Biomedical subjects
Publications and source records attributed to L Abet.
Reported in this paper is experience obtained from combined use of ultrasonography and mammography in the diagnosis of cystic mammary tumours. In any case of diagnosis, roentgen-mammography should be preceded by ultrasonic mammography. The latter should even replace roentgen-mammography for representation of cystic tumours. Indications are suggested.
Two colpo-urethrocystographic examinations each were applied to twelve patients with functional urinary incontinence and to one continent woman. A ball chain and a wick were used for urethra marking, with the view to identifying possible effects of metallic foreign bodies on physiological parameters of the urethra and urethrovesical transition. The findings obtained from the two techniques were clearly different. Visibility of details and diagnostic information were unambiguously improved in the wake of the wick technique. Morphological changes in the urethral region and urethrovesical transition were recordable by the ball chain method. The two techniques yielded differentiated data of PUV and PU angles. Examinations were undertaken in two hospitals on a rotational basis for more information about reproducibility and for better comparability of findings obtained by different examiners. Such approach was considered to be essential to general assessment of the methods reviewed.
The method of colpo-urethrocystography is now increasingly used in hospitals which admit women for treatment of functional urinary incontinence. Both the quality of examination and the resulting value of the method were found to depend decisively on the techniques used. The results of a systematic purpose-oriented methodological study, with 40 cases of colpo-urethro-cystography included, were evaluated, and a resulting examination programme is described which can be out with the facilities available in the GDR. Here are the most important requirements: 1. Availability of fluoroscope with image intensifier, TV connection, and high-voltage generator; 2. Use of hard rays, X-ray exposure system, HS 11 or HS 90 X-ray film, 18 X 24 in format (vertical), in conjunction with highly amplifying sheet; 3. Marking of urinary bladder by means of 250 ml of contrast fluid (20 ml Propyliodon, 40 ml Visotrast 290, 190 ml physiological salt solution) and marking of urethra, using a lipiodol-UF soaked textile wick.
Malignant ovarian tumours in 199 patients were studied for their lymphogenic expansion, depending on histological tumour types and on criteria for classification by stage. The condition of the tumour capsule was found to be the most important indicator to incipient lymphogenic dissemination, with an exception being recordable only from dysgerminomas. These insights together with additional considerations have formed a background against which recommendations are made for indications for lymphography of patients with malignant ovarian tumours.
There have been various reports in the literature on the use of barium-sulphate suspensions in cystography for radiological diagnosis of urinary incontinence in women. The advantages of barium-sulphate are compared with risks of its use in this paper. Equally good results without risk can be achieved by means of water-soluble iodic contrast media. The authors, being aware of the higher expenses involved in their proposal, recommend to use for cystography only water-soluble iodic contrast media.
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Thirty-one case histories of patients, most of them with pathological galactographic findings, were evaluated with view to assessing the diagnostic value of galactography, as compared to clinical examination, mammography, and cytological checks, all in the context of pathological nipple discharge. The histological result was used for reference. The highest amount of accuracy, in connection with growing and tissue displacing processes, was recorded from galactography. It, therefore, should be given an established position for early use in complex diagnosis.
Contradictory reports in the literature on the reliability of lymphography stimulated the authors to test the diagnostic accuracy, employing methods which are approximately analogous to practice, using carcinoma of the cervix as the model on which the study was carried out. Using 21 observers it was found that there was no correlation between their experience and on-target accuracy of the diagnosis. Good observers obtained an accuracy of 85% with good proportions between sensitivity in the recognition of detail, specificity and readiness to arrive at a decision on the basis of discriminatory ability. With the help of the concept of the ROC curves, the position taken up by the observers in respect of diagnostic decisions, and a complex manner of assessing the various characteristic factors determining diagnostic accuracy, are demonstrated. This form of test, which permits manipulation of different variants of diagnosis, is recommended, among other things, for performance control at the end of training and continuing education courses in other fields of x-ray diagnosis as well.
Sixteen diagnosticians were repeatedly shown a series of lymphograms. On repeated viewing, the participants were informed of their diagnostic decisions at the first reading (accuracy, sensitivity, specificity). The results show that it was possible to influence the participants in their judgement and attitude. Changes in individual attitudes are demonstrated diagnostically and the individual diagnostic parameters were subjected to a quantitative analysis. The accuracy of the results are related to the method and to the diagnostician with reference to the composition of the clinical material.
The results of a retrograde analysis of lymphographic processes in 111 patients with malign vulvar and vaginal tumours are substantiating statements concerning the importance of lymphography in diagnosing metastastic processes in lymph-nodes of the inguinal and retroperitoneal region. -- Metastases could be proved lymphographically in 24 (34%) out of 70 carcinomas of the vulva and 8 (22%) out of 37 carcinomas of the vagina. In 24% of all patients with carcinomas of the vulva there were lymph-nodes involved, in two of these cases without a simultaneous involvement of the inguinal region. With carcinomas of the vagina a lumbar involvement was found in 50% of the cases. The accuracy of lymphographic diagnosis was 79% regarding the inguinal region and 89% in the iliac region. Despite of the lower accuracy with regard to inguinal lymph-nodes lymphography exceeds findings obtained by clinical palpation in this respect. As a result of the study, the use of lymphography in case of vulvar and vaginal carcinomas of all clinical stages is considered to be profitable for diagnosing and therapy planning.
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A review has been made of lymphographic diagnoses recorded from patients with cervical carcinoma over more than five years. The diagnosis by lymphography of nodes metastases had to be altered in some 25 per cent, and correction proved necessary also in cases in which lymphography had failed to yield conclusive information. - In the group with lymphographically secured cancer lymph nodes coincided with histological results in 70 per cent of all primary and 90 per cent of secondary checks. Comparable gaps were recorded also from the group with lymphographically inconclusive information on lymph node cancer. - The following conclusions are drawn from the study described: (a) The accuracy of lymphographic diagnosis depends on the experiences of the examiner and changes within time and this must be considered in the evaluation of therapeutic success or failure. - (b) Conclusive findings in the context of lymph node problems are obtainable from selective use of lymphography.
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