PURPOSE: To evaluate the long-term results of recanalization of occluded iliac arteries with local low-dose thrombolysis, angioplasty, and, if necessary, stent implantation.MATERIALS AND METHODS: Forty-seven patients with acute or chronic occlusions of the common or external iliac artery, or both, underwent local low-dose thrombolysis (n = 47), percutaneous transluminal angioplasty (PTA) (with balloon dilation [n = 43] and rotational angioplasty [n = 30] in the patients in whom a retrograde recanalization was performed), and, if needed, intravascular stent placement (n = 18). Follow-up lasted 3-53 (mean, 21) months.RESULTS: The primary recanalization rate was 98% (46 of 47). The mean ankle-brachial index increased from 0.33 to 0.81 within 14 days after treatment and was 0.76 at the most recent follow-up. Two early (< 14 days) and two late reocclusions (after 24 and 30 months) occurred; one restenosis detected with duplex sonography and angiography was observed after 19 months.CONCLUSION: This therapy represents a true alternative to vascular surgery and a first-line treatment for acute or chronically occluded iliac arteries.

Renal artery stenosis (RAS) is a rare cause of hypertension. Radiological tests can disclose the morphological changes, but not their functional effect on renal function and perfusion. Normalization of the blood pressure can be achieved by intervention (operation, percutaneous transluminal renal angiography; PTRA), in cases of prolonged RAS-induced hypertension long-term preservation of the organ function is most important. The purpose of this study was the validation of captopril renography as a screening test for hypertension secondary to RAS prior to PTRA. Captoprilrenography with 99mTc-MAG 3 has a high sensitivity (94%) and acceptable specificity (88%) for the screening of hypertensive patients. The positive predictive value is 74% and the negative predictive value 98%, compared with the "gold standard" of angiography.

Renal artery stenosis (RAS) is a rare cause of hypertension. Radiological tests can disclose the morphological changes, but not their functional effect on renal function and perfusion. Normalization of the blood pressure can be achieved by intervention (operation, percutaneous transluminal renal angiography; PTRA), in cases of prolonged RAS-induced hypertension long-term preservation of the organ function is most important. The purpose of this study was the validation of captopril renography as a screening test for hypertension secondary to RAS prior to PTRA. Captopril renography with 99mTc-MAG 3 has a high sensitivity (94%) and acceptable specificity (88%) for the screening of hypertensive patients. The positive predictive value is 74% and the negative predictive value 98%, compared with the "gold standard" of angiography.

Chest radiographs, full lung tomography and computed tomography of the chest provide increasing sensitivity for evaluation of pulmonary metastases. Pulmonary nodules of 5–10 mm diameter are detectable with increasing frequency by use of high kilovoltage chest radiographs. Full lung linear tomography provides an overall accuracy of 72–97% in diagnosis of pulmonary nodules. Chest CT delineates pulmonary nodules as small as 3 mm within 10 mm slice sections. However, as sensitivity increases, specificity diminishes in identifying metastatic nodules. Sensitivity in CT is also reduced by false negative findings due to unequal respiratory cycles. Comparative radiologic-pathologic evaluation of nodule detection proved CT to be the most sensitive screening method for pulmonary metastases. Timing of follow-up studies for pulmonary nodule detection in cancer patients can be determined by tumor growth kinetics; 3–6 month intervals proved to be useful.

Art und Ausmaß von Embolien, die bei der Angioplastie von Beckenarterienstenosen auftreten, wurden bei 50 Patienten untersucht. Bei 18 % waren Embolien nachweisbar. Diese bestanden überwiegend aus atheromatösem Material und waren bei 10 % der Patienten bereits makroskopisch zu erkennen. Hierdurch bedingte Komplikationen sind jedoch sehr selten.

Very soon after percutaneous transluminal angioplasty (PTA) was introduced in the therapeutic management of vascular diseases of our clinic in 1978, we were asked to dilate our first restenosed distal anastomosis of a femoropopliteal bypass in a patient who already had had three operations. Although we were very restrictive in the following years in indicating PTA for treatment of postoperative reocclusions, the good results we achieved led to an increasing demand for postoperative problems to be solved with interventional radiological methods (Fig. 1).

In approximately 2-7% of patients with Wegener's granulomatosis involvement of the prostate has been demonstrated histologically. This usually comes about quite late in the course of disease, after generalization of the granulomatous vasculitis from respiratory tract to kidneys and other organs. The patient we present had a highly atypical first manifestation of Wegener's granulomatosis in the prostate, generalized vasculitis not developing until later. When a biopsy shows unclear granulomatous changes in the prostate, a test for anticytoplasmatic antibodies should be performed in addition to the conventional serologic and cultural examinations. Anticytoplasmatic antibodies are highly specific for the diagnosis of active Wegener's granulomatosis. Early diagnosis and immediate initiation of immunosuppressive therapy with cyclophosphamide and corticosteroids can prevent or limit organ damage and improve the prognosis in Wegener's granulomatosis.

