Biomedical subjects
Publications and source records attributed to H Schild.
Assessment of injuries of the hip joint requires a thorough knowledge of the radiological and anatomical conditions and topography of the acetabular region. The authors attempt to present an introduction into the x-ray anatomy of the healthy and of the traumatized acetabulum by means of a juxtaposition of schemes and x-ray films and of pictures of the skeleton.
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The accuracy of computed tomography in staging bladder carcinoma has been investigated in 74 patients who underwent cystectomy (n = 70) and pelvic lymphadenectomy (n = 74). The results of the initial CT findings (prospective analysis) and the results of reviewing all CT scans retrospectively by 3 investigators have been compared. Retrospectively, T-staging was correct in 64%, overstaging was seen in 26% and understaging in 10%. N-staging was correct in 99% (n = 73/74) and obstruction of the upper urinary tract with dilatation of the ureter could be diagnosed in every case. The differences between retrospective and prospective analysis are discussed. Staging errors are seen in patients with tumor infiltration of the prostate or the uterus, with microscopic invasion of the perivesical fat, after irradiation of the pelvis or previous surgery. Metastatic involvement of lymph nodes below 1.5 cm diameter cannot be recognized.
In 10 patients at the age of 17 to 59 years the diagnosis of a cavernomatous transformation of the portal vein primarily was made by sonography and was confirmed by computer tomography and angiography, respectively. These findings were seen by chance when an abdominal ultrasound was performed in order to clarify splenomegaly or esophageal varices. The characteristics of the disease are the positive proof of a convoluted agglomeration of racemose venous structures that have replaced the normal single portal vein and signs of portal hypertension. The sonographic figures are so typical that ultrasound is the decisive procedure in its diagnosis and that direct or indirect splenoportography is not necessary. The present results show that clinical manifestations of cavernomatous transformation of the portal vein are delayed sometimes in to adolescence and that invasive diagnostic methods are only necessary when shunt operation is planned.
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At the department of pediatric surgery of the University of Mainz each child was routinely sonographically examined between September 1981 and April 1982. 582 children were examined. Pathological findings were detected in 4.8% of all cases, leading to a change in operative treatment in 45.4%. To determine more precisely the diagnosis of a disease in children undergoing surgery, routinely sonographically examination are recommended as screening method.
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Sonography was performed in 206 patients with space-occupying processes in the region of the lateral soft parts of the neck, of the parotid gland or the submandibular gland (3.5; 7.5 and/or 8-10 MHz real-time contact field scanner). This sonographic examination enabled differentiation of 166 solid from 40 cystic space-occupying masses: 102 lymphatic node enlargements, 12 primary tumours of the neck, 24 neck cysts, one thymus and epidermoid cyst, on carotid aneurysm, diseases of the salivary glands (35 neoplasias, 8 cysts, 9 inflammatory tumours, 6 cases of sialolithiasis, 5 abscesses, 2 intracapsular lymphomas). The following valuable additional information was gained from sonography in respect of surgical treatment: 1. In the region of the lateral soft parts of the neck, it was possible to effect a clear differential diagnosis of the original findings based on palpation; differential diagnostic clarification of the tumour volume; spatial location of fixed tumours of the neck in relation to the adjacent soft parts of the neck, such as vessels, musculature etc.; quantification of tumour regression subsequent to chemotherapy or radiotherapy. 2. In case of diseases of the salivary glands, differentiation between salivary calculi, neoplasia, inflammation and cyst; extension of tumour; localisation of processes in the immediate vicinity; preoperative localisation of salivary calculi.
Experimental and clinical investigations of fractures of the head of the tibia by computed tomography are described. CT provides much information which is of significance for treatment. In particular, it demonstrates the size of fragments, of defects and areas of compression more clearly than does conventional radiography.
A modified procedure for infiltrating the coeliac plexus for the treatment of chronic pain syndromes is described. The injection of the analgesic is made through a fine needle introduced via a transabdominal approach under CT guidance. The advantages of this technique, compared with the dorsal approach, are a more accurate placement of the solution and the ability to carry out this procedure in very sick patients. No complications have been observed.
22 cases of angiomyolipoma were studied by computerized tomography. Characteristics of the tumours were density values less than -25 HU in 21 patients; one patient having tuberous sclerosis showed higher attenuation values. In 6 of 22 patients angiomyolipomas were associated with tuberous sclerosis. Two large tumours presented with spontaneous rupture and massive retroperitoneal hemorrhage. CT findings are sufficiently typical for angiomyolipomas and therefore suitable for distinguishing the benign lesion from renal cell carcinoma.
Ultrasonic examination was performed in 79 patients with blunt abdominal trauma, using 3.5 mHz real-time sonography. The examination aimed at clarifying intraperitoneal and retroperitoneal haemorrhage and injury to organs. Sonographic detection of haemorrhage succeeded in 13/13 of spleen ruptures and in one case of a liver rupture. 6 renal traumas were recognised by means of indirect signs and only twice by the direct identification of a band-shaped interruption of the parenchyma. Non-invasive sonography can be employed primarily in place of diagnostic peritoneal lavage for the detection of life-threatening intraperitoneal haemorrhages with an accuracy of more than 90%. Primary diagnosis of the source of haemorrhage is limited to individual cases because of the unfavourable conditions under which examination is performed. In unclear cases essential additional information is supplied by sonographic examination of the course of the disease.
Turn fibular ligaments of the ankle go often undetected when not accompanied by osseous lesions. The significance of injuries to the major supporting ligaments of the ankle is underestimated in children. Next to the clinical findings stress radiographs of the ankle joint in two projections are mandatory. Measurements of anterior and lateral displacement under stress and displacement index need to be compared with the healthy ankle. Diagnosis of a fibular ligament rupture is based on clinical findings and on differences between the measurement results (injured compared to healthy) by way of three different techniques. Rupture of a fibular ligament is an absolute indication for surgery--even in children.
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The authors draw attention to the disease pattern of the so-called bowing fracture, basing on examples from their own group of patients. This is a traumatic bending of the bones without any roentgenological identification of a fracture. It is characteristic of this condition that it takes quite some time -- if the case arises at all -- before a discrete apposition of the bones is seen.
The article points to the possibility of producing a topogram with the gantry in oblique position. Although this yields a distorted image, it enables accurate planning of the section and also a localization of objects in slanted position, for example, the intervertebral disks of the lower lumbar vertebral column, thus saving the patient time, material and radiation exposure.
CT enables the identification and localization of foreign bodies which cannot be visualised at all or only slightly so via conventional x-ray film, iatrogenic foreign bodies not recognisable by the usual methods were identified by us by means of CT in two cases direct and in one case indirect as a "soft part finding". Basing on these three cases the article discusses the validity of CT when searching for foreign bodies.
The naviculo-capitate fracture syndrome is a rare type of wrist injury with special diagnostic and therapeutic problems. A case report is presented and discussed.