Biomedical subjects
Publications and source records attributed to H Czembirek.
A model for analysis, adapted to double contrast technique, is presented which helps to detect extrinsic lesions of the gastrointestinal tract. During retrospective evaluation of double contrast examinations of 73 patients this scheme enabled the correct diagnosis in 96%.
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In this study we investigated the appearance of renal cysts in 43 chronic hemodialyzed patients using ultrasound (3.5 MHz-sector scanner). The mean age of the patients was 45 years, and the mean duration of dialysis was 26.3 months. In 21 patients (= 49%) cysts could be found. In 10 of these patients a former investigation at beginning of dialysis did not demonstrate any cystic lesions. The diameter of the cysts varied between 5 and 30 mm. Considering the duration of dialysis, in 9 (= 39%) out of 23 patients with a maximum duration of dialysis of 2 years cysts could be demonstrated by ultrasound, and in 12 (= 60%) of 20 patients, who had been dialysed for more than 2 years. The clinical impact of the demonstration of such cysts was recently reported in cases which developed complications like tumour formation or severe bleeding.
Renal lime milk cysts are very rare. By ultrasound and computed tomography the diagnosis is easier than by normal X-rays. Presentation of a typical example.
The case is reported of a 35-year-old man who had been treated with hemodialysis for five years because of renal insufficiency due to chronic glomerulonephritis. Renal cystic disease acquired during maintenance dialysis was complicated by bilateral kidney rupture within an interval of two months. Development of cystic changes of kidneys during long-term hemodialysis was first reported in 1977. The main complications of this cystic transformation are, according to the literature, development of neoplasms and hemorrhage into the cysts. In the present case the clinical symptomatology consisted of episodes of severe pain in the flank, hematuria, hypotension and lowering of hematocrit. An ultrasound study demonstrated enlargement of some cysts compared to another study some months ago, and internal echoes due to hemorrhage could be seen in some of the cysts. Because of the danger of spontaneous kidney rupture with consecutive life-threatening hemorrhage, surgery is indicated in such cases.
Among 279 consecutive patients (average age 53.8 years) with acute venous thrombosis, "complete" or "nearly complete" search for neoplasm was undertaken in 93 (average 60.6 years), "not complete" search in 186 (average 50.1 years). Subsequently the patients were followed regularly for possible malignant tumour (average follow-up period 36.9 months). In the group as a whole the following causes of thrombosis were identified: contraceptives 9.3%; post-operative 9%; malignant tumour diagnosed immediately or within 12 months 5.8%; traumatic 5%; immobilization 3.2%; post-partum 2.9%; diverse other causes 8.2%; unknown 59.5%. Neoplasm was found in 12.9% of 93 somewhat older "completely" examined patients. Taking into account age, 7.8% of all patients over 50 years developed thrombosis in association with neoplasm. In 6 of 16 patients with malignant tumour the venous thrombosis followed a particular course. Extensive thromboses in several bouts predominated. In 48.4% there were three-bout thromboses, in a further 27.4% four-bout thromboses involving also the pelvic vein. Isolated lower-leg venous thrombosis occurred in 9.2%, while the remaining one or multiple-bout thromboses occurred only in a few. Massive pelvic and leg vein thrombosis occurred in 43% of patients with malignant neoplasm, much more frequently than in those without neoplasm.
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Ultrasound scans of the upper abdomen were carried out in fifty patients with cystic fibrosis (age 2 to 26 years). 38% showed an abnormal hepatic sonogram. On eight occasions it was possible to confirm these changes by a liver biopsy. In 14% there was homogenous increase in liver echoes. 22% showed an non-homogeneous liver structure due to fibrotic and cirrhotic changes and cholangitis. Four of these patients had splenomegaly due to portal hypertension. 85% of the pancreatic scans which could be evaluated showed small pancreases with high echoes. Cholelithiasis was not present in any. Sonography of the upper abdomen is the method of choice for evaluating the liver, biliary system, pancreas and spleen.
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The case of a 51 years old man with a hepatocellular carcinoma (HCC) is reported. Though the tumor is of multifocal origin and widespread the disease takes a favourable course. Histology revealed a well differentiated HCC with clusters of polygonal tumor cells and fibrous stroma, the pattern of which reminds of focal nodular hyperplasia (FNH). HCC has developed in a non cirrhotic liver. Clinically, the patient is in a good condition 22 months after diagnosis of the tumor. The value of all possible methods--invasive and not invasive--for diagnosis of HCC is assessed and compared with literature. According to the literature the survival time comes to 3 to 6 months on average, only single cases take a more favourable course. Correlation of morphology and biological behaviour of tumor is lacking. In our case the pattern of fibrosis similar to FNH is striking and points to a development of carcinoma in preexisting FNH. In literature, however, evidence for a malignant transformation of FNH is lacking.
