.7% were found to be vital. Neither the T2 sequence nor the non-contrast-enhanced T1 sequence showed significant differences between vital and avital teeth. However, the contrast-enhanced sequence and, in particular, a comparison of signal intensities between the non-contrast-enhanced T1 sequence and the contrast-enhanced sequence showed a significant difference between vital and avital teeth. Conclusion: Contrast-enhanced MRI enables us to draw conclusions on pulpal perfusion in vivo.

Ziel der Studie war es, aus der Signalintensitatssteigerung des N. petrosus major unter Kontrastmittelgabe Ruckschlusse auf die Atiologie einer idiopathischen peripheren Fazialisparese zu ziehen. 18 Patienten die wegen einer akuten peripheren Fazialisparese stationar aufgenommen worden waren, wurden im Rahmen einer prospektiven Studie magnetresonanztomographisch untersucht (ACS Intera, Fa. Philips). Der petrose Verlauf des N. facialis wurde in Dunnschichttechnik unter Verwendung einer Oberflachenspule dargestellt. Nach multiplanarer Rekonstruktion (MPR) wurden an einer Workstation „region of interests“ (ROI) in den proximalen Verlauf des N. petrosus major eingezeichnet und quantitativ ausgewertet. Bei allen 18 Patienten war der N. petrosus major nach MPR erkennbar, sein Durchmesser betrug im Mittel 0,68 mm (0,5–0,9). Nach Kontrastmittelgabe wurde als mittlere Signalsteigerung 50,3% gemessen (−10 bis 146%); 2 Patienten wiesen nach Kontrastmittelgabe eine geringe Intensitatsverminderung und 16 Patienten eine Intensitatssteigerung auf. Es konnte keine Korrelation der Signalintensitatssteigerung mit der Anamnese, dem klinischen Verlauf, den laborchemischen Daten oder den elektrophysiologischen Ergebnissen gefunden werden. Die MRT-Darstellung des proximalen Verlaufs des N. petrosus major gelingt sicher. Im Gegensatz zur quantitativen Analyse im N. facialis stehen die Ergebnisse der ROI-Messung im N. petrosus major in keinem Zusammenhang mit der Anamnese oder mit den klinischen bzw. laborchemischen Daten. Somit kann aus den Ergebnissen der quantitativen MRT-Analyse des Nerven nicht auf die Atiologie geschlossen werden.

PURPOSE To evaluate the role of contrast enhanced MRI in quantifying signal changes of the inferior alveolar nerve following inflammatory changes of the mandible. MATERIAL AND METHODS 30 patients with inflammatory changes of the mandible underwent MRI of the face. Both sides of the mandible, the affected as well as the unaffected healthy side were evaluated retrospectively. Regions of interest were placed at 5 defined places on both sides to assess signal intensity before and after intravenous application of paramagnetic contrast agent. The results of the measurements were compared between the healthy and the affected side (t-test, p < 0.05) and correlated with clinical findings (t-test, p < 0.05). RESULTS All patients with hypesthesia of the inferior alveolar nerve in areas of the lips or chin (n = 4) showed a marked increase in signal intensity from 35 % to 83 % distal to the inflammatory process. Patients without sensitivity disorders showed less increase in signal intensity with a maximum of 51 % distal to the inflammatory process. In nearly all patients no contrast enhancement was observed distal to the first molar on the unaffected side. CONCLUSIONS Quantitative analysis of contrast enhanced MRI of the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible, the neurovascular bundle shows a significant increase in signal intensity distal to the lesion compared to the unaffected healthy side of the mandible.

