[Computer tomography in traumatology. Pelvic injuries].
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Biomedical subjects
Publications and source records attributed to H H Jend.
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Results obtained via computed tomography in 37 cases of osseous destruction in 14 patients with histiocytosis X, are analysed in this article. The CT image yielded independent of the site of manifestation the representation of purely lytical osseous destruction; the sclerosing margins, which did not show any enhancement in serial CT, were either absent or more or less prominent. There was no paraosseous tumour growth in any of the examined cases.
Although well known, the morphology of branchial cysts has not been sufficiently presented in CT literature. In the present case report, diagnostic criteria are given, such as typical site of occurrence, ductal extension towards the supratonsillar fossa, and cystic, but occasionally soft tissue density. Differential diagnosis is given for cases which cannot be classified according to these criteria.
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An attempt has been made to define the role of CT in the diagnosis of cerebello-pontine angle tumours; 190 patients with this suspected diagnosis were examined by CT (including intravenous contrast enhancement and CT air cisternography) as well as other radiological, otological, neurological and audiometric investigations. Amongst these methods, CT is of most value. A knowledge of the variations of the internal auditory meatus and measurements of the porus acousticus are essential for evaluating the computer tomographic appearances.
The results of computed tomography in 89 patients with tumours of the epipharynx and oropharynx involving the mouth are compared with the findings of other forms of clinical examination. In 26 patients, CT provided additional relevant information, in eight patients CT provided less information than clinical examination. The value of CT depended largely on the localisation of the tumour; the poorest results were found in tumours of the tonsils and the soft palate. CT provided additional information most commonly with large tumours, since these are frequently associated with bone destruction, local infiltration and occlusion of large vessels.
Pressure exerted against the ankle joint during lateral exposures shows a typical form of subluxation of the talus in respect of the tibia if there has been rupture of the anterior fibulo-talar ligament. This displacement can be quantified by using the standard technique of Seiler and Holzrichter. Retrospective evaluation of exposures carried out with pressure in 206 patients with stretching or rupture of the ligaments of the ankle joint have shown that stretching can be diagnosed if the joint space reaches 7 mm, and a rupture can be diagnosed with a joint space of 11 mm. If there is a difference of more than 5 mm in the joint space of the two joints, a rupture is present. With these criteria, 85% of all ligament injuries can be correctly diagnosed. In the remaining 15%, early arthrography provides the necessary information.
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The computed tomographic morphology of malignant choroidal melanoma and its perfusion characteristics are described. Thirty-three static and serial CT examinations made on 29 patients with choroidal melanoma, three with pseudotumors of the macula and one with choroidal metastasis revealed the choroidal melanoma to be usually a hyperdense, markedly perfused tumor, while the non-contrast diagnostically undifferentiable pseudotumors and the choroidal metastasis, revealed no significant change in density after the administration of contrast material. Density values of perfusion characteristics of choroidal melanoma that are outside of the normal range are a result of secondary changes within the immediate surroundings of the tumor, such as detachment of the retina, tumor-induced glaucoma, or tumor necrosis.
The computer tomographic appearances of 16 traumatic lesions of the spleen have been analysed. The changes n the spleen were related to the subsequent therapeutic procedures. The clinically important distinction between parenchymal rupture and parenchymal-capsular rupture can always be made with certainty. CT also adds information concerning parasplenic abnormalities, traumatic changes in upper abdominal organs and additional injuries to other parts of the body.
By using serial computer tomography, an arterio-venous fistula of the liver could be demonstrated in five cases. The computer tomographic findings which, previously, could only be obtained by angiography, are described. The value of the method as a diagnostic procedure is discussed and its limitations compared with angiography are documented.
Computer tomography of the facial bones provides the maxillo-facial surgeon with valuable information regarding the type and extent of typical mid-facial fractures (le Fort fractures I to III, fractures of the malar bone, orbital fractures, fractures of the skull base close to the facial bones). The procedure takes little extra time. The patient is saved additional investigations, requiring changes in position which may, at times, be hazardous. Our experience extends to 59 examinations, which is used for an analysis of mid-facial fractures. Some typical examples are given.
Technical improvements and the use of intrathecal Metrizamide have made computer tomography of the spine a valuable diagnostic method. The value of CT in demonstrating morphological changes in the spine was investigated in 77 examinations of congenital malformation or inflammatory and degenerative disease. Measurements of the spinal canal provide more accurate information than conventional radiology and these are discussed. Intradural injection of contrast medium makes it possible to diagnose abnormalities of the cord by means of CT. Inflammatory changes in the spine and in the paraspinal soft tissues are shown at an early stage. A diagnosis of tumour can be confirmed by CT-controlled needle biopsy. It is usually possible to demonstrate disc prolapse without the use of contrast medium. On the other hand, the investigation of pain following disc operations remains a difficult problem.
The authors studied the survival rates of the P2 and P3 patients within a group of 287 patients suffering from carcinomas of the urinary bladder who had been treated by urologic operation and radiotherapy. A differentiation was made between the surgical methods transurethral resection (TUR), bladder wall resection and cystectomy. P2 patients presented significantly higher three-year survival rates after bladder wall resection or cystectomy (10/17) than after TUR (7/23). In stage P3, no differences were found with regard to the surgical method. The results are discussed and compared to those communicated in literature.