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Modern sonography has led to an increased appraisal of the therapeutic consequences in cases of polypoid lesions of the gallbladder wall. In 30 patients it was attempted to differentiate between cholesterol polyps and polypoid lesions suspect for malignancy. Histologic results and data in the literature induce us to recommend cholecystectomy in solitary lesions of more than 5 mm, combined occurrence with gallstones and in patients beyond the 60th year of life.

Piezoelectric lithotripsy was undertaken on 50 patients with gallbladder stones, none of them requiring anaesthesia, analgetics or sedatives. Stone fragmentation was achieved in all patients during the first treatment. In 44 patients the maximum fragment size was less than 50% of the initial stone diameter. The mean maximum fragment size after the first treatment was 4.3 mm (+/- 3.3 mm). After a follow-up of 0-2 months in 14 of the 50 patients and of 2-4 months in 6 of 13 patients, no more stones could be seen by ultrasonography. After an average period of 8 weeks, 17 of 50 patients were free of stones. Piezoelectric lithotripsy did not have any severe side effects besides a mild pancreatitis in one patient.

In order to determine whether cholecystography and computed tomography (CT) are capable of better gallstone characterization than conventional radiography alone, 91 patients (76 females, 15 males; mean age 47 +/- 12 years) with symptomatic single gallstones were studied prospectively prior to extracorporeal shock-wave lithotripsy with concomitant oral stone dissolution therapy. In addition, the value of oral cholecystography in demonstrating patency of the cystic duct was compared with ultrasound assessment of gallbladder function. Despite "negative" plain gallbladder radiographs in all patients, oral cholecystography showed significant stone calcification in 8 of the 91 patients and CT showed stone calcifications in 52 of the 91 patients. In 12 patients the maximum stone density was between 50 and 90 Hounsfield units, and in 40 patients it was more than 90 Hounsfield units. CT revealed ring-like calcification in the majority (79%) of these stones. Oral cholecystography showed satisfactory concentration of contrast medium in all patients, while ultrasonography of the gallbladder following a chemically defined test meal demonstrated contractility of more than 50% of initial volume in 69 patients and of less than 30% in 9 patients. Although oral cholecystography is a simple, readily available complication-free method, ultrasound assessment of gallbladder contraction is better for selecting patients for extracorporeal shock-wave lithotripsy. CT allows significantly better characterization of gallstones than oral cholecystography and conventional plain gallbladder radiography.

In 45 patients we assessed the functional results and complications for three different reconstructive procedures after resection of primary tumors of the proximal humerus. An osteoarticular allograft was used in 11, a clavicula pro humero operation in 15 and a tumour prosthesis in 19. The glenoid was resected with the proximal humerus in 25 patients. The axillary nerve was resected in 42 patients. The complication rate was lowest after reconstruction with a tumour prosthesis. The clavicula pro humero operation resulted in the most revisions. Cumulative survival rates for all the reconstructive procedures were similar. At follow-up at two years the functional results for the three reconstructive procedures were the same with a mean functional rating of 79% (Musculoskeletal Tumor Society). Excision of the glenoid had no influence on the functional result. Our findings indicate that the use of a tumour prosthesis is the most reliable limb-salvage procedure for the proximal humerus. The clavicula pro humero is an appropriate procedure if a prosthesis cannot be used.

Local therapy of pelvic Ewing's sarcoma remains a challenge because of the complex anatomy and large tumor volumes. Wide resections often end up contaminated with marginal margins in one part of the specimen. Pelvic tumor surgery causes considerable disability, because of the loss of hip function. This may cause a low quality of life for tumor survivors. The aim of the study was to evaluate the oncologic results of combined surgery and radiotherapy of pelvic Ewing's sarcoma. Functional and psychosocial outcome of the tumor survivors was assessed.Thirty-six pelvic Ewing's sarcoma patients were treated surgically for local tumor control between 1986 and 1996. Chemotherapy was administered according to current European Intergroup/Cooperative Ewing's Sarcoma Study (EI/CESS) protocols. Radiotherapy was also performed on all patients. All patients were intended to get wide tumor excision and a limb salvage procedure. Complications necessitating operative revision were analyzed and functional results were scored according to the criteria of the Musculoskeletal Tumor Society (MSTS). Quality of life and psychosocial functioning was assessed by the QLQ-C 30 of the European Organization for Research and Treatment of Cancer (EORTC).The overall 5- and 10-year survival rate was 45%. The prognosis of patients with primary metastases was 33%. There were two local recurrences after marginal resection. Every second patient needed at least one surgical revision. A secondary hindquarter amputation was avoided in all patients. MSTS functional evaluation instruments reached 59% (+/-21.0%). Global quality of life of the QLQ-C 30 showed good results (70 +/- 16%) compared to the general population (75 +/- 24%).The advantages of surgical local control of pelvic Ewing's sarcoma should be offered to the patient. Quality of life measurement after internal hemipelvectomy shows that the life of these patients is more than worth living and that they are able to compensate the functional impairment.

