[en] The lateral distant view (LDV) of the rectum is proposed for more precise identification of localization of rectal tumors for preoperative planning and to increase the number of sphincter saving operations. In a prospective study 129 patients with rectal tumors were compared with radiologic and rectoscopic measurements and with the intraoperative tumor site. Other factors which may influence the resectability of tumors have been examined in a part of this patients by measuring the width of the presacral space, the anorectal angle and the pelvic diameters by radiological pelvimetry. Radiological measurement on the lateral distant view showed that tumors usually are located much higher (0.5 to 12.5 cm) than is suggested by rectoscopy. Unlike the rectoscopy, the lateral distant view also can be used for measuring the length of the anal canal. This measurement is most important for evaluating the distance between the tumor and the inner end of the anal canal and reflects the width of a possibly tumor-free margin. Sphincter saving operations could be predicted much better by the lateral distant view than by rectoscopy. (Author)

[en] The value of pharmaco-angiography (Priscol, angiotensin) in the diagnosis of tumourous and inflammatory diseases in bones and soft tissues was investigated in 81 patients. Priscol was used in 49 patients, angiotensin in 28 and both substances in four. It was shown that neither Priscol nor angiotensin produced results of diagnostic value, provided an optimal technique was used (antegrade, selective contrast injection with an adequate volume of contrast and in the absence of vascular spasm). Priscol was of value for reducing or preventing spasm in peripheral vessels. Angiotensin is superior to Priscol in demonstrating the angiographic criteria, but pharmaco-angiography did not result in a better distinction between tumours and inflammatory lesions. (orig.) 891 MG/orig. 892 MKO

[en] Unilateral or bilateral embolisation of the internal iliac artery was effected in nine patients with incontrollable bleeding due to bladder tumour or invasion of a tumour into the bladder, or as a result of massive alterations of the urinary bladder caused by radiation exposure. A clearly superior haemostasis was achieved via bilateral embolisation (in 4 out of 5 patients) compared with unilateral embolisation (2 of 4 patients). Side effects were observed in two-thirds of the cases (elevated temperature, transient pareses and pain in the gluteal and leg regions). (orig.)

No abstract available

[en] Thirty-seven patients, in whom the stomach had been transposed in order to replace a long segment of the oesophagus, were studied. Radiologically important early complications and the late results of this surgical technique were correlated. Twenty-five patients were observed radiologically and clinically for a period of three to 20 months. The study was directed at the morphology of the transposed stomach and of the anastomosis, and particularly at the problem of gastro-oesophageal reflux. Knowledge of the operation site is essential for evaluating the transplant (pleura defect). Radiological examination is the most suitable method for evaluating the cervical extra-thoracic anastomosis in the early post-operative phase (six to ten days). It is also effective at a later stage for the early recognition of fibrotic stenosis which will require treatment. An attempt has been made to define an ideal situation following gastric transposition which will usually correspond with a good clinical result. (orig.)

[en] Three case reports are reviewed to illustrate the possibility of treating irradiation-induced lesions of the subclavian-brachial vascular segment (aneurysm and segmental occlusions) 14, 20, and 26 years after radical mastectomy and subsequent radiotherapy. All patients had an extraanatomic vein bypass graft from the carotid to the brachial artery crossing the shoulder near the acromioclavicular joint, with the advantage that the tissue changed by radiotherapy or infected by ulceration could be circumvented. There were no postoperative complications, with adequate function of the grafts (follow-up, 17, 24, and 20 months, respectively)

[en] The influence of the various functional states of the pelvic floor on the radiological assessment of the tumour levels and the distant tumour-free distance in rectum neoplasms was investigated. The parameters 'anal canal length', 'anorectalangle' and 'impression of the puborectalis muscle' were measured in lateral distant views of the rectum in a series of healthy controls (n = 160). In addition, these parameters and the 'distant tumour-free distance' were measured in patients with rectal cancer (n = 40). For each patient the lateral distant view at rest, during contraction and during maximal relaxation (straining) of the pelvic floor, were available for retrospective analysis. Depending on the various functional states of the pelvic floor, the differences between the same parameters were statistically significant (p < 0.001). The average difference between the distal tumour-free distances during contraction and straining was 1.5 cm. Therefore, measurements of this distance in one lateral distant view exclusively may result in an inaccurate assessment of the tumour level. For the individual planning of extreme sphincter-saving surgery in low rectal cancer based on lateral distant view, the view at rest appears to be the most suitable. However, additional x-rays during contraction and maximal relaxation of the pelvic floor, respectively, should be available to identify the view at rest for an accurate assessment of the tumour level and to avoid misinterpretations which would have falsely influenced the planning of rectum surgery in 20% of our cases. (orig.)

[en] Pseudodisplacement of a left sided superior vena cava catheter in a persistent superior vena cava may be expected in adults in 0,37% and in a group of children with congenital heart disease in 2,5%. Embryology, anatomy and clinical implications is discussed on the basis of our own cases. The vena cava superior sinistra persitents is depending on a sufficient calibre a suitable vessel for a superior cava catheter. (orig.)

[en] During a 16-months prospective study the frequency of displacements and complications of superior vena cava catheter has been investigated. The study showed, that the right jugular catheter has the lowest frequency of complications, and should be of primary choice. Pneumothoraces are rare with jugular vena catheters (0,05%), more frequently with subclavian catheters. Setting of superior vena catheter displacement in large veins is quite common. More important are catheter displacements in small veins, which are more frequent with jugular than with subclavian vena catheter (vena thoracica interna, vena pericardiacophrenica). Adequate X-ray control (high KV technic, sufficient amount of contrast medium) is necessary to recognize these complications. Correction of displaced catheter should be done under fluoroscopy. Serious complications s.e. tension pneumothorax and haematothorax are rare and should be treated surgically. In some cases non recognized extraversal catheterposition is followed by infusions into the pleural cavity or the mediastinum. (orig.)

[en] To warrant permanent surgical cure of high anal fistulae, while avoiding at the same time faecal incontinence due to inadvertent division of the puborectalis muscle, distinction between a trans- and suprasphincteric fistula track is essential. This differentiation is often crucial, since digital-rectal palpation and conventional fistulography tend to be unreliable. Therefore we developed a radiological technique of imaging the anorectal fistulous track, 'drain fistulography'. After silicon drainage of the fistula the contrast-visualization of anal canal, rectum and fistula drain allows to assess the topographic relation between fistula and anal sphincters as well as the sphincteric functional component above the fistula. A transsphincteric fistula track was demonstrated in 7 of 8 patients (5 with recurrent fistulae) by means of 'drain fistulography', permitting complete laying open of each fistula in a second operation. In one patient a supraphincteric fistula track was found and a 'mucosal flap repair' was carried out. After a mean observation time of 53 months all patients are perfectly continent and free of recurrence. The method of 'drain fistulography' is a valuable diagnostic tool to select the appropriate definitive surgical procedure in the treatment of high anal fistulae. (orig.)