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Biomedical subjects

H J Triebel

Publications and source records attributed to H J Triebel.

30 records · Page 2Linked to original sources

[Dacryocystography--conventional technic or digital subtraction technic?].

The lacrimal drainage systems of 92 patients were examined by a digital subtraction technique; 30 patients were examined additionally by a conventional technique, using films obtained during screening for the contrast injection. The digital subtraction dacryocystogram provided excellent demonstration of the lacrymal sac and of the tear ducts, but there is little diagnostic gain when compared with the conventional technique. Both methods are highly reliable. In view of its low radiation dose and rapid and simple course, conventional dacryocystography is regarded as the method of choice for routine examinations. The digital subtraction technique should be reserved for special problems.

Adolescent↗

[Morphology of Paget's osteodystrophia deformans in the computed tomogram].

Thirty-four patients with known Paget's disease were examined by CT in order to characterise the appearances of the bones on transverse sections. The typical findings have been related to their anatomical localisation and frequency. The differential diagnosis from conditions with similar CT appearances, such as osteoplastic metastases, fibrous dysplasia or osteomyelosclerosis, is discussed. The CT appearances of Paget's disease are typical in the same way as conventional radiographs.

Aged↗

[Pulmonary siderosis in an arc welder].

An arc welder of 32 years of age is presented with a random finding of miliar reticulonodular shadows in the plain film of the thorax. Subjectively and objectively the patient appears healthy. The presence of a pneumoconiosis is confirmed by biopsy. Differential diagnosis had to consider sarcoidosis and pulmonary siderosis in view of the known professional anamnesis. This case report underlines the reped demand to assess x-ray films of the thoracic organs only if the clinical findings and anamnesis are thoroughly known.

Adult↗

[Sonography as a screening method in suspected rupture of the rotator cuff].

We have found ultrasonography of the shoulder in differentiating between normal rotator cuff and rotator cuff lesion according to trauma a very helpful method. In comparison to arthrography it is a quick and painless method without any risk. Whereas other authors report a sensitivity of 100% and a specificity of 94% in shoulder disease we recommend ultrasonography in acute shoulder trauma as a screening method. Pathological findings in ultrasonography will make the decision for arthrography easy. The major diagnostic pitfall is the calcified tendon of the rotator cuff.

Calcinosis↗

Semiquantitative SPECT imaging for assessment of bone reactions in internal derangements of the temporomandibular joint.

The temporomandibular joints (TMJs) of 60 patients with arthrographically confirmed internal derangements and 30 volunteers were examined with single photon emission computed tomography (SPECT). Semiquantitative evaluation was done by forming a quotient from the counts of a constantly sized TMJ-ROI relative to the overall counts of the cranium. The TMJ/cranium quotient depended on the age of the subject, with younger patients showing a larger quotient than older ones. Normal joints were separated from the afflicted ones by means of a discriminant analysis. Sensitivity of semiquantitative evaluation was 78% (disc displacements with reduction) and 89% (disc displacements without reduction). Correct visual evaluation was made in 53% of the reducing and 75% of the nonreducing discs. Semiquantitative SPECT of the TMJs provides important information on the extent of osseous changes in afflicted joints and is suitable for follow-up of splint therapy. It may also be helpful as a screening method in detecting clinically normal joints before arthrography is carried out and in assessing the presumptive response to treatment with a splint.

Adolescent↗

[Semiquantitative SPECT of anterior dislocation of the temporomandibular joint disk].

SPECT examination of the TMJ using 99m Tc-MDP was performed in 43 patients with arthrographically proven anterior dislocation of the disc and in 30 normals. The results were evaluated visually and also in a semi-quantitative manner that took account of relative 99m Tc activity in the TMJ and of the age of the patient. In the presence of arthrographically proven anterior, but reversible, disc dislocation, the semi-quantitative method proved positive in 75% of cases (28 cases). In joints with fixed anterior dislocation (29 cases), bone changes were demonstrated in 86%. Visual evaluation was positive in 50% of reversible, and in 72% of non-reversible dislocations. Semi-quantitative SPECT of the TMJ is excellent for demonstrating bone reaction resulting from TMJ dysfunction and for indicating the severity of the joint abnormality.

Adolescent↗

[Computed tomography of anterior dislocation of the temporomandibular articular disk].

