The authors present their experience in more than seven years of dynamic computed tomography in clinical practice. Time density curves and characteristic examples in specific regions of interest enrich the presentation. Dynamic computed tomography makes an important contribu tion to the diagnosis and evaluation of a pathologic process: the demonstration of the dynamics of blood flow within the lesion and surrounding normal tissue. Since both the lesion itself and adjacent normal tissue demonstrate characteristic findings in each circulatory phase, the study provides a large amount of data on the flow of blood and contrast material which facilitate both recognition and diiferentation of a lesion. Late studies following administration of a contrast agent allow an estimate of the passage of the contrast medium to the inter stitium, which is of diagnostic importance. Chapters dealing with specific clinical entities also contain useful information on the most appropriate means of contrast agent administration (bolus injection or infusion) as well as a discussion of indications for the procedure. Dynamic computed tomography represents a significant advance over conventional computed tomography in some situations, and this signifies a major contri bution to the diagnostic capabilities of the clinical radiologist. The authors are to be commended for the fact that they have clearly defined the limits of dynamic computed tomography. I hope that the first English language edition, following the appea rance of the German version in 1983, will be well received."

Fast neutron therapy was introduced in London in 1970. The book gives an overview of the developments of the past 28 years, assesses the results of fast neutron treatment, and reviews the compiled clinical data worldwide. The authors describe the radiobiological profile of the neutron beams and evaluate the neutron RBE for secondary cancer induction, they introduce heavy-ion therapy, which combines high physical selectivity with the biological advantages of high-LET radiation for some tumor types, and finally they describe the very recent developments in Boron Neutron Capture Therapy (BNCT).

The idea for this treatise on the radiological anatomy of superficial and deep spinal cord vasculature evolved from daily routine neuroradiological work. This was also the reason for subdividing the monograph into a postmortem anatomical and a clinical part. The actual importance of a clear conception of radio anatomic fundamentals was made clear by many clinical conferences with neurologists, neurosurgeons and orthopedists, where a lack of knowledge about medullary syndromes of suspected vascular origin became evident. Also among neuroradiologists there is still widespread uncertainty in the interpretation of myelograms and angiographies in such cases. A study of the spinal cord's angioarchitecture is all the more justified and necessary considering the vast number of descriptions of cerebro vascular anatomy and pathology. The clinical challenge posed by patients suffering from partial or complete transverse spinal lesions has grown due to new diagnostic and therapeutic approaches. Myelography using water-soluble contrast media, X-ray computed tomography, magnetic resonance imaging and spinal angiography today allow and require both earlier and topographically and pathogenetically more exact classification of diseases of the spinal cord and its surrounding structures. Due to progress in microneurosurgery and interventional neuroradiology, even intramedullary lesions have become more and more accessible and treatable. Therefore this monograph mainly addresses those concerned with invasive therapeutic techniques and who are familiar with the interpretation of radio anatomic findings. A comprehensive description of medullary vascular syndromes would be beyond the scope of this treatise."

Diagnostic errors are important in all branches of medicine because they are an indication of poor patient care. As the number of malpractice cases continues to grow, radiologists will become increasingly involved in litigation. The aetiology of radiological error is multi-factorial. This book focuses on (1) some medico-legal aspects inherent to radiology (radiation exposure related to imaging procedures and malpractice issues related to contrast media administration are discussed in detail) and on (2) the spectrum of diagnostic errors in radiology. Communication issues between the radiologists and physicians and between the radiologists and patients are also presented. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation.

Isolated Cells and Perfused Organs 1. O. Kaplan, P.C.M. van Zijl, J.S. Cohen, Washington, DC/USA NMR Studies of Metabolism of Cells and Perfused Organs Individual Nuclei 2. S.R. Williams, London, UK In Vivo Proton Spectroscopy: Experimental Asoects and Potential 3. N. Beckmann, Basel, Switzerland In Vivo 13C Spectroscopy in Humans 4. M.J.W. Prior, R.J. Maxwell, J.R. Griffiths, London, UK Fluorine - 19F NMR Spectroscopy and Imaging In Vivo 5. J.S. Ingwall, Boston, MA/USA Measuring Cation Movements Across the Cell Wall Using NMR Spectroscopy: Sodium Movements in Striated Muscle 6. M. Rudin, A. Sauter, Basel, Switzerland In Vivo Phosphorus-31 NMR: Potential and Limitations