Following the introduction of a series of noninvasive imaging modalities (CT, MRI, Doppler sonography) during the last two decades the indications for cerebral angiography have been markedly reduced and, consequently, the number of examinations has been dramatically diminished, in most centres by more than 50%. Thus, angiography is usually not indicated in head trauma, or in brain tumours, both of which were important indications for cerebral angiography prior to the CT era. One may expect this trend to continue, since CT and MRI angiography will reduce the need for conventional cerebral angiography even further.

In a pilot study the safety and therapeutic effects of an immunostimulatory intralymphatic treatment with natural human interleukin-2 (IL-2) in combination with zidovudine were evaluated in nine patients with AIDS. Therapy with IL-2 consisted of one subcutaneous injection of 0.1 microgram/kg IL-2, followed by four intralymphatic IL-2 infusions of 0.1 microgram/kg each within a period of up to 15 days. Enlargement of lymph nodes was seen in six and a transient increase of CD4 cells in five out of nine persons in association with the IL-2 therapy. An increase of HIV p24-antigenemia was observed only in the two patients in whom zidovudine dosage had to be reduced because of side effects. Moderate clinical side effects occurred in eight of the nine patients. Four patients developed zidovudine associated anemia. Six participants showed a favourable course of disease with survival of 25 to 54 months (median 30 months) despite a previous diagnosis of manifest AIDS before IL-2 therapy. This pilot study demonstrates that a combination therapy with intralymphatic IL-2 and zidovudine can induce positive immunomodulatory effects, even in the presence of manifest AIDS. Further studies should explore the tolerability and effects of a prolonged therapy with IL-2 in combination with a more potent antiviral drug combination therapy.

The participation of (6R) 5,6,7,8-tetrahydrobiopterin (6-BH4) in regulating the tyrosine supply for melanin biosynthesis was investigated by the examination of human keratinocytes, melanocytes, and epidermal suction blisters from normal human skin and from patients with the depigmentation disorder vitiligo. Cells, as well as total epidermis, contained high phenylalanine hydroxylase activities and also displayed the capacity to synthesize and recycle 6-BH4, the essential cofactor for this enzyme. In vitiligo, 4a-hydroxy-BH4 dehydratase activity was extremely low or absent, yielding an accumulation of the nonenzymatic by-product 7-tetrahydrobiopterin (7-BH4) at concentrations up to 8 x 10(-6) M in the epidermis. This by-product is a potent competitive inhibitor in the phenylalanine hydroxylase reaction with an inhibition constant of 10(-6) M. Thus, 6-BH4 seems to control melanin biosynthesis in the human epidermis, whereas 7-BH4 may initiate depigmentation in patients with vitiligo.

Mouse bone marrow-derived mast cells (BMMC) store and release serotonin whose synthesis is initiated by tryptophan 5-monooxygenase. (6R)-H4biopterin serves as the natural cofactor for this reaction. GTP cyclohydrolase I catalyzes the first and rate-limiting step of its synthesis. In this study we demonstrate that among a panel of growth-promoting cytokines including kit ligand (KL), interleukin 3 (IL-3), IL-4, IL-9, and nerve growth factor, KL selectively enhances the synthesis of H4biopterin through up-regulation of GTP cyclohydrolase I activity to 6.2-fold levels. The activities of the subsequent enzymes 6-pyruvoyl-H4pterin synthase and sepiapterin reductase remain unaffected. The activity of tryptophan 5-monooxygenase was selectively enhanced 4.5-fold by the combination of IL-3 with KL. All other factors could not substitute for KL. The constitutive high activity of aromatic L-amino acid decarboxylase is not different in cells cultured in IL-3 and/or KL. In consequence, the concerted action of IL-3 and KL on the GTP cyclohydrolase I and the tryptophan 5-monooxygenase reaction enhances the production of serotonin to about 20-fold levels. Additionally, KL specifically causes the release of about half of total serotonin produced. Hence, our data demonstrate a novel role of these cytokines for the function of mouse BMMC and provide a coherent view of the regulation of serotonin synthesis in this cell type.

