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Background and Study Aims: We have conducted a study to compare the diagnostic yields of magnetic resonance imaging (MRI) and capsule endoscopy for the detection of small-bowel polyps in patients with inherited polyposis syndromes., Patients and Methods: MRI was performed in 20 patients, with either Peutz-Jeghers' syndrome (PJS; n = 4) or familial adenomatous polyposis (FAP; n = 16), and capsule endoscopy was done the next day. The number, size, and location of polyps were analyzed., Results: Overall, 448 polyps ranging from about 1 mm to 30 mm in size were detected in eight patients by capsule endoscopy, whereas with MRI only 24 polyps all bigger than 5 mm could be seen in the four PJS patients., Conclusions: Polyps bigger than 15 mm were detected similarly with capsule endoscopy and MRI, whereas smaller polyps were seen much more often with capsule endoscopy. Polyps smaller than 5 mm were exclusively seen with capsule endoscopy. However, location of the detected polyps and determination of their exact sizes was more accurate by MRI.

Schizophrenia is a severe mental disorder with a relapsing long-term course in 80 % of the sufferers. The underlying neurobiological principles of the long-term course are widely unknown. Therefore an attempt is made to evaluate data from structural imaging and neuropsychology to shed some light on these mechanisms. Interestingly there was a significant correlation between length of illness and volume reduction in the prefrontal grey matter in schizophrenia. There was a lack of such a correlation for the whole brain volume, white matter volume or the grey matter volume outside the prefrontal lobe. Furthermore none of the neuropsychological measures correlated with length of illness. Both findings are supported by data from prospective studies up to five years demonstrating a significant loss of frontal grey matter volume, but no change of cognitive dysfunction in the course of time. The attempt is made to connect prefrontal grey matter loss with post-mortem findings of reduced neuropil but preserved cytoarchitecture leading to recently described candidate genes and their function.

Background and Study Aims: The purpose of this study was to evaluate the accuracy of respiratory-triggered three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) for the detection of primary sclerosing cholangitis (PSC) and to compare the specific findings of magnetic resonance cholangiography and endoscopic retrograde cholangiography in patients with PSC., Patients and Methods: The MRCP findings were evaluated in 150 patients with clinical symptoms (progressive fatigue, pruritus followed by icterus) and/or elevated values for alkaline phosphatase and serum aspartate transaminase, and occasionally an elevated serum concentration of bilirubin as a sign of cholestasis, who were consecutively referred for magnetic resonance imaging. Two observers independently classified bile duct abnormalities and established the MRCP diagnosis in a consensus reading. The results of MRCP were compared with the definitive diagnosis, which was based on the clinical history and laboratory and histological data, as well as on endoscopic retrograde cholangio-pancreatography (ERCP) findings. In a second step, the observers compared the delineation of the biliary system and morphological findings using MRCP and ERCP in patients with confirmed PSC., Results: Diagnostic examinations were obtained in 146 of the 150 MRCPs (97 %). The diagnosis of PSC was confirmed by clinical data and ERCP in 34 of these 150 patients (23 %). The sensitivity and specificity of MRCP for diagnosing PSC were 88 % (29 of 33) and 99 % (108 of 109), respectively. MRCP and ERCP yielded similar scores for the delineation of the biliary system (P = 0.2) in patients with PSC. However, different bile duct abnormalities leading to the diagnosis of PSC were depicted by MRCP and ERCP; more bile duct stenoses and pruning were seen with ERCP and more skip dilatation with MRCP (P < 10(-4))., Conclusion: In patients with PSC, MRCP is a highly sensitive method and its diagnostic accuracy is comparable to that of ERCP.

Aortic and intracranial arterial aneurysms constitute frequent clinical entities for which sophisticated vascular surgical and interventional radiological therapeutic procedures have been established. To a much lesser extent arterial aneurysms can also occur at any other vascular site due to a large number of possible reasons. In this article we conducted a Medline search of the world literature for reports on these rare vascular disorders and summarize the most important clinical aspects on this subject. Altogether 5535 cases of non-aortic extracranial aneurysms are reviewed.

