[Roentgen diagnosis of the suprarenal glands (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Georgi.
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The technique and efficacy of therapeutic catheter embolization of the kidney with butyl-2-cyanoacrylate (Histoacryl) were studied in 80 rabbits (including control groups) and in 10 dogs. A mixture of butyl-2-cyanoacrylate, 50% glucose, and tantalum powder was used for the embolization. Complete and permanent vascular occlusion was found in nearly all cases. The main complication observed was a reflux of embolizing material into the lumbar arteries, which occurred in seven rabbits. Clinically therapeutic embolization was performed in six patients with hypernephroma. The indication for embolization in these patients, as well as in two others with iatrogenic lesions, was pronounced hematuria. Cessation of bleeding was achieved in all cases. For embolization the coaxial catheter technique is recommended; in special cases with extensive arteriovenous shunts, adjunctive balloon occlusion would be advisable.
Renal ischemia and cooling may be achieved by intraluminal balloon occlusion and intermittent hypothermic perfusion using a double lumen, balloon-tipped catheter introduced into the renal artery percutaneously. This technique was used successfully in 26 of 31 extensive nephrolithotomies, eliminating the need for dissection and clamping of the renal artery and intricate surface cooling. Intrarenal operations could be performed as effectively as with clamp occlusion. Despite a mean ischemia time of 54 minutes the individual 131I-hippuran clearance of the operated kidneys was only reduced to a mean 78.4 per cent of the preoperative value 2 to 3 weeks postoperatively and increased to 92.2 per cent after 3 to 6 months, with a tendency toward further improvement.
The possibility of demonstrating the venous system of the entire pancreas by retrograde portal contrast injection with simultaneous balloon occlusion of the portal vein, coeliac axis and superior mesenteric artery was investigated in 12 dogs. In seven cases good filling of the larger pancreatic veins was obtained. Portal and arterial pressure relationships altered considerably during various experimental conditions. A rise in serum transaminases was observed only once when there was thrombosis of the portal vein and branches of the hepatic veins. Apart from this, there was no rise in transaminases or alphaamylase. Histologically there were only minor changes in the liver after total occlusion of 40 minutes, the occlusion having been performed over periods of six minutes with two to five minutes of flow alternating. The application of this method to man is discussed.
The diagnosis of phaeochromocytomas is based on the clinical features and on the hormone findings in the peripheral blood. Localisation, however, depends on radiological methods. Pneumoperitoneum was abandoned, because of its low accuracy, in favour of arteriography; lately, suprarenal phlebography has been available for the localisation of phaeochromocytomas. Our experience in nine patients with operatively confirmed phaeochromocytomas is described. Together with venous sampling from the caval system and the suprarenal veins for catecholamine estimations, it was possible to localise all tumours correctly. One tumour lying in the sympathetic chain in the thorax was correctly localised by hormone estimation. Our experience suggests that suprarenal phlebography represents a reliable method for localising phaeochromocytomas which carries a low risk and is to be preferred to arteriography.
The value of selective and superselective arteriography is limited. The difficulties in differentiation between tumors and chronic pancreatitis make it frequently impossible to come to an early diagnosis by the method. Beside arterial vessel changes pathological venous lesions may play a role in view of resectability. Because of anatomical structures phlebography of the vena portae and its origens is not commonly used. Especially selective pancreas phlebography is possible only by means of indirect catherterization. Among the different techniques the transumbilical route seems to be mort effective than recently thought of. In this paper a new technique of pancreas phlebography by means of catheterization of the umbilical vein is introduced. Twelve präparations of human pancreas at autopsy and six postmortal catheterizations of the portal veins in situ in man have been studied. First results of this occlusion-phlebography of the pancreas are presented for the first time. Problems are discussed which may arise when applicating this method in vivo. In is expected to get more important angiographic information about pancreatic diseases. Certainly it can be used to investigate hemodynamic and biochemical changes.
It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.
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Percutaneous, transhepatic catheterisation of the portal vein in order to occlude the gastric coronary vein was carried out in six patients with bleeding oesophageal varices. Bleeding stopped in three patients, but in the other three ceased only temporarily. Complications were one pleural effusion and one haemothorax. At autopsy, marginal portal vein thrombosis was found in two cases. The indication for this procedure is the presence of bleeding from oesophageal varices which cannot be controlled by conservative means in a patient unfit for operation. It provides an opportunity for carrying out a decompression shunt operation in the interva between the bleeds.
Megacaliosis is a renal dysplasia which is characterised by rudimentary papillae. The pathogenesis, clinical features and radiological appearances in fire cases are described and the differential diagnosis from other types of calyceal ectasia is discussed, In typical cases the diagnosis of megacaliosis can be made from the excretion urogram. We regard divided renal function studies as essential before making the diagnosis. Where the renal changes are not quite typical, it is necessary to exclude obstructive and inflammatory disease, vesico-ureteric reflux and renal tuberculosis.
Angiodensitometry complements conventional renal angiography and provides important additional functional information without subjecting the patient to any further stress. Since blood flow through the renal arteries can be determined, it is an important method for the preoperative investigation of renal disease.
A method for antegrade pyelography and pyelonephrostomy is described using a long, thin needle with a shorter, wider Seldinger cannula. Puncture with a thin needle reduces the risk during antegrade demonstration of the upper urinary tract and can also be used for puncturing collecting systems which are only slightly dilated. When necessary, the Seldinger cannula can be advanced over the needle; subsequently, with the aid of a J-wire, a nephropyelostomy can be performed. The method has been used in 20 patients. In one case of intended bilateral nephropyelostomy the puncture was successful on only one side. There were no serious complications. In only one patient a small perirenal haematoma was found at operation.
66 patients suffering from tumors of the small intestine were operated upon between 1963 and 1976 in the Surgical Department of the University of Mainz Medical School. In 16 cases benign tumors were found (6 neurinoma, 4 leiomyoma, 4 lipoma, 2 polyps), in 50 cases the tumors were malignant (24 carcinoma, 20 sarcoma, 2 malignant schwannoma, 4 carcinoids). Only in 12 patients surgery was radical and no metastases found. In more than one third of the patients surgery had to be done as an emergency operation because of life threatening complications. The correct diagnosis was established preoperatively only in 57.5% of all cases. Only 5 out of 15 patients still living have survived more than 5 years. Correct interpretation of early clinical symptoms, repeated X-ray studies and additional chemotherapy may improve the prognosis of malignant tumors of the small intestine.
A method permitting percutaneous catheterization and temporary balloon occlusion of the human renal artery with a 5-F-Swan-Ganz-Catheter is presented. When properly performed, the arterial occlusion is reliable, low in complications, and less traumatizing to the vessel than external clamp occlusion. The technique was employed in 112 patients for occlusion of the renal artery prior to tumor nephrectomy, for attaining stop-flow conditions for improved nephrophlebography, for preventing the reflux of emboli at transarterial embolisation of inoperable kidney tumors, or, combined with simultaneous hypothermic perfusion via the second lumen of the catheter, in extensive kidney surgery necessitating ischemia. Particularly this last range of application offers new possibilities for in-situ surgery of the kidney, as it renders dissection of the renal pedicle and cumbersome surface cooling of the kidney unnecessary.
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Bleeding from oesophageal varices was stopped in two patients by percutaneous transhepatic transportal injection of 50% glucose and thrombin into the gastric coronary vein and the gastro-oesophageal varices draining into it. The only complication was a right-sided pleural effusion in one of the patients.