Die Wertigkeit der Echtzeitelastographie in der Diagnostik des Prostatakarzinoms

Randomized biopsy sampling under transrectal ultrasound (TRUS) guidance is the gold standard for the diagnosis of prostate cancer. In addition improvements in the quality of conventional ultrasound, new methods that complement conventional TRUS are opening the door to earlier and better targeted diagnosis of prostate cancer. One of these new methods is sonoelastography. Its impact on prostate cancer diagnostics has not yet been fully investigated, but the number of publications on this new technique indicate increasing interest in it.     

Die Wertigkeit des 2005 modifizierten Gleason-Gradings in der urologischen Diagnostik von Prostatakarzinomen

In several consensus conferences of the International Society of Urological Pathology (ISUP), the Gleason grading system of prostatic carcinomas was modified and adapted to the routine histological diagnostics of specimens of core needle biopsies and radical prostatectomies. The main results are the documentation of all histological patterns (primary, secondary, tertiary) and a shifting of the maximal Gleason score of biopsies from 6 to 7a (3+4) and of radical prostatectomies from 6 and 7 to 7a and 7b (4+3). Score 2 to 4 carcinomas do not exist in the peripheral prostate. pT2 prostatic carcinomas with good prognosis have a maximal score of 7a; pT3 carcinomas with poor prognosis have a most frequent score of 7b. The agreement of the Gleason scores of core needle biopsies and radical prostatectomy specimens is more than 80%. Inter- and intraobserver reproducibility is better than after the conventional Gleason grading. The prognostic value of scores 6 and 7a may be similar. The border between low- and high-grade prostatic carcinoma may be probably Gleason score 7a and 7b. The prognostic value of score 6 should be changed to score 7a in the different therapeutic options for prostatic carcinomas.     

Die Verkalkung der Menisci des Kniegelenkes

Ohne ZusammenfassungMit 2 Textabbildungen (4 Einzelbilder)     

Die Luxation der Semilunarknorpel des Kniegelenkes

Ohne Zusammenfassung     

73. Diagnostik der frischen Knorpelverletzung des Kniegelenkes

ZusammenfaBung Die Diagnostikreiner Knorpelverletzungen ist sehr schwierig: Bei 163 Patienten mit Knorpelschaden (aus einem Kollektiv von 389 Kniegelenks-Arthroskopien) war in keinem Fall unmittelbar nach dem Unfall eine Knorpelverletzung vermutet worden.Derklinische Befund erweckt höchstens den Verdacht auf Knorpelläsion. In derArthrographie ist der Knorpelschaden nur als Zusatzbefund oder bei bekannter Lokalisation nachweisbar. Nur dieArthroskopie und dieArthrotomie sind sicher diagnostisch; die Arthroskopie ist von geringerer Morbidität und ergibt einen beBeren Überblick über sämtliche Gelenksflächen des Kniegelenkes.     

Spezielle radiologische Diagnostik der verletzten Schulter

The most appropriate method of diagnosis varies depending on the kind and the aetiology of shoulder injury. In the case of recurring dislocation, as for multidirectional bilateral instability, X-ray exposures in two planes should be performed; it may be that special projections (acetabular profile after Bernageau; Y view of scapula after Neer/Morrison) are needed. In the case of (multiply) fragmented fractures and in that of fixed dorsal dislocation the radiographs in two planes should be supplemented by computed tomography. When subluxation is suspected MR arthrography is the method of choice for diagnosis. Subacromial pain syndrome including rotator cuff pathology is best investigated with the aid of X-rays in two planes, if necessary with specific projections (Y view of the scapula as per Neer/Morrison), ultrasonography, and if appropriate, MRT.     

Die Rupturen der Sehnen am Streckapparat des Kniegelenkes

Ruptures of the quadriceps and patellar tendon are comparatively rare lesions. From the number of cases from 1973 till 1983 17 ruptures of the femoral extensor tenson and 8 ruptures of the patellar tendon were controlled diagnostically, therapeutically and in view of their long-term results. Causally in the group of quadriceps tendons 13 spontaneous ruptures were facing 4 traumatically caused ruptures. In case of traumatic ruptures 3 of them were adolescents after extreme traumatic violence by rapid traumata. Degeneratively conditioned subcutaneous quadriceps tendon ruptures we only found in case of men who were on an average older than 50 years. In spite of physiologically extreme resistance to ruptures 6 of 8 ruptures of the ligamentum patellae were ascribed to the fact that by the progressing degeneration the temaining strain capacity of the tendon was reduced below the measure of normal load. In each individual case the aspects of expert opinion were traced-above all in case of tendon ruptures with osseous patella lesions. For the first time a temporally staggered bilateral spontaneous rupture of the patella was described. The operative approach has been discussed just as much as the necessity to examine the internal knee-joint structures arthroscopically in case of the plurality of accompanying retinaculum lesions.     