Purpose: Budd-Chiari syndrome is a fairly uncommon disease in Europe. This often leads to its late diagnosis. The syndrome is characterised by portal hypertension and splanchnic congestion due to obstruction of hepatic venous outflow. This paper describes the treatment of three patients with Budd-Chiari syndrome by interventional therapeutic techniques and discusses alternative treatment modalities., Patients and Methods: The first patient presented with veno-occlusive disease and was treated by the placement of a transjugular intrahepatic portosystemic stent-shunt. The second patient showed an occlusion of the major hepatic veins. After percutaneous recanalisation, a stent was placed in the right hepatic vein which remained patient. The third patient had a membranous obstruction of the right hepatic vein which was treated by percutaneous balloon dilatation., Results: In all patients the clinical symptoms resolved completely after treatment and no complications were encountered., Conclusions: The authors conclude that interventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with Budd-Chiari syndrome and are safe, effective and relatively inexpensive. However, further studies are required to assess the long-term results and survival rates of these patients.

Purpose: To evaluate early reliable radiographic signs of loosening in cementless total hip arthroplasty compared to clinical follow-up., Methods: Within a time interval of 5 years 89 patients with 101 hips underwent total hip arthroplasty using the Autophor 900 S-prosthesis. Clinical and radiographic follow-up were first performed retrospectively followed by a prospective investigation., Results: Radiographic evaluation showed prosthesis fixation in 93%. Loosening of the prosthesis was identified in 4 cases of the acetabular component and in 4 cases of the femoral stem. Pain was associated with radiographically detectable loosening of the cementless arthroplastic components in only two cases., Conclusion: Within a follow-up period of up to five years, loosening of cementless total hip arthroplasty occurs in about 7%. The most reliable radiographic signs of loosening are complete radiolucent zones wider than 2 mm at the bone-component interface, progressive subsidence, migration, or tilt of the component. Pain and movement disorders are not specific symptoms and do not necessarily indicate a loosening of the prosthesis.

Purpose: To determine the value of MRI in typical and atypical aortic dissections., Methods: MRI investigations on 16 patients with aortic dissections were analysed retrospectively; for 8 patients CT investigations carried out at almost the same time were available for comparison., Results: In all cases the diagnosis of aortic dissection was possible from MRI and CT. If a dissection membrane and a double lumen were present these were detected in all patients by both methods. In three patients with atypical dissections, only an asymmetrical abnormal wall thickening as sole sign for the presence of an aortic dissection was seen. A differentiation between true and false lumen was possible in 16 of 17 MRI investigations and in 5 of 8 CT investigations on the basis of differing blood flow velocities or, respectively, the detection of a thrombus in the false lumen. The relationship of the dissection membrane to the large aortic branches as well as the determination of the branch vessel origin with regard to true or false lumen could be evaluated better with MRI than with CT., Conclusions: Thus MRI has a significant role in the diagnosis and follow-up of aortic dissections. The advantage in comparison to the alternative spiral CT technique is, in addition to the absence of radiation exposure, the better analysis of the extent of the dissection as a result of the multi-planar slice orientation (especially in the region of the aortic arch and the arch vessel origins) without the necessity to administer iodine-containing contrast media.

Although retroperitoneal hemorrhage is a rather seldom complication of Behçet's syndrome it is in no way unusual. Younger patients in particular those from the eastern Mediterranean or east Asian regions in whom a retroperitoneal hemorrhage or an aneurysm in the aorto-iliaco-femoral flow region has be diagnosed must be considered for the differential diagnosis of Behçet's syndrome. The consequences for the surgeon are resection deep into healthy tissue and in general an appropriately close follow-up with strict avoidance of arterial angiography.

