Retrograde Venenokklusion - Zur Therapie der verlogenen Impotenz

Retrograde occlusion of penile drainage veins can produce improvement in patients with impotence due to venous leaks. We performed 50 transfemoral and three transjugular procedures; 46 (86%) were technically successful. Clinical improvement was found in 24 out of the 46 procedures (52%). In 20 patients spontaneous intercourse became possible, in four this occurred after intracavernous injection of vaso-active substances. In eleven patients there was deterioration after one to twenty months; in seven this was treated by repeated venous occlusion. In 13 patients improvement has been maintained over a period of one to thirty months (average 10.5 months). There were no complications.

Transrenal ureteral occlusion: results and problems.

Purpose The effectiveness of transrenal ureteral occlusion was evaluated. Patients and Methods Transrenal ureteral occlusions were performed in 83 ureters of 76 patients. Thirty-one ureters were occluded with use of tissue adhesive, which was secured in place with Gianturco coils in 21. Fifty-two ureters were occluded by means of silicone-filled, detachable latex balloons. Average follow-up was 3.6 months (range, 1 week to 38 months) for patients treated with the tissue adhesive and 7.9 months (range, 1 week to 61 months) for patients treated with the detachable balloons. Results Seventeen (55%) of the 31 ureters occluded with tissue adhesive and 36 (69%) of the 52 ureters occluded with det…

Effectiveness of platinum wire microcoils for venous occlusion: A study on patients treated for venogenic impotence

The purpose of this study was to determine the effectiveness of venous occlusions achieved by embolization with platinum microwire coils. Follow-up venographies in 19 patients, 1-20 months (average 8 months) after coil embolizations, were evaluated. Twenty-eight of 126 (22.2%) coil embolizations were found to be patent. Coils which had not formed or partially formed upon embolization had a patency/recanalization rate of 37.5% (12/32). Among coils which had formed nearly completely or completely only 16 of 95 (17%) showed venous patency. As coil embolization had been augmented by sclerotherapy in all patients, the effectiveness of long-term venous occlusion by platinum wire coils alone is pr…

Penile Abflußvenenokklusion: Vergleich von erektiler Funktion und Kavernosometrie vor und nach perkutanen Eingriffen

After percutaneous transpenile or retrograde venous occlusion for the treatment of a cavernous leak, the clinical results were correlated with cavernosometric flow measurements in 27 patients. In 15 patients, venous occlusion led to a reduction of the maintenance flow: in patients who showed improvement there was an average reduction of 30 ml/min, in those without improvement or deterioration it averaged 0.3 or 13 ml/min respectively. In 7 patients there was increased flow (up to +21 ml/min). One of these patients showed improved erectile function; the remaining 6 showed no change as was also the case in 5 other patients who had no change in cavernosometric measurements. Our findings sugges…

Funktionsangiographie der kniegelenknahen Arterien: Konsequenzen für die Stentimplantation?

Angiographic studies of the arteries adjoining the knee in 25 patients show extensive kinking and stenoses of the popliteal artery and less frequently of the distal femoral artery during flexion of the knee joint. This is due to the loss of elasticity with increasing age forcing the vessel into a tortuous course during shortening of the pathway of the popliteal artery with knee flexion. Independent of the principle of the different stents available they probably will not increase the contractility of the stented vessel in the longitudinal axis. It is to expect that after implantation of stents into the popliteal artery kinking will occur predominantly in the original segments of the vessel …

Gadolinium-DTPA (Magnevist®) als Kontrastmittel für die arterielle DSA

16 DSA investigations using intra-arterial Gd-DTPA were performed on 12 patients. The contrast medium was administered either as a 0.5 molar gadolinium solution (commercially available) or diluted with distilled water to a 0.2-0.4 molar gadolinium solution. The injection was made either by pressure injector or by hand. The aortic arch, abdominal aorta and pelvic and lower limb arteries were examined. 14 of the 16 procedures were diagnostically adequate, but compared with iodinated contrast materials, contrast was less marked. There were no cardiovascular, neurological or allergic side effects. Three patients suffered a feeling of heat and one patient had mild pain during the injection. Even…

CT-Arthrographie der Schulter nach operativer Versorgung ventraler Instabilitäten

25 patients who had undergone a modified Lange repair were examined postoperatively after about four years, both clinically and by CT arthrography. Ventral redislocation was no longer seen postoperatively. As regards residual ventral instability, there was agreement between CT arthrography and the clinical findings in 20/25 patients (90%). Newly developed or residual dorsal instability could be accurately demonstrated by the presence of pathological changes of the dorsal labrum and by the observation of a wide dorsal joint recess. CT arthrography did not provide reliable evidence concerning loss of function and mobility of the treated shoulder. However, the presence of marked capsular foldi…

Perkutane Implantation einer endovaskulären Gianturco-Prothese bei V.-subclavia-Verschluß

