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The rare Dunbar syndrome or medial arcuate ligament syndrome (MALS) is defined as compression of the celiac trunk and/or ganglion by the medial arcuate ligament. It is often diagnosed after patients have suffered for a long time and is characterized by intermittent food-related pain, nausea, and unexplained weight loss. After exclusion of other causes of the above symptoms by gastroscopy, colonoscopy, CT, or MRI, the gold standard for diagnosis is dynamic color-coded duplex sonography, which may be supplemented by CT or MR angiography. The treatment of choice is a laparoscopic division of the arcuate ligament at the celiac trunk, although percutaneous transluminal angioplasty (PTA) with stent implantation may be performed in cases of postoperative persistence of symptoms or recurrent stenosis. Since symptoms persist postoperatively in up to 50% of cases, strict indication and complete diagnosis in designated centers are of great importance for successful treatment., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In light of recently published international guidelines concerning the diagnosis, treatment, and aftercare of urethral strictures and stenoses, the objective of this study was to synthesize an overview of guideline recommendations provided by the American Urological Association (AUA, 2023), the Société Internationale d'Urologie (SIU, 2010), and the European Association of Urology (EAU, 2023). The recommendations offered by these three associations, as well as the guidelines addressing urethral trauma from the EAU, AUA, and the Urological Society of India (USI), were assessed in terms of their guidance on posterior urethral stenosis. On the whole, the recommendations from the various guidelines exhibit considerable alignment. However, SIU and EAU place a stronger emphasis on the role of repeated endoscopic treatment compared to AUA. The preferred approach for managing radiation-induced bulbomembranous stenosis remains a subject of debate. Furthermore, endoscopic treatments enhanced with intralesional therapies may potentially serve as a significant treatment modality for addressing even fully obliterated stenoses., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

We report about a 79 years old female patient which was admitted due to a symptomatic AV block 3rd degree. The coronary angiography excluded a coronary artery disease and the echocardiography revealed a normal left ventricular systolic function. Therefore a dual-chamber pacemaker was implanted. Following two micro-dislocations of the right ventricular lead, which required operative revisions, a computed tomography of the heart was performed. This detected an aneurysm of the ascending aorta (5 cm maximum diameter) with compression of the superior caval vein. This case shows that a possible cause of recurrent micro-dislocations could be a pathological anatomy of the heart.

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a syndrome of elevated intracranial pressure (ICP) in the absence of any known causative factor. Most patients with IIH respond to weight reduction, repeated lumbar punctures and carbonic anhydrase inhibitors, such as acetazolamide and topiramate to reduce cerebrospinal fluid (CSF) production. Despite a number of pathogenetic theories, the cause of IIH remains unknown. With the availability of magnetic resonance (MR) venography and cerebral angiography, venous disease is increasingly being discussed as the etiology of IIH, with a high proportion of patients presenting with nonthrombotic unilateral or bilateral dural venous sinus stenoses. Based on this observation, endovascular stenting of stenotic dural sinuses in patients with IIH has gained popularity. Whether dural venous sinus stenoses are the cause or the consequence of increased ICP is still under debate. In patients with failure of conservative treatment or non-compliance, a more aggressive treatment, such as CSF shunting or surgical optic nerve fenestration, should be performed. For approximately 13 years endovascular stenting of the stenotic sinuses has been used and discussed as an alternative and effective treatment of IIH. Since the first report in 2002, individual cases and case series have been published demonstrating that stents immediately lower the venous pressure gradient, which is associated with clinical improvement. This effect occurs within days or weeks and is permanent in many cases.

Background: Eustachian tube dysfunction can cause middle ear diseases and impair quality of life. Sufficient diagnostic tools for chronic obstructive eustachian tube dysfunction are lacking and not reliable enough., Patients and Methods: The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was published by McCoul et al. in 2012 as an instrument to evaluate eustachian tube function. They demonstrated the reliability und validity of their questionnaire. The cut-off point for the diagnosis of eustachian tube dysfunction is ≥ 14.5 at 100 % sensitivity and 100 % specificity. We translated the ETDQ-7 into German and used it on 100 healthy subjects and 43 patients with chronic obstructive eustachian tube dysfunction., Results: The results in the English questionnaire were confirmed by our examinations with the German version of the questionnaire. The mean ETDQ-7 score was 8.67 in the healthy subjects and 24.7 in the patients with chronic obstructive eustachian tube dysfunction. The area under the curve in ROC analysis was 98.8 % (p < 0.0001)., Conclusion: We recommend the ETDQ-7 as an addition to patient history in the examination of eustachian tube dysfunction. It may as well be valuable in follow-up examinations to monitor treatment success.