Nach der Einfuhrung einer Reihe nichtinvasiver Darstellungsmethoden (CT, MRT, Dopplersonographie) verminderten sich die Indikationen fur zerebrale Angiographien in den letzten 20 Jahren deutlich. In der Folge nahm die Zahl dieser Untersuchungen deutlich ab, in manchen Zentren um mehr als 50%.

Wir verstehen unter Weichteilsarkomen maligne Neubildungen der verschiedensten Ursprungsgewebe [18] wie Tumoren des fibrosen Bindegewebes (malignes fibroses Histiozytom, Fibrosarkom, Desmoidtumor) Tumoren des tendosynovialen Gewebes (malignes Synovialom) Tumoren des Fettgewebes (Liposarkom) Tumoren des Muskelgewebes (Leiomyo-, Rhabdomyosarkom) Tumoren der Gefase (Hamangioperizytom, Hamangiosarkom bzw. malignes Hamangioendotheliom, Lymphangiosarkom) Tumoren des peripheren Nervengewebes (malignes Schwannom) extraskelettale Knochentumoren (osteognes Sarkom, Chondrosarkom, Ewing-Sarkom) sowie nicht klassifizierbare Weichteiltumoren (alveolares Weichteilsarkom, malignes Mesenchymom, Plasmozytom, strahleninduziertes Sarkom).

In order to determine whether cholecystography and computed tomography (CT) are capable of better gallstone characterization than conventional radiography alone, 91 patients (76 females, 15 males; mean age 47 +/- 12 years) with symptomatic single gallstones were studied prospectively prior to extracorporeal shock-wave lithotripsy with concomitant oral stone dissolution therapy. In addition, the value of oral cholecystography in demonstrating patency of the cystic duct was compared with ultrasound assessment of gallbladder function. Despite "negative" plain gallbladder radiographs in all patients, oral cholecystography showed significant stone calcification in 8 of the 91 patients and CT showed stone calcifications in 52 of the 91 patients. In 12 patients the maximum stone density was between 50 and 90 Hounsfield units, and in 40 patients it was more than 90 Hounsfield units. CT revealed ring-like calcification in the majority (79%) of these stones. Oral cholecystography showed satisfactory concentration of contrast medium in all patients, while ultrasonography of the gallbladder following a chemically defined test meal demonstrated contractility of more than 50% of initial volume in 69 patients and of less than 30% in 9 patients. Although oral cholecystography is a simple, readily available complication-free method, ultrasound assessment of gallbladder contraction is better for selecting patients for extracorporeal shock-wave lithotripsy. CT allows significantly better characterization of gallstones than oral cholecystography and conventional plain gallbladder radiography.

A 44-year-old man, a known alcoholic and heavy smoker, was hospitalized with high fever and respiratory failure which a few hours later required intubation and artificial ventilation, although the chest x-ray had been unremarkable. Later serial chest x-ray films showed intrapulmonary infiltrations, while Legionella Bozemanii was demonstrated by direct immunofluorescence. Cranial computed tomography was unremarkable, despite the onset of tetraparesis and a severe midbrain syndrome. Cerebrospinal fluid contained merely mild lymphocytic pleocytosis. However, magnetic resonance imaging revealed symmetrical demyelinization foci in the brainstem as a sign of encephalitis. The neurological deficits regressed almost completely after several weeks of antibiotic treatment and rehabilitation measures over several months.

A new flexible probe to be introduced through the nose was used for the intubation of the jejunum for double-contrast small bowel enema. The new probe has a diameter of only 2.8 mm and was better tolerated than the normally applied Camus probe. Nevertheless, the failure rate (intubation of jejunum not successful) with the new probe as compared to the Camus probe was higher (17% versus 1%). We, therefore, conclude that the new probe should mainly be used by experienced examiners.

We report the rare case of a 27-year-old man with decompensated cirrhosis of the liver caused by a deficiency of alpha-1-antitrypsin. The patient was scheduled for liver transplantation. Diagnostic procedures prior to surgery revealed an unusual hepatofugal collateral channel with a marked mesenterico-, lieno-, and renocaval shunt. Since the liver cirrhosis had already been manifest during early infancy, this shunt had formed spontaneously without developing esophagogastric varices.

