OBJECTIVE:We report on a 3-year experience using single-shot, ultrasonography-guided, percutaneous ethanol ablation (PEA) of hyperplastic parathyroid glands in chronic dialysis patients suffering from secondary or tertiary hyperparathyroidism.MATERIALS AND METHODS:Seventeen uraemic patients (mean age 52 +/- 14 years) with hypercalcaemia and elevated serum levels of parathyroid hormone were assessed for ethanol ablation. Ten patients did not fulfil the inclusion criteria and underwent surgical parathyroidectomy. Seven patients were treated using PEA.RESULTS:All patients treated with PEA tolerated the procedure well, and no major complications were observed. Three out of seven patients underwent further ethanol ablation due to recurrent symptomatic hyperparathyroidism. Following the procedures, serum values of total calcium and parathyroid hormone remained within target range with concomitant medical therapy in all patients.CONCLUSION:PEA performed as a single-shot therapy can be used as a minimally invasive and safe supplement to medical therapy in the treatment of secondary or tertiary hyperparathyroidism in selected patients. In case of recurrence, treatment can be repeated without any problems.

Problemstellung: Der Unterschied der Sonographie gegenüber den anderen Schnittbildverfahren (CT/MR) ist die Echtzeitinformation, wobei z.B. bei US-KM-Untersuchungen die real-time-Darstellung der verschiedenen KM-Anflutungs- bzw. Durchblutungsphasen wesentliche diagnostische Informationen liefert.

212 mobile patients with acute symptomatic iliofemoral deep vein thrombosis were investigated by magnetic resonance imaging (MRI) of the pelvic and abdominal veins. Most proximal parts of clots could be localized in the following vein segments: common femoral vein 24 (11%), external iliac vein 93 (44%), common iliac vein 49 (23%), inferior caval vein 46 (22%). All patients were treated with low molecular weight heparin, compression bandages and walking exercises. In order to assess the potential danger of this regimen avoiding bed rest V/Q scans were performed at admission and repeated 10 days later. A comparison between the outcome of the 46 patients with thrombi in the vena cava and 743 patients with femoral DVT, who were treated by the same regime, did not reveal a statistically significant difference, neither of the rate of primary pulmonary embolism (PE) nor of new PE's in the second lung-scan. 31 patients with caval vein thrombosis could be followed between 1 and 7,5 years later. Six patients died, mainly from malignant disease. The late results of the remaining 25 patients were surprisingly mild in most instances, although 10 patients had to be readmitted, 5 because of thromboembolic recurrence.

Objective: The aim of the study was to determine whether regional cerebral blood flow in survivors of torture suffering from post-traumatic stress disorder (PTSD) differed significantly from that in healthy controls. Method: We examined the cerebral regional distribution of 99m-technetium-hexamethylpropyleneamineoxime (HMPAO) using single photon emission computed tomography (SPECT) in 8 patients and in 8 healthy controls. A semi-quantitative analysis was performed in which symmetrical regions of interest (ROI) were drawn in all subjects. Results: Regional blood flow was markedly more heterogeneous in patients suffering from PTSD than in healthy controls. The differences are significant. Conclusion: Severe psychological trauma induced by torture can cause neurobiologic alterations that may contribute, even years after the original trauma, to a number of complaints commonly expressed by patients suffering from PTSD.

AIMSThe aim of this study was to develop a criterion with a high negative predictive value for the evaluation of breast lesions. We aimed to determine the value of combining three non-invasive tests, mammography (MM), ultrasonography (USS) and 99mTc-methoxyisobutylisonitrite (99mTc-MIBI) scintimammography (scinti-MM).METHODSWe included 94 consecutive patients with suspected lesions detected by mammography or on physical examination. MM, USS and scinti-MM were performed no more than 4 weeks prior to excisional biopsy in all patients. We then compared the biopsy results with a score calculated for each patient, derived from the results of the three tests, which we termed 'mamma malignancy index' (MMI).RESULTSEach of the three exams yielded a score ranging from 0 to 2, with 0 representing an almost certainly benign lesion, 1 an indeterminate finding and 2 a likely malignant lesion, and hence giving a total score ranging from 0 to 6. The biopsy results showed that the lesions in 64 patients were benign. Forty-nine (77%) of these patients had received an MMI score of 0 or 1. The negative predictive value for malignancy in patients with a score less than 2 was 100%.CONCLUSIONSSince the smallest detected lesion was 9 mm in diameter, we conclude that MMI may be a highly useful diagnostic tool in the delineation of breast lesions > or =1 cm which should not be routinely referred for biopsy but may be followed non-invasively. Although fine needle aspiration has limitations, we would recommend it as a less invasive method to evaluate suspected lesions smaller than 1 cm.