A new and interdisciplinary S2k AWMF guideline for the treatment of obstructive sialadenitis has been published. There have been several technical achievements, for instance in the field of ultrasonography, via sialendoscopy, or by MR-sialography, that have increased the possibilities for diagnosis and treatment of patients with obstructive sialadenitis. In the past, the treatment of choice in case of unsuccessful medical treatment was a complete extirpation of the affected salivary gland. Nowadays, using a variety of modern treatment options (like sialendoscopy, or extracorporeal shock-waves lithotripsy sometimes combined with salivary duct incision), it is possible in most patients, especially in cases of sialolithiasis, to preserve the affected gland. A functional recovery after gland-sparing surgery is described but more data is needed to finally evaluate the long-time results. The new guideline describes all relevant steps to diagnose an obstructive sialadenitis and values all diagnostic tools critically. Finally, all recommendable therapy options are described and valued, too., (© Georg Thieme Verlag KG Stuttgart · New York.)

We present the case of a female infant born prematurely at 34 weeks of gestation. Prenatally a midsized ventricular septal defect was diagnosed. Due to marked respiratory distress intubation was attempted but failed, since the tube could not be placed beyond the glottis. Oxygenation could be improved by nasopharyngeal bag ventilation. The clinical course as well as radiographic imaging was suggestive for a complete tracheal agenesis with broncho-oesophageal fistula which was confirmed at autopsy. Tracheal agenesis (TA) is a rare differential diagnosis of postnatal respiratory distress and the obstetrician or neonatologist will regularly be surprised by this malformation. Partial or complete absence of the trachea without associated malformations will be rarely diagnosed antenatally. In the case of the absence of an oesophageal fistula to the remaining airway a congenital high airway obstruction syndrome (CHAOS) ensues, leading to enlarged hyperechogenic lungs, dilated and fluid-filled trachea and bronchi and an absent tracheal flow during foetal breathing. Aetiology of TA is unknown, therapeutic options are limited thus making TA a usually fatal disorder., (© Georg Thieme Verlag KG Stuttgart · New York.)

This paper reviews the past and present developments in the treatment of chronic obstructive eustachian tube dysfunction. Alongside tube catheterization and bougie insertion, modern approaches such as laser eustachian tuboplasty and balloon eustachian tuboplasty (BET) are described. In BET, transnasal endoscopic insertion via the pharyngeal ostium places a balloon catheter in the cartilaginous portion of the eustachian tube. This is then dilated to a pressure of 10 bar for 2 min. Up until January 2013, 351 chronic obstructive eustachian tube dysfunction patients had been treated in our department using BET. The average preoperative eustachian tube score was 2.1 (± 1.8 standard deviation, SD); 12 months postoperatively it was 6.1 (± 2.6 SD). Of these patients, 87% expressed satisfaction with the improvement in chronic obstructive dysfunction. These results demonstrate that BET is a safe and effective treatment for improving eustachian tube function and ear ventilation.

Balloon dilation is a novel method in the management of chronic Eustachian tube dysfunction. Routine preoperative CT has been recommended in order to rule out possible bone dehiscence in the region of the carotid canal or aneurysms of the internal carotid artery which can lead to vascular injuries and life-threatening bleeding or brain damage during the dilation procedure.We evaluated head CT scans of 1000 patients to assess the occurrence of carotid canal dehiscence, aneurysms or other vascular malformations and to measure the osseous part of the carotid canal.No dehiscence was noted in a total of 2000 boney carotid canals. The mean thickness of the carotid canal wall was 1.02 ± 0.29 mm. No aneurysms or vascular malformations were detected.The necessity of routine CT scans before balloon dilation should be critically discussed with a view to protecting patients from unnecessary radiation exposure and saving costs in the health care system.