Purpose: To evaluate the effect of angiography on patient management and mortality in patients with GIB of unknown origin., Material and Methods: 88 angiographies were performed in 74 patients with GIB of unknown origin (18 upper gastrointestinal tract [GIT]), 35 lower GIT. 21 unknown localisation) and were evaluated retrospectively in regard to the influence on patient management and clinical outcome., Results: After unsuccessful endoscopic diagnosis, angiography shows a sensitivity of 60% in the acute phase of GIB. Once the GIB had stopped the sensitivity was 14%. Following angiographic localisation, patients were more commonly treated surgically (71% vs. 44.5%) and subsequently had a lower rate of persistent or recurring bleeding (15% vs. 37.5%) as well as a lower event related mortality (10.5% vs. 25%). Patients with angiographic localisation of the bleeding site had a better outcome than patients with unsuccessful bleeding localisation, with regard to both surgical (85% vs. 62.5%) and conservative (100% vs. 85%) treatment., Conclusion: Angiographic localisation should be attempted in all cases of unknown GI-bleeding after endoscopic methods have been unsuccessful or ambiguous, because such a procedure has a positive effect on patient management and outcome. Moreover, angiography also offers therapeutic options.

Xanthogranulomatous pyelonephritis (XGP) is a rare and aggressive form of chronic pyelonephritis for which partial or complete nephrectomy is mandatory [1.2]. The diagnosis and, in particular, the differentiation from hypernephroma is mostly established by the histopathological examination only. We have reviewed the literature and present an unusual case of XGP with septic spreading into the lungs mimicking pulmonary metastasis and with an inflammatory infiltration of the descending colon.

Jejunal diverticulosis consists of multiple acquired jejunal herniations of the mucosa and submucosa with an incidence of 1.3 to 2.3%. Clinical symptoms are rare. Numerous and large diverticulae, however, can cause severe abdominal complaints. Etiologically factors always consist of a motility disorder with bacterial overgrowth and rise of intraluminal pressure. An enteroclysis helps to determine the diagnosis. Plain x-rays and a CT of the abdomen are other helpful radiological tools.

Focal fatty liver disease can cause difficulties in the differential diagnosis by ultrasound, CT, and MRI. This case report describes the atypical findings of focal spared areas of fatty liver disease in association with inflammatory changes, which were thought to be malignant focal liver lesions.

Question: Is it possible to draw conclusions on aetiology, histology or clinical course, looking at the different radiomorphologic appearance and its changes in chest x-rays of patients with "fibrosing alveolitis"?, Material and Method: Retrospective correlation of chest x-rays with all relevant clinical and histological data of 33 patients., Results: In all patients typical clinical signs with changes of lung function and typical histological changes were found. There was no strict correlation between single parameters and radiological findings. In the estimation of the clinical course, no correspondence between radiological findings and clinical data was found in only 18% of the parameters., Conclusion: The chest x-ray is an objective investigation which clearly shows the course of fibrosing alveolitis beside its undisputed function in diagnosing acute complications like infiltration, effusion or development of pneumothorax.

Primary hypertrophic osteoarthropathy represents only about 3-5% of all cases of hypertrophic osteoarthropathy and is therefore a rare disease (1, 6). Characteristic X-ray findings are demonstrated for a specific case report.

The clinical and radiological findings of 5 patients with a total of 7 hepatobiliary cystadenomas are reported. In all cases sonography and computed tomography were performed, in three cases angiography was carried out, and in one case magnetic resonance imaging was used. On sonography and computed tomography hepatobiliary cystadenomas exhibit relatively typical findings as a multicystic, space-occupying lesion with septation and papillary mucosal nodes; hence the diagnosis can be made preoperatively in most cases. For differential diagnosis, the malignant form, hepatobiliary cystadenocarcinoma has to be considered which can only be distinguished from the benign form by histology.

