Biomedical subjects
Publications and source records attributed to M Galanski.
A patient developed marked cerebellar atrophy after a single suicidal intoxication with 7 grams phenytoin. The clinical signs of cerebellar dysfunction subsided very slowly and incompletely within 18 months. We documented the cerebellar atrophy by CTs 4 weeks and 1 year after the intoxication, and we suggest that a single severe acute intoxication with phenytoin may directly cause cerebellar degeneration.
In 51 patients with histologically proven gastric carcinoma ultrasonography of the abdomen for the preoperative staging was performed. The primary tumor was found by sonography in 73% of the cases. Only 40% of the lymph-node metastases could be detected. Ultrasonography as a non-invasive procedure is an usefull examination for the preoperative diagnosis of gastric carcinoma, especially concerning extraluminal tumor extension. Explorative laparotomy, however, for the determination of the local resectability can not be avoided by ultrasonography.
In patients suffering from an immunosuppressive state pneumonia is a common manifestation of infection. In these patients the radiological appearance of pneumonia is influenced by the still existing immunocompetent reaction and not by the germ itself. Basic defense mechanisms in known underlying disease, clinical condition and the influence of epidemiology on the occurrence of pneumonia are discussed briefly.
Advances in the area of tumour therapy and transplantation medicine as well as increasing numbers of immunodeficiency syndromes have resulted into growing importance of opportunistic infections. The radiological diagnosis and differential diagnosis become more difficult due to the broad spectrum of possible pathogenic organisms, pulmonary complications as part of the underlying disease and finally through possible side effects of therapy. An assignment of these changes to certain radiographic patterns seems useful. However, very few infections present with a characteristic pattern. In the majority of cases the radiography by itself cannot lead to the correct diagnosis. Here, more than in other areas, additional information and wide experience are of great importance to the radiologist.
Numerous projections are described in the literature for plain film radiography of the shoulder joint. A review is given of the indications, advantages and disadvantages of the most common views. The significance of special, additional views is discussed.
Osteoporosis is a disease leading to enhanced fragility of bone in association with minimal trauma. This is because of thinning and rarefaction of spongy and cortical bone. Initially, osteoporosis is often only detectable in the spine; later, peripheral cortical bone is also affected. Osteoporosis mainly is a problem associated with postmenopausal bone loss (PMO). With the increasing use of technique evaluating bone density, non-PMO-associated osteoporosis can be increasingly detected. In early menopause, estrogen substitution prevents further bone loss; in severe cases strategies to increase bone mass are under investigation and are very effective in the patients tested so far. Radiological methods are of value to diagnose osteoporosis and monitor the efficacy of treatment. Density measurement of trabecular and cortical spinal bone with computed tomography seems to be the technique of choice. Peripheral measurements must still prove their value, however. The advantage of quantitative CT is its capacity, selectively and reproducibly, to determine distinct bone structures like cortical or trabecular bone. Normal lateral X-ray films of the spine are essential to assess vertebral deforming events and exclude further wedging during therapeutic trials.
Three patients with a combination of neurofibromatosis and multiple non-ossifying fibromas are presented. All patients possessed multiple osteolytic lesions with sclerotic margins, resembling non-ossifying fibromas. Two patients showed similar lesions in additional localizations. In two patients, non-ossifying fibroma was histologically verified. The simultaneous occurrence of neurofibromatosis and multiple non-ossifying fibromas can possibly be put down to a generalized mesodermal dysplasia. However, the definite explanation is unknown.
The ultrasonographic appearance of the pleura was investigated in 20 healthy subjects and eight patients with radiologically established pneumothorax. The respiratory excursions of the visceral pleura could be demonstrated ultrasonographically in all 20 healthy patients. In addition, comet tail artifacts were regularly evoked at the boundary between the pleura and the ventilated pulmonary parenchyma. In all eight patients with pneumothorax, the pleural collection of air could be demonstrated ultrasonographically by the absence of pleural movements and comet tail artifacts. In emergency situations in which radiographs are not available or are not available quickly enough, ultrasonography can make a decisive contribution to diagnosis of pneumothorax.
Currently, the method of choice for evaluation of head and neck cancers is CT, because in many respects it is superior to the other imaging modalities except for MR. For parotid tumors, however, histological grading is of major importance. The staging of tumors of the hypopharynx and larynx can be done just as reliably by CT and microlaryngoscopy; the latter has the advantage of including biopsy. Ultrasound is of primary value in providing information on metastases to the cervical lymph nodes. If CT is used for staging of the primary tumor or planning radiation therapy, then it also can be utilized for the detection of lymphatic spread.
The case of a patient suffering from multifocal idiopathic stenosing enteritis is described. The clinical picture is characterized by a recurrent ileus-symptomatology, which is conditioned by multiple strictures of the small bowel with a considerable dilatation of the inserted small bowel segments, by a differently marked malabsorption syndrome and by an intermittent clinical course. Aspects of the differential diagnosis are discussed, especially in relation to the non-granulomatous ulcerative jejuno-ileitis.
