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Virtual colonoscopy provides a computer-simulated endoluminal perspective of the air-filled, distended colon using modern CT scanning (spiral CT). According to recent studies the sensitivity and specificity of this technique are high for adenomatous polyps > or = 10 mm. A 67-year-old patient was admitted to our hospital because of diarrhoea and constipation, associated with abdominal pain in the lower right abdomen. Prior to admission the patient had undergone virtual colonoscopy in a specialised radiological practice which had detected no abnormalities apart from colonic diverticulosis. However, conventional video-colonoscopy revealed a subtotal circular malignant stenosis in the region of the right colonic flexure. A poorly differentiated adenocarcinoma was diagnosed histologically. Staging showed peritoneal carcinosis with infiltration of the right ureter and lymphangiosis carcinomatosa of the pectoral lobe of the left lung. After right hemicolectomy because of metastasised carcinoma of the ascending colon (pT4pN1pM1) we started palliative chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin. The risk of misdiagnosis by virtual colonoscopy is clearly increased in patients with subtotal tumour stenosis of the ascending colon. Conventional video-colonoscopy remains the gold standard for the diagnosis of colorectal carcinoma.

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BACKGROUND: In paralysed limbs quite often edemas are seen, which might pose problems during rehabilitation. The origin of these edemas is not fully understood. METHODS: 48 patients with hemiplegia and edema of the paralysed arm were studied; in 40 patients lymphoscintigraphic studies (static and dynamic lymphography) were performed. RESULTS: In 80% of these cases lymphatic flow in the paralysed arm was increased compared to the healthy arm. If there was marked edema in the paralysed arm, the increase of lymph flow was considerable (p < 0.01). CONCLUSIONS: Edemas in hemiplegic extremities are not due to lymphedema, as in lymphedema the lymph flow usually is very slow. They most likely are caused by disorders of filtration and reabsorption, due to a dysfunction of the autonomic nervous system.

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Over a period of 11 years, percutaneous transluminal angioplasty (PTA) was performed in 47 patients with post-transplantation renal artery stenosis. In 42 of 47 patients (89%) PTA was technically successful. Complications or technical failure (n = 5) were observed in the beginning of the series and were due to technical problems. Within a five-year follow-up period in 33 patients, blood pressure (BP) remained constant in 18% and mean pressure was improved in 48%. In 33%, normal BP was reached without any need for medication. Systolic and diastolic BP were reduced from 175.9/105.7 (mean values) before PTA to 146.9/91.0 six months after PTA. Depending upon the initial value, serum creatinine was reduced after PTA by from 0.0 to 1.0 mg/dl with noticeable difference between individual values. An account of this effect, renal function was of reduced value for controlling the effectiveness of PTA. The morphology of the stenoses corresponded only partially with the clinical results: in five patients mean BP after successful PTA remained constant, while two patients with reduced therapeutic result (remaining stenosis > 30%) had either markedly improved BP (n = 1) or normal BP (n = 1). The technical improvement of PTA instrumentation has broadened the spectrum of indications and improved the safety of the procedure.

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Recanalization (angioplasty) and occlusion (embolization) are the major interventional radiological procedures used in renal vessels. In recanalization of the renal artery, percutaneous transluminal angioplasty of renal arterial stenosis is the most common procedure. About 80% of renal arterial stenoses are suitable for this procedure, that is, about 80% of patients can be spared major abdominal surgery. Methods, results and complications are discussed. Local lysis of acute renal arterial occlusions is rarely employed, since the diagnosis is usually made too late. Functional improvements may be expected even when recanalization is successful only when the procedure is performed within one hour of the occlusion or when collaterals suffice for organ-preserving metabolic activities. Embolization of the renal artery is employed in particular in the case of tumors of the kidneys, more frequently with a pre-operative rather than a palliative intent. Pre-operative embolization aims at facilitating surgery and reducing the need for transfused blood. The palliative procedure employed in inoperable tumors aims at prolonging life, controlling acute bleeds, and combatting paraneoplastic syndromes. The method is described.

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Computed tomography (CT) was performed in 142 patients thought to have an endobronchial tumor based on clinical or radiologic grounds. In 121 patients an endobronchial mass was confirmed at bronchoscopy with biopsy or at surgery. The CT scans were evaluated independently by two experienced observers (A and B). For statistical purposes the result in each single bronchus from the level of the trachea to the segmental bronchi was considered separately. A total of 361 abnormal and 1,413 normal bronchi were confirmed with bronchoscopy or surgery. Observers A and B identified 100% and 99%, respectively, of the abnormal bronchi and 97% and 96%, respectively, of the normal bronchi on CT scans. For the standard CT examination (8-mm-thick sections) a sensitivity of 94% (observer A) or 91% (observer B) and a specificity of 99% (observers A and B) were found in the diagnosis of a normal or narrowed bronchial lumen. CT proved to be a reliable method for demonstrating tumor lesions of the bronchi.