Computed tomography (CT) is widely recognized as a part of the routine preoperative staging in patients with esophageal carcinoma. Applying a tailored technique, CT criteria of transmural growth and infiltration of adjacent structures are highly accurate for estimating resectability. The size-based assessment of mediastinal and abdominal lymph nodes is usually reported with low sensitivity and specificity. Spiral technology (spiral CT) increases image quality by a reduction of artifacts due to respiratory motion or cardiac pulsation, higher anatomic detail, and peak vascular opacification throughout the entire examination. Thus, an improvement of diagnostic accuracy in the staging of esophageal carcinoma can be expected. Its targeted application and a comparison with the conventional technique are presented.

Among 220 renal tumors which we detected by computed tomography, there were 168 renal cell carcinomas, 24 tumor of the renal pelvis, 16 angiomyolipomas, 6 Wilms tumors, 3 oncocytomas, one liposarcoma, one mesenchymal tumor, and one rhabdomyosarcoma. Computed tomography had the highest accuracy of the diagnostic procedures with a sensitivity of 99.5% and a specificity of 98%. 83% of the renal cell carcinomas showed signs of malignancy in computed tomography; the staging of the renal tumors by computed tomography was correct in 67% of the cases. The diagnostic value of other diagnostic tools (sonography, urography, angiography, cavography) of renal tumors is discussed in terms of our own results.

Galeazzi's fracture represents the rather rare association of a fracture of the radial shaft with disruption of the distal radio-ulnar joint (13). The assessment of 19 galeazzi's fractures revealed the typical displacement of the distal radial fragment with a concomitant contraction in 7 and a lateral dislocation to the ulnar and/or volar side in 7 cases. The characteristic dorsal and/or lateral dislocation of the ulna following the disruption of the distal radio-ulnar joint was seen in 16 patients. Besides this dislocation additional radiographic signs of the rupture of the capsule and ligaments were a widening of the joint space of the distal radio-ulnar articulation shown on the ap-projection in 10, a pathological shortening of the radius or ulnae in 7 and the avulsion of the ulnar styloid process in 10 patients.

Injuries of the thoracic skeleton are an important indicator of other, relevant traumatic changes after a polytrauma. Most fractures occur in the ribs, followed by fractures of the clavicle, the scapula and the sternum. Because of their high kinetic energy, car accidents are the main reason for thoracic fractures. The basic radiologic tool is the a.p. projection of the thorax in supine position; in addition, other conventional x-ray examinations or computed tomography are performed. Most thoracic fractures are treated conservatively, only in few cases (instability of the thorax, risk of pseudoarthrosis, incongruence of joint surfaces) surgical procedures are used.

Double-contrast CT arthrography of the shoulder is an imaging modality of great diagnostic accuracy with regard to glenohumeral instabilities. The purpose of this study is to describe the technique of the method and to demonstrate normal and pathological conditions in detail. Finally, its diagnostic value compared to other imaging modalities is outlined.

Computed tomography (CT) of the gastrointestinal tract is mostly employed in the staging of malignant lesions. Additionally, the application of CT in the diagnostic work-up of unclear abdominal complaints becomes more and more widespread. These different indications require adequate and standardised examination procedures. In this publication the general principles of gastrointestinal CT are presented, and the characteristic CT features of malignant and benign diseases are illustrated. The advantages, limitations and common pitfalls are pointed out.

336 sonographic examinations were performed with a portable ultrasound scanner on 217 patients in intensive-care units. In 302/336 (90%) cases, the region of clinical interest could be demonstrated completely or mostly by ultrasound. The clinical question could be answered by ultrasound in 270/310 (87%) cases partially. In 17/210 (5%) cases the clinical question could not be answered by ultrasound, in 26/336 (8%) cases there was no clinical question at all. 211/336 (63%) sonographic examinations were retrospectively classified as clinically relevant. A large part of clinically relevant examinations was found at the sonographic evaluation of the liver (100%), of the pericardium (96%), of the kidneys (89%), of the blood vessels (80%), of the gallbladder (78%), of the pleural space (76%) and on sonographic evaluation of patients with blunt abdominal trauma (91%). A relatively small part of clinically relevant examinations was found at sonographic evaluation of circumscribed or free intraabdominal fluid (59% resp. 57%), of cholestasis (53%) and of suspected neoplasm (11%). Sonographic examinations of the pancreas (40%) or the spleen (33%) and examinations without any clinical question (50%) also showed little clinical relevance.