Spezielle radiologische Diagnostik der verletzten Schulter

Trauma und Berufskrankheit - In Abhängigkeit von der Art und der Ursache der Schulterverletzung empfehlen sich unterschiedliche Diagnosemethoden. Bei rezidivierender Luxation sollten ebenso...     

Die Kreuzbandplastiken des Kniegelenkes

Zusammenfassung Die Verfasser berichten über eine eigene Technik der Kreuzbandplastik des Kniegelenks, die unter Verwendung konservierter Sehnentransplantate auf dem bewährten Verfahren von H. Groves aufgebaut ist. Die Verwendung dieser Transplantate ermöglicht eine Vereinfachung und Standardisierung der Technik für die vordere, hintere und kombinierte Plastik. Eine frühfunktionelle Behandlung und eine frühe Belastung des operierten Beines sind möglich. Die Technik wird an schematischen Zeichnungen dargelegt und mit Operationsfotos und klinischen Fällen belegt.

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The crucial ligament graft of the knee-jointA simplified method using free, conserved tendon graftings

Summary The report on a special technique of the cruciate ligament plastic operation of the knee-joint, based on the proved method of H. Groves by using preserved tendon transplants, is presented. The use of these transplants makes possible a simplification and standardization of the technique for the anterior, posterior and combined plastic and enables an early functional treatment and an early weight of the operated leg. The technique is demonstrated in schematic diagrams, operation photos and clinical cases.

     

Ein kurzer Beitrag zur Diagnostik und Unfallbegutachtung der Mauskrankheit des Kniegelenkes

Ohne Zusammenfassung     

Die Wertigkeit der Positronen-Emissionstomographie (18F-FDG-PET) in der Diagnostik von Rectum-Rezidivcarcinomen

INTRODUCTION:Diagnosis of extraluminal recurrent rectal cancer may be difficult. Currently the diagnosis is based on routine imaging procedures. Diagnosis often remains unverified until histological proof can be acquired by transcutaneous biopsy or operative exploration. The diagnostic value of positron emission tomography (PET) in recurrent rectal cancer was evaluated in a prospective study at the Department of Surgery of the RWTH Aachen University Hospital. The aim of the study was to assess the sensitivity of PET in the detection of recurrent rectal cancer in comparison with conventional procedures. Furthermore, the valency of PET in the diagnosis of the local expansion and metastasis was evaluated. METHODS: Since June 1997, PET has been performed in all patients with suspected recurrent rectal cancer. The examined area reaches from the neck to the symphysis. Visual assessment follows transversal, frontal and sagittal sector scans. Enhanced focal FDG uptake over the physiological enrichment of the environment (e.g., urinary tract) was defined as a criterion of malignancy. The findings were compared with the results of routine diagnosis and histological examinations. RESULTS: Up to now, 23 patients have been subjected to a PET examination. In 17 cases, a local recurrence could be proved. An intrahepatic metastasis was found in 11 patients, pulmonary metastasis in 3 patients, lymph-node metastasis in 5 patients, and a peritoneal carcinomatosis was found in 4 patients. All these findings were confirmed by histological examinations after biopsy and operation or by other imaging procedures and the clinical follow-up. CONCLUSIONS: The controlled results show that PET can detect recurrent rectal cancer and its metastasis with great precision. PET seems to be a useful additional examination in the diagnosis of extraluminal recurrent rectal cancer.     

Die Strecksteife des Kniegelenkes

Zusammenfassung Die Kniestrecksteife bei der Immobilisation gesunder Kniegelenke ist keine Kontraktur, sondern durch die fibröse Strangbildung — gleichsam Verlötung — zwischen den Synovialblättern des oberen Recessus bedingt. Die Verklebungen kommen durch den herabgesetzten Synovialflüssigkeitsaustausch am ruhiggestellten Gelenk zustande. Durch Fixierung des Kniegelenkes in ca. 120° Beugestellung wird der obere Recussus weitgehend entfaltet und eine Verklebung mit dadurch bedingter Beugehemmung vermieden. Die Lösung von bindegewebigen, beugehemmenden Strängen im oberen Recessus ist durch Luftfüllung des Gelenkes zu beseitigen.Bei der seltenen durch Dystrophie bedingten Beugehemmung handelt es sich, im Gegensatz zur Strecksteife nach Immobilisation, nicht um fibröse Verklebungen, sondern um eine echte Schrumpfung des oberen Kniegelenkrecessus.

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Summary The knee extension stiffness during immobilisation of sound knee joints is no contracture, but is conditioned by the fibrous cord formation — almost a soldering — between the synovial membranes of the upper recessus. These agglutinations occur because of the reduced synovial liquid exchange in the immobilised joint. By fixing the knee joint in a flexural position of 120° the upper recessus will be largely unfolded and flexion stoppage depending on agglutination avoided. The detachment of flexion-stopping, connective tissue cords in the upper recessus can be eliminated by an air filling (inflation) of the joint.Contrary to the extension stiffness after immobilisation, the rare flexural stoppage caused by dystrophy is not a matter of fibrous agglutinations, but of a pure shrinking of the knee joint's upper recessus.