The biennial symposium 'Radiology Today' continues its original mission to bring together European and American radiologists to discuss advances in the field. This volume presents material by well-known experts in cardiovascular and skeletal radiology. Its aim is to provide an overview of each major topic, trends in clinical development, and current interests in research. The future holds much promise for cardiovascular and skeletal radiology, primarily because of new techniques and procedures, but also because of the development of imaginative approaches to clinical problems. Ideas are born on both sides of the Atlantic, and we believe that it is important to ensure a rapid exchange of new information and to determine how it fits into today's medical care, keeping in mind the quality of patients' care, their safety and comfort, as well as cost. The traditional role of radiologists as consultants has increased greatly over time, with new responsibilities being continuously added. We radiologists are challenged to determine the diagnostic pathway appropriate to each patient. To arrive at the diagnosis quickly, safely, and at the lowest possible cost is as important as our participation in determining the patient's management. Some therapeutic procedures are even carried out by diagnostic radiol ogists themselves, employing ultrasound, computed tomography, or fluoroscopy and intracavitary catheters. Abscesses can be drained, and blood vessels dilated or blocked. In diagnosis and therapy, events are moving quickly, and advances are made at a rapid pace."

Percutaneous transluminal angioscopy is opening up exciting possibilities for the interventional radiologist, since it can picture vascular features with an accuracy and clarity that previously has not been possible. Dr. Beck paves the way for the use of this new tool in clinical diagnosis; he details the technical prerequisites, gives step-by-step instructions for applying the technique and discusses how to interprete the resulting images. The amazing results of percutaneous angioscopy are compared with the results of conventional angioscopy. This approach introduces the new and unknown in perspective with the tried and trusted of the past. Major advantages become obvious: unclear or uncertain angiographical findings can be cleared up, interventional procedures can be supported, and the effects of interventional radiology can be seen before and after vascular treatment. The author's unique insight and systematic approach to the vascular system make this atlas a truly pioneering work.

Percutaneous lumbar discectomy is a new surgical method for treating lumbar disc diseases. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the nucleus pulposus under local anesthesia. Probably 20 % of all patients requiring lumbar disc surgery can be successfully treated by this method. During the past two years, percutaneous discectomy has spread rapidly, and it is now performed in most clinical departments engaged in spinal surgery. The first International Symposium on Percutaneous Lumbar Discectomy, held in Berlin in August 1988, covered all current procedures known as "percutaneous discectomy" and the entire range of percutaneous techniques, both clinical and experimental. Its publication is important because of the recency of this new surgical procedure, the outstanding experience of the speakers - including the Japanese, American, and European "pioneers" of the technique - and last but not least the gaps in the knowledge of physicians concerning this topic. This procedure opens up new perspectives in the surgical treatment of degenerative diseases of the lumbar spine.

A comprehensive review of current endovascular techniques for the treatment of cerebral aneurysms, this is a practical manual for those practicing, or intending to practice, this rapidly expanding branch of minimally invasive surgery. The authors provide descriptions based on an extensive combined experience of clinical management, technical problems, complications and recent results, and discuss the limitations and role of combined extravasular/endovascular techniques.

This book deals with all aspects of surgery of the pancreas. The leading authorities from all over the world have contributed to this volume. Surgery of acute pancreatitis, chronic pancreatitis and pancreatic malignancies is demonstrated. This book defines standards for pancreaticand general surgeons. In addition all aspects of diagnostics, pathophysiology and basic scientific data with regard to pancreatic disease are presented.