Observation d'une femme de 72 ans, hemodialysee, avec œdeme croissant du bras portant le shunt. L'obliteration de la veine sous-claviere a ete traitee par fibrinolyse locale, dilatation et prothese de Gianturco

Selektive Blutentnahme aus dem Sinus petrosus inferior: Vergleich von CRF- und TRH-Stimulation

In 10 patients with hypophyseal Cushing microadenomas, selective bilateral sampling from the inferior petrosal sinuses was performed and the effect of stimulation by iv TRH and CRF was compared. On the side of the microadenoma. ACTH concentration rose from 650 +/- 242 pg/ml to 2712 +/- 843 pg/ml following injection of CRF and 2025 +/- 242 pg/ml after TRH. Contralateral values were 165 +/- 79 pg/ml, 490 +/- 200 pg/ml and 165 +/- 72 pg/ml respectively. Prolactin concentration on the side of the adenoma was 98 +/- 49 ng/ml before stimulation, 236 +/- 62 ng/ml after CRF and 747 +/- 168 ng/ml after TRH. Contralateral concentration was 22 +/- 10 ng/ml, 64 +/- 19 ng/ml respectively. Sampling local…

CT after enucleation of renal cell carcinoma.

Computed tomography (CT) was performed in 28 patients 2 weeks to 120 months after enucleation of renal cell carcinoma. The postoperative defect could be exactly localized in all patients. A wedge-shaped (N = 11) or concave (N = 9) morphology was typical. No dependence between morphology of the defect and localization or size of the tumor or the operative technique was observed. The defects were smaller (1.9 cm) than the original prominent tumors (3.6 cm). Defect size was dependent on the operative technique: closure by suture of the renal capsule in smaller defects or by fat flap in larger ones. Postoperative hematomas or delayed perfusion in the adjacent parenchyma were seen in five patien…

Die Skaphoidpseudarthrose: Häufigkeit, Pathogenese und Verlauf

Eight-three scaphoid pseudo-arthroses were found amongst 1.104 scaphoid examinations. Sixty-seven were present at the first examination and 16 pseudoarthroses developed amongst 252 scaphoid fractures. Men were affected predominantly, particularly in the 20 to 40-year old group. Fractures in the proximal third of the scaphoid and vertical oblique fractures had a particular tendency to pseudo-arthrosis formation. The operative treatment of choice is a Matti-Russe bone graft. Only one patient in seven with definite scaphoid pseudo-arthrosis showed firm fusion.

Das Verhalten der Kollateralen bei der perkutanen transluminalen Angioplastie

The fate of 106 collaterals was investigated following percutaneous transluminal dilatation of 113 stenoses and occlusions. Following dilatation, 78% of collaterals were unchanged and 22% could no longer be demonstrated. The success of the dilatation had no bearing on the fate of the collaterals. Collaterals beginning or ending in a dilated portion of vessel disappeared more frequently (30%) than the others (11%). Following five dilatations, some vessels were demonstrated in the area of stenosis, which had not been demonstrated previously. Evidently local events, such as displacement of arteriosclerotic plaques may lead to occlusion or reopening of vessels. Remaining collaterals may be of g…

Leber-CT mit portal-venöser Kontrastmittelgabe

Contrast administration through the superior mesenteric or splenic arteries provided additional information in 22 out of 31 patients, when compared with intravenous contrast bolus for CT of the liver. In 11 patients, the demonstration of a tumour lead to a change in treatment. False positive findings occurred in four of the 31 patients. In 2 patients intrahepatic lesions were overlooked, but were found during angiography carried out at the same examination. The diagnosis of intrahepatic space-occupying lesions is discussed as well as the CT appearances of portal-venous liver perfusion.

Parosteal osteosarcoma of the talus.

A case of parosteal osteosarcoma in the very rare location of the talus is presented. The radiological, pathological, and clinical characteristics of parosteal osteosarcoma are described and the differential diagnosis discussed.

Selective bilateral blood sampling from the inferior petrosal sinus in Cushing's disease: effects of corticotropin-releasing factor and thyrotropin-releasing hormone on pituitary secretion.