Der Dunndarm ist nicht nur der langste, sondern auch der physiologisch wichtigste Teil des Magen-Darm-Kanals. Ohne Magen und Dickdarm kann man leben. Der Verlust des gesamten Dunndarms ist auf Dauer mit dem Leben nicht vereinbar.

Inzidenz: Der Anteil der Dunndarmtumoren an den Tumoren des Gastrointestinaltraktes ist insgesamt gering. Die Angaben in der Literatur schwanken von 0,1–6% [1, 2, 4–7].

Among 947 patients operated on for gastric carcinoma between 1961 and 1976 there were 60 with early (superficial) gastric carcinoma. All but two patients consulted their doctor for diverse complaints. In one third of them treatment was delayed for a year or longer. In 26 of the 64 cancer foci it was limited to the mucosa. The correct diagnosis was made radiologically in 60%, gastroscopically in 70%. Selective endoscopic biopsy increased accuracy to 90%. The remaining false-negative findings occurred in the ulcerative form, which was the most frequent one. Improved radiological techniques (double-contrast) and obligatory gastroscopy with biopsy increased the relative proportion of early (superficial) carcinoma from under 4% in 1961 to 15%. The diagnosis of this type of carcinoma can be made only by careful histological study of the surgical specimens. Here as elsewhere in the surgery of carcinoma, multicentricity (in 5%) and possible lymph node metastases (10-20%) must be taken consideration in the surgical management.

We report three patients with a Sneddon syndrome in whom predominantly small (500-900 kD) IgM-containing serum immune complexes were detectable. Furthermore, antiphospholipid antibodies and increased von Willebrand factor antigen were found in the sera of two cases. Especially the data demonstrating small circulating immune complex as suggest that Sneddon's syndrome, a rare vasculitis disorder, might immunologically be characterized by circulating IgM-containing immune complexes which, in addition, could play a role in the pathogenesis of this disease entity. The elevated antiphospholipid antibodies as well as the increased von Willebrand factor antigen in the sera of the investigated patients have to be considered as nonspecific vasculitis-associated phenomena.

Four patients with spontaneous bleeding from the pancreas are described. Transpapillary bleeding is diagnosed endoscopically. Angiography can demonstrate the eroded vessel directly. Ultrasound, CT and ERCP demonstrate the underlying abnormality in the pancreas. Bleeding into a cyst produces characteristic echoes, or an increase in density. NMR is able to demonstrate pancreatitis and pancreatic pseudo-cysts. Early diagnosis is extremely important, since without appropriate surgery, pancreatic bleeding is frequently fatal.

Will man die Wertigkeit der Kernspintomographie (KST) bei Lebererkrankungen beurteilen, mus man zwischen umschriebenen Lasionen und diffusen Parenchymschaden differenzieren. Die KST bietet eine Zusatzinformation bei den echodichten Lasionen im Ultraschall, wo sie zwischen Metastasen, Hamangiomen und Hamartomen differenzieren kann. Bei den diffusen Leberparenchymschaden erlaubt die Bestimmung der Relaxationszeiten eine quantitative Gewebsdifferenzierung bei der Fettleber, bei den Zirrhosen (athylisch-primar biliar), bei der Hamochromatose (zirrhotischer Umbau) und beim Leberzellkarzinom. Eine Zukunftsperspektive ist die NMR-Spektroskopie. In evaluating nuclear magnetic tomography for the diagnosis of liver disease, one must differentiate between circumscribed and diffuse lesions. Nuclear magnetic tomography provides additional information for lesions which are echogenic on ultrasound and can differentiate between metastases, haemangiomas and hamartomas. In diffuse parenchymal disease measurement of relaxation time can differentiate between fatty liver, cirrhosis (alcoholic, primary biliary), haemochromatosis (cirrhotic transformation) and hepatoma. NMR spectroscopy is a method for the future.

The effects of exposure to continuous light, continuous darkness, and administration of melatonin on prostatic androgen receptors in relation to pubertal development in rats were examined. Darkness produced dissimilar results between the pubertal and adult groups. Whereas the prostate weight in the pubertal group remained unaltered, it increased in the adult group. In the pubertal group exposed to darkness, plasma melatonin increased significantly, and androgen receptors declined, whereas in the adult group these receptors rose significantly with a simultaneous increment of melatonin concentration in plasma. Exposure to continuous light did not produce any effective alterations in the parameters examined. The afternoon melatonin administration showed trends similar to those seen in animals exposed to darkness. The results indicate that exposure to darkness or administration of melatonin both have age-dependent effects on prostatic androgen receptors. Exposure to darkness may interfere with the process of sexual maturation in the pubertal animal as a result of increased melatonin production.

The tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave applications to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative.

Unter den Tumoren des vorderen Mediastinums kommt das Thymom am haufigsten vor (4). 25–50% der Patienten mit Thymustumoren leiden an einer Myasthenia gravis (MG). 15% aller Kranken mit einer MG weisen einen Thymustumor auf (13), bei etwa 65 bis 70% der Myasthenie-Kranken last sich eine Thymushyperplasie feststellen (3).

Among 947 patients operated on for gastric carcinoma between 1961 and 1976 there were 60 with early (superficial) gastric carcinoma. All but two patients consulted their doctor for diverse complaints. In one third of them treatment was delayed for a year or longer. In 26 of the 64 cancer foci it was limited to the mucosa. The correct diagnosis was made radiologically in 60%, gastroscopically in 70%. Selective endoscopic biopsy increased accuracy to 90%. The remaining false-negative findings occurred in the ulcerative form, which was the most frequent one. Improved radiological techniques (double-contrast) and obligatory gastroscopy with biopsy increased the relative proportion of early (superficial) carcinoma from under 4% in 1961 to 15%. The diagnosis of this type of carcinoma can be made only by careful histological study of the surgical specimens. Here as elsewhere in the surgery of carcinoma, multicentricity (in 5%) and possible lymph node metastases (10-20%) must be taken consideration in the surgical management.

If a patient has peri- and intra-articular calcinosis, as well as acro-osteolysis and esophageal hypomotility, and rheumatic symptoms, Crest syndrome should be considered as a manifestation of progressive systemic sclerosis. In connection with relevant symptoms on the skin and visceral involvement, radiological studies offer the possibility of classifying progressive systemic sclerosis more accurately.

Fully developed Gardner's syndrome is characterised by the triad of intestinal polyposis, osteomas and multiple soft tissue tumours. Absence of any one of these manifestations results in a bisymptomatic form. We describe three patients, one woman and two men aged 40, 46 and 51 years. In two patients the triad was fully expressed, but with varying organ involvement. The third patient was of the bisymptomatic type with osseous and intestinal lesions.

A 71-yr-old female patient was admitted for investigation of a massive leukocytosis and loss of weight. Physical examination revealed a reduction in the respiratory excursion of the left lung, a left pleural friction rub located ventrobasally and tension of the upper abdominal wall. Additional diagnostic procedure excluded extrasplenic disease. Ultrasound-guided puncture demonstrated the presence of pus in the splenic bed, and splenic abscess was diagnosed. Subsequent surgery confirmed this diagnosis. Histological findings revealed extensive splenic infarction. Since bacteriological investigation revealed the identical pathogens in the pus obtained with the puncture needle, in the intraoperative swab and in the midstream urine, the splenic abscess was most likely caused by hematogenous spread of a urinary tract infection into the splenic infarction. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day, free of symptoms. The clinical picture, radiological diagnosis, origin, therapy and course of splenic abscess are discussed with reference to the literature.

Cystic degeneration of the adventitia of the popliteal artery is a rare clinico-angiographic diagnosis in the chronic ischaemia syndrome of the lower extremity. If the three cardinal signs occur concomitantly, namely, intermittent ischaemia syndrome, unilocular manifestation near the joint and clearly limited filling defect in the arteriogram, diagnosis can be made with a high measure of certainty. Among our angiographically examined patients, we observed, in the course of one year, three male patients who presented the full picture of the disease with regard to clinic, localisation and angiographic findings. Intraoperatively it was not possible to establish a connection between adventitia cyst and neighbouring articular capsule; this applies, in fact, to all our cases. Histologically we found in one case, in the hollow spaces of the adventitia, an indication of the possible existence of a synovial recess, so that the scattering of mucine-secreting endothelium of the joint into the vascular adventitia is again brought up for discussion.

Piezoelectric lithotripsy was undertaken on 50 patients with gallbladder stones, none of them requiring anaesthesia, analgetics or sedatives. Stone fragmentation was achieved in all patients during the first treatment. In 44 patients the maximum fragment size was less than 50% of the initial stone diameter. The mean maximum fragment size after the first treatment was 4.3 mm (+/- 3.3 mm). After a follow-up of 0-2 months in 14 of the 50 patients and of 2-4 months in 6 of 13 patients, no more stones could be seen by ultrasonography. After an average period of 8 weeks, 17 of 50 patients were free of stones. Piezoelectric lithotripsy did not have any severe side effects besides a mild pancreatitis in one patient.