Over the past few years, a wealth of new insights have been gained and put to use in basic gastrointestinal tumor research, including tumor suppressor genes, oncogenes, cell-cycle con- trol, apoptosis, adhesion receptors, signal transduction, and gene therapy. Similarly, progress has been made in preven- tion, molecular diagnosis, laparoscopic staging, and antibody- based immunotherapy, and new drugs such as thyrnidylate and topoisomerase I inhibitors have been developed espe- cially for the treatment of colorectal carcinoma. Despite this burgeoning of knowledge in both basic and clinical research, however, we have just begun to put these results into clinical practice. Therefore, the key goal of this volume is to bring together basic and clinical research findings so as to facilitate the translation of these advances into the clinical manage- ment of gastrointestinal tumors. We hope that this volume, which covers a broad spectrum of research and clinical medicine, will impart new insights and greater understanding to all those interested in the therapy of gastrointestinal tumors and will stimulate further scientific research. Berlin, January 1996 E. D. Kreuser P. M. Schlag Contents 1 I. Basic Research S. J. Meltzer The Molecular Biology of Esophageal Carcinoma 1 E. R. Greenberg Preventing Colorectal Cancer...9 M. Streit, R. Schmidt, R. U. Hi/genfeld, E. Thiel, and E. -D. Kreuser Adhesion Receptors in Malignant Transformation and Dissemination of Gastrointestinal Tumors...19 R. Kaiser, E. Thiel, and E. -D. Kreuser Human Gene Therapy in Gastrointestinal Diseases: In Vivo and In Vitro Approaches ...

There has long been disagreement about various aspects of the structure and function of the "gatekeeper" (Greek pyloros, from pyle = gate and ouros = guard). In recent years the problem has often been mentioned in anatomy, physiology, gastroenterology, radiology and even in nuclear medicine. For instance, while referring to manometric and gastric emptying studies, Schu- urkes and van Nuenten (1984 ) pointed out that there was considerable contro- versy as to whether a true pyloric sphincter existed in most species, and espe- cially in man. According to Reeve (1981) many functional aspects of sphincters are poorly understood; the exact mechanism of control of the transfer of chyme from stomach to duodenum through the pylorus is still not clear. Malagelada (1983) states that controversy surrounds the motor activity and function of the antro- duodenal junction; there is disagreement as to whether the pylorus functions as or as an integral part of the distal antrum. Ehrlein et al. (1984) a separate unit reiterate that pyloric motility is poorly understood, and according to Funch- Jensen (1987) there are many unsolved questions. Malagelada (1990) states that the stomach performs multiple functions with a deceivingly simple anat- omy; this is regarded as the key to the investigator's frustration when trying to uncover its secrets. One source of the many controversies surrounding the pylorus may be species differences, according to Schulze-Delrieu et al. (1984).

This book is designed to provide a foundation for physicians-in-training and a quick guide to further enhance the skills set of practicing interventionalists. It is a concise reference manual covering the major aspects of clinical scenarios, procedures, and techniques. Non-Vascular Interventional Radiology of the Abdomen expertly addresses the planning and execution of commonly encountered procedures, including organ specific biopsies, abscess drainage, urinary interventions, gastrostomy, gastrojejunostomy, and biliary interventions.

The decision of Harvey Cushing to leave general surgery and concentrate on the infant field of central nervous system surgery was in retrospect a landmark in the history of neurosurgery. His concentrated work, and also that of his colleague Walter Dandy, originated with the desires of both pioneers to understand surgical anatomy and neurophysiology. The fundamental knowledge and surgical techni ques that they provided became the standard of excellence for several generations of neurosurgeons; so much so that the general belief was that the surgical techniques could not be improved upon. Twenty-five to thirty years ago microtechniques began to appear in a few surgical research centers, they were then gradually applied to clinical neurosurgery and have contributed to a new level of understanding in surgical anatomy and neurophysiology. We are now fortunate to have a new standard of morbidity and mortality in the surgical treatment of intrathecal aneurysms, angiomas, and tumors. It has been said that microneurosurgery was reaching its limits, especially when treating lesions in and around the cavernous sinus and skull base; those lesions notorious for involvement of the dural and extradural compartments, with a tendency to infiltrate adjacent nerves and blood vessels. The dangers of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea appeared unsurmountable. The lateral aspects of the petro-clival region have been of interest to a few pioneering ENT surgeons and neurosurgeons but the cavernous sinus in most respects has remained the final unconquered summit."

