Biomedical subjects
Publications and source records attributed to H Schild.
A pancreatic pseudocyst with mediastinal extension is demonstrated by ultrasound and CT. The value of these examinations compared to conventional radiography is stressed in establishing the correct diagnosis including differential diagnostic considerations.
The microcystic adenoma of the pancreas is a very rare benign pancreatic tumour. This tumour, which is usually large and grows slowly, results in displacement and compression of the adjacent organs. Angiography reveals hypervascularisation. The characteristic structure of the tumour can be recognized both in the sonogram and in the computer tomogram.
Fifty-two patients with proven esophageal carcinoma underwent thoracic and abdominal computed tomography (CT) prior to treatment. The mediastinum, lungs and abdomen were studied for evidence of direct invasion or metastases. Correlation with surgical findings were available in 15 thoracic and 29 abdominal CT-scans. Results indicate that experience of the radiologist is the most important factor in evaluation and in accuracy of CT-scanning. The extent of mediastinal spread in 13 of 15 and intraabdominal metastases in 23 of 29 patients were correctly identified. All errors were caused by false-negative diagnoses. The ability of CT to reliably predict the extent of disease can help the surgeon to plan an optimal therapy.
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The angiographic picture of metastatic choriocarcinoma is well known since long, computertomographic findings, however, have not yet been described. The article gives a case-report and discusses the computertomographic picture of the disease.
Report of four cases of fracture of capitulum humeri treated by operation. The necessity of an exact preoperative radiological diagnostic work-up including lateral tomography of the elbow is pointed out. It is described how difficulties occurring during and after surgery can be avoided by choice of an adequate approach and a suitable internal fixation. Presented is the radio-volar approach and temporary fragment fixation with K-wires from ventral to dorsal. Three cases treated in a similar way show the efficiency of the procedure.
Osseous elbow lesions in the growing skeleton often involve problems of diagnosis, indication and therapy which are essentially different from those occurring in adult persons. Beyond its task to prove or to exclude a fracture line, X-ray diagnosis also has to search systematically for discernible soft tissue modifications (adipoid signs) or for disturbed correlations of positions and axes. When adopting an indication for conservative or surgical treatment, it has to be considered that rotation faults are not compensated during the further growth of bones and that an insufficient reposition of an epiphysis fracture causes a tendency towards an increase of the joint deformity when the bone is growing. The treatment of a bone fracture aims not only at a good elbow joint function which can be achieved even by a conservative, insufficient reposition, but also at an exact reposition and a reliable fixation during the short healing time. In most cases, the latter is only possible by means of fine metal implants (drilling wires and screws for little fragments which, by way of exception, do not touch the epiphyseal cartilage). This is the only way to avoid joint deformations and defective positions in adolescents which can promote the formation of destructive arthroses in adults. As opposed to fractures in adult persons, the functional result is not deteriorated by an additional immobilization for a period of three to four weeks effected in order to guarantee the so-called "minimal osteosynthesis".
We have studied 438 patients radiologically in order to observe the so-called "radius-capitellum axis". In about a quarter of people with normal elbows the axis passes lateral to the middle portion of the capitellum, so that even when there is marked deviation, there is no certainty that the humero-radial joint is abnormal. Deviation of the axis can be caused by changes in the shape of the capitellum or of the radius, or by distension of the capsule of the elbow joint, or by various changes in muscular pull.
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Computer tomographic examination of the tibia was carried out in ten patients two days to four years after removal of an intramedullary nail. Sclerosis of the marrow cavity and cortex and bone formation in the nail track are characteristic findings. They have been correlated with the appearances on conventional x-rays. Changes in the density of the marrow cavity, which is normally increased around the previous nail tract, do not necessarily indicate the presence of infection. In the absence of complications, the increased marrow space density may return to normal negative values corresponding with fat density.
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Besides the presence of blood in an injured joint, fat-containing blood can also be found in the joint with intra-articular fractures. This condition, which can be demonstrated by x-ray film, is known as lipohaemarthrosis. We found this to be the case in 8 out of 295 patients with shoulder dislocation. The origin, significance and differential diagnosis of this condition are described.
Luxations and luxations fractures of the carpometacarpal joints are rare, with the exception of the thumb. Basing on the case histories of 3 patients treated by the authors, these injuries are described and discussed.
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In the presence of multiple injuries, 30% of fractures of the sacrum are missed on the first examination. The clinical features are non-specific and are often obscured by other injuries. Interruption or displacement of contrast lines on the A. P. view, if bilateral, are definite evidence of a fracture. In evaluating films of the sacrum it is therefore recommended that these lines be examined carefully. Such changes were found in two thirds of longitudinal and one third of horizontal fractures. Special attention should also be paid to the lateral and cranial articular processes, since these are areas of weakness in the pelvis and are predisposed to fracture.
Analysis of roentgenographs of injured elbows must go beyond the identification or exclusion of a line indicating a fracture, especially in children and adolescents. Decisive diagnostic pointers can be supplied by the displacement of fatty bodies, which is a very sensitive indicator of an intra-articular growth, as our postmortem examinations have shown. A systematic search for disturbances of relative positionings (which are defined e.g. by the radius-capitulum axis or the ventral longitudinal humerus axis) and consideration of the sequence in time of the appearance of ossification centres in elbows of children, will prevent gross mistakes in the assessment of the pathological situation.