[The intramural esophageal hematoma].
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Biomedical subjects
Publications and source records attributed to N Goebel.
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During 1986 and 1987, 47 patients with renal cell carcinoma were evaluated preoperatively with CT, angiography and MRI. The preoperative tumor stage (T), lymph node metastases and venous involvement determined with the three methods were compared to the operative and histopathological findings. For T stage, angiography proved less accurate (54%) than CT (64%) or MRI (63%). MRI was found to be superior to CT in assessing lymph nodes, with an overall accuracy of 89% and sensitivity of 100% compared to 77 and 60%, respectively, of CT. For venous involvement CT was overall more accurate (74%) than angiography (65%) or MRI (63%). All three methods expressed a low sensitivity (between 31 and 41%) and a high specificity (between 95 and 100%) for detecting venous involvement. The minimal advantages of MRI compared to its high cost do not justify its routine use. CT remains the method of choice in staging preoperatively renal cell carcinoma.
Synovial cysts of various joints and tendon sheaths (knee, elbow, hip, proximal interphalangeal joints are well known. Cysts arising from the zygapophyseal joints however are rare, but not unknown. 3 patients with lumbosciatic pain, due to nerve root compression by a synovial cyst of the zygapophyseal joints are described. The age ranged from 54 to 77 years. There are 2 men and 1 woman. The symptoms and signs involved the fourth (1 patient) and fifth (1 patient) lumbal nerve root and the first sacral nerve root (1 patient). X-rays showed degenerative changes of the facet joints in 2 cases and spondylolisthesis in 1 case. Myelography revealed compression of the fifth lumbar and the first sacral nerve root, but did not allow to make the exact diagnoses. CT scans however made the diagnoses possible in all 3 cases. Treatment was surgical excision of the cyst in 2 cases, 1 patient showed pain relief after steroid-infiltration in the affected facet joint.
A 46-year old patient had suffered from progressive nocturnal sciatica and motor weakness of the left lower extremity for three years. The physical examination revealed a discrete neurologic deficit of the left L5 and S1 root. By CT a small presacral mass between the L5 and S1 roots was found. During the CT-guided fine needle puncture the patient felt an electrifying pain radiating into the left lower extremity. The cytomorphological examination showed benign mesenchymal cells, indicative of a neurinoma. Since progredient neurological deficit is to be expected, exstirpation of the compressing tumor is the therapy of choice. Our patient however decided to postpone the operation because of only mild symptoms.
We describe three cases of idiopathic thrombosis of the superior mesenteric and portal veins, in one case with additional thrombosis of the splenic vein. All patients suffered from unspecific, slowly increasing pain. The cause of the same could be detected only via CT. After anticoagulation the patients became symptom-free. A follow-up CT showed recanalisation of the affected veins.
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We report a case of human fascioliasis treated successfully with a single dose of triclabendazole, a benzimidazole compound. The most obvious effect was the rapid cessation of faecal egg excretion, which had been refractory to two previous treatment courses of albendazole. Cure seems to be confirmed by the absence of Fasciola eggs in repeated stool examinations after six months, achievement of clinical wellbeing, and normalization of laboratory tests. The only side effect of the treatment was a brief episode of fever and right upper abdominal pain occurring four days after administration of triclabendazole. The syndrome was probably due to disintegrating dead parasites; further observations are needed to explain the pathogenesis of this episode.
Hepatosplenomegaly is seldom caused by cystic tumefactions. 4 cases are presented, in which pseudocysts of the pancreas invaded and enlarged the spleen or liver.
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We report a case of a 37 year old man who presented with vomiting and colicky abdominal pain and who was found to have microscopic haematuria. Radiological-examination showed a right hydronephrosis apparently caused by a paracaecal tumour extending to involve the right ureter. This was resected and proved histologically to be a mesenteric fibromatosis. The patient has none of the factors predisposing to the development of this lesion, in particular Gardner's syndrome. Eight months following surgery he appears to have made a full recovery. Previous publications on this rare intra-abdominal neoplasm are reviewed.
The enlarged parathyroid glands of twenty-four patients with primary, and 5 with tertiary, hyperparathyroidism were prospectively studied with MRI, CT, ultrasonography and subtraction scintigraphy prior to surgery. Sensitivities in a prospective study were 63, 60, 53 and 44% for the primary, and 71, 67, 44 and 11% for the tertiary, disease form. On MRI, diseased parathyroids showed the "typical" behaviour of tumours with high signal intensity on T2-weighted and low signal intensity in T1-weighted images. On CT, the lesions were hypodense and on US hypoechoic relative to the thyroid. Retrospective analysis of MRI and CT images yielded sensitivities of 87 and 85%, respectively.
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Intraabdominal pseudotumor of the plasma cell granuloma type in a 19-year-old man is reported. The patient presented with fever and weight loss lasting months, and the laboratory findings revealed high sedimentation rate, hypochromic, microcytic anemia, thrombocytosis, elevated alkaline phosphatase, decreased thromboplastin time and polyclonal hypergammaglobulinemia. When the plasma cell granuloma was removed, all laboratory findings returned to normal within 3 months and the patient remained asymptomatic during the two-year follow-up.
Liver echinococcosis, the most frequently occurring form of parasitosis, is caused by the following two types of tapeworm: echinococcus granulosus and echinococcus multilocularis. Both types are to be found in Austria, the latter even being endemic. Imaging techniques such as computed tomography and sonography enable the diagnosis to be made easily, quickly and accurately, although the number of conditions to be considered in the differential diagnosis is considerable. A comparison of the two methods in 32 patients, 25 with echinococcus multilocularis and 7 with echinococcus granulosus demonstrates that ultrasound is slightly inferior to computed tomography. However, ultrasound should be the primary method of investigation and is of great importance in follow-up, whilst computed tomography is necessary pre-operatively to assess the extrahepatic involvement.
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The persistence of myocardial sinusoids in both ventricles as an isolated anomaly is described. A 21-year-old patient had progressive heart failure considered as cardiomyopathy of obscure etiology. Two-dimensional echocardiography demonstrated channel-like structures in the thickened myocardium of both hypokinetic ventricles. Angiography showed a honeycomblike inner contour in both ventricles. Autopsy proved the diagnosis of persistent sinusoids in a thickened myocardium.
In a 43-year old patient, in whom a transluminal revascularisation of an occluded popliteal artery had ben performed, computed tomography showed a popliteal artery entrapment syndrome. The popliteal artery coursed on the medial side of a lateralised, medial gastrocnemius muscle and was also compressed from dorsally by an accessory muscle that extended from the medial femoral condylus to the medial gastrocnemius muscle. The findings were confirmed by an operation.
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