In 1932 there appeared the work of SCHMORL and JUNGHANNS, Die gesunde und kranke Wirbelsiiule im Rontgenbild, which laid the foundations of diagnostic radiology of the spine. Since that time the discipline has been extended and refined in a systematic manner and our knowledge has been greatly enriched by the large number of monographs in which leading experts have assembled additional data. An encyclopedic treatment of all that is currently known requires not only that reference be made to all work published since 1932 in order to reveal the problems that remain but also that a serious attempt be made to contribute to the solution of such problems. For this reason, Professor TONDURY and Professor THEILER of Zurich, who know more than anyone else about the ontogeny of the spine, have been invited to display their erudition in this field. Should contra dictions or divergent opinions on certain points be revealed through this confrontation with radiologically obtained findings, so much the better; the effect of this could only be to spur workers in both disciplines on to more advanced research. We have only to recall how in Goethe's time the premaxilla was still the subject of controversy, yet this great man pursuing his studies in comparative anatomy and anthropology was able to prove its existence beyond all doubt. Mainz, May 1974 L. DIETHELM Inhaltsverzeichnis - Contents A. Die normale Wirbelsliule . . . . . . . . . . . . . . . . . . . . 1 1 I. Phylogenetische Entwicklung des Achsenskelets. Von K. THEILER 1 1. Die Bogenelemente. . . . . . . . . . . . . . . 2. Die Chorda dorsalis . . . . . . . . . . . . . ."

Significant development made in the Siemens CT scanner SOMATOM PLUS have opened new possibilities for diagnostic imaging in computed tomography. Spiral CT with a continously rotating X-ray tube and synchronous table increments for up to 60 cm in less than half a minute make radiological diagnosis more accurate. Blind gaps are no longer a major problem, and all structures, especially in the lungs, can be identified and diagnosed. The practical experience of an expert groupof clinical researchers and physicists is now made available in this book.

In the past, CT was the first choice among diagnostic measures for neurological diseases, and MRI was con- sidered to be a supplementary test. However, with the introduction of an ever increasing number of devices, MRI is being used routinely, and it is possible that eventually CT will become supplementary to MRI. This guide to the practical use of MRI has been compiled bearing these considerations in mind. Minimal working knowledge of the simple operations - that does not require details about the technical production of television images - is all that is required in order to obtain information from the views. Thus, even if a clinician is not thoroughly familiar with the theories of MRI, he can use it as efficiently as he does the CT scan. In this book, the theoretical aspects of the principles of MRI are deliberately simplified and the text can be used solely as an atlas. In the introduction, useful general features of MRI interpretation are described and itemized, and major diseases of the central nervous system are presented.

This book reflects the views of an international faculty and provides an authoritative appraisal of modern radiology. It represents the sec ond volume in a planned series of competent overviews, and is mod eled on the successful first volume, Radiology Today, which was enthu siastically received by an international readership. We were encour aged by the comments we received to continue blending the latest ad vances in radiology with comprehensive teaching material concerning modern radiological practice. The Radiology Today 1982 meeting again brought together outstanding radiologists from Europe and North America for the purpose of sharing their experiences and their viewpoints of the current position and opportunities of imaging in medicine. Updating his/her knowledge of advances in medical imaging has be come an integral part of continuing medical education for every radiol ogist. Because all imaging modalities are continuously being refined, new clinical applications develop and frequently replace more com plex or more invasive procedures. Also, the relationship of imaging procedures to each other changes constantly, and with it the configura tion of critical diagnostic pathways for investigation of clinical signs and symptoms. To recognize this trend is important, because it is ex panding the role of the radiologist: our involvement in active guidance to the point of the patient's diagnostic workup has increased signifi cantly where it has become strategic."

The anatomic structure of the vascular supply of the pelvis has long been the subject of study. Progress in angiography rendered it a valu- able diagnostic aid. Nevertheless, angiography is finding new applica- tions in combination with the technique of superselective catheteriza- tion, opening the way for interventional angiography. Remarkable as this may prove, one must not overlook the difficulties involved, most of which essentially result from insufficient knowledge of the anatomic structure concerned: the pelvic arteries are particularly pro b- lema tic owing to their complexity and multiple variations. For this reason we here attempt to chart precisely the course of each artery supplying the pelvis and to provide a synthetic study of the different vascular territories. The book is completed by some pathologic exam- ples which illustrate the sometimes very important role of embolization in therapy. VII Acknowledgements This work has been produced in close collaboration with urologists, gynecologists, orthopedic surgeons, gastroitestinal surgeons, and neu- rosurgeons. We would particularly like to thank all those who have referred their patients to us, and especially Prof. Kuss from the Depart- ment of Urology, Hopital La Pitie, whose role in the realization of this book was crucial, and his colleagues, Prof. LE GUILLOU, Prof. JARDIN, and Prof. CHATELAIN. Others to whom we owe our thanks in the above respect are Prof. STEG and Prof. BoccoN-GmoD (Depart- ment of Urology, Hopital Cochin); Prof. DUFOUR, Prof. CUKIER, and Dr. LEPAGE (Department of Urology, Hopital Necker); Prof.