We sought to enhance the sensitivity of selective bilateral blood sampling to determine adrenocorticotropin (ACTH) and prolactin levels in the inferior petrosal sinus (IPS) by administering two stimulatory agents--corticotropin-releasing factor (CRF) and thyrotropin-releasing hormone (TRH). We then determined the ACTH and prolactin levels in the IPS of 10 patients with Cushing's disease. After peripheral administration of both CRF and TRH, ACTH levels were significantly higher on the tumor side in all patients. The prolactin level was significantly higher on the tumor side when CRF or TRH was used to stimulate pituitary secretion. Postsurgical immunohistochemistry studies revealed productio…

Fokal-noduläre Hyperplasie der Leber bei 930 Patienten

Analysis of 930 patients with focal nodular hyperplasia of the liver (FNH), including 23 seen by the authors, showed the following results: 82.2% of patients were female, 37.8% of these had taken female steroidal hormones. There was no preference for a particular lobe of the liver. 57.7% of FNH were subcapsular, 33.7% were intrahepatic and 8.8% were pedunculated. Average size was 5.9 cm, 80.8% of the patients were asymptomatic. In 93.5% (115 out of 123) a space-occupying lesion in the liver could be demonstrated by sonography. In 13%, second or multiple tumours were missed by sonography. CT without enhancement demonstrated FNH in 90.4% (94 out of 104 patients). A rapid, marked increase in d…

Spiral CT of bronchial arteries in chronic thromboembolism.

OBJECTIVE: Computed tomography study of bronchial artery anatomy and evaluation of dilatation and tortuousity as indicators for pulmonary hypertension and surgical risk in patients with chronic thromboembolism were performed. MATERIALS AND METHODS: We retrospectively reviewed contrast-enhanced, thin section spiral CT scans of 39 patients undergoing pulmonary thromboendarterectomy. Findings were compared with mean pulmonary artery (PA) pressure in all, postoperative mortality in 33, and postoperative CT in 5 patients. Twenty patients without pulmonary hypertension served as controls. RESULTS: In the pulmonary hypertension group, 50 bronchial arteries were observed in 30 of 39 patients. Their…

Die perkutane Harnleiterokklusion

One hundred and nineteen transrenal occlusions of 77 ureters were carried out in 71 patients. Thirty-one ureters were occluded by means of glue and in 21 Gianturco coils were introduced at the same time. Forty-six ureters were occluded by means of disposable silicone-filled latex balloons. Seventeen out of 31 ureters treated with glue (55%) and 32 out of 46 ureters with balloons (70%) were permanently occluded. On 42 occasions, re-occlusions had to be carried out, the average period from the initial occlusion being 2.5 weeks for glue and 19.5 weeks for balloons. In nine out of the 119 ureteric occlusions (7.5%), there were mild complications; these were easily treated and were of no consequ…

Pulmonary contusion: CT vs plain radiograms.

In experimentally induced pulmonary contusions, CT (n = 27) and chest X-ray (n = 24) findings were compared with the findings at autopsy. Twenty-seven of 27 (100%) pulmonary contusions were visible by CT immediately after trauma compared with 9 of 24 (37.5%) in the chest X-ray. After 30 min follow-up, 18 of 24 (75%) lesions were seen on the plain film. Five of 24 (21%) contusions escaped detection on conventional radiographs. Computed tomography underestimated lesion size in 5 of 60 (8%) measurements, conventional radiographs in 21 of 36 (58%) measurements. Pathological examination never revealed a pulmonary contusion that was not demonstrated by CT. Therefore, pulmonary contusion seems unl…

Der Sicherheitsgurt: Auswirkungen auf das Verletzungsmuster von Autoinsassen

Since 1984 the law concerning safety belts has been implemented; this paper deals with the findings in 386 victims of motor accidents who were x-rayed between 1981 and 1989. Minor injuries have been ignored. The number of passengers wearing belts increased by 30% after 1984. The number of passenger injuries did not decrease. Injuries directly caused by the belts included a small number of fractures of clavicles, the sternum and ribs and one pelvic fracture, one serious abdominal injury with tearing of the mesenteric artery and one ruptured spleen. An indirect result of wearing seat belts was a marked increase in cervical whiplash injuries and some increase in thoracic vertebral fractures. N…

Radiologische Verlaufskontrolle der Thoraxorgane beim Intensivpflegepatienten

Correlation between chest radiographs and clinical indicators was studied in 212 patients in intensive care. 1. There was good correlation between raised pulmonary artery pressure and radiological signs of left heart insufficiency, but not with the value of central venous pressure. 2. Fever and leukocytosis nearly always precede radiological evidence of pneumonia; their persistence does not necessarily indicate persistent pneumonia. 3. Pneumonias, effusions, atelectases and emboli are more common on the right. 4. More than 70% of central venous catheters were incorrectly placed; most commonly, the catheter was placed too low. Life-threatening complications occurred in 1.3%.