Purpose: To compare in a single-blind study the reliability of quantitative measurements and subjective evaluations of contrast enhancement of the facial nerve in patients with idiopathic facial paralysis. Materials and Methods: Magnetic resonance images with a 0.7mm slice thickness (surface coil) were obtained in patients with idiopathic facial paralysis before and after administration of Gd-DTPA, 0.1 mmol/kg. The five intratemporal segments of the facial nerve were quantitatively measured and subjectively assessed by five radiologists as to the degree of enhancement. The results were compared as to the reliability of both methods. Results: Using the quantitative measuring method, 175 measurements were calculated from a total of 350 regions of interest. At all 35 measured sites, the five quantitative measurements produced identical results. In contrast, the subjective assessment of the five radiologists arrived at a majority consensus in only 16 sites. A complete agreement was not reached for any measured site. Conclusion: The measured quantitative increase in signal intensity after administration of contrast medium is more reliable than subjective assessment. The quantitative method enables reproducible signal intensity measurements even for different window settings and can be easily and swiftly performed at the workstation.

Objective The aim of the study was to assess whether MRI has a prognostic value at an early stage of Bell's palsy. Material and methods Prospective, blinded study on 30 patients suffering from Bell's palsy, who came to hospital until the sixth day of illness, to receive high doses steroid therapy. MRI was done on the first day of inpatient treatment as a gradient-echo-sequence with a slice thickness of 0.7 mm before and after i. v. administration of 0.1 mmol GdDTPA/kg weight. The signal intensity increase was evaluated quantitatively by region on interest (ROI). The results were compared to the clinical outcome and the results of electrophysiology. Results The examinations of all patients could be evaluated. The 3 patients who developed a chronic facial paralysis were detected by MRI on the first day of inpatient treatment. The patients, who showed MR signs for an unfavorable course, had a highly significant pathologic compound muscle action potential (CMAP) as a result of the electrophysiologic measurement. Rather than using complex measurement procedures it is possible to obtain reliable prognostic information from just one measurement within the Internal auditory canal before and after i. v. administration of contrast. Conclusion MRI has a prognostic value at an early stage of the illness. In the clinical setting this measurement is easy to perform, so that it is possible to obtain prognostic information at a stage when causal treatment is still possible.

PURPOSE: To determine the value of supine chest radiography in comparison to orientating chest CT in the initial diagnostic evaluation of severely polytraumatised patients. MATERIAL AND METHODS: 303 patients with primary indication for a cranial CT following trauma were investigated between 1988 and 1993. After performing the cranial CT all patients underwent a chest CT with an average of 6 CT slices without changing the position of the patient and with a median scan time of 4 minutes. The results of the chest CT were correlated with the findings of the supine chest radiography in regard to therapeutically relevant pathological changes. RESULTS: The sensitivity in detection of pneumothorax in supine chest radiography was 53% versus 97% in CT, atelectasis 20% versus 94%, lung contusion 79% versus 99%, haemotothorax 62% versus 97%. More fractures were found conventionally (sensitivity 94%) than by chest CT (sensitivity 44%). CONCLUSION: Supine chest radiography of polytraumatised patients is clearly inferior to orientating chest CT in demonstrating posttraumatic lesions; obtaining therapeutically relevant information justifies the additionally needed small amount of time.

PURPOSE To find reliable data of the incidence of different variations of the spine. MATERIAL AND METHODS Standardised radiographic examinations of 10,922 young, healthy pilot aspirants of the German air force were made. Radiographic examination included the whole spine in a.p. and lateral projection, the cervical spine in oblique projection and in a subunit of 5781 men the lumbar spine in oblique projection. RESULTS The following incidences were found: mild habit scoliosis: 80.4%, structural scoliosis: 9%, severe thoracal kyphosis without severe lumbar lordosis: 5.1% and together with severe lumbar lordosis: 30.8%, mild forms of kyphosis of adolescence: 23.3%, severe forms: 2.1% and cuneiform deformation of vertebral body: 4.9%, sacralization: 7.8%, lumbarization: 5.9%, spondylolysis: 6.2%, spondylolisthesis: 4.3% and lumbar chondrosis: 2.1%. Chondrosis of the thoracal and cervical spine, osteochondrosis and coalescent vertebral bodies were found in less than 0.8% each. CONCLUSION In only 2.6% were there no pathological findings. This shows importance of radiological spine examinations especially for industrial and preventive medicine.

