Biomedical subjects
Publications and source records attributed to H Schild.
The perioperative course of two patients is exemplified to demonstrate the significance of the preoperative thoracic computed tomography for the selection of a proper surgical approach.
Superior mesenteric vein thrombosis after splenectomy is very rare. In the case described of a patient presenting with acute abdominal pain the diagnosis was made primarily by real-time and Doppler ultrasonography. This reduced the time elapsing before it was recognized that angiography and subsequent thrombectomy were indicated.
Clavicular fracture is one of the most frequent skeletal lesions. In most cases the median third of the clavicula is affected (this is due to the peculiar biomechanical structure). Accompanying lesions and complications of clavicular fractures are rare. A total of 13 x-ray diagnostic techniques are described for clavicular fractures. X-ray film should, as a matter of principle, always be taken in two planes. Definitely the major part of clavicular fractures are treated conservatively (rucksack dressing), whereas surgery is reserved for few and strictly defined indications.
Isolated aneurysms of the iliac arteries are rare. They must be considered as a disease pattern of their own as against aneurysms of the abdominal aorta because of the specific anatomical conditions in the pelvis. The clinical symptomatology is determined by their localisation and topographical relationships within the pelvis; this can give rise to problems in differential diagnosis primary urological, neurological or gastrointestinal diseases. The prognosis is decisively determined by early and correct diagnosis because of the danger of rupture. Sonography, computed tomography and angiography are indispensable aids in preoperative planning.
The CT image of renal metastases is described for 29 patients. The most frequent primary tumour was the bronchial carcinoma, followed by melanoma and cervical carcinoma. In 12 of 29 patients (41%) the metastases occurred bilaterally, in 17 (59%) unilaterally. 9/29 (31%) had solitary, 20/29 (69%) multiple renal metastases. In 19 (66%) these had a size of up to 3 cm and were situated intraparenchymally. Space-occupying growths up to a size of 10 cm which grew exophytically were seen in melanoma and carcinoma of the larynx and chorion. In the plain CT the metastases presented isodense or slightly hypodense in 25 of 27 examinations (93%). After application of contrast medium all presented hypodense with the exception of metastases of a chorionic carcinoma.
To visualise the rupture of the scaphoid bone it will be sufficient--as has been proven--to perform two additional projections from the navicular series besides the standard x-rays of the wrist joint, namely, with the hand in writing-pen position and in hyperpronation. With this procedure, almost all (99%) of fractures detected during first examination can be diagnosed. To prove the occurrence of fractures of the wrist besides those of the os naviculare, specific x-rays are employed in accordance with the results of an on-target clinical examination. Such x-rays are, in particular: lateral radioulnar x-ray rotated by 10 degrees in volar direction to assess the os triquetrum; lateral radioulnar x-ray in 10-30 degrees supination to visualise the os pisiforme; carpal tunnel x-ray to assess the entire hollow of the hand, in particular the volar parts of os pisiforme, os hamatum (hamulus) and os trapezium. Although such fractures can partly also be diagnosed by means of a navicular series, as already stated, it is not permissible to exclude the presence of a fracture if there are no abnormal findings in the navicular quartet whereas clinical findings are positive.
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A new percutaneous inferior venacaval filter was used in 15 patients. The filter is constructed of stainless steel wires formed into a helical basket and anchoring legs. It can be inserted through a 10F catheter in an antegrade or retrograde fashion and can also be retrieved percutaneously. In a follow-up period of up to 13 months, the filter was well tolerated. One patient died of recurrent embolism despite filter protection. Local thrombogenicity was noted in 2 patients, but no other side effects were observed. Short-term heparinization following filter insertion is advisable. Heparin coating of the filter is under evaluation.
Seventy-three patients with vascular occlusions in the pelvis or lower limbs and three patients with upper limb lesions were treated by local low dose fibrinolysin, with strict control of any possible bleeding tendencies. Adequate recanalisation was obtained in 56 patients (73.6%). In ten patients, the occlusion recurred while the patient was still in hospital. After four to six months, 37 of the 56 (67%) of the vessels were still patent. In 18 patients, peripheral emboli resulted in some deterioration, but in 15 of these cases this could be treated successfully by operation. The methods and indications of local fibrinolysis therapy and the problems associated with it are discussed.