51 patients with metastatic colorectal cancer (stage Dukes D) were treated with intravenous (i.v.) infusion on days 1, 3, 5, 8 and 16 with folinic acid (200 mg/m2) and 5-fluorouracil (600 mg/m2), and on days 1, 8 and 16 with cisplatinum (25 mg/m2 i.v.); cycles were repeated every 4 weeks. All 51 patients were evaluable for toxicity and response criteria. 26 patients had objective responses (3 complete responses, 5.9%; 23 partial responses, 45.1%), relative risk 51% (95% confidence intervals 36.7–65.0%). Response duration ranged from 4 to 28.0 months (median 16.8). Overall median survival of all patients included was 14.7 months (range 3.0–33.0). Toxicity of WHO grade III, requiring dose reduction, occurred in 9 (18%) patients. The regimen described here appears to be active, safe and well tolerated for treatment of patients with advanced colorectal cancer.

BACKGROUND:Neoplasias, especially in their more advanced stages, are often associated with chronic anemia of malignancy which impairs the patient's physical ability and quality of life.PATIENTS AND METHODS:Forty-two patients with chronic anemia associated with hematological malignancies (18 multiple myelomas, 10 myelodysplastic syndromes) or solid tumors (9 breast cancers, 5 colon cancers) were treated with 150-300 units/kg rHuEPO for a median time period of 16 weeks. Response was defined as an increase of the initial hemoglobin level by at least 2 g/dl.RESULTS:The response rates for solid tumors were comparable (44.4% and 40% for breast cancer and colon cancer, respectively), whilst the response in patients with hematological malignancies depended strongly on the disease entity (77.8% for multiple myeloma, 10% for myelodysplastic syndrome). Pretreatment serum levels of endogenous erythropoietin (EPO) were significantly higher in non-responding patients than in responders. During rHuEPO therapy, EPO levels in non-responders increased even further, while they remained basically unchanged in responding patients. In responders, the WHO performance status before the start of rHuEPO therapy was more favorable and showed impressive improvement during the course of treatment. The median survival time of responders was 28.0 months as compared to only 9.2 months for non-responders. Clinical symptoms of anemia subsided or at least considerably improved under successful rHuEPO therapy. With the exception of occasional flu-like symptoms, no undesirable effects of rHuEPO treatment were observed.CONCLUSIONS:In conclusion, rHuEPO treatment corrected anemia of malignancy both in patients with hematologic disease and in those with solid tumors, but responsiveness varied considerably amongst the different disease entities.

Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.

Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.

We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.

Bei 7 von 53 Patienten mit retroperitonealen Malignomen wurde sonographisch eine Tumorausdehnung in die Vena cava inferior (VCI) festgestellt und die Ergebnisse mit Cavographie und Operation verglichen. In drei Fällen stimmten Sonographie und Cavographie überein, bei 3 Patienten konnte die Länge der Cavaveränderungen nur im Ultraschall exakt beurteilt werden. Während sonographisch in einem Fall ein infiltratives Einwachsen vermutet wurde, ergab die Cavographie einen zapfenförmigen Tumorthrombus. Die Indikation zur Cavographie wird heute nur mehr in Einzelfällen zur Unterscheidung zwischen komplettem und inkomplettem Cavaverschluß und bei Verdacht auf Wandinfiltration gestellt.

In seven out of 45 cases with malignant growths in kidneys and adrenal glands, sonography presented tumor-induced changes in the vena cava. The accuracy of this technique in detecting changes in the vena cava corresponds to that of cavography. Thus, it is no longer necessary to use cavography--except as a supplementary method mainly in cases where with sonography it is difficult to differentiate between an incomplete and a complete occlusion of the vena cava or between a cone-shaped invasion of the neoplastic thrombus into the inferior vena cava and an infiltration of the tumor into the wall of the vena cava.

The data of 34 patients with a sonographically established dilated common bile duct were analysed as to the clinical significance of these findings. Whereas it was possible to diagnose dilated proximal common bile ducts in all of the cases under examination, presentation of the distal section succeeded in only 56% of the patients involved. Thus distal concretions escaped diagnosis in seven out of 24 cases. There is no established relation between the extent of dilatation of the common bile duct and hyperbilirubinemia; quite to the contrary, in three cases without any signs of arrest of bile excretion under chemical analysis, it was not until ultrasonography was performed that some initial indications of an impeded bile outflow due to concretions were discovered. It was possible to obtain a confirmed diagnosis in the case of two pancreas carcinomas, three bile duct carcinomas, a local recurrent carcinoma of the gall bladder and lymph node metastases of a gastric carcinoma in the hepaticoduodenal ligament. In another gall bladder carcinoma nothing but dilated bile ducts presented itself. What was thought to be a hepatoma, turned out to be a carcinoma of the bile duct during autopsy. A cirrhotic carcinoma of the common bile duct was considered to be a case of calculi in the common bile duct without shadow when examined with ultrasound. During their stay in the hospital, four patients passed gallstones, thus relieving distention of the duct. Additional tests were carried out in 16 patients (47%) in order to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)