[Sparing of the accessory nerve in radical neck dissection].
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Biomedical subjects
Publications and source records attributed to H P Busch.
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The size of conventional image intensifiers is a limiting factor in performing transvenous digital subtraction angiography of the lower extremities. The results of transvenous digital subtraction angiography using a 57 cm image intensifier on 205 patients with vasoocclusive disease of the legs are presented. Two exposed fields sufficed in most cases for demonstration of all arteries, from the aortic bifurcation to the trifurcation at the lower leg. The principal advantages were the reduction of the contrast medium volume and the decrease in examination time. The reduced resolving power was a limiting factor in evaluating discrete wall lesions and of small vessels, but this did not induce diagnostic difficulties. The studies were evaluated retrospectively by an experienced vascular surgeon and in 85% of the cases were considered to be of diagnostic value.
Measurements for quantifying the image characteristics were carried out on three DSA installations (DVI 1 - Philips, Angiotron - Siemens and DF 3000 - General Electric). Contrast resolution was measured with a vessel phantom (General Electric) and spatial resolution with a lead grid. A further parameter was the dose entering the image intensifier. The Angiotron was used with an intensifier with 53 cm. diameter and the DF 3000 with temporal subtraction of the video images and the subtraction of dual energy images (hybrid technique). These measurements can be carried out quickly and easily and are a step towards standardisation of measurements of image characteristics of DSA installations.
Intravenous Digital Subtraction Angiography (DSA) is described in a patient with severe fibromuscular renal artery dysplasia. DSA identified only a mild renovascular stenosis, while intraarterial angiography demonstrated multiple severe stenoses alternating with aneurysmatic segments. This case confirms the limitations of intravenous subtraction angiography. Higher spatial resolution is required if small stenoses are to be ruled out.
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Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)
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