Venous aneurysms are rare: only 311 cases of venous aneurysms and 56 cases of aneurysms in vein transplants have been reported since 1939 to date. 62% of the patients suffering from venous aneurysms were less than 40 years of age. The most frequently involved vessels were the internal jugular vein (n = 56), the portal vein (n = 28), the v. saphena magna (n = 30) the popliteal vein (n = 23), the azygos vein (n = 22) and the vena cava superior (n = 20). The diameters of the aneurysms were between 1 and 16 cm. Symptoms, if at all noticeable, depend on the localisation of the aneurysm, but they are unspecific in the majority of cases. The most frequent finding was the space- occupying growth seen in 190 patients (52%). Pulmonary embolisms originating from venous aneurysms were seen in 19/311 (6.1%), a rupture of an aneurysm in 4/311 (1.2%) of the venous aneurysms and 5/56 (8.9%) of the aneurysms in transplant veins, respectively. and were fatal in 1 (0.3%) and 2 (3.6%) of the cases, respectively. Of the 205 patients who were operated on, 3 (1.5%) died from intraoperative complications.

In 12 of 49 patients operated on for liver injuries we performed sonographic examination of the abdomen on admission to hospital within the framework of emergency diagnostics. The most sensitive finding was the identification of the presence of intraabdominal free fluid. The liver injury itself was sonographically diagnosed in only 5 patients. Sonographically, an additional injury of the spleen was found in 2 of 3 patients; in one patient it was possible to detect an injury of the kidney.

Diagnosis of erectile dysfunction is performed by means of Doppler sonography, cavernosography and cavernosometry, as well as by angiographic methods. Interventional radiological treatment methods are, arterially, vasodilatation or vasorecanalisation, and, as far as the venous approach is concerned, percutaneous venous occlusion. The article reviews the diagnostic and therapeutic radiological methods.

CT examinations of 6 years served as basis for the incidence of hormonally inactive space-occupying masses at the adrenal. Of a total of 25,000 patients, 313 (1.3%) suffered from disease of the adrenals, and of these 261 patients had a hormonally inactive adrenal tumour. Adenomas were the most frequent space-occupying growths (101 patients), followed by metastases of the adrenals (77 patients), whereas adrenal carcinomas (4 patients), myelolipomas (3 patients), ganglioneuromas (3 patients) adrenal cysts (3 patients) and adrenal haemorrhages (2 patients) were rare findings.

The CT image of renal metastases is described for 29 patients. The most frequent primary tumour was the bronchial carcinoma, followed by melanoma and cervical carcinoma. In 12 of 29 patients (41%) the metastases occurred bilaterally, in 17 (59%) unilaterally. 9/29 (31%) had solitary, 20/29 (69%) multiple renal metastases. In 19 (66%) these had a size of up to 3 cm and were situated intraparenchymally. Space-occupying growths up to a size of 10 cm which grew exophytically were seen in melanoma and carcinoma of the larynx and chorion. In the plain CT the metastases presented isodense or slightly hypodense in 25 of 27 examinations (93%). After application of contrast medium all presented hypodense with the exception of metastases of a chorionic carcinoma.

Spontaneous thrombolysis with recanalisation of peripheral arterial vessels is a well-known, albeit rare phenomenon. The probable mechanisms of this phenomenon is the activation of local fibrinolytic processes by local mediators of the vascular endothelial cells. Vascular stenoses of atherosclerotic origin are also subject to regression, depending on the plasma LDL level. Reangiography is indicated for determining further therapy planning if there is a change in clinical signs towards either improvement or deterioration. Reangiography is imperative if the previous angiography was performed before more than three months.