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. In the present study the role of this method was assessed in a population of adult patients with ventilatory dysfunction of the Eustachian tube which did not respond to other treatment. The presence of a space-occupying lesion was ruled out. Clinical symptoms improved in 70 % of the patients after balloon dilation and none of the patients reported deterioration of symptoms. Balloon dilation is a rapid, simple and safe method and is currently used in particular for treating patients with ventilatory dysfunction of the Eustachian tube which does not respond to other treatment. Further studies, ideally multicentre studies are required in order to optimize the definition of existing and potential new indications for this treatment approach.

Rectal stricture is a serious although infrequent complication of transanal endoscopic microsurgery (TEM). In some cases, these strictures may be refractory to treatment by endoscopic balloon dilatation. Biodegradable stents might improve the outcome by providing an extended period of dilatation. Moreover, these stents can remain in place without the need to remove them. In the presented case, a biodegradable polidioxanone stent originally developed to treat benign oesophageal stenoses was used to treat a patient suffering from rectal stricture following a TEM., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Sufficient diagnostic tools and effective therapies for chronic obstructive eustachian tube dysfunction are lacking., Patients and Methods: A total of 120 patients (209 ears) with chronic obstructive eustachian tube dysfunction were treated over a 2-year period using transnasal endoscopic balloon dilatation of the cartilaginous part of the eustachian tube (balloon eustachian tuboplasty, BET). A balloon catheter is inserted into the eustachian tube via the pharyngeal opening and dilated with a pressure of 10 bar for 2 min., Results: The first 12 patients (20 dilatations) had a pretreatment average tube score of 1.25 (± 1.83 SD), and 1 year after treatment, the score improved to 6.2 (± 2.61 SD). Furthermore, the pretreatment and 2-month posttreatment data of 66 additional patients (115 dilatations) were analyzed. In these patients, the tube score improved significantly from 2.21 (± 2.02 SD) to 5.4 (± 2.53 SD)., Conclusion: The initial long-term results suggest that BET is feasible and safe for the treatment of chronic obstructive eustachian tube dysfunction.

Intracranial arterial stenoses clinically present as acute, fluctuating or recurrent neurological deficits which are caused by hemodynamically impaired perfusion of the corresponding area of the brain. The type and the extent of the deficit, however, are not only determined by the location of the stenosis but also depend on the individual anatomical conditions of the patient, such as the degree of collateralization and variants of the circle of Willis.

Clinical Issue: Symptomatic intracranial stenoses are associated with a high risk of stroke. Medical management with platelet inhibitors or anticoagulation has not been shown to substantially lower this risk. Hence, alternative treatment options are desperately needed., Treatment Innovations: The concept of percutaneous intervention using balloon angioplasty with or without stenting is appealing at first sight which is why intracranial balloons and stents were developed., Performance: Initial studies using dedicated intracranial stents were more promising; however, the only randomized trial recently published using a dedicated intracranial self-expanding stent demonstrated a high periprocedural complication rate. EVALUATION AND PRACTICAL RECOMMENDATIONS: Due to study design limitations it would be premature to categorically denounce an interventional option for the treatment of symptomatic intracranial stenoses. More importantly, the results of the randomized SAMMPRIS trial should stimulate the development of safer technology and patient selection to minimize procedural risks. This will perhaps allow significant risk reduction of this potentially devastating intracranial condition when it cannot otherwise be addressed.

Intracranial stenosis is the cause of 10 % of strokes. Besides medicinal treatment, intracranial bypass surgery, percutaneous transluminal angioplasty and stenting are available treatment approaches. According to the 2005 published WASID trial antiplatelets should be preferred to oral anticoagulation in secondary preventive therapy of ischemic stroke; however patients with high grade intracranial stenosis still have a poor prognosis. Intracranial bypass surgery, which was taken into account as a treatment option even in 1985, showed a generally worse outcome in relation to medicinal therapy. Intracranial angioplasty and stenting, representing improvements in endovascular treatment, were proven to be effective and feasible treatment approaches for patients with symptomatic high grade intracranial stenosis. Within the scope of the SAMMPRIS trial published in 2011, which propagated an advantage of aggressive medicinal treatment versus endovascular therapy, a retrospective study was performed at the department of neuroradiology of the Homburg University of Saarland.

Background: Sialendoscopy is an established, minimal-invasive technique to diagnose and treat obstructive diseases of major salivary glands. Knowledge on learning curve and distribution in Germany is limited. MATERIAL UND METHODS: An 11 item questionnaire on Sialendoscopy was sent to all 159 German ent-hospitals. To determine the learning curve, all patients that underwent sialendoscopy during a 1-year-period after invention of sialendoscopy in our department were prospectively followed and evaluated., Results: Sialendoscopy is currently performed in a minority (24%) of ent-departments in Germany. Denial was justified by technical problems, a lack of cost-benefit and small number of patients in descending order. A significant reduction of intervention time (61.0 ± 32.7 min to 43.2 ± 33.6 min, p=0.013) and less frequent aborted operations were noted after comparison of the first vs. the second half amount of interventions as indicators of a learning curve. Complications were not found to be significantly raised in the first half of interventions., Conclusion: The fact that sialendoscopy is provided in only a minority of ent-departments will in the future most likely be overcome by technical improvements. A learning curve has to be anticipated., (© Georg Thieme Verlag KG Stuttgart · New York.)

The management of coral reef lesions reported in this case study demonstrates the complementary and non-competing character of the open and endovascular treatment. The minimally invasive procedure of stent-optimized angioplasty seems to be advantageous as the primary therapy in selected cases. In the case of clinical deterioration the endovascular technique allows surgical reconstruction without significantly diminishing the result. Catheter-based techniques therefore remain an additional instrument for treatment in the hands of vascular surgeons which substantially broadens the range of therapy options for this disease entity.

The treatment of stenoses and non-stone-related obstructive diseases of the major salivary glands has undergone significant changes due to the development of minimally invasive treatment modalities. Correct diagnosis can often not be established in detail with all diagnostic tools except sialendoscopy, which is necessary for gland-preserving therapy. Over the last 10 years a range of minimally invasive treatment approaches aimed at preserving gland function have been developed. In addition to sialography-controlled therapy, interventional sialendoscopy plays a central role, representing the treatment of first choice in all stenoses and non-stone-related obstructions of the salivary duct system and with a success rate of about 85%-90%. By combining sialendoscopy with other minimally invasive surgical procedures, the function of the gland can be preserved in more than 95%. Thus sialendoscopy plays a crucial role in the treatment of non-stone-related obstructive diseases of the major salivary glands. In stenoses of the salivary gland ducts extirpation of the gland should be considered only as a last step.

With the improved availability of sialendoscopy (SE) during the last decade the therapeutical concept for sialoliths has remarkably changed. Due to the introduction of SE the diagnostic opportunities could be extended. Before introduction of SE, the diagnostic was focused only on the existence and size of sialoliths. Now, questions like consistence of sialoliths and their mobility in the duct system, stenoses with sialolithiasis-like symptoms as well as the evaluation of the remaining secretory capacity of the involved gland became relevant for the therapeutic decision. Furthermore there are an increasing number of therapeutic opportunities available. For some of these techniques long term experiences are missing so far. On the basis of the review of the current literature and a retrospective analysis of 256 own patients the different techniques and their indication are described. The combination of different therapeutical options of the SE and the still established extracorporal shockwave lithotripsy (ESWL) results in an important reduction of glandular resection in patients with sialolithiasis. Thus, the rate of glandular resection for the glandular submandibular can be decreased to 5 % and for the glandular parotis to 1 %. In summary, the most effective way is a stepwise approach based on the diagnostic tools of SE and including the laser-lithotripsy and ESWL in the treatment of sialolithiasis.

Congenital nasal pyriform stenosis can be a life threatening emergency in neonates which must be included in the differential diagnosis of nasal airway obstruction. We describe the case of a male child who developed symptoms 36 h after birth. As the conservative therapy was not successful surgery became necessary.