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Imaging of the normal bronchial system by CT was examined in 75 patients while employing different imaging parameters. The main and lobar bronchi could be demonstrated almost without exception in the standard examination of the thorax. Segmental bronchi were delineated in an average of 81% of the cases (512 image matrix) or 74% (256 image matrix), respectively. The lowest identification rate was seen in the segmental bronchi of the middle lobe and lingula being 38% (512 image matrix) and 18% (256 image matrix), respectively. Increase of the magnification factor did not result in any significant improvement of imaging. An increase in the identification rate of the segmental bronchi of the middle lobe and lingula was achieved only after reducing the slice thickness from 8 mm to 4 mm, the yield being now 87% (512 image matrix) and 82% (256 image matrix), respectively, whereas the remaining segmental bronchi could be made to show up almost without exception. The standard parameters are sufficient for routine examination of the bronchial system. If imaging is diagnostically not satisfactory, reducing the slice thickness yields improved imaging, especially of small bronchi.

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66 patients with suspected bronchial tumors were examined by conventional tomography and by CT. The results were evaluated separately by two radiologists (A and B). All diagnoses were confirmed by bronchoscopy or surgery. In evaluating individual bronchi, conventional tomography had a sensitivity of 88% (A) or 87% (B) and a specificity of 97% (A) or 95% (B); CT had a sensitivity of 95% (A and B) and a specificity of 99% (A and B). If CT is available, our experience indicates that conventional tomography is no longer indicated.

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Twenty-nine patients suspected of having an endobronchial mass were examined by magnetic resonance (MR) and CT. Seventy-nine pathological and 319 normal bronchi were confirmed by bronchoscopy and/or operation in these patients. The studies were evaluated by two observers (A and B): By MR, only 72% (A) or 71% (B) of the pathological and 45% (A) or 43% (B) of the normal bronchi, respectively, were visualized. Computed tomography identified all pathological and 97% of the normal bronchi (A and B). Therefore, comparison between MR and CT was based only on those bronchi that were adequately visualized on MR as well as CT. For these bronchi the sensitivity of MR was 88% (A) or 77% (B) and of CT 96% (A) and 93% (B). Specificity was 92% (A) and 94% (B) for MR and 97% (A and B) for CT. At the present stage of development CT proved to be superior to MR in demonstrating endobronchial lesions.

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This study was designed in order to evaluate frequency and natural development of periventricular increased echogenicity (periventricular halos) as a sonographic feature. Sixty healthy term neonates were examined sonographically through the open fontanel within the first twelve hrs of life (phase I). Out of this group, forty-three infants were again studied between the twenty-fourth and forty-eighth hr of life (phase II), forty between third and eighth day of life (phase III), twenty between third and sixth week of life (phase IV) and twelve between third and fifth months of life (phase V). Halos were found in occipital areas in 83% in I, in 86% in II, in 85% in III, in 35% in IV and in 0% in V. They presented as increased echogenicity predominantly occipitally and frontally at the external angles of both lateral ventricles. There was no correlation to the mode of delivery. The differential diagnosis (haemorrhage, hypoxicischaemic injury, oedema) is discussed. Periventricular increased echogenicity represents a common sonographic finding in clinically healthy term infants. When present in the typical form as described here it seems to have no pathological significance. Each clinician examining neonatal heads sonographically should be familiar with his phenomenon and its interpretation.

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The efficacy of and tolerance to ticlopidine, a platelet inhibitor, in preventing progression of obliterative arterial disease was compared with that of a placebo in a double-blind and randomized trial in 43 patients (22 on placebo, 21 on ticlopidine) over a period of one year. The course of the disease in both groups was assessed by serial angiography of the lower limbs, both at the beginning and at the end of the study. There was a significantly reduced progression in the ticlopidine group (P less than 0.01). The results support the hypothesis that platelets are of great importance in the progression of arteriosclerosis and that inhibition of platelet function is an effective principle of prevention. Ticlopidine in this respect is an alternative to the use of acetylsalicylic acid.

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Arteriovenous fistulas of the vertebral artery are in most cases caused by penetrating injuries. This report concerns a patient with ankylosing spondylitis, whose fistula most probably was brought about by puncture of the internal jugular vein for aorto-coronary-bypass surgery.

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In 100 newborn and infants the total diameter of both lateral ventricles in the region of cella-media was measured ultrasonographically by one-dimensional (A-Scan) and two-dimensional (B-Scan) technique. Comparison of the results of both methods showed good correlation (r = 0,945). Possible reasons of differing results are discussed. The importance of cella-media-index is emphasized. The transparietal A-Scan technique is sufficiently reliable in determining the width of the lateral ventricles. However, the B-Scan (through the open fontanel) will give many additional informations about intracranial structures and should be applied whenever possible.

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Three methods complementing each other are available for the preoperative intraocular localisation of foreign bodies. Basing on the results obtained, it is recommended, first of all, to localise the site of the foreign body by means of conventional x-ray film, followed by fine diagnosis via ultrasound and, finally, in problematic or doubtful cases, by means of computed tomography.

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