Fractures of the navicular bone are the most frequent fractures in the region of the wrist bone. Injuries of the other carpal bones are often primarily overlooked, since the examiner commands over less routine in diagnosing these rare fractures and the carpal bones are often superimposed over one another. We examined 9.723 x-ray films of the hand performed because of suspected fracture of the os naviculare, in order to find out how often lesions of the carpal bones - with the exception of those of the scaphoid bone - were discovered via the x-ray series of the os naviculare manus. For each individual wrist bone we recorded the incidence of fractures, clinical treatment and diagnoses, including any special x-ray takes that would be necessary for the detection of a particular fracture.

In a 43 year old man with an inguinal abscess a paravertebral soft tissue swelling suggested a gravitation abscess. On CT only a retrocrural fat accumulation was identified.

The microcystic adenoma of the pancreas is a very rare benign pancreatic tumour. This tumour, which is usually large and grows slowly, results in displacement and compression of the adjacent organs. Angiography reveals hypervascularisation. The characteristic structure of the tumour can be recognized both in the sonogram and in the computer tomogram.

Luxations and luxations fractures of the carpometacarpal joints are rare, with the exception of the thumb. Basing on the case histories of 3 patients treated by the authors, these injuries are described and discussed.

This is a report on an intra-abdominally fixed T-drain. Surgical removal was avoided without complications by detaching it with a ring stripper.

The authors draw attention to the disease pattern of the so-called bowing fracture, basing on examples from their own group of patients. This is a traumatic bending of the bones without any roentgenological identification of a fracture. It is characteristic of this condition that it takes quite some time -- if the case arises at all -- before a discrete apposition of the bones is seen.

Detailed CT diagnosis of liver metastases requires besides plain CT also computed tomography using a contrast medium which can be applied by different methods and routes of application. The problems associated with plain CT and with CT using water-soluble and fat-soluble contrast media are presented in a concise manner.

To visualise the rupture of the scaphoid bone it will be sufficient--as has been proven--to perform two additional projections from the navicular series besides the standard x-rays of the wrist joint, namely, with the hand in writing-pen position and in hyperpronation. With this procedure, almost all (99%) of fractures detected during first examination can be diagnosed. To prove the occurrence of fractures of the wrist besides those of the os naviculare, specific x-rays are employed in accordance with the results of an on-target clinical examination. Such x-rays are, in particular: lateral radioulnar x-ray rotated by 10 degrees in volar direction to assess the os triquetrum; lateral radioulnar x-ray in 10-30 degrees supination to visualise the os pisiforme; carpal tunnel x-ray to assess the entire hollow of the hand, in particular the volar parts of os pisiforme, os hamatum (hamulus) and os trapezium. Although such fractures can partly also be diagnosed by means of a navicular series, as already stated, it is not permissible to exclude the presence of a fracture if there are no abnormal findings in the navicular quartet whereas clinical findings are positive.

The supraspinal ligament calcification of thoracic spine is a rare roentgenographic finding. If this calcificated ligament is fractured several times it may be possible to misinterpret it as rib serial fractures, if it is overshadowed by dorsal ribs in the side projection of thorax. According to Resnick (4) such a ligamentous calcification is found within the overall framework of the "DISH"-syndrome.

In alkaptonuria, a recessively inherited disturbance of amino acid metabolism, deposits of oxydation products of homogentisinic acid result in the disease pattern of ochronosis. Due to the enhanced brittleness of the supporting and gliding tissue, ochronotic arthropathy develops at the vertebral column and later at the major joints with typical roentgenological changes especially in the intervertebral space and the intervertebral disk, as well as the adjacent vertebral bodies. The bone scintigram shows enhanced accumulation in the base and tectorial plates as well as in the adjacent sclerosing zones in the spongiosa of the affected vertebral bodies.