The term autoimmune pancreatitis (AIP) describes a nonalcoholic, chronic lymphoplasmocytic pancreatitis. The lymphoplasmocytic infiltration is characterized by periductal localization of predominantly CD4-positive T cells, fibrosis, and acinar atrophy, frequently resulting in stenosis of the main pancreatic and distal common bile ducts. Imaging studies often reveal a diffuse narrowing of the pancreatic main duct and swelling of the pancreatic head wrongly suggesting the presence of a malignant tumor. Clinical signs include mild abdominal pain, jaundice, recurrent episodes of acute pancreatitis, and even new-onset diabetes mellitus. Additionally, AIP can be associated with other autoimmune diseases such as Sjögren's syndrome, primary sclerosing cholangitis, chronic inflammatory bowel diseases, and retroperitoneal fibrosis. Serological markers include autoantibodies and increased levels of gamma globulin and especially IgG4. Steroids seem to be effective in improving clinical symptoms as well as in the resolution of pancreatic and bile duct narrowing. This distinguishes AIP from other forms of pancreatitis and from pancreatic neoplasms. Further studies of the underlying pathophysiologic mechanisms, prognosis, and new diagnostic tools are needed to provide adequate and effective treatment in the future. In this article, we summarize the current knowledge about AIP and present 17 cases that underwent surgical resection at our institution from 2003 to 2004.

Magnetic resonance cholangio-pancreaticograpy (MRCP) is a non-invasive imaging modality of the pancreatico-biliary system which plays an increasingly important role in the clinical and diagnostic workup of patients with biliary or pancreatic diseases. The present review is designed to give an overview of the currently available and appropriate sequences, their technical background, as well as new developments and their relevance to the various clinical issues and challenges. The impact of the latest technical innovations, such as integrated parallel imaging techniques and navigator-based respiratory triggering, on the diagnostic capacities of MRCP is discussed. In this context, the individual value of RARE, T2w single shot turbo/fast spin echo (SSFSE) and the recently introduced 3D T2w turbo/fast spin echo sequences (T2w 3D-T/FSE) is reviewed. RARE imaging may be preferred in severely ill patients with limitations in cooperation, SSFSE is particularly effective in differentiating benign and malignant stenosis, and 3D-FSE offers additional advantages in the detection of small biliary concrements.

Purpose: To compare virtual with flexible bronchoscopy for the detection of bronchial stenoses., Materials and Methods: In a retrospective study, we compared the results of 26 patients, who had clinical suspected pathologies of the tracheobronchial airways and underwent both flexible bronchoscopy and multislice CT with 3D surface rendering of the airways. Flexible bronchoscopy and virtual bronchoscopy were compared as to the rate of detecting bronchial stenoses. For statistical analysis, we divided the tracheobronchial tree in the following sections: trachea, 2 main bronchi, 6 lobar bronchi, 18 segmental bronchi and 36 subsegmental bronchi, corresponding to 63 bronchial sections for each patient (on average) and a total of 1638 bronchial sections for all 26 patients. We graded the bronchial stenosis as less than 50 %, as 50 to 95 % and as complete obstruction., Results: Virtual bronchoscopy detected 25 bronchial stenoses, while flexible bronchoscopy only revealed 17 stenoses. Stenoses with a diameter less than 50 % were found with virtual bronchoscopy 14 times and with flexible bronchoscopy 10 times. Stenoses with a diameter between 50 and 95 % were detected 7 and 4 times, respectively, and complete obstructions 4 and 3 times, respectively. Tracheobronchial stenoses were well recognized with virtual bronchoscopy. Moreover, the virtual method enabled the visualization of high-grade stenoses and post-stenotic areas that could not be passed by the fiberoptic bronchoscope. Virtual bronchoscopy detected stenoses at a higher rate but the difference was not statistically significant (stenoses < 50 %: p = 0.352, 50 - 95 %: p = 0.339, complete obstruction: p = 0.696)., Conclusion: Virtual bronchoscopy is a useful non-invasive method for the diagnostic evaluation of the tracheobronchial tree. In comparison with flexible bronchoscopy, virtual bronchoscopy is superior in revealing high-grade stenoses and visualizing post-stenotic areas.

History and Admission Findings: A 68-year-old woman was admitted with upper abdominal symptoms, epigastric fullness and nausea, eight days after initiation of heparin anticoagulation for deep-vein thrombosis. There were no other clinical abnormalities., Investigations: Abdominal ultrasound and computed tomography showed an intramural duodenal haematoma. Endoscopy revealed a stenosing lesion in the duodenum., Treatment and Course: Instead of conventional parenteral nutrition, a triple-lumen feeding tube was placed, one lumen in the jejunum for feeding, the other for gastric decompression. Six months later the symptoms had completely disappeared and ultrasound, endoscopy and computed tomography no longer detected any lesion., Conclusion: Intrajejunal feeding and gastric decompression via a multi-lumen tube provided effective conservative treatment of duodenal ileus together with gastric decompression.