Microaneurysms of renal and visceral arteries are characteristic signs of periarteritis nodosa. Normally they are not found in Wegener's disease, where glomerulonephritis is commonly observed. We report on a patient with vasculitis of the upper and lower respiratory tract, focal glomerulonephritis, prostatic and pulmonary granulomas and anti-cytoplasm antibodies corresponding to Wegener's disease. The most striking findings in angiography were multiple small aneurysms of the peripheral branches of the renal artery. At necroscopy these angiographic findings were histologically proven as necrosis of the arterial wall with destruction of the elastic lamina, causing local vascular ectasia. These renal vascular changes are a characteristic sign of periarteritis nodosa. The combination of clinical, laboratory, radiologic and histologic findings in our patient can be explained as an overlap-syndrome of Wegener's disease and periarteritis nodosa. We assume that the combination of pathologic findings in our patient correspond to a rare atypical renal manifestation of Wegener's disease.

Quality and frequency of embolisation caused by angioplasty of stenoses of iliac arteries were investigated in 50 patients. In 18% emboli were found. They mostly consisted of atheromatous material and were visible by macroscopic view in 10% of the patients. Complications caused by embolisation during angioplasty of iliac artery stenosis however are very rare.

Even in this era of sonography, arthrography of the shoulder is an important diagnostic investigation, making it possible to exclude unrecognized connective tissue lesions in patients with chronic shoulder pain resistant to therapy. Sometimes standard X-ray techniques do not yield all the information the surgeon needs about ventral or dorsal localization of a rotator-cuff rupture. An additional approach to the joint is needed: a transthoracic lateral-view X-ray provides the surgeon with adequate information to help in selection of the most appropriate operative approach to the shoulder.

Since carcinoma of the esophagus originates in the mucosa, diagnostic procedures that directly image the mucosa such as endoscopy and barium esophagograms are useful as screening procedures. These examinations are limited in their ability to detect submucosal or extraesophageal disease. CT is suited for evaluation of sagittal and vertical spread of the carcinoma because of its cross-sectional imaging ability.

In einem Zeitraum von 8 Jahren wurden in der Universitätsklinik Freiburg und in der Hochrheinklinik Bad Säckingen insgesamt 4450 (von 1978–1987: 4750) perkutane transluminale Angioplastien (PTA) durchgeführt. Von 1984 bis 1986 wurden sämtliche Patienten klinisch und teilweise angiographisch nachuntersucht. Der weitaus größte Anteil der angioplastischen Eingriffe lag im Becken-Bein-Bereich.

Die Angiographie liefert bei der Beurteilung eines stenotischen oder okkludierten Segmentes einer Arterie lediglich eine Gefäßsilhouette, die über den Stenosegrad gelegentlich nur unzulänglich informiert. Umgekehrt ist eine Angiographie nach Ballondilatation nicht immer aussagekräftig, was die Flußdynamik nach PTA betrifft. Von Interesse ist auch die murale Gefäßbeschaffenheit nach Rekanalisation oder Dilatation im Sonogramm. Seit 1978 wurden durch die Universität Freiburg/Zentrum Radiologie und durch die Hochrheinklinik Säckingen/Röntgenabteilung 4450 perkutane Angioplastien durchgeführt (Tabelle 1).

Ein zentrales Problem für die Durchführung einer lokalen Lyse ist die zeitliche Begrenzung nach einer Thrombose. Gründe für eine Verschlußsituation in einem arteriellen Gefäß sind vielfältig, wobei die Angiographie als diagnostische Methode der 1. Wahl lediglich das verschlossene Gefäßsegment zeigt. Eine Information über das okkludierte Gefäß selbst ist jedoch nicht möglich. Die Sonographie ist hier in der Lage, über ein nicht darstellbares Gefäßlumen weitere Informationen zu geben. Wichtig ist ebenfalls eine weitere Information über das thrombotische Material selbst. 4450 perkutane Angioplastien wurden seit 1978 in der Universitätsklinik Freiburg und in der Hochrheinklinik Säckingen durchgeführt. Bei 250 Patienten wurde eine lokale intraarterielle Lyse kombiniert, teils mit oder ohne Dilatation.

The diagnostic value of CT in follicular thymic hyperplasia and in thymomas in 8 patients with myasthenia gravis and in 12 patients without myasthenia gravis suffering from thymic tumors was evaluated by correlating CT-findings to surgical results and pathological-histological findings. Thymic size of the six patients with histologically proven follicular hyperplasia were scattered within the normal range, but half of them were at the upper limit. Thymic tumors were differentiated between invasive and non invasive tumors by CT staging. Solid tumors with different histology could not be further classified; the attenuation values ranging from 15-55 HU were the same in tumors, follicular hyperplasia and normal thymus.