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PURPOSE: To inform about the experiences by introducing this method, concerning feasibility, indication, procedure, histologic analysis, changes in admission of patients, consequences for the diagnostic work-up of breast lesions. MATERIAL AND METHODS: In 80 patients, 84 lesions were biopsied. The patients were chosen according to the "Breast Imaging Reporting A Data System", recommended by the American College of Radiology, with slight modifications. The examinations were performed on a mammographic unit with a special equipment for stereotactic biopsy, using a biopsy gun. RESULTS: Histologic assessment was possible for all the cores provided. 12 of 84 lesions (14.3%) contained carcinoma, 53/84 (63.1%) mastopathic changes, 19/84 (22.6%) other benign findings. The percentage of out-patients was constantly high with 55%, the number of gynecologic in-patients increased slightly from 24 to 27%. The number of open biopsies decreased from 9 to 6 per month with a considerable decrease (30%) of negative biopsies. CONCLUSIONS: Co-operation with the admitting physicians, who are also doing mammography, should set a new course towards stereotactic core breast biopsy already before the patients are admitted to the hospital. An increasing acceptance by the gynecologists doing open biopsies could lead to a further decrease of unnecessary operations. The effect by direct histologic feedback improves the quality of mammographic diagnostic.

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PURPOSE: To evaluate the current practice of temporary vena cava filter placement and its complications. MATERIALS AND METHODS: A multicenter registry was conducted from May 1995 until May 1997 using a standardized questionnaire. One hundred eighty-eight patients were evaluated. Patient characteristics, filter indications, filter characteristics, and complications were registered. RESULTS: Deep vein thrombosis was proven in 95.2% of the patients. Main filter indication was thrombolysis therapy (53.1%). Average filter time was 5.4 days. An Antheor filter was inserted in 56.4%, a Guenther filter in 26.6%, and a Prolyser filter in 17.%. Transfemoral filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during filter protection. Major filter problems were filter thrombosis (16%) and filter dislocation (4.8%). When thrombus was found in or at the filter before explantation, additional thrombolysis was performed in 16.7%, additional filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of filters were replaced with permanent filters. DISCUSSION: Temporary vena cava filters are placed to prevent PE in a defined patient population. Despite their presence, PEs still occur in a small percentage. Problems of filter thrombosis and dislocation have to be solved. CONCLUSION: The results of this multicenter registry support the need for innovative filter design, as well as a randomized, prospective study.

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Arteriograms were carried out on 176 patients using 4-F catheters through a transbrachial approach. Criteria for exclusion from the series were injuries to the upper limb, hemiparesis or poor pulses in the presence of a normal femoral pulse. There were no local vascular complications requiring treatment. On two occasions the brachial artery could not be punctured. Acute posterior cerebral infarction was the only serious complication (0.5%). 67% of the patients were examined on an outpatient basis and this did not appear to increase the risk of complication. We regard this as a suitable method for demonstrating the pelvic and lower limb arteries on ambulant patients.

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189 non-palpable breast lesions in 182 patients were localized using conventional mammographic apparatus, a wire grid compression plate and a cannula with a hooked mandrin. The technique of the examination for defining the lesion in three planes and fixation of the lesion with the wire is described. In 173 instances (91.5%), the lesion was found at the first biopsy and subsequent biopsies were necessary on only 24 occasions. One lesion (0.5%) was missed completely. 47 carcinomas were found (24.9%) and the incidence of malignancy increased from 14.3% to 33.3% during the series. The mean ratio defining the size of the biopsy and the size of the lesion was 3.3 and indicates good preservation of breast tissue. Radiographs of the specimen taken with compression showed 186 lesions (98.4%). The method, which is comfortable for the patient, provides satisfactory detection and localization of the lesions; results are similar to those of stereotactic methods but this method is quicker and much less expensive.

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Digital subtraction sialography seems to provide a better display of glandular anatomy and pathological changes of parotid and submandibular gland. Further comparative studies are however necessary to better evaluate this simple and fast procedure.