Purpose: Cystic processes are changing the course of the inferior alveolar nerve in the mandible. This study evaluates the possibility of demonstrating the relationship between space-occupying processes and the course of the neurovascular bundle. Materials and Methods: Thirteen patients with cystic processes in the mandible (9 keratocystic lesions, 1 eosinophilic granuloma, 1 plasmocytoma, 2 adamantinomas) were examined by MRI (1.5-T magnet, 8-cm surface coil, PD-gradient-echo-sequences in sagittal and coronal orientation, without enhancement) and the results retrospectively evaluated. Results: The entire course of the nerve could be delineated in all patients. In six patients with minor cystic processes, the nerve was identified in both sagittal and coronal orientation. In seven patients with major cystic lesions, only parts of the nerve were detected in either image orientation, but the nerve could be visualized in its entire length by evaluating coronal and sagittal images side by side. Conclusion: It is possible to delineate the inferior alveolar nerve in its entirety along pathologic mandibular lesions. For large cystic lesions, this requires the evaluation of both coronal and sagittal sections of multidirectional MRI.

The objective of this study was to evaluate signal intensity increases in the greater petrosal nerve after contrast agent administration to gather information on the etiology of idiopathic peripheral facial paralysis. Magnetic resonance images were obtained from 18 patients who received inpatient medical treatment for acute peripheral facial nerve palsy. Images of intratemporal segments of the facial nerve were taken with a slice thickness of 0.75 mm. After multiplanar reconstruction, regions of interest (ROI) were defined in the proximal segment of the greater petrosal nerve. After multiplanar reconstruction, it was possible to visualize the greater petrosal nerves of all 18 patients. The nerve's average diameter was found to be 0.68 mm (range 0.5-0.9). Signal intensity increased by an average of 50.3% (range -10-146%) after contrast agent administration. Whereas this intensity was slightly reduced in two patients, it was increased in 16. No correlation could be established between greater signal intensity and medical history, clinical condition, laboratory findings, or electrophysiological data. In contrast to quantitative measurements in the facial nerve, ROI measurements in the greater petrosal nerve do not correlate with medical history, clinical condition, or laboratory findings. For this reason, MRI of this nerve does not enable us to draw conclusions on the etiology of idiopathic peripheral facial paralysis.

To evaluate the role of contrast enhanced MRI in quantifying signal changes of the inferior alveolar nerve following inflammatory changes of the mandible.30 patients with inflammatory changes of the mandible underwent MRI of the face. Both sides of the mandible, the affected as well as the unaffected healthy side were evaluated retrospectively. Regions of interest were placed at 5 defined places on both sides to assess signal intensity before and after intravenous application of paramagnetic contrast agent. The results of the measurements were compared between the healthy and the affected side (t-test, p0.05) and correlated with clinical findings (t-test, p0.05).All patients with hypesthesia of the inferior alveolar nerve in areas of the lips or chin (n = 4) showed a marked increase in signal intensity from 35 % to 83 % distal to the inflammatory process. Patients without sensitivity disorders showed less increase in signal intensity with a maximum of 51 % distal to the inflammatory process. In nearly all patients no contrast enhancement was observed distal to the first molar on the unaffected side.Quantitative analysis of contrast enhanced MRI of the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible, the neurovascular bundle shows a significant increase in signal intensity distal to the lesion compared to the unaffected healthy side of the mandible.