We present the case report of a patient with neurofibromatosis and regional dysmorphism in the superficial femoral vein. Colour coded duplex sonography revealed an incidental finding: thickening of a short portion of the vein wall with calcification. This unusual finding strongly suggests a causal relationship. Pathological processes in the arteries have often been described in patients with von Recklinghausen's disease (neurofibromatosis). Dysplastic and hyperplastic reactions of the intramural nerve tissues and the smooth muscle elements in the vascular wall have been observed. This leads to the formation of aneurysms and arteriovenous fistulas and to stenosing processes in the peripheral, visceral and cerebral arteries. However, involvement of the veins in type 1 von Recklinghausen's neurofibromatosis has only been reported in old histopathological studies of medium-sized and small vessels.

Popliteal artery entrapment is a rare cause of claudication symptoms, but should always be included in the differential diagnosis of lower limb ischaemia in young patients, especially men. On an embryological basis, PAES is the result of the abnormal development of the popliteal artery or the gastrocnemius muscle. The anomaly is manifested as one of four types. Untreated, the entrapment results in the deterioration of the artery, resulting in eventual occlusion. Presenting the case of a 37 year old female patient with bilateral PAES and a review of the literature we discuss the clinical findings, diagnosis, treatment options and the management of the often asymptomatic opposite side.

Purpose: The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest., Material and Method: In 6 consecutive patients with partial lung resection (n = 2) and lung transplantation (n = 4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model., Results: The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions., Conclusions: Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Objective: The purpose of this study was to investigate the validity of cardiotocography for the detection of cord complications., Material and Methods: A low-risk population of 4196 cases was selected in which cord complications have been recognized in 34.3%. Cases with cord complications and controls were paired by parity, gestational age, maternal age and mode of delivery. 25 pairs were randomly selected. 50 tracings were presented twice to 4 obstetricians in a double-blind manner. As parameters for the determination of the validity of fetal monitoring the reliability, positive (ppv) and negative predictive value (npv), sensitivity and specificity were used. Inter- and intra-observer variability were also examined., Results: Reliability 52%, ppv 52%, npv 52%, sensitivity 46%, specificity 58%. Interobserver variability: All 4 obstetricians agreed in 47 of 100 evaluations. The level of agreement was higher in the controls (63%) than in the cord complication group (56%). The intraobserver variability was 25%., Conclusions: Cardiotocography is not useful for the detection of cord complications. The range of possibilities has not been exploited yet, even for the evaluation of the fetal state.

The new technique of non-invasive magnetic resonance (MR) sialography was evaluated for normal and various pathologic conditions of the parotid gland. Ten volunteers and 15 patients with various symptomatic diseases of the parotid gland were tested in the present study. Diseases included pleomorphic adenoma, cystadenolymphoma, carcinoma ex pleomorphic adenoma, ductal carcinoma, adenoid cystic carcinoma, lymphoepithelial carcinoma, non-Hodgkin's lymphoma, sialolithiasis, sialadenitis, Heerfordt's syndrome and congenital duct ectasies. In addition to the usually performed T1 and T2 cross-sectional sequences a heavily weighted T2 sequence (TR 3600, TE 800) was performed and allowed depiction of a fluid-filled parotid duct. Results showed that the main parotid and primary branching ducts were depicted reliably in all normal cases and all patients, except one with sicca syndrome. Pathological conditions such as duct dilatations, duct strictures, obstructing duct calculus and irregular shapes and courses of the ductal system were demonstrable. While X-ray sialography obtained a higher resolution, only MR sialography was able to depict dilated ducts proximal from a complete obstruction, as well as all ductal cysts. Our findings show that MR sialography can be applied successfully to investigations of the parotid gland system. There have been no contraindications or complications to date because MR sialography is non-invasive. The technique will also allow the salivary ducts and lesions to be differentiated from the course of the facial nerve.

