B. Schwaighofer

Degenerative Achilles tendon disease: assessment by magnetic resonance and ultrasonography

As Magnetic Resonance (MR) imaging and Ultrasound (US) allow the evaluation of soft-tissue structures not previously possible with other imaging techniques, a clinical study has been undertaken to determine the value of these two modalities in the detection of lesions in the Achilles tendon (AT), other than acute total rupture. Seven healthy subjects and 28 symptomatic patients with Achillodynia and/or signs of thickening of the AT were investigated with MR and US; all results were compared with the clinical features. Surgical findings were available in 14 patients. The patients were divided into three groups; those with tendon thickening, incomplete and complete chronic ruptures. Thickening of the AT was easily detected with both methods. MR was superior in the detection of incomplete tendon rupture and in the evaluation of various stages of chronic degenerative changes. We conclude that only if US remains unclear, an additional MR study should be performed and together with the clinical diagnosis indication for surgery can be made more efficient.

MRI evaluation of pigmented skin tumors. Preliminary study.

Magnetic resonance imaging (MRI) was performed in 16 patients with pigmented skin lesions, seven with nodular melanomas, two with superficial spreading melanomas, two with subcutaneous melanoma metastases, and five with different benign pigmented nodular skin lesions. The results of MRI were compared with the histologic diagnoses. Signal intensities of the lesions were compared with subcutaneous fat, revealing a lower signal intensity of all lesions on T1-weighted images. Intensity measurements showed a significant (P less than .01) difference between benign and malignant lesions on T2-weighted images.

Esophageal tracheal combitube (ETC) for emergency intubation: anatomical evaluation of ETC placement by radiography.

The esophageal tracheal combitube (ETC) is designed for emergency intubation. The ETC is inserted blindly allowing ventilation after either esophageal or endotracheal placement. A special pharyngeal balloon serves to seal the upper airways. In 10 cardiac arrest patients, emergency intubation with the ETC was performed. Blood gas analyses showed adequate ventilation. Radiography proved correct placement of the proximal and distal balloons in accordance with design theory. Hyperinflation experiments documented expansion of the proximal balloon into the oral cavity rather than towards the epiglottis.

Duplex sonography of tumors of the carotid body.

Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.

[Diagnosis of varices in liver cirrhosis: duplex ultrasound versus gastroscopy].

This study assesses the usefulness of duplex sonography in the diagnosis of oesophageal varices. 32 patients with liver cirrhosis were studied by endoscopy and duplex sonography. There was an excellent correlation in the case of the medium-sized and large-sized varices. Only small varices could not be detected by duplex sonography. On the other hand, 3 large-sized paraoesophageal varices, which were not identified by endoscopy, were easily seen by duplex sonography. The sensitivity of duplex sonography was between 0.8 and 0.9, the accuracy between 0.93 and 0.96.