The objective of this study was to assess whether signal changes can be detected in the neurovascular bundle of the mandibular canal after the extraction of a third molar. We retrospectively analyzed MRI scans of 30 test subjects with healthy mandibles and 41 patients who had had a wisdom tooth extracted. Signal intensities were measured at particular sites in the neurovascular bundle, which were defined as regions of interest (ROI) in the sagittal T1-weighted images before and after intravenous administration of a paramagnetic contrast agent. On the basis of the signal intensity increases that were measured after contrast agent administration, we compared the signal increases obtained for the patients who had received surgical treatment with the results obtained for the population of test subjects with unremarkable mandibles ( t-test, P0.05). Compared with the healthy test subjects, patients who had received surgical treatment showed significantly higher signal intensity increases at two measurement sites, i.e., the second molar and the second premolar ( P0.05). We found no significant differences when the measurements were performed at the first molar ( P=0.06), the third molar ( P=0.47) and in the area of the ascending mandibular ramus ( P=0.79). Compared with a population of healthy test subjects, patients who had their third molars surgically removed show higher signal intensity increases in the neurovascular bundle after intravenous contrast agent administration. The underlying cause may be the higher blood flow in the arteries and veins and the perineural plexus, which may give evidence of the pathophysiological mechanism of nerve damage in the narrow canal as a result of osteotomy.

Cystic processes are changing the course of the inferior alveolar nerve in the mandible. This study evaluates the possibility of demonstrating the relationship between space-occupying processes and the course of the neurovascular bundle.Thirteen patients with cystic processes in the mandible (9 keratocystic lesions, 1 eosinophilic granuloma, 1 plasmocytoma, 2 adamantinomas) were examined by MRI (1.5-T magnet, 8-cm surface coil, PD-gradient-echo-sequences in sagittal and coronal orientation, without enhancement) and the results retrospectively evaluated.The entire course of the nerve could be delineated in all patients. In six patients with minor cystic processes, the nerve was identified in both sagittal and coronal orientation. In seven patients with major cystic lesions, only parts of the nerve were detected in either image orientation, but the nerve could be visualized in its entire length by evaluating coronal and sagittal images side by side.It is possible to delineate the inferior alveolar nerve in its entirety along pathologic mandibular lesions. For large cystic lesions, this requires the evaluation of both coronal and sagittal sections of multidirectional MRI.

To compare in a single-blind study the reliability of quantitative measurements and subjective evaluations of contrast enhancement of the facial nerve in patients with idiopathic facial paralysis.Magnetic resonance images with a 0.7 mm slice thickness (surface coil) were obtained in patients with idiopathic facial paralysis before and after administration of Gd-DTPA, 0.1 mmol/kg. The five intratemporal segments of the facial nerve were quantitatively measured and subjectively assessed by five radiologists as to the degree of enhancement. The results were compared as to the reliability of both methods.Using the quantitative measuring method, 175 measurements were calculated from a total of 350 regions of interest. At all 35 measured sites, the five quantitative measurements produced identical results. In contrast, the subjective assessment of the five radiologists arrived at a majority consensus in only 16 sites. A complete agreement was not reached for any measured site.The measured quantitative increase in signal intensity after administration of contrast medium is more reliable than subjective assessment. The quantitative method enables reproducible signal intensity measurements even for different window settings and can be easily and swiftly performed at the workstation.

Durch den Einsatz von biodegradierbaren Implantaten (BDI) in der Frakturbehandlung entfallt die Metallentfernung. Dadurch lassen sich eine erhebliche Kosteneinsparung, eine bedeutende Erhohung des Patientenkomforts sowie eine physiologischere Knochenheilung erzielen. In bisherigen Studien wurden Fremdkorperreaktionen der umgebenden Weichteile beobachtet. Auserdem liegen keine zuverlassigen Informationen zur humanen in-vivo-Degrada-tion dieser Implantate vor. Daher war die Zielsetzung dieser prospektiven Studie, die klinischen und radiologischen Ergebnisse nach osteosynthetischer Versorgung von distalen Fibulafrakturen mit biodegradierbaren Schrauben sowie die Haufigkeit von Fremdkorperreaktionen zu analysieren. Auserdem sollte der Stellenwert der Magnetresonanztomographie (MRT) zur Darstellung der BDI, deren Degradation und damit assoziierter Komplikationen untersucht werden.