In evaluating nuclear magnetic tomography for the diagnosis of liver disease, one must differentiate between circumscribed and diffuse lesions. Nuclear magnetic tomography provides additional information for lesions which are echogenic on ultrasound and can differentiate between metastases, haemangiomas and hamartomas. In diffuse parenchymal disease measurement of relaxation time can differentiate between fatty liver, cirrhosis (alcoholic, primary biliary), haemochromatosis (cirrhotic transformation) and hepatoma. NMR spectroscopy is a method for the future.

Wir stellen hier zwei hamophile Patienten mit erworbenem Immundefizienzsyndrom (AIDS) vor. Beim ersten, 34jahrigen Patienten mit einer seit 6 Jahren bekannten Hamophilie B war eine Substitution mit Faktor IX bisher nur gelegentlich erforderlich gewesen. Die stationare Aufnahme erfolgte wegen schwerster Pneumocystis carinii Pneunomie. Die Diagnose AIDS wurde aufgrund typischer immunologischer Befunde mit Inversion des T-Helfer-/T-Suppressorzell-Verhaltnis, verminderter Mitogenstimulierbarkeit der Lymphozyten, reduzierter Interleukin-2-Produktion, Anergie auf Recall-Antigene im Hauttest, Leuko- und Thrombopenie, Gewichtsverlust, Fieber, vorausgegangener Lymphadenopathie, Zugehorigkeit zu einer Risikogruppe, positivem HTLVIII-Antikorpernachweis sowie der vorliegenden opportunistischen Infektion gestellt. Beim zweiten Patienten handelt es sich um einen auf regelmasige Faktor VIII-Substitution angewiesenen 22jahrigen mit Hamophilie A, der ebenfalls wegen Pneumocystis carinii Pneumonie aufgenommen wurde. Ein AIDS lies sich aufgrund der gleichen Kriterien wie beim ersten Patienten diagnostizieren.

A case of true duplication of the gallbladder and three cases with roentgen signs simulating duplication are reported. In true duplication the diagnosis was made by routine cholecystography which showed a double gallbladder with ductular shape. In three cases the cause for an incorrect diagnosis by cholecystography were an ampullary right renal pelvis visualized by heterotopic renal excretion of the contrast medium, a short loop of the first and second part of the duodenum and a diverticulum at the outer border of the duodenum.

From 1972 and 1982 we observed 6 cases of diffuse pleural mesothelioma and 3 cases of peritoneal mesothelioma in the Department of Internal Medicine of the University of Erlangen-Nürnberg. In 5 of 6 cases one sided noncharacteristic relapsing pleural effusion was the only sign of the pleural tumor process. Only in one case a pleural tumor constallation was diagnosed. Tomography of the lung showed a normal free central bronchial system and peripheral bronchial infiltration or displacement. In all cases CT scans were able to localize the tumor furthermore to demonstrate the exact extension and the infiltration of the mediastinum or of the diaphragm into the abdomen. Beside conventional x-rays such as double contrast examination of the colon and mesenterial angiography CT scans played the major role in diagnosing this rare peritoneal mesothelioma. Massive ascites, mesenterial infiltration, thickening of the mesenterial radix, and tumor embedding of bowel and vessels is of diagnostic significance. To ensure the diagnosis one has to do a thoraco- or laparoscopy.

Cystic dilatations of the biliary tract are rare anomalies. In the individual case, diagnosis may pose great problems. The relevance of the various methods was assessed in eight patients investigated with different diagnostic methods. In all patients the predominant symptom was uncharacteristic upper abdominal complaints. Two patients showed intermittent jaundice. Among non-invasive methods sonography is preeminent and permits precise demonstration of intra- and extrahepatic biliary duct dilatations. It can be complemented by CAT-scanning. Whereas intravenous cholegraphy does not permit sufficient ascertainment of the diagnosis, ERCP and PTC allow precise demonstration of the anomaly. Functional hepatobiliary scanning is indicated where endoscopic methods are not available. Among the eight patients sonography was decisively relevant in five cases and ERCP in all cases. The remaining functional assessments furnished important additional informations.