There have been few descriptions extravasation into the superior vena cava and right atrium during intravenous DSA. This is seen almost exclusively when using straight catheters. The configuration of pigtail DSA catheters should reduce or prevent damage to vessel wall due to extravasation. Following an extravasation into the right atrium, which we ascribed to inadequate stability of the distal end of the pigtail catheter, we carried out in vitro experiments with seven DSA catheters from a variety of manufacturers, using an atrial model. Three of these catheters behaved in a manner that would be liable to produce extravasation.
There are various opinions regarding the aetiology and pathogenesis of dislocation of the shoulder. Various aspects of these theories and their clinical significance have been examined in the course of a clinical and radiological follow-up. Crucial to the development of subluxation is the occurrence of trauma. The age of the patient is important in the prognosis: more than 60% of patients under the age of 30 develop recurrent or persistent dislocation. Apart from a congenital disposition and inadequate treatment, accompanying injuries are primarily responsible for the development of persistent dislocation. Late follow-up has shown that radiologically recognisable post-traumatic changes are apparent in at least one-third of the patients. Persistent symptoms are much more common and consist of pain, limitation of movement, weakness and paraesthesia. In evaluating the late results, one should distinguish between objective functional limitation of movement and subjectively felt reduction in function.
After breathing pure oxygen, total atelectasis of one lung was produced in ten dogs; its development and regression was followed by CT and by conventional radiology. 30 seconds after cessation of ventilation, it was possible to show a rise in CT density of the atelectatic lung from -764 +/- 32 HU to -739 +/- 49 HU. The average time from the cessation of ventilation to total atelectasis averaged 5.5 +/- 1.1 minutes. The earliest sign on conventional radiographs was often seen after 30 seconds and usually after 60 seconds and consisted of mediastinal displacement. Extensive atelectasis regressed in only one out of six animals within one hour after resuming ventilation. The experimental methods and results and the significance of the physiological findings in a clinical context are discussed.
Analysis of 930 patients with focal nodular hyperplasia of the liver (FNH), including 23 seen by the authors, showed the following results: 82.2% of patients were female, 37.8% of these had taken female steroidal hormones. There was no preference for a particular lobe of the liver. 57.7% of FNH were subcapsular, 33.7% were intrahepatic and 8.8% were pedunculated. Average size was 5.9 cm, 80.8% of the patients were asymptomatic. In 93.5% (115 out of 123) a space-occupying lesion in the liver could be demonstrated by sonography. In 13%, second or multiple tumours were missed by sonography. CT without enhancement demonstrated FNH in 90.4% (94 out of 104 patients). A rapid, marked increase in density after contrast was seen in 64 out of 68 lesions (94.1%). Colloid scintigraphy showed normal uptake in 34.9% of patients. Hepato-biliary functional scintigraphy demonstrated 32 out of 35 lesions (91.4%). In 97.3% (183 out of 188) FNH was demonstrated by angiography, in 95.4% as a highly vascular tumour.
Contrast administration through the superior mesenteric or splenic arteries provided additional information in 22 out of 31 patients, when compared with intravenous contrast bolus for CT of the liver. In 11 patients, the demonstration of a tumour lead to a change in treatment. False positive findings occurred in four of the 31 patients. In 2 patients intrahepatic lesions were overlooked, but were found during angiography carried out at the same examination. The diagnosis of intrahepatic space-occupying lesions is discussed as well as the CT appearances of portal-venous liver perfusion.
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After presenting an own case of a cavernous hemangioma of the mediastinum, the clinical pattern, differential diagnosis, diagnostic procedure (computed tomography), and therapy of this rare tumor form are described.
In a 43 year old man with an inguinal abscess a paravertebral soft tissue swelling suggested a gravitation abscess. On CT only a retrocrural fat accumulation was identified.