Der Einsatz biodegradierbarer Implantaten (BDI) in der Frakturbehandlung erspart die Metallentfernung, wodurch eine erhebliche Kosteneinsparung und eine bedeutende Erhohung des Patientenkomforts bei physiologischerer Knochenheilung erzielbar sind. Bisher liegen keine zuverlassigen Informationen zur humanen in-vivo-Degradation dieser Implantate vor. Daher war die Zielsetzung dieser prospektiven Studie, die klinischen und radiologischen Ergebnisse nach osteosynthetischer Versorgung von Radiuskopfchenfrakturen mit biodegradierbaren Stiften sowie die Haufigkeit von Fremdkorperreaktionen zu analysieren. Zudem wurde die Magnetresonanztomographie (MRT) hinsichtlich ihrer Aussagefahigkeit zur Darstellung der BDI, deren Degradation und damit assoziierter Komplikationen evaluiert.

The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthroscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A (n=86) received a standard Military Hospital Ulm (MH) MRI--sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30 degrees, 512 matrix). In addition, one sub-Group, AK (n=21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n=88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm--sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20 degrees, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%-99%) and the high negative prediction value (97%-98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.

The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions.195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination.156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %.MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.

Magnetic resonance imaging is not established in the preoperative diagnosis of mandibular cystic lesions; therefore, no attempts have been made thus far to evaluate the course of the mandibular neurovascular bundle along the process. However, the radiologist can detect the neurovascular bundle along the cystic lesion by high-resolution MR imaging and convey this information to the maxillofacial surgeon. This reduces the risk of intraoperative damage of the nerve. The examination of the neurovascular bundle can easily be integrated in a tumor MRI protocol of the jaw if the slice orientation is adapted to the course of the mandibular canal.

The aim of the study was to assess whether MRI has a prognostic value at an early stage of Bell's palsy.Prospective, blinded study on 30 patients suffering from Bell's palsy, who came to hospital until the sixth day of illness, to receive high doses steroid therapy. MRI was done on the first day of inpatient treatment as a gradient-echo-sequence with a slice thickness of 0.7 mm before and after i. v. administration of 0.1 mmol GdDTPA/kg weight. The signal intensity increase was evaluated quantitatively by region on interest (ROI). The results were compared to the clinical outcome and the results of electrophysiology.The examinations of all patients could be evaluated. The 3 patients who developed a chronic facial paralysis were detected by MRI on the first day of inpatient treatment. The patients, who showed MR signs for an unfavorable course, had a highly significant pathologic compound muscle action potential (CMAP) as a result of the electrophysiologic measurement. Rather than using complex measurement procedures it is possible to obtain reliable prognostic information from just one measurement within the Internal auditory canal before and after i. v. administration of contrast.MRI has a prognostic value at an early stage of the illness. In the clinical setting this measurement is easy to perform, so that it is possible to obtain prognostic information at a stage when causal treatment is still possible.

Ziel der prospektiven Studie war die Rolle der MRT zur Darstellung von BDI im Bereich der Extremitaten und deren Abbau zu untersuchen. Dazu wurden SR-polyglycolic acid (SR-PGA)-Schrauben zur Versorgung von 8 Sprunggelenks- und 1 Humerusfraktur bei 9 Patienten sowie Poly-DL-lactid-Stifte (PDLLA) bei 9 Patienten mit Radiuskopfchenfrakturen verwendet und mittels MRT (1,5 Tesla) nachuntersucht. In allen Fallen liesen sich Lage und Grose der BDI mittels MRT nachweisen. Wahrend SR-PGA-Schrauben zunehmende Heterogenitat aufwiesen, erschienen PDLLA-Stifte bis zu 18 Monaten postop. Unverandert. Die MRT erwies sich als geeignetes Verfahren zur nichtinvasiven Darstellung von Grose und Lokalisation von DBI, wobei erstmals Zeichen der Degradation von SR-PGA-Schrauben mittels MRT nachgewiesen werden konnten.

