Lithopaedion in a 92-year-old woman.
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Biomedical subjects
Publications and source records attributed to K Brezina.
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A differentiation is made between primary and secondary forms of osteoporosis. Furthermore the degeneration forms of rheumatism are discussed.
Renal displacement is very infrequently associated with a space occupying adrenal disease and sometimes imposes major diagnostic problems. The diagnosis of monstrous, retroperitoneal cysts is of particular difficulty. In a 51-year-old female patient the diagnosis and the association of a cystic formation to the adrenal gland could only be made at surgery, despite the steadily increasing renal displacement. The etiology of adrenal cysts, the diagnostic procedures and the possible concurrence of hypertension are discussed.
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In 817 patients who were subjected both to X-ray examination and endoscopy of the stomach, the diagnosis was verified histologically. The radiological findings were confirmed in 86% of the cases and the results of endoscopy were verified in 89% of cases. The diagnosis of gastric ulcer was confirmed by X-rays in 87% of cases, by endoscopy in 95%. 88% of the malignant tumours of the stomach were discovered on X-ray examination and 89% through endoscopy. The diagnostic results of X-ray examination to detect carcinoma of the gastric stump or of an anastomosis were somewhat poorer. With optimal technique the results of radiodiagnostic examination are hardly inferior to those of endoscopy. There are advantages and disadvantages inherent in both techniques but they are of a different nature so that the two methods are by no means competitive; indeed, they are complementary and a combination of both methods yields maximum results. X-ray examination offers considerable advantages if it is carried out before endoscopy.
Radiologic and endoscopic examinations were performed in 166 histologically verified carcinomas of the stomach. 71% of the carcinomas were diagnosed at the first examination by X-ray and/or endoscopy. By a second examination of the radiologically but not endoscopically suspected the percentage of diagnosed carcinomas was increased to 83%. Though the results of endoscopy on an average are somewhat better due to the practicability of biopsy, X-ray examination cannot be renounced. In early cancer the most reliable diagnosis is to be realized by endoscopy on the basis of X-ray findings.
Definite quality criteria must be observed to achieve optimum diagnostic success in mammography. These criteria refer to the apparatus, film, development of film, method and interpretation of findings. Cooperation with a mamma centre is discussed in case extended diagnosis of breast findings is required, or in case it becomes necessary to mark any non-palpable changes.
The significance of sialography in diagnosis of parotid gland tumors is based on the differentiation of chronic inflammatory, benign and malignant lesions. This method combined with history and physical findings will establish the diagnosis in 80% of cases with parotid gland tumors. Water-soluble contrast media are most useful for ductography. It provides good contrast, stays in the duct system for a sufficient period of time and will not cause inconvenience to the patient. Tomograms are particularly valuable in addition to the standard a.p. and lateral standard views. Chronic inflammation causes alterations with small paraductal contrast accumulations throughout the entire efferent duct system. Benign tumors may be recognized by straight ducts and interlobular paravasates. In malignant neoplasms filling defects are more characteristic than parenchymal staining. Peracute and subacute inflammations as well as tuberculosis are difficult to diagnose by sialography.
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Reduplication malformations of uterus and vagina are caused either by absence or inkomplete fusion of the paired Müller's ducts. When this occurs in conjunction with gynatresia it's often not diagnosed until many years after the menarche. Even by hysterosalpingography only few cases of combined inhibition malformation of the female genitaltract are diagnosed. The radiological findings in a patient with uterus bicornis bicollis and vagina septa unilateralis associated with unilateral renal aplasia are described.
A compression tube with holes is used to detect small, non-palpable changes in the breast. The holes show on X-ray of the breast. Densifications of 5 mm, and even smaller at different levels of the gland may be punctured and aspirated with a double canula through the holes of the tube. It is possible to control the correct course of the aspiration needle with an X-ray contrast medium. In the same way the position of a small tumour can be marked with a dye. Amongst 85 carcinomas of the breast there were 5 preinvasive tumours. 3 of these were only diagnosed following X-ray-controlled needle biopsy and cytological examination.
211 female patients with proved uterus myomatosus have been mammographed. With more than 50% chronic mastopathies could be identified; i.e. twice as much than with non-selected radiographically examined patients. The pattern showed fibrocytic changes as well as fibroplastic ones, fibrous involutions and--especially frequently--cystic degenerations. Fibrocytic degeneration occurred mostly with women who had already given birth and lactated. In glandular-cystic hyperplasias of the endometrium, mastophathies occurred twice as often than in hysteromyomas with normal mucose. An at least relative hyperoestrinism is made responsible for the myoma, but especially for the mucosa hyperplasia. Therefore, the same hormonal situation has to be responsible for the a.m., mainly fibrotic changes of the mammary gland. Of course no characteristic effect of the oestrogens can be derived from this, as it certainly is connected with the development of the total hormonal situation of the female. According to various investigators, most forms of chronic mastopathy bear a higher risk of carcinomas. For this reason, all structural transformations which appear one-sided in radiological case control (course observation) have to be considered cases of risk.
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