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Cystic lymphangioma of the small-bowel mesentery is a rare manifestation of an intraabdominal tumor in elderly patients. We present a case of a small-bowel mesentery lymphangioma, causing fever and chills and present clinical and pathologic features. Furthermore, etiology and differential diagnosis of this tumor are discussed.

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Inferior mesenteric angiography was carried out in 14 patients with locoregional recurrence following sphincter-saving resection of a colorectal primary tumour in the left hemicolon or rectum. The aim was to check the margins of clearance of the lymphatic drainage. All patients had been operated on electively and with curative intent. All patients had a biopsy-proven recurrence and 11 of the 14 patients (79%) showed residual arteries that should have been resected at primary surgery, and at laparotomy for the recurrence incomplete resection of the lymphatic drainage area was confirmed. In 6 patients the recurrence was resected, in 4 of them with no evidence of microscopic residual disease. From these findings it may be argued that the lymph nodes incompletely resected at primary operation may have been the origin of the locoregional recurrence. Angiography may detect this situation, and may be worthwhile when planning a reintervention.

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Within a group of 101 patients treated for locally recurrent colorectal cancer 10 of them presented with a recurrence located in the lymphnodes of the primary tumor bed. This "pseudo-recurrence" shows some typical findings as elevated CEA serum levels in asymptomatic patients, and intact anastomosis endoscopically. However, angiography reveals the presence of the inferior mesenteric artery and it branches left behind at operation for the primary tumor. Furthermore, endoluminal ultrasound may be able to detect these situations. Both investigations are a must in patients following resection of a colorectal primary tumor of the left hemicolon or rectum being suspicious for a locoregional recurrence. Detection of a lymphnode recurrence may be of value in planning for a reintervention as it helps to select patients with a better chance for a curative surgical approach.

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Primary leiomyosarcoma of the heart is very rare, and in most cases the diagnosis is performed during postmortem examinations. We report on a 71-year-old woman with a large leiomyosarcoma of the right atrium. The preoperative diagnosis of cardiac tumor was made by 2-D echocardiography, transesophageal echocardiography, computed tomography, and MR-imaging, and was confirmed by histological and immunhistological findings of the resected part.

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Report on sonographic diagnosis of clinically atypical ileocolic invagination in a four-year old boy. Desinvagination by an enema with water-soluble contrast material was not successful. Surgery resulted in the surprising additional finding of an acute appendicitis which might have been the reason for the invagination.

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In contrast to childhood, idiopathic intussusception in adults is quite rate. We report on the diagnosis (conventional plain x-ray films, sonography, coloscopy, enema) of a clinically atypical colo-colic invagination in a 29-year old woman. Since no tumour-related cause was found, disinvagination by a water-soluble contrast enema material was successfully performed.

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In 42 patients with suspected recurrent colorectal cancer, results of conventional diagnostic methods were compared with those of immunoscintigraphy. In 69% of all cases, the intraoperative findings of a second-look operation served for validation, whereas in 31% close follow-up was used. Recurrent tumors were successfully localized in 83% of patients by conventional methods, whereas immunoscintigraphy was expressive in 57% of cases. Immunoscintigraphy was disappointing especially because of its low sensitivity (23%) and low predictive value (positive, 33%; negative, 37%) with regard to successful diagnosis of extrahepatic tumors compared with the results of conventional methods (77% sensitivity; positive, 94%; negative, 79%). The rate of false-positive results was relatively high with immunoscintigraphy (n = 12), 83% of which were related to extrahepatic recurrent tumors. The value of immunoscintigraphy using an immunococktail of 131-J-labeled F(ab')2 fragments of monoclonal antibodies against CEA, with Ca 19-9 as an additional diagnostic tool for early detection of recurrent colorectal cancer, must therefore be viewed critically.

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In 42 patients with suspicion of recurrent colorectal cancer results of conventional diagnostic methods were compared to those of immunoscintigraphy. In 69% of all cases the intraoperative findings of a second-look operation served for validation, in 31% the follow-up was controlled. Localization of recurrent tumors was successful in 83% using conventional methods versus 57% by immunoscintigraphy. This procedure disappointed especially by a low sensitivity (23%) and low predictive parameters (pos.: 33%; neg.: 37%) in regard to diagnosis of extrahepatic tumors compared to results of conventional methods (77%), 94% respectively 79%). The quote of false positive results was surprisingly high in immunoscintigraphy (n = 12), 83% of these especially in localization of extrahepatic tumors. Therefore, the validity of immunoscintigraphy as an additive diagnostic tool for early detection of recurrent colorectal cancer must be regarded critically.