Between 1984 and 1994, 27 men and 4 women with primary spontaneous pneumothorax were treated surgically by excision of the bullae, without pleurectomy. The purpose of the present study was to establish by computed tomography (CT) of the lung whether the excision permanently eliminated the cause of pneumothorax. The median follow-up was 72 (21-127) months. There were two patients with recurrences (6.4%) who were operated on again. Sixteen of 31 patients had new blebs in the apex of the lung as documented by postoperative CT. The study indicates that simple excision of the bullous area cannot prevent the recurrence of blebs.

To determine the value of supine chest radiography in comparison to orientating chest CT in the initial diagnostic evaluation of severely polytraumatised patients.303 patients with primary indication for a cranial CT following trauma were investigated between 1988 and 1993. After performing the cranial CT all patients underwent a chest CT with an average of 6 CT slices without changing the position of the patient and with a median scan time of 4 minutes. The results of the chest CT were correlated with the findings of the supine chest radiography in regard to therapeutically relevant pathological changes.The sensitivity in detection of pneumothorax in supine chest radiography was 53% versus 97% in CT, atelectasis 20% versus 94%, lung contusion 79% versus 99%, haemotothorax 62% versus 97%. More fractures were found conventionally (sensitivity 94%) than by chest CT (sensitivity 44%).Supine chest radiography of polytraumatised patients is clearly inferior to orientating chest CT in demonstrating posttraumatic lesions; obtaining therapeutically relevant information justifies the additionally needed small amount of time.

Durch die zunehmende sportliche Freizeitgestaltung erlangt das funktionelle Kompartmentsyndrom mit pathologischer Druckerhohung durch Muskelarbeit eine wachsende klinische Relevanz. Zusatzliche pathophysiologische Initialfaktoren wie arterielle und/oder venose Obstruktion der Vasa tibialis abhangig vom Mundungsverhalten werden vermutet (Pieper, 1995), sind klinisch aber nicht untersucht. Ziel der Studie war es deshalb zu untersuchen, ob es im Verlauf der A. tibialis anterior und ihrer Begleitvenen klinisch/radiologisch uberprufbare anatomische Varianten gibt, die durch Behinderung des arteriellen Einstroms und/oder des venosen Ruckstroms die intrakompartmentale Druckerhohung beeinflussen konnen.

To find reliable data of the incidence of different variations of the spine.Standardised radiographic examinations of 10,922 young, healthy pilot aspirants of the German air force were made. Radiographic examination included the whole spine in a.p. and lateral projection, the cervical spine in oblique projection and in a subunit of 5781 men the lumbar spine in oblique projection.The following incidences were found: mild habit scoliosis: 80.4%, structural scoliosis: 9%, severe thoracal kyphosis without severe lumbar lordosis: 5.1% and together with severe lumbar lordosis: 30.8%, mild forms of kyphosis of adolescence: 23.3%, severe forms: 2.1% and cuneiform deformation of vertebral body: 4.9%, sacralization: 7.8%, lumbarization: 5.9%, spondylolysis: 6.2%, spondylolisthesis: 4.3% and lumbar chondrosis: 2.1%. Chondrosis of the thoracal and cervical spine, osteochondrosis and coalescent vertebral bodies were found in less than 0.8% each.In only 2.6% were there no pathological findings. This shows importance of radiological spine examinations especially for industrial and preventive medicine.

Fistulas between the iliac artery and the ureter are uncommon. Overall, fewer than 20 cases have been described in the literature. We report the first bilateral case, in which there was an association with indwelling bilateral ureteral stents and a history of radiation therapy following hysterectomy performed because of malignancy. The patient presented with massive gross haematuria.

