Biomedical subjects
Publications and source records attributed to A Majewski.
We at Virginia Baptist Hospital feel that the Sensor Medics 3100A high frequency oscillatory ventilator to be an effective and safe ventilator for the treatment of RDS and PIE. This ventilator appears to offer a gentler form of mechanical ventilation which is potentially of greatest value to the smallest premature infants.
From 1971 to 1980, 639 patients with carcinoma of the cervix and 271 patients with endometrial cancer were treated in the Division of Radiation Therapy of the Medical School Hannover. In 606 patients radical radiation therapy was followed by routine surgery, 304 patients have been irradiated primarily due to the local spread of the tumor. The radiation therapy consisted of a combination of external beam and intracavitary therapy. In patients with carcinoma of the cervix the five-year survival was 92% for stage Ia, 78% for stage Ib, 67% for stage IIa, 47% for stage IIb, 20% for stage III and 7% for stage IV. In patients with endometrial cancer the five-year survival was 91% for stage I, 71% for stage II, 60% for stage III and 0% for stage IV. Severe complications, i.e., ureteral stricture or fistula occurred in 1% to 1.5% of the patients with cervix cancer and in 0.5% to 1% of the patients with endometrial cancer.
The non invasive diagnostic possibilities of MR have resulted in better diagnosis of degenerative spinal diseases. Twenty-one patients with failed back surgery syndrome (postdiscectomy syndrome) were studied to evaluate the possibility of 1-Tesla magnetic resonance (MR) imaging with gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) in differentiating post operative scar tissue from recurrent disc herniation. The enhanced MR studies correctly depicted the character of abnormal epidural tissue in all patients. We conclude that MR with GD-DTPA might be the method of choice to differentiate reliably postoperative epidural fibrosis from recurrent disc prolapse.
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The authors studied the influence of perception time on the quantified image quality of radiographs, using as an experimental basis the target presentation time during which there was no active involvement of the observer. No change in the influence on the observer was seen down to an observation time of 1 sec.; there was a slight but practically negligible drop on further reduction to 0.5 sec. At 0.1 sec. there was a drop that would have been approximately compensated by a contrast enhancement of object detail to about twice the original value. The influence of the perception time was placed in relation to an example of the influence of structured noise on the detection performance. This influence proved to be significantly greater than that of time. A comparison of the concept of "conspicuity" as defined by Revesz and Kundel was set in relation to the term "Auffälligkeit" ("distinctiveness") coined by Stender. It was established that the quality reserve QR after Borcke corresponds to "Auffälligkeit" as defined by Stender and should best be separated from image quality changes dues to the influence of structured noise on the detection of radiological abnormalities.
In a retrospective study, the results of real-time sonography and grid mammography in 161 patients with histologically confirmed breast cancer were analyzed and compared with the histopathologic characteristics of the tumours to assess the diagnostic accuracy of these preoperative image-producing methods. The results showed the determination of the tumour size as obtained by the image-producing methods to correlate closely with the histopathologic findings. Furthermore, both real-time sonography and mammography yielded certain indications allowing prognostically valuable conclusions in respect of malignancy and invasiveness of the carcinomas. Taking into account the different but complementing diagnostic results of both methods, the combination of grid mammography and real-time sonography must be considered as the presently most reliable preoperative diagnostic procedure.
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A modified needle for the antegrade transfemoral approach in diagnostic and interventional procedures is described that simplifies access to the superficial femoral artery, and that can easily be manufactured from standard puncture needles.