In this age when we are witnessing a veritable explosion in new modalities in diagnos tic imaging we continue to have a great need for detailed studies of the vascularity of the brain in patients who have all types of cerebral vascular disease. Much of the understanding of cerebral vascular occlusive lesions which we developed in the last two decades was based on our ability to demonstrate the vessels that were affected. Much experimental work in animals had been done where major cerebral vessels were obstructed and the effects of these obstructions on the brain observed pathologically. However, it was not until cerebral angiography could be performed with the detail that became possible in the decades of the '60 's and subsequently that we could begin to understand the relationship of the obstructed vessels observed angiographically to the clinical findings. In addition, much physiologic information was obtained. For instance, the concept ofluxury perfusion which is used to describe non-nutritional flow through the tissues was observed first angiographically although the term was not used until LASSEN described it as a pathophysiological phenomenon observed during cerebral blood flow studies with radioactive isotopes. The concept of embolic occlusions of the cerebral vessels as against thrombosis was clarified and the relative frequency of thrombosis versus embolism was better understood. The concept of collateral circulation of the brain through so-called meningeal end-to end arterial anastomoses was vastly better understood when serial angiography in obstructive cerebral vascular disease was carried out with increasing frequency."

The cerebello-pontine angle has always posed a challenge to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. Angle masses which are very small and difficult to detect frequently produce symptoms, but may remain silent while growing to exceptional size. The neuroradiologist must have firm knowl edge of the clinical manifestations of the diverse angle lesions in order to tailor his studies to the patients' needs. The majority of angle lesions are benign; thus successful surgery has the potential for complete cure. Angle lesions typically arise in conjunction with vital neurovascular structures, and often displace these away from their expected positions. Large lesions may attenuate the vestibulocochlear and facial nerves and thin them over their dome. Since the nerves often remain functional, the surgeon then faces the need to separate the tumor from the contiguous nerve, with preservation of neurological function. Depending on the exact location and extension of the lesion, resection may best be attempted via otologic or neurosurgical approaches. The neuroradiologist must determine - precisely -the presence, site, size, and extension( s) of the lesion and the displacement of vital neurovascular structures as a guide to selecting the line of surgical attack. Since the arteries, veins, and nerves that traverse the angle are fine structures, the neuroradiologist must perform studies of the highest quality to do his job effectively."

La radiologie digestive a ete pendant de nombreuses decennies Ie fleuron de la radiologie fran

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and therapeutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-induced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and com ments. As clinically used, it now pertains to the inadvertent side-effects and com plications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmental, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders-a major, although gen erally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condition. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

The esophagus, ostensibly a simple tubular structure whose functional role often is minimized and even ignored, is, in re- ality, a highly complex viscus. The problems associated with disorders of the esophagus are not only related to the usual en- tities which may be anticipated in any portion of the gastroin- testinal tract, but include in a major fashion the functional mechanisms indigenous to the pharyngoesophageal and eso- phagogastric junctions. A number of disorders, representative of the classical cate- gories of disease, affect the esophagus. These include the various congenital and developmental abnormalities, of which some are complex. Trauma to the esophagus is not un- common, and infective and inflammatory lesions of this struc- ture are encountered relatively frequently. The different types of neoplasms of the esophagus are relatively few in number, but are commonly observed-the most serious, from the point of view of survival, being carcinoma. The collagen disorders, particularly scleroderma and dermatomyositis, affect the eso- phagus all too often. A miscellaneous group includes such en- tities as achalasia and varices, occurring in varying degrees of frequency. Functional abnormalities of the oropharynx, hypo- pharynx and esophagus, particularly relating to swallowing and the frequently encountered instances of spasm of the pharyngoesophageal and the esophagogastric junctions, consti- tute an important and common source of difficulty in the pa- tient population at large. In this regard, anatomic, radiologic, and physiologic studies of these structures have provided through the years vital data which has proved of considerable VII ...