From July 1988 until December 1990 1141 patients with left-sided idiopathic varicocele underwent phlebography of the spermatic internal vein, and percutaneous sclerotherapy with sodium morruate (Varicocid) was intended to be performed. In 125 of these patients sclerotherapy was not feasible. The reasons for this were analysed in a retrospective study. According to the anatomical situation of the spermatic vein, there were significant differences in technical success. In case of incompetent valve of the spermatic vein at the renal origin (type I, 2A, 3, 4A), selective probing and following sclerotherapy was possible in 97%. Anatomic variations with competent valve of the spermatic vein (type 0, 2B, 4B) led to difficulties in selectively probing the vessel, and sclerotherapy was feasible in only 72.7%. In these angiographically difficult cases, spasm of the spermatic vein and/or perforation prevented sclerotherapy in 29 of 125 patients.

From May 1985 to July 1989, 143 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum auto-injection therapy (CCAT) with papaverine alone (1257 injections) or with a standardized papaverine-phentolamine mixture (11035 injections). On the basis of these 12,292 protocol auto-injections and over 4 years' experience with intracavernosal auto-injection therapy we conclude: CCAT, especially with the papaverine-phentolamine mixture, constitutes an effective therapy (full rigidity in 95.9%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multidisciplinary evaluation, especially in the case of arterial and/or neurogenic aetiology of the erectile dysfunction; in addition, the contraindications must be strictly observed, the treatment and technique fully explained, and a regular system instituted. CCAT is generally well accepted by the patients and their partners (100%/98.3%) and has distinct positive effects on self-esteem (77.8%), performance anxiety (84.4%) and partnership (79.5%). The most serious side-effect was prolonged erection (25 out of 12,292 injections). In 3 patients reversible fibrotic changes near the tunica albuginea were observed.

In 33 patients with erectile dysfunction arterial inflow was measured by Doppler-sonography over the superficial dorsal and deep cavernous arteries in the proximal section after local application of 1.6 mg glycerol trinitrate (nitroglycerin) to the glans penis. With this test we were able to reveal a minimal increases in maximal systolic flow over both arteries at 29/66 measurement sites. This is thus an easier way of localizing penile vessels in the flaccid state. In no case did we see tumescence or rigidity.

A total of 326 patients with chronic erectile dysfunction were investigated by a multidisciplinary approach. It was found that several causes combined (multifactorial genesis) in 77.1%. Organic causes alone were found quite frequently, viz. in 43.6%, while primarily psychogenic causes alone were found in only 5.5%; in contrast, combined organic and psychogenic causes were found in 46.0%. There were pathologic organic findings in 89.6%: vascular in 74.5% (arterial 64.1%, cavernous/venous 30.4%), neurogenic in 42.0%; side effects of drugs in (10.1%); endocrine (7.7%) and local penile causes (4.3%) are not so important in erectile dysfunction. Treatment suited to the pathogenesis was instituted (psychotherapy, vein ligation, self-injection of vasoactive drugs into the corpus cavernosum).

In 26 of 214 patients with erectile dysfunction and proved venous incompetence by cavernosography, an additional bidirectional Doppler ultrasound was performed also to demonstrate venous outflow disturbances. All except one leakage in the superficial and deep dorsal veins could be demonstrated as well as 4 of 6 cavernosum-glandular shunts. Bidirectional Doppler ultrasound visualized a continuous retrograde blood flow from the sulcus coronarius to the root of the penis in superficial and deep dorsal penile veins as well as in ectopic penile veins, an orthograde blood flow in the sulcus coronarius in cavernosum-glandular shunt.