Turn fibular ligaments of the ankle go often undetected when not accompanied by osseous lesions. The significance of injuries to the major supporting ligaments of the ankle is underestimated in children. Next to the clinical findings stress radiographs of the ankle joint in two projections are mandatory. Measurements of anterior and lateral displacement under stress and displacement index need to be compared with the healthy ankle. Diagnosis of a fibular ligament rupture is based on clinical findings and on differences between the measurement results (injured compared to healthy) by way of three different techniques. Rupture of a fibular ligament is an absolute indication for surgery--even in children.

Besides the presence of blood in an injured joint, fat-containing blood can also be found in the joint with intra-articular fractures. This condition, which can be demonstrated by x-ray film, is known as lipohaemarthrosis. We found this to be the case in 8 out of 295 patients with shoulder dislocation. The origin, significance and differential diagnosis of this condition are described.

Assessment of injuries of the hip joint requires a thorough knowledge of the radiological and anatomical conditions and topography of the acetabular region. The authors attempt to present an introduction into the x-ray anatomy of the healthy and of the traumatized acetabulum by means of a juxtaposition of schemes and x-ray films and of pictures of the skeleton.

The article points to the possibility of producing a topogram with the gantry in oblique position. Although this yields a distorted image, it enables accurate planning of the section and also a localization of objects in slanted position, for example, the intervertebral disks of the lower lumbar vertebral column, thus saving the patient time, material and radiation exposure.

Lesions of the knee joint are relatively frequent and are on the increase due to the increasing number of sports and traffic accidents. Violent force exercised on the knee can lead basically to two different kinds of injury sequels. As a rule, injuries to the bone do not present diagnostic problems if there is a clear break in continuity. On the other hand, it is often very difficult to detect chondral or osteochondral lesions and also certain types of longitudinal patellar fractures and fractures of the head of the tibia. Their visualisation requires more far-reaching diagnostic measures. Fundamentally more difficult to identify: the second group of lesions, namely, those of the internal structures of the knee, unless there is a marked instability which is usually accessible to clinical examination. Relatively slight osseous tears or ruptures of a ligament often remain unnoticed on the plain x-ray film. Other diagnostic techniques are imperative in such cases. The first part deals specifically with the radiological aspects of knee injuries. The majority of injuries close to the knee region can be visualized by making use of all techniques of roentgenology. However, if the examination methods get too costly and complicated without ensuring an absolutely safe diagnosis, other techniques must be employed. An example in this regard are the chondral or osteochondral lesions. It is here that arthroscopy often yields better results while offering at the same time a possibility to remove individual small fragments.

Clavicular fracture is one of the most frequent skeletal lesions. In most cases the median third of the clavicula is affected (this is due to the peculiar biomechanical structure). Accompanying lesions and complications of clavicular fractures are rare. A total of 13 x-ray diagnostic techniques are described for clavicular fractures. X-ray film should, as a matter of principle, always be taken in two planes. Definitely the major part of clavicular fractures are treated conservatively (rucksack dressing), whereas surgery is reserved for few and strictly defined indications.

Analysis of roentgenographs of injured elbows must go beyond the identification or exclusion of a line indicating a fracture, especially in children and adolescents. Decisive diagnostic pointers can be supplied by the displacement of fatty bodies, which is a very sensitive indicator of an intra-articular growth, as our postmortem examinations have shown. A systematic search for disturbances of relative positionings (which are defined e.g. by the radius-capitulum axis or the ventral longitudinal humerus axis) and consideration of the sequence in time of the appearance of ossification centres in elbows of children, will prevent gross mistakes in the assessment of the pathological situation.

The second part is devoted to the presentation of the accident surgery aspects of knee lesions. For every topographical region the anatomical features, the most frequent causes of fractures, as well as the conventional classification criteria, are described. In each case also the principal surgical methods are described. Lesions of tendons or ligaments have been included only insofar as they have occurred within the context of an osseous lesion.