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Liver angiography and liver perfusion scintigraphy with Tc-99m-labeled macroaggregated albumin (MAA) were performed in 36 patients with liver metastases from colorectal cancer prior to continuous 5-fluorouracil hepatic artery infusion (HAI) hemotherapy. Of the 26 patients showing metastases on arteriogram, five revealed increased tumor vascularisation, five had normal vascularisation, and 16 showed decreased vascularisation of the metastases relative to liver. In liver perfusion scintigraphy, 15 of the 36 patients showed increased perfusion of the metastases, four had normal perfusion, and 17 had decreased tumor perfusion. The observed differences in survival in the different groups were not statistically significant: patients survived 15 months in the group with increased tumor vascularisation, 8 months for normal vascularisation, and 14 months for decreased tumor vascularisation; survival was 28 months for the group of increased, and 13 and 14 months for the normal and decreased tumor perfusion groups respectively. Also, response rates with 80%, 40%, and 75% responders in the group of increased, normal, and decreased tumor vascularisation, respectively, and 80%, 50%, and 59% responders in the group of increased, normal, and decreased perfusion, respectively, were not significantly different. These results indicate that there is no possibility to discriminate potential responders from nonresponders by results of liver angiography or perfusion scintigraphy.

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Between 1984-1987 6 multiple trauma patients with pelvic fractures and bleeding from pelvic vessels were treated by transcatheter embolization. Although diagnosis and therapy were early in two cases, there was an overall time delay of median 17 hours (1-38 h) until localisation of bleeding lesions. In this period multiple transfusions (median: 33.7 units of packed erythrocytes, 14.5 units of fresh frozen plasma) could not control hemorrhage. After successful transcatheter embolization circulation stabilized immediately and durably. 4 patients died, 2 of them from septic-toxic multi-organ-failure.

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In patients with local recurrence or liver metastases from colorectal cancer the preoperative results of conventional diagnostic methods (sonography, computed tomography, x-ray, endoscopy) and immunoscintigraphy performed with 131I labeled CEA/Ca 19-9 antibodies were compared to intraoperative findings. Specificity of immunoscintigraphy in detecting liver metastases was higher compared to conventional diagnostic methods but its predictive reliability was disappointing, especially in regard to diagnosis of the number of liver metastases and detection of local recurrence or peritoneal seedings. Compared to all intraoperative findings a positive predictive value of 74% and a negative predictive value of 42% for immunoscintigraphy could be found as compared to 88% and 63%, respectively, for conventional diagnostic methods. So immunoscintigraphy in our experience cannot give more information beyond conventional diagnostic tools for indication or planning of operative strategy in the treatment of recurrent colorectal cancer.

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Late complications following adjuvant or curative radiotherapy become clinically more evident with increasing duration of the observation period. Atherosclerotic disease secondary to radiation therapy is a rare complication. This is a report on 10 such cases requiring reconstructive vascular surgery between 1980 and January 1986. Previous radiotherapy was performed for malignancies in 9 patients and for thyroiditis in one patient. The time interval between radiation and onset of symptoms due to radiation induced atherosclerotic disease was on average 19.5 years (5-37 years). In order to reduce wound and graft infection to a minimum the extra-anatomical position of the graft was preferred. There was no major morbidity nor mortality postoperatively. During the mean follow-up of 22 months (1-63 months) one late graft occlusion was observed. Our results show that vascular reconstruction of radiation induced atherosclerotic disease is possible. Reconstructive surgery is clearly indicated for patients who underwent previous curative therapy for malignant disease.

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At the instance of a 30-year-old female patient a casuistic contribution to the differential diagnosis of the so-called "postcholecystectomy syndrome" by means of ERC is given. On condition after cholecystectomy an amputation neuroma had again led to colics. Amputation neuromas are rare, but not unknown causes for complaints after operations at the bile ducts. The origin of such a neuroma at the extrahepatic bile ducts is discussed.

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