In a prospective study, the findings on arthrography and CT in 51 TMJs with anterior meniscus dislocation were compared. The CT diagnosis of anterior dislocation was made by a standardised method which we have developed and which depends upon evaluating axial sections. Sensitivity of the CT methods was 87%. In the absence of arthrography, a negative diagnosis in the asymptomatic contralateral side was made in 81%. Ruptures and adhesions could not be demonstrated by CT. For these reasons, arthrography is to be preferred to CT for making the initial diagnosis. CT should be carried out for special indications, such as contrast sensitivity, the documentation of a clinically confirmed diagnosis and for follow-up of treatment. Currently an attempt is being made to stage the disease by computed tomography.

Arthrography↗

[Roentgenologic diagnosis and differential diagnosis of carcinomatous lymphangiosis of the lungs].

Generalised lymphatic carcinosis, also known as lymphangitis carcinomatosa, cannot be diagnosed by just one x-ray film of the thoracic organs. However, if an enhanced reticular striated pattern is seen, possibly associated with miliar stippling or hilar masses it is recommended to perform short-term follow-ups and comparisons with previous x-ray films. Lymphangitis carcinomatosa becomes probable if rapid progression of the findings or development of new lesions is seen besides the already existing ones and if this is associated with rapidly increasing dyspnoea. Pulmonary tomography will not yield highly significant results, but it can substantiate the diagnosis, the same applies to computed tomography of the thorax. CT is particularly important in differential diagnosis. Earliest possible diagnosis of lymphangitis carcinomatosa is of great importance for therapy, since it may be a first pointer towards an unknown metastasising primary tumor or haematogenous dissemination of already known tumours.

Adenocarcinoma↗

[Advanced pulmonary alveolar microlithiasis].

A severe course of microlithiasis alveolaris pulmonum in a 28-year old patient is described. The disease, which had progressed to a very advanced stage at the time of examination, produced in the plain radiograph of the thorax an extensive, homogeneous, ground-glass like shadow of practically all organs of the thorax. The typical miliary (spot-like) shadow ("sandstorm lung") is visible only in the lateral and apical parts of the lung. CT revealed massive calcareous deposits which increased in craniocaudal and ventrodorsal direction. Bullous metaplasia of the lung was particularly striking in the apical region. No effective therapy is known so far. A combined heart and lung transplantation might be the only therapy that could prolong the patient's life.

Adult↗

[Arthrography of the temporomandibular joint. Indications, technic and interpretation].

Articular dysfunction of the TMJ with anterior displacement of the disc ("internal derangement") is an entity which has been separated from other types of the "myofascial pain syndromes" and which can be treated conservatively or by surgery. Arthrography of the TMJ has contributed greatly to an understanding of normal and abnormal function and, in many cases, it can provide a diagnosis. On the basis of our experience with 80 investigations we discuss technical problems and the clinical indications. The indications for arthrography are in the pre-operative diagnosis, when clinical findings are uncertain, in order to demonstrate perforation, in order to confirm a suspected diagnosis and to assist in prosthetic treatment.

Arthrography↗

[Rotator cuff ruptures of the shoulder joint. Sonography--arthrography].

47 patients suspected of rupture of the rotator cuff were sonographed and arthrographed. Rupture of the rotator cuff was diagnosed in 12 cases, both diagnostic methods yielding the same result. In 29 patients sonography and arthrography did not reveal any abnormal findings. Six ruptures evident in sonography were not confirmed by arthrography and were considered false positive. Direct pointers towards rupture of the cuff would be: echoless defects, cuff cannot be visualised fully or in part, irregularities of movement during dynamic examination. Echoless "cystic" areas in the periarticular soft parts must be considered an indirect pointer. Echorich focal findings in the echopoor cuff represent a differential diagnostic problem and we cannot give a final assessment as yet. Shoulder sonography is justified as a screening method in suspicion of rotator cuff rupture before initiating arthrography. If sonography reveals no abnormal findings, shoulder arthrography need not be performed.

Arthrography↗

[Secondary changes in the bones of the foot in lupus vulgaris].

The case of a seventy-year old lady is presented who, forty-five years ago, had dermal tuberculosis of the left lower limb and foot. After removal of the infected skin areas with an electric cauter the patient developed massive skin indurations, besides the typical scarification. Actual X-rays showed a decrease in seize of metatarsal bones and digits without lytic or porotic signs. Furthermore, dorsal luxation of the digits was visible. These alterations were interpreted as secondary bone remodelling resulting from long-term traction due to the extensive scarring.

Aged↗