Our personal treatment concept for trigger thumb in children is presented. The guiding symptoms are fixed flexion deformity, (painful) restriction of motion (with a click phenomenon) or persistent extension deformity. Although it is a simple pathology, careful diagnosis is mandatory to rule out other reasons with the same symptoms as trigger thumb, as some of these will lead to severe aesthetic and functional impairment. In 26 patients with persistent symptoms, the A1 ring ligament of the thumb was cut. Free active and passive joint motion was comparable to the opposite side in 92.7% of patients. In 2 cases a secondary operation was necessary because of incomplete A1 ring ligament release. If it is diagnosed and operated on early with a careful operative technique, nowadays no aesthetic or functional impairment should occur in children because of trigger thumb.

Purpose: Evaluation of hydro-MRI in the diagnosis of chronic inflammatory bowel disease (IBD)., Material and Methods: 33 patients with suspected Crohn's disease or ulcerative colitis were studied prospectively. After distension of the colon by a rectal enema, breathhold MR imaging was performed during bowel relaxation. Results were compared to the clinical diagnosis, endoscopy, barium studies and histopathology., Results: 24/24 patients with active Crohn's disease were correctly diagnosed by MRI. Conversely, MRI was positive in only 2/5 patients with ulcerative colitis. In 5 patients the presence of IBD was excluded. There were no false positives., Conclusion: Hydro-MRI is a very reliable modality in the diagnosis of Crohn's disease. In the differentiation of Crohn's disease from ulcerative colitis, hydro-MRI seems to be a promising imaging procedure.

History and Clinical Findings: A 25-year-old woman had for 5 years complained of lower and mid-abdominal pain, at first monthly but later continuous and gradually increasing in severity. At the same time she had diarrhoea associated with nausea, vomiting and weight loss. Physical examination showed a markedly distended abdomen, diffuse pain on pressure over the whole abdomen, most marked in the left middle and lower part, and high pitched peristalsis, but was otherwise unremarkable., Investigations: Abdominal radiography indicated small-intestinal ileus, while ultrasound revealed absent peristalsis in the small intestine and a 10 cm stenosis in the terminal ileum. Coloscopy demonstrated a fibrosed stenosis of the terminal ileum but a biopsy showed no specific changes., Treatment and Course: Under suspicion of Crohn's disease with stenosis of the terminal ileum a partial resection of the ileum was performed. The ileum was on inspection thickened with scar tissue but no inflammation. Histology revealed florid chronic mucosal and submucosal inflammation, haemorrhages and ulcers, as well as numerous islands of endometriosis in the subserosa and muscularis propria., Conclusion: Endometriosis is a rare disease in women of the reproductive age, but should be considered in the differential diagnosis of Crohn's disease of the terminal ileum.

Arteriography of a 34-year-old golf player with M. Raynaud symptoms of his left hand revealed filling defects in the digital arteries II to IV fingers associated with corkscrew-like configuration of the ulnar artery in Guyon's space. The preoperative workup including 50 clinical laboratory tests searching for connective tissue diseases, vasculitis, and haematological disorders was without pathological findings; more central embolic sources were excluded angio- and cardiologically. MRI-scan demonstrated an anomalous muscle at the level of the hamate hook located underneath the M. palmaris brevis forming a sling around the ulnar artery. Surgery showed the ulnar artery distal to the anomalous muscle dilated with fibrotic thickening and intraluminal thrombosis. The involved A. ulnaris segment was resected and an interpositional vein graft performed. Histopathologic sections showed fibrosis of the arterial wall with intraluminal thrombosis and elastica fragmentation indicating traumatic genesis (hypothenar-hammer syndrome). We suspect intensive golf playing with the grip style and repetitive movements leading to pressure injury of the hypothenar area and the underlying ulnar artery. Contraction of the anomalous muscle belly may have additionally compressed the artery slowing down the arterial flow and accelerating the thrombosis.

Venous compression is a clinical entity distinct from deep vein thrombosis although the clinical signs may be indistinguishable. Reasons for venous compression are tumors, scars, hematomas, postoperative changes and anatomic variations. The differential diagnosis between compression and thrombosis is important because therapy and prognosis differ markedly between the two patient groups. Ultrasound, computed tomography and magnetic resonance tomography are the diagnostic tools of choice because they offer not only information about the intraluminal situation but also about the extraluminal pathology.