Disseminated nodular and miliary lesions of the lung.
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Biomedical subjects
Publications and source records attributed to E Voegeli.
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There has been a definite increase in the incidence of Crohn's disease in recent years. A particular feature of this disease is the high incidence of recurrence after surgical removal of affected portions of the gut. This may be due to a resection carried out through a diseased segment and this stresses the importance of recognising early changes. This is not possible by conventional radiology (small bowel examination, barium enema) and is therefore an indication for pre-operative visceral angiography. The results obtained in ten patients, who subsequently came to surgery, were compared with the findings on conventional radiology and endoscopy. Angiography proved the best method for the early demonstration of inflammatory changes. This was confirmed by histological examination of the resected specimen.
Changes in pulmonary blood flow as see on chest radiographs have assumed considerable importance recently in the evaluation of left ventricular insufficiency. In order to study the results of poor radiographs on the evaluation of pulmonary haemodynamics, blood-flow patterns were studied in 39 individuals of various ages during normal inspiration, during the Valsalva manoeuvre and during expiration. All had normal lungs. The results indicate that changes in blood-flow patterns and loss of marginal definition of basal vessels are unreliable signs of left-sided insufficiency in old patients or in unco-operative patients, in the presence of a high diaphragm and in the supine position.
The usefulness of arteriography in the diagnosis and management of bone tumours has been evaluated in 78 cases (49 malignant neoplasms, 17 benign tumours and 12 inflammatory lesions). Using well-defined criteria, of which the presence or absence of tumour vessels is of decisive importance, arteriography represents - not as a routine procedure but in selected cases - a most useful guide to establishing the diagnosis, by adding important information to standard radiography, by defining the extent of the lesion and by assisting in the selection of the best site for biopsy.
In patients suffering from traffic accidents traumatic lesions of the chest are of special importance since in 50% of deaths the thoracic trauma is responsible for the final outcome. The fatal course is, however, not always due to severe and irreparable dammage to thoracic organs, but very often due to under-estimation of initial symptoms and thus inadequate treatment. For the proper diagnosis of traumatic lesions of the thorax the plain film of the chest is, therefore, fundamentally important. In this paper, which is mainly dealing with lesions of the airways and lungs, the significance of radiological symptoms is stressed and a correlation with pathophysiologic as well as histologic data is attempted.
Diagnostic accuracy in the prediction of acute mesenteric ischemia from clinical symptoms and radiologic examinations (conventional radiography and angiography) has been analyzed in a retrospective study of 17 cases. The findings suggest that arteriography should always be performed if acute mesenteric ischemia is suspected on clinical grounds and from conventional radiography.
The indications for and diagnostic value of visceral angiography in 30 cases of acute gastrointestinal bleeding are discussed. In one third of these emergency angiograms the etiology of the bleeding could not be demonstrated. In two thirds of the cases the source of bleeding was successfully localized. In half the positive angiograms the bleeding site was shown directly in the form of extravasation of contrast, while in the remaining half pathological findings were demonstrated without evidence of contrast media extravasation.
The diagnostic value of selective pancreatic angiography and retrograde pancreatic cholangiography used in combination was studied in 24 patients with chronic pancreatitis or pancreatico-duodenal carcinomas. This was done as a prospective study. The accuracy of the individual methods is 75% and 79% respectively; used in combination, a correct diagnosis is obtained in 91% of cases. The advantage of combining the techniques depends on the fact that they supplement each other.
Hypertension in endocrine disorders (Cushing's syndrome, Conn's syndrome, Pheochromocytoma) is frequently accompanied by a confusing clinical symptomatology. The underlying pathology is a cortical hyperplasia or a tumor of the adrenal cortex or medulla. The differentiation from other causes of hypertension is primarily based upon laboratory findings (plasma and urinary concentration of cortico-steroids, Renin, Angiotensin and catecholamines as well as their derivates). The preoperative tumor localization by urography, arteriography and adrenal venography as well as the visualization of glandular hypertrophy by adrenal venography is of fundamental importance with regard to treatment of these disorders.
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