Incidence and extent of pulmonary complications were evaluated retrospectively in 101 patients with hepatic coma (34 patients with acute liver failure, 57 patients with hepatic encephalopathy and 10 patients with mixed forms). 76 patients (73.3%) had pulmonary complications (pulmonary edema 57 cases, pneumonia 20 cases, tracheobronchitis 30 cases). Lethality of the group with pulmonary complications was 97% as compared to 16% in the group without pulmonary complications. Pathogenesis of pulmonary complications is not completely clear; different mechanisms are being discussed like central mechanisms, vascular lesions caused by metabolic or toxic factors, cardiac failure, and increased susceptibility to infection. In 9 out of 59 cases (15.3%) with respiratory failure no morphological changes could be observed in the lungs; in these cases intrapulmonary shunts might have been the cause for the pulmonary complications. The incidence of pulmonary complications increased by a factor of 2.4 during intensive care unit treatment of the patients; this increase shows, that intensive care unit treatment still has to be improved.
The quality of pancreatic sonography is determined not only by the technical equipment used and by the experience of the interpreter but also by the variable anatomical and nutritional status of the patients examined. The sonograms obtained from 211 consecutively examined patients were analyzed with regard to the quality of pancreatic imaging. Direct visualization of the parenchyma of the pancreatic head and body was found in 47%. In an additional 36%, unequivocal localization of the pancreatic area was possible by delineating the peripancreatic vessels. 17% of the studies were non-diagnostic due to over-lying intestinal gas in obese patients and cases of extensive scarring. This percentage can be reduced by a modified examination technique. The use of alternative radiological methods is, therefore, obligatory in less than 10%.
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The article discusses the possibilities of application and performance spectrum of the ultrasonic method when examining patients with space-occupying growths within the framework of orthopaedics. An analysis of 33 patients with inflammatory or neoplastic tumours showed that sonography promotes highly valuable information in respect of the presence and extension of a tumour of the soft tissues, besides supplying roughly outlined information on the structure of such tumours. Hence, sonography can supply valuable aid for the decision regarding further diagnostic measures, complementary to the basic x-ray examinations.
A modification of the double contrast technique for examining the small bowel is described. This employs an infusion system with variable infusion pressure, which makes it possible to adjust the flow of contrast medium, methyl cellulose and water separately, permitting continuous double contrast demonstration of the entire small bowel. The ileum, which was poorly demonstrated by conventional double contrast methods, can be shown satisfactorily in a high percentage of cases (70%). Side effects and failures, which were frequent at first, have become less common with increasing experience.
The radiation exposure of jejunum, skin and gonads during dynamic double contrast studies of the small intestine was measured by thermoluminescence-dosimetry. This radiological examination performed under fluoroscopic control, resulted in a higher dose of skin radiation than when applying conventional methods. The gonadal dose, however was not increased when small fields of view were used during fluoroscopy.
The successful transplantation of a single kidney of a two year old child to a 38 year old recipient is reported. The size of the kidney increased 400% and the function 340% over a period of 23 months. Adequate function of the transplant was accomplished through growth and considerable compensatory hypertrophy despite intercurrent rejection reactions.
The conception of Warren's Shunt--selective decompression of esophageal varices while maintaining prograde portal flow--was controlled by pre- and postoperative angiographic examinations on 12 patients: No change in portal perfusion was established angiographically in ten of the patients. Two patients developed aneurysmatic, arterio-portal fistulae as a result of postoperative portal decompression. In one of these cases, a thrombosis of the portal vein with hepatofugal perfusion of the left gastric vein was detected. The postoperative examinations indicated functioning shunts in 9 out of 12 patients. These results formed the basis for the discussion regarding the value of visceral angiography in the selection of the surgical technique and regarding its value in control of therapy. Surgical questions concerning the visceral vascular anatomy can be answered sufficiently. Furthermore, celiac and mesenteric angiography yield information on portal hemodynamics. Nevertheless, the additional application of invasive scintigraphy seems to be necessary for establishing quantitative radiological parameters of prognostic relevance.