The results of 230 retrograde phlebographies of the V. spermatica int., 165 percutaneous sclerotherapies and 60 follow-up phlebographies on subfertile patients are presented. In 24 patients (10%) complications occurred, yet in none of the cases clinical damage became evident. Percutaneous sclerotherapie is contraindicated, when selective probing of the V. spermatica int. is impossible or massive collaterals to other venous systems could lead to an uncontrolled spread of the sclerosing agent. Treatment of idiopathic varicocele in subfertile men by percutaneous sclerotherapy is a safe and effective method, which can be performed on an outpatient basis. In our opinion the so far used surgical treatment can be replaced by it as a method of choice.

Among 1217 percutaneous retrograde phlebographies of the left renal/testicular vein 1069 were performed for primary treatment of left-sided idiopathic varicocele. In 989 of these patients (92.5%) an insufficient testicular (internal spermatic) vein with reflux to the pampiniform plexus could be shown phlebographically, in 802 cases percutaneous sclerotherapy could be performed. This amounts 75.0% of patients with varicocele or 81.1% of the cases with a phlebographically proven testicular vein insufficiency. In this group percutaneous sclerotherapy has proven to be a safe and effective treatment of idiopathic varicocele on an outpatient basis and has replaced surgical ligation as method of choice. However, with anatomical and technical obstacles to sclerotherapy, especially in patients with varicocele but without phlebographic evidence of an insufficient testicular vein, surgery remains an essential means of therapy.

Among 4019 computed tomograms of the head performed in 2 years we found 2 epidural empyemas combined with an ipsilateral orbital phlegmon and one periorbital abscess with an incipient orbital phlegmon. In all 3 patients they turned out to be intracranial or orbital complications of an adjacent paranasal sinusitis. The CT diagnosis was a guideline for further therapy and was verified by immediate surgery. The reliable diagnosis of orbital and intracranial space-occupying lesions makes CT the radiological method of choice in case of suspicion of a complicated sinusitis.

The complex interactions of psychological, neurological, hormonal and vascular aspects of erectile dysfunctions require a standardised multidisciplinary diagnostic evaluation. The recent establishment of new noninvasive and invasive investigative procedures has led to a fundamental change in the assessment of erectile dysfunctions. Selective angiography of the internal pudendal artery and its branches represents the crucial diagnostic step before treatment can start. Indication, technique and results of 26 bilaterally performed pudendal angiographies on impotent patients are described.

The lymphatic spread in 123 patients with biopsy-proven malignant head and neck tumors was evaluated by CT in a prospective study. In 53 cases, clinical examination, CT and pathological-histological work-up of the surgical specimens were comparatively analysed. The fraction of false-negative judged lymph nodes by palpation was 21%. This high error in judgement could be diminished to 7.5% by the use of CT. 83% of squamous cell metastases showed a central decrease in density due to necrosis after intravenous infusion of contrast material.

The recent establishment of new diagnostic procedures (Doppler ultrasound, plethysmography, selective hypogastric arteriography) permitted clarification of the etiology of impotence. Based on the fact that in 30–40% of all impotent men a vasculogenic erectile dysfunction is evident, revascularization procedures could be employed. A critical survey of the diagnostic means and therapy of vasculogenic impotence is given, indicating that penile revascularization offers a valuable alternative to penile implants.

Forty-four patients with a left-sided idiopathic varicocele were examined with bidirectional Doppler ultrasound (US), physical examination, and percutaneous retrograde venography. On the basis of the Doppler findings, the varicoceles were classified as either stop type or shunt type. On venography, the stop-type varicoceles showed only retrograde blood flow (reflux) in the testicular (internal spermatic) vein, whereas each shunt-type varicocele showed both retrograde and orthograde (i.e., physiologic) venous blood flow: First, reflux appeared in the testicular vein, then orthograde flow occurred in the deferential vein, cremasteric vein, or both. The shunt-type varicocele therefore represented a kind of venous bypass. Thus, the existence of two hemodynamically different types of varicocele as suggested initially by Doppler US is confirmed by percutaneous retrograde venography. The shunting of venous blood appears to be a precondition for medium and large varicoceles and might have some prognostic significance for subfertility associated with varicoceles.