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Plasma cell granuloma of the lung is a rare, benign focal lesion of nonspecific inflammatory genesis with few symptoms and often discovered by chance during mass-radiography. Radiologically it is characterized by a usually well-circumscribed solitary round focus (70% of cases), as an infiltrate or as atelectasis if it grows endobronchially. The histological picture is polymorph with mature plasma cells, lymphocytes, vacuolized histiocytes, fibroblasts and other elements of the reticulo-endothelial system. It has been given many names, pseudotumour appearing in the older literature. In the differential diagnosis a peripheral lesion can be mistaken for benign tumour, specific granuloma or metastasis, the more central form for bronchial carcinoma. The condition was observed in six personal cases, operated on between 1967 and 1982.

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The diagnostic results of hysterosalpingography and laparoscopy were compared (30 patients). Agreement between the methods was found in 73%. In 17% of the women, findings seen on hysterosalpingography, could not be confirmed at laparoscopy. Conversely, in 10% of negative hysterosalpingograms, adhesions were found at laparoscopy. Possible causes for these differences are discussed. At present three different methods are used for hysterosalpingography. Compared with a metal cannula or a Foley catheter, the use of a baby's feeding tube resulted in a reduction of tubal spasm. A reduction in screening time and consequent decrease in gonadal radiation is possible without loss of diagnostic information.

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In 69 patients with extrahepatic biliary obstruction a specially designed teflon tube, the endoprosthesis, was inserted across the ductal stenosis either by percutaneous or by endoscopic route to reduce jaundice. After gaining experience our success rate of stent placement was more than 90%. Compared with catheter drainage the endoprosthesis worked faster and more efficiently, while in palliative treatment the quality of life of the patient improved and secondary cholangitis was prevented. The rate of significant long-term stent obstruction can be tolerated in view of the expected life span of four months as average in our material.

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The radiological due to extensive extramedullary haematopoiesis taking place in the posterior mediastinum in two patients are described, and the literature is reviewed. Characteristic features are a polycyclic or spindle-shaped configuration of the mass, with bilateral paravertebral localisation in the caudal and middle third of the thorax. There is absence of inflammatory or neoplastic changes in the neighbouring skeleton, but in thalassaemia there may be changes in the paravertebral portion of the ribs. Computer tomographically, the combination of a solid paravertebral tumour, with adjacent rib changes, is characteristic of thalassaemia with extramedullary haematopoiesis. In the absence of other skeletal changes, computed tomography is valuable for differential diagnosis. Lymphomas occur considerably more often and may appear identical but, because of the well know fat content of myolipoma, the scan shows contrast values between -15 and + 40 HU. Because of their high vascularity, there is a marked increase in density following intravenous contrast medium.

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CT scans of 36 carcinomas of the laryngo-pharyngeal region were analysed retrospectively and the results compared with the endoscopic and operative findings. For the final tumour staging in 18 cases of carcinoma of the larynx equivalent results were obtained in 12 cases; CT scan offered a better evaluation in two cases and insufficient dates in four. Destruction of cartilagineous structures, submucosal tumour infiltration and the pre-epiglottic space are better shown on CT scans. Faulty evaluation of tumour presence of extent are due to superficial tumour growth or to motion artefacts. For the final staging of 18 carcinomas of the pharynx results of CT and clinical findings were comparable in nine cases. CT was less precise in five and superior to endoscopy in four. Evaluation of neoplastic infiltration of the parapharyngeal soft-tissue and of the skull base was the main advantage of CT scanning. Low grade tumours of the oro- and hypopharynx were not visible on CT and tumours of the base of the tongue were insufficiently displayed.

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Twenty-two patients with trauma to the pelvis and abdomen were examined by computer tomography. Subcapsular haematomas, haematomas and rupture of organs, intra- and retroperitoneal haematomas and pelvic fractures could be reliably diagnosed in this way. Serial observations on the tissue density of an haematoma allows one to judge its age. Lack of contrast enhancement of an haematoma makes the injection of contrast a useful test. Computer tomography has reduced the indications for angiography in blunt abdominal trauma.

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Bone tumors of the extremities are usually diagnosed by conventional radiography. A good angiogram may render information not only about intra- and extraosseous extension of the tumor, but often also about the biological dignity. CT is usually not necessary, especially since it is sometimes difficult to define the extraosseous borders of these extremity tumors with this method. In bone tumors of the pelvis, however, neither conventional radiography nor angiography render reliable information about the extent of the tumor, which CT is very well able to do. Therefore CT is primarily indicated for evaluation of bone tumors in this region. Angiography is done only for preoperative evaluation of the vascular architecture or for potential therapeutic embolisation.

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