In former times Pneumocystis carinii (PC) primarily affected premature infants. More recently, it has proved to be one of the major infectious complications among immunocompromised patients, particularly those with AIDS. The most frequent radiographic feature is diffuse, bilateral alveolar and interstitial perihilar shadowing, spreading in a butterfly pattern. The typical findings may mimic other infectious diseases, but the presence of large pleural effusions of hilar adenopathy is evidence against the diagnosis of PC-pneumonia.
Hamartomas of the tuber cinereum are tumour-like collections of normal tissue in abnormal location. They are benign lesions with slow or absent growth and without any tendency to neoplastic evolution. Due to their neurosecreting properties they usually cause precocious puberty. Further neuroendocrine disturbances, seizures, or psychoneurological symptoms may be associated in some cases. Cisternography and CT are the most conclusive radiologic procedures in all cases. The typical feature is a well circumscribed round-shaped isodense soft tissue mass without contrast enhancement. Usually the tumour is small, rarely exceeding 2 cm. in diameter. If CT diagnosis is not conclusive, examination in the coronal plane or CT cisternography are recommended. Although CT does not permit a histological diagnosis the clinical and radiological features together are sufficient to make a highly suggestive diagnosis. The treatment of choice is medical therapy. Surgery should be restricted to those tumours which damage surrounding structures by their size and cause other symptoms than precocious puberty.
Air cisternograms at post mortem and positive contrast cisternograms on patients were performed in order to study intracisternal structures, particularly cranial nerves, as seen on CT. Air and contrast CT cisternograms showed excellent demonstration of the second, third, fifth, sixth, seventh and eighth cranial nerves. The ninth and tenth cranial nerves could not always be separated from each other and demonstration of the first, fourth, eleventh and twelfth cranial nerves was often not possible or was unsatisfactory. With a knowledge of the normal anatomy and of important surrounding structures, the individual cranial nerves are easily identified. The anthropologic baseline appears highly suitable for CT examination of the basal cisterns. The complementary coronal projection is also very valuable.
Aggressive fibromatosis (desmoid, desmoid tumour) resembles, in its infiltrating and destructive growth, a fibrosarcoma, but does not metastasize. Because of its high recurrence rate, the tumour remains a surgical problem. Various imaging methods were evaluated retrospectively in 23 patients with histologically confirmed aggressive fibromatosis. Conventional radiological procedures are poor at demonstrating the extent and type of tumour. Modern tomographic methods are more able to determine the size of the lesion and a combination of angiography and CT can frequently provide a definite diagnosis.
Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.
The sonographic appearance of histologically verified pancreatic metastases is reported in seven patients with advanced spread of tumor. All metastases appeared as homogeneous, solid, space-occupying lesions with a more hypoechoic internal structure than the pancreatic parenchyma. In five cases, multiple metastases were demonstrated; in two cases, there was a solitary metastasis in the head and tail of the pancreas. Pancreatic metastases are diagnosed infrequently because of the paucity of clinical symptoms and the small size of the foci. In six patients, the diameters of the metastases were 0.5-2.0 cm, and only three patients had organ-related clinical symptoms. The putative diagnosis of organ metastases must be made when multiple hypoechoic foci can be demonstrated in the pancreas in a patient with a malignant tumor. Pancreatic carcinoma, acute pancreatitis, and focal infiltrates in Hodgkin and non-Hodgkin lymphomas must be considered when diagnosing multiple pancreatic lesions.
Among all the radiological examination techniques, CT is today, besides scintigraphy, the method of choice as far as the detection of functional adrenal lesions is concerned. In primary aldosteronism, CT classification of the syndrome is based on the detection of an adenoma which can be reliably detected in adenoma sizes up to 8-10 mm. Thus, 70 to 80% of Conn's syndromes can be classified. In adrenal Cushing's syndrome, the distinction between adenoma and carcinoma of the adrenal gland is up to CT and can usually be easily made due to the characteristic morphology of each type of lesion. In case of a typical adrenal or juxtaadrenal tumor location, detection of a pheochromocytoma is likewise easy. In ectopic and multiple pheochromocytomas or such as occur as part of a MEN-syndrome, the situation is quite different. If lesions of the adrenal gland are found by accident in examinations otherwise indicated, the question arises whether the process is malignant or benign. In this respect, all the traditional imaging methods, including CT, involve a considerable factor of uncertainty, especially if a malignant tumor is anamnestically known and the question of metastases arises. According to recent information, MR-imaging seems to be advantageous concerning this difficult differential diagnosis.
The percutaneous approach to the adrenal glands is impeded by their high paraaortal subphrenic location. Regarding the information conveyed in literature and referring to our experience, a summary of the technique, indication and findings of percutaneous biopsy of the adrenal gland is presented. Percutaneous needle biopsy of the right adrenal gland is most easily performed by lateral transhepatic approach under sonographic guidance, while in biopsy of the left adrenal gland protection of the spleen, kidney, pancreas and stomach can only be achieved by dorsal approach under CT control. At present, the main indication for biopsy of the adrenal gland still is differentiation between metastases and non-functioning adenomas in tumor patients. Adequate technique provided, the sensitivity of punctures of the adrenal gland varies from 80 to 90%. Clinical suspicion of pheochromocytoma is an absolute contraindication for fine needle biopsy.