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Eighty-eight patients with possible ankylosing spondylitis (AS) were selected for this followup study. They showed normal or at most suspicious radiographic findings of the sacroiliac joints. After 5 years' followup, 24, and after 10 years 32 patients (59% of the 54 finally available, 36% of the 88 original patients) had definite AS. In 12 individuals, AS could be excluded. Of the 10 remaining patients, 6 still had possible, and 4 had undifferentiated spondyloarthropathy. A comparison between HLA-B27 positive and negative patients showed a significantly increased frequency of definite AS or possible and undifferentiated spondyloarthropathy (p less than 0.05) in the group of HLA-B27 positive patients. The development of AS was characterized by a prolonged course: radiological sacroiliitis became evident after at least 9 +/- 6 years, radiological signs of spinal involvement after 11 +/- 6 years mean disease duration. After 18 +/- 6 years 25 (78%) of 32 patients with AS still maintained good or sufficient functional capacity, indicating a good functional prognosis in the great majority of the patients.
Chest x-ray films obtained by means of a portable x-ray apparatus were reviewed in 101 patients with skin burns and/or burns of the airways. The densitometric difference between measurements at a specific area in the sixth intercostal space lateral to the right hilus, and another measurement area in the mediastinum at the level of the sixth thoracic vertebral body correlated inversely with a radiographic adult respiratory distress syndrome score as suggested by Rommelsheim and Thelen. Our findings suggest that the densitometric difference between mediastinum and lung may aid in the evaluation of ARDS, especially if x-rays have different exposure parameters.
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In an anatomic study of 46 specimens, the angle of the brachiocephalic trunk and the left subclavian artery to the tangent of the aortic arch was measured in an effort to decide which route offers the quickest access to the descending aorta in lower extremity angiography for severe occlusive vascular diseases. The study shows that the average angles (77.1 +/- 16.0 degrees for the brachiocephalic trunk/77.7 +/- 16.3 degrees for the left subclavian artery) are not significantly different. Since the right axillary approach incurs other risks that could only be compensated by significantly quicker access, i.e. shorter maneuvering time in the aortic arch we conclude that in patients of all ages the left side should be the access route of choice.
Of 88 selected patients with possible ankylosing spondylitis (AS) 54 (61%) participated in two phases of a 10 years' follow-up study. Thirty-two (59%) developed definite AS according to the New York criteria, 10 (19%) had possible/undifferentiated seronegative spondylarthropathy (SSA) and 12 patients had other diagnoses. Only 3 (9%) of 35 patients with sacroiliitis did not fulfill the New York criteria for definite AS until the last examination. Sacroiliitis and radiological spinal signs of AS appeared rather late above a mean age of 40 years and after a mean disease duration of more than 10 years. After 18 years mean disease duration 25 (78%) of 32 AS patients had good or sufficient functional capacity indicating an overall good functional prognosis. HLA B27 typing proved to be useful in patients with possible early AS: 29 (71%) of 41 B27 positive and 3 (23%) of 13 B27 negative patients developed definite AS (p less than 0.005). A combination of the B27 test with data of the history, clinical, laboratory, and radiological examination proposed as early diagnostic criteria detected patients with the outcome diagnosis of definite AS with even higher significance (p less than 0.001). These criteria were also useful in the identification of patients with possible or undifferentiated SSA. The recently recognized entity of undifferentiated SSA should only be diagnosed after long term follow-up.
Based on experience in arteriography of the hand in 108 patients the authors present in a retrospective study the surgical indications (trauma, tumour, angiodysplasia, malformation and embolic lesion) and results of this method. The diagnostic value of arteriography of the hand is shown by means of results and examples.
Certain phenomena in the region of the initial lymphatics during clinical examination (indirect lymphography and microlymphography)--namely build-up and course and filling and diffusion--have still to be elucidated. The glutaraldehyde and MERCOX methods were used to simulate indirect application conditions in clinical procedures in skin specimens (human and pig) which were then examined by scanning electron microscopy. The results presented include novel findings on the microtopography of these lymph vessels and the typology of filling refluxes which are of importance when indirect imaging techniques are employed. Various speeds of application were used and the function of the opening apparatus with previously undescribed structures (endothelial bridges and connective tissue trabeculae) was taken into consideration. Recommendations aimed at standardizing the nomenclature of parietal structures and sections of the lymphatics have been incorporated in the report.