Focal liver masses: differential diagnosis with pulsed Doppler US

Duplex Doppler ultrasound (US) was used in 68 consecutive patients with focal liver lesions, including 12 hepatocellular carcinomas, one cholangiocarcinoma, 37 metastases, 15 hemangiomas, one hemangioendothelioma, and two focal nodular hyperplasias. Of the hepatocellular carcinomas, six were diffusely hyperechoic, two were hypoechoic, two were single hyperechoic lesions, and two were multifocal and hyperechoic. All ten tumors with Doppler shifts of 5 kHz or above proved to be hepatocellular carcinomas. The other two hepatocellular carcinomas showed Doppler shifts of 3 kHz. In contrast, no hemangioma showed shifts above 0.7 kHz, and ten of the 15 gave no detectable signal. Of the metastases, 20 gave no signal and 17 had signals of up to 4 kHz. Three-kilohertz signals were also obtained from a cholangiocarcinoma, a hemangioendothelioma, and focal nodular hyperplasia. Correlation with angiographic findings suggested that the high-velocity Doppler signals were associated with large pressure gradients due to arteriovenous shunting. Duplex Doppler US can therefore aid in the differential diagnosis of diffuse and focal liver lesions.     

Angioödem durch C1-Esterase-Inhibitor-Mangel oder ACE-Hemmer?

A 49-year-old woman was admitted to the intensive care ward with increasing shortness of breath due to a massive soft tissue swelling of the neck and face and a marked macroglossia. Similar symptoms were already observed earlier in the patient as well as her father, although such symptoms were never as dramatic as they were on this occasion. The patient was intubated bronchoscopically and treated unsuccessfully with cortisone, fresh plasma und C1-esterase inhibitor. The patient only first reported intake of an ACE inhibitor a few days after the acute episode, which was most probably the causative factor given that serum C1 and C4 complement factors were almost normal.     

Untersuchungen an 1,3-Dicarbonyl-Verbindungen, 22. Mitt. 3-Acyl-4-oxo-4H-[1]benzofuro[3,2-b]pyrane

1,3-Dicarbonyl Compounds, XXII: 3-Acyl-4H-[1]benzofuro[3,2-b]pyran-4-ones Attempts are reported to obtain the aldehyde 7 , a key compound for the synthesis of substances which are potentially antiallergic.     

The functional treatment of pyogenic arthritis of the adult knee.

A method of treatment of pyogenic arthritis of the adult knee employing wide open arthrotomy and early active motion, as well as synovectomy in some knees, was used in thirty-four patients with pyogenic arthritis of the knee. Of these patients, sixteen had a good result, twelve had a fair result, and six had a poor result. This method of treatment was used as a salvage procedure in most of the patients, but may have more general application in the treatment of pyogenic arthritis of the knee.