Bolus-enhanced renal spiral CT: technique, diagnostic value and drawbacks

Abstract In addition to pre- and postcontrast renal CT scans, early bolus-enhanced spiral scans during demarcation of the corticomedullary junction were acquired in 85 patients. The diagnostic value and drawbacks of the three imaging series in the evaluation of renal disease were assessed. Renal calcifications and calculus disease detected at precontrast scans (18%) were obscured after contrast administration and excretion in most cases. In the detection of renal lesions bolus-enhanced spiral CT and delayed postcontrast scans had an identical diagnostic yield (94%). Bolus-enhanced spiral CT was superior in the assessment of lesion vascularity and vascular anatomy as well as opacification of…

Gefäßrekanalisation mit einem elektrischen Thermokauter-Katheter -In-vitro-Erfahrungen mit einem neuen Kathetersystem

Recanalisation of arteriosclerotic occlusions by means of laser angioplasty, Kensey catheter and the "hot tip" catheter is undergoing early, successful clinical trials. The thermo-cautery catheter described in this paper uses the well known technique of cutting with high frequency electric currents in order to achieve vascular recanalisation. Seven attempts were made to recanalise occlusions at post mortem; four were successful, but perforation occurred in three. Histologically we found a narrow rim of carbonisation of tissues surrounded by a zone of homogenisation and a transitional zone.

Angiographien im Kleinkindes- und Kindesalter

Between 1973 and 1991 we performed 160 percutaneous angiograms (130 arteriograms, 30 phlebograms) in children and infants; 12 patients were less than one year and 52 less than ten years old. 44 of the examinations were done by a DSA technique. The examinations were carried out under general anaesthesia except in 8 cases. In 50.7% an arteriogram was carried out for the investigation of a suspected or known tumour, in 9.3% an arteriogram was required following trauma. The most common phlebographic examination was for the demonstration of the spermatic vein; in 27 patients this was done for cryptorchidism or a varicocele. The only complication following a diagnostic angiogram was perforation o…

Ergebnisse und Komplikationen von 616 perkutanen transhepatischen Gallenwegsdrainagen

During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.

Transvaskuläre Fensterung eines dissektierenden Aortenaneurysmas

Transpenile Venenokklusion zur Therapie der erektilen Impotenz

In 15 of 18 patients, 2 of them with previous surgery, transpenile venoablation was performed for treatment of erectile dysfunction due to cavernous leakage. In 4 this was combined with retrograde venooclusion via the internal iliac vein. In 4 patients normal erectile status could be obtained. In 3 other patients erections became possible with use of intracavernous vasoactive agents. In two only mild amelioration, and in two others no change of erectile dysfunction were obtained. Follow-up studies are yet missing in 3 patients. Complications of the procedure were not observed.

Perkutan transhepatische Feinkaliber-Cholangioskopie

Percutaneous transhepatic fine calibre cholangioscopy is described. A specially developed transparent instrument is used, which makes it unnecessary to have a steerable endoscope; visualisation of the biliary tree is of diagnostic value for assessing biliary stenoses due to tumours (choice of biopsy site, extent of intraductal radiation therapy) and for the assessment of anastomoses between the biliary system and the gut (condition of the mucosa, stenoses). In the presence of percutaneous biliary drainage, the method has little utility. Extension of the method for treating intraductal stones may be possible if in future a useful lumen can be added to the fine endoscope.

MR-Tomographie versus CT-Arthrographie bei glenohumeralen Instabilitäten

In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superi…

Comparison of selective internal iliac pharmaco-angiography, penile brachial index and duplex sonography with pulsed Doppler analysis for the evaluation of vasculogenic (arteriogenic) impotence.

AbstractBetween July 1987 and February 1988 selective internal iliac angiography was performed before and after intracavernous injection of papaverine plus phentolamine in 43 patients with erectile dysfunction. In 63% of the patients stenosis or occlusion of the pudendal artery was found. The penile brachial index was calculated and duplex sonography with pulsed Doppler analysis was performed in 23 patients. Angiography and penile brachial index correlated in only 39% of the patients, whereas selective internal iliac angiography and duplex sonography correlated in 91% (21 of 23). In 2 patients duplex sonography with pulsed Doppler analysis rendered better information about penile arterial p…

Computertomographie der Atelektase

After breathing pure oxygen, total atelectasis of one lung was produced in ten dogs; its development and regression was followed by CT and by conventional radiology. 30 seconds after cessation of ventilation, it was possible to show a rise in CT density of the atelectatic lung from -764 +/- 32 HU to -739 +/- 49 HU. The average time from the cessation of ventilation to total atelectasis averaged 5.5 +/- 1.1 minutes. The earliest sign on conventional radiographs was often seen after 30 seconds and usually after 60 seconds and consisted of mediastinal displacement. Extensive atelectasis regressed in only one out of six animals within one hour after resuming ventilation. The experimental method…

Hochauflösende Dünnschicht-CT zum präoperativen Staging beim Rektumtumor: Vergleich mit der endo-luminalen Sonographie und der Histologie

Rectal carcinomas are amongst the most common malignant tumours. The aim of this work was to determine whether high resolution CT with thin sections (1 mm) can provide satisfactory delineation of perirectal tumour infiltration. Correct determination of local tumour spread was possible in four out of nine patients and distinction between those tumours confined to the rectal wall and those infiltrating the perirectal tissues was possible in four out of eight patients.