Biomedical subjects
Publications and source records attributed to D Koischwitz.
Diagnosis, clinic and therapy of adrenal pseudocysts are described by means of three cases. The three characteristic signs of this rare diseases are: 1. traumatic anamnesis, 2. radiating lumbal pains, 3. calcified, paravertebral cyst.
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The radiological changes in the kidneys and skeleton in primary oxalosis in a patient are described. Crystalline calcium oxalate deposits, which are a secondary phenomenon, are responsible for the findings, which are of great significance both functionally and prognostically. Hyperoxalaemia is due to an enzyme defect, which leads to hyperoxaluria; this causes a reduction in renal function and can lead to rapid progression of the condition.
Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.
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Three hundred and thirty-seven patients with portal hypertension and recurrent bleeding from oesophageal varices were examined by sonography. The situation was correctly elucidated in 17 out of 21 patients (81%) with pre-hepatic blocks, in 275 out of 313 cases (88%) with intra-hepatic blocks and in two out of three cases with post-hepatic blocks. The relevant findings consisted of stenoses and occlusions of the portal venous system and collaterals in pre-hepatic blocks, dilatation of the portal venous system and hepato-fugal collaterals in intra-hepatic blocks and occlusion of the hepatic veins in post-hepatic blocks. Sonography is recommended in cases of portal hypertension because of its non-invasive nature and high accuracy as the primary form of investigation. Spleno-portography should be used only if surgery is indicated.
The syndrome of mastocytosis extends from cutaneous urticaria pigmentosa through systemic mastocytosis to the rarely occurring mast cell leukaemia. Our investigations with a large patient collective have shown that systemic forms of the disease occur more often than is generally supposed. In particular the incidence of bone marrow manifestations deserve more attention. The inflammatory-granulomatous findings in the bone marrow suggest an immunoactive component in the pathogenesis of this disease. The bone lesions that occur in about 50% of patients are probably the result of the common endosteal site of the mastocytosis granuloma. These lesions can be generalized (osteoporosis-osteosclerosis) or localized (osteolytic-osteosclerotic foci). In clinical practice bone biopsy and skeletal radiology complement one another; in addition to skin biopsy bone biopsy supplies the initial diagnosis of mastocytosis and documents systemic manifestation; the X-ray picture informs the clinician about the type and extent of the bone pathology.
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Radiologic and pathoanatomic findings in two patients with the very rate primary osteoliposarcoma of bone are reported. In one case, there was a manifestation on the left femoral shaft which led to pathologic fracture. Amputation of the femur was followed by a 2.5-year tumor-free interval. In the second case, there was a manifestation in the region of the right upper part of the ilium. After radiation and cytostatic therapy, pronounced intratumoral ossifications occurred and the patient's condition was good up to exitus lethalis 3 years after diagnosis. Osteoliposarcoma thus shows a markedly more favorable prognosis than the osteosarcoma and rather corresponds to that of a liposarcoma. Typical clinical and radiologic symptoms are lacking.
Three patients with industrial exposure to PVC are described, who developed angio-sarcomas of the liver; in one patient this was combined with a multi-lobular primary hepato-cellular carcinoma. The epidemiology, clinical features and diagnosis are discussed, with particular reference to angiography, sonography and computerized tomography. The non-invasive methods, such as computerized tomography and sonography, are the techniques of choice if an angiosarcoma is suspected after long exposure to PVC.
In a total of 202 patients conventional scintigraphy as well as emission computed tomography (SPECT) of the liver were performed. In 123 patients focal lesions could be excluded whereas in 30 cases the presence of liver tumors was verified. In 5 of the respective cases correct diagnosis was only possible by SPECT, in 9 further cases SPECT improved the diagnostic accuracy (topography, size and number of defects). In patients with normal findings of the liver, conventional scintigraphy yielded false-positive findings in 9 cases and SPECT in 7 cases. By combination of both methods the false-positive diagnoses could be reduced to 5. 48 patients had cirrhosis of the liver: in all of them conventional camera scintigraphy was superior to SPECT because of reduced activity accumulation in the liver (insufficient statistics).
54 patients with cirrhosis of the liver and relapsing esophageal bleeding received mesentericocaval dacron shunts between 1st January 1975 and 31st December 1979 and were followed up to the end of 1980. Patients were accepted for surgery under the following conditions: (1) liver function had to be compensated, (2) there had to be no signs and symptoms of hepatoportal encephalopathy, (3) there had to be no signs and symptoms of activity of cirrhosis of the liver, (4) liver volume had to be between 1 000 and 2 500 ml, (5) portal vein perfusion had to be 15-35%, (6) stenosis of liver arteries had to be excluded. Lethality during the hospital period and from hepatoportal encephalopathy was 7.4%, late lethality was 11%; this accounted for a 5-year survival rate of 70%. Residual perfusion of the portal vein could be demonstrated in many cases by intra- and postoperative measurements with different methods. The dacron prosthesis was implanted into the superior mesenteric vein in an acute angle (it had a diameter of 16 mm). The prosthesis was occluded by thrombosis in 3 out of the first 18 cases operated upon. This could be prevented in the following 36 patients by intra- and postoperative longterm heparinisation.
The rating of sonography compared with contrast roentgenography is examined for the biliary system. A high quota of accuracy equivalent or superior to contrast radiography is achieved by sonography, as demonstrated by a comparison or oral cholecystography with sonography (accuracy 69% to 95.5%), IV cholangiocholecystography (accuracy 86.5% to 88.9%) and ERCP (accuracy 69.9% to 67.3%).
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The results of angiography of the hand in workers in the vinyl chloride industry are described. Amongst 93 patients, there were 19 on whom angiograms of the hand were performed because of Raynaud-like changes, pain or other pathological findings. All patients examined by angiography showed abnormalities in the vessels in the hands and fingers of varying severity. Vascular occlusions (17 patients), stenoses (9 patients) and thread-like narrowing of the digital arteries (6 patients) with the development of a collateral circulation, were prominent findings. In addition there was elongation and tortuosity of the digital arteries (14 patients) which were regarded as cirsoid aneurysms. The angiographic findings have been correlated with the known histological changes.
The rare condition of chondroplasia punctata is illustrated by two patients. The very different manifestation and course of the disease in these two patients confirms Spranger et al's (1971) view that it is an heterogeneous disease which can be divided into two types. The rhizomelic type is characterised by well marked punctate cartilage calcification, shortening of the extremities, deformities of the metaphyses and epiphyses, frequent cataracts and a fatal outcome. In the Conradi-Hünermann-type the changes are less marked and the patients may survive. In order to classify the disease correctly, radiological examination in early childhood is desirable.
The value of computer tomography in the demonstration of venous collaterals in cases with occlusion or malformation of the superior and inferior vena cava has been demonstrated in five patients. The ascending lumbar veins and the vena azygos are of special significance in the formation of collaterals.