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Résumé Le raidissement du genou pendant l'immobilisation des articulations de genou saines n'est pas une contracture, mais est causé par la formation des cordons fibreux — presque une soudure — parmi les membranes synoviales du recessus supérieur. Ces adhérences se forment à cause de l'échange diminué des liquides synoviaux dans l'articulation immobilisée. Par la fixation de l'articulation du genou dans une position fléchie de ca. 120° le recessus supérieur est largement déployé et l'adhérence ensemble avec un empêchement de la flexion est évitée. Le détachement des cordons de tissu conjonctif empêchant la flexion dans le recessus supérieur est à éliminer par le gonflement d'air de l'articulation.Au contraire du raidissement après l'immobilisation, en cas de l'empêchement de flexion très rare, causé par la dystrophie, il ne s'agit pas d'une adhérence fibreuse mais d'un véritable rétrecissement au recessus supérieur de l'articulation du genou.

     

Die Arthrolyse des Kniegelenkes

The surgical treatment of the extensor rigidity of the knee joint described by Payr was performed in fourteen cases at the Orthopedic University Hospital of Giessen. A flexion of more than 90° was achieved in all patients. In case of correct indication, this method has still its value in orthopedia even regarding the changed patient categories.     

Die Behandlung der verletzten milz

Zusammenfassung Neue Methoden zur Blutstillung am Parenchym erlauben es, Milzverletzungen sicher zu versorgen. Insbesondere die Infrarotkontaktcoagulation hat sich als einfache, billige and verläßliche Methode erwiesen. Die Notwendigkeit der technischen Splenektomie bei akzidentellen Verletzungen konnte auf ein Fünftel gesenkt, von 58 verletzten Milzen beim stumpfen Bauchtrauma konnten 8 erhalten werden.

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Treatment of the injured spleen

Summary Secure hemostasis in the spleen can be achieved by infrared contact coagulation, a simple, cheap and reliable method. The need for technical splenectomy during abdominal operations can be reduced to one fifth, in blunt abdominal trauma a substantial number of spleens can be saved.

Auszugsweise vorgetragen auf der Tagung der Vereinigung Mittelrheinischer Chirurgen in Würz-burg, 2.-4. 10. 1980     

Die Wertigkeit des intraoperativen Ultraschalls bei der benignen Knotenstruma

Background

In treating benign nodular goiter, selective surgery taking into account morphology and function is better than standard subtotal resection for reducing the frequency of nodules in the thyroid remnant. Intraoperative ultrasound (IOPUS) may additionally influence operative radicality and also the incidence of remaining nodules.

Methods

One hundred consecutive patients with benign nodular goiter were operated on with IOPUS; the specimens were compared with results of preoperative ultrasound and intraoperative palpation. Of these patients, 80 were reinvestigated after 3±1.6 years. A series of 80 patients with the same operative strategy but without IOPUS was used as control group, having been reinvestigated sonographically 1 year postoperatively, and was compared to the IOPUS group with respect to operative procedures, size of remnants, and sonography of lesions in thyroid remnants.

Results

In 35% of the thyroid lobes, preoperatively undetected nodules could be identified additionally by IOPUS, which also provided information on extent and structure in a further 20%. It resulted in the indication for more radical surgery in 24% and greater tissue preservation in 10%. Compared to surgery without IOPUS, IOPUS-guided surgery was more radical (total lobectomy in 40% vs 24%, nonresected lobes in 16% vs 26%, P<0.05) and showed a lower incidence of nodules in remnants at follow-up (2.5% vs 12.5%, P<0.05).

Conclusions

With IOPUS, more nodules are detectable, size and structure of the remnants are optimized, and the number of nodular lesions in thyroid remnants is lower. Thus, an even lower risk of recurrence can be expected for long-term follow-up. All in all, the routine use of IOPUS can be advocated, with maintenance of the selective operative strategy.     

Die Wertigkeit der Sentinel-Lymphknotenbiopsie am Beispiel des malignen Melanoms

Zusammenfassung Die Sentinel-Lympknotenbiopsie hat beim Melanom die elektive Lymphknotendissektion verdrängt und liefert eine exakte Stagingmethode des regionären Lymphabstromgebietes bei geringer Morbidität. Patienten mit einem nachgewiesenen Befall des Wächterlymphknotens können mit Hilfe der Sentinel-Lympknotenbiopsie gezielt einer regionären Lymphknotendissektion unterzogen werden, die Schaffung von homogenen Patientengruppen bei der frühzeitigen Eingliederung in adjuvante onkologische Behandlungsregimes wird ermöglicht. Der Wächterlymphknotenbefall gilt derzeit als wichtiger unabhängiger prognostischer Faktor, die Wertigkeit anschließender operativer und/oder medikamentöser Therapiemaßnahmen bei positivem Wächterlymphknoten im Hinblick auf eine Prognoseverbesserung ist Gegenstand laufender Studien.