Biomedical subjects
Publications and source records attributed to N Goebel.
In a patient with liver fascioliasis (already excreting eggs with the faeces) a CT scan of the liver showed after i. v. contrast injection a relatively characteristic aspect with multiple, small, hypodense areas, partly in formations of bunches of grapes, partly in a street-like arrangement towards the portal vein - bile duct - areas. 9 months later the hypodense lesions had markedly decreased.
In a prospective study (238 men, mean age 53 years) the changes in native vessels were studied 3 months after aorto-coronary bypass operation and 5 months after preoperative angiography. Progression was defined as increase in stenoses of at least 20% or new total occlusion. Progression was significantly more frequent in vessels with bypass than without; it was located proximally to the anastomoses in most cases, less frequently at the anastomoses and very rarely distally to the anastomoses. Proximal progression was significantly more frequent with open bypasses than with occluded ones. Stenoses at the anastomoses were significantly more frequent with occluded bypasses than with open ones. More severe stenoses had a stronger tendency to progression than less severe stenoses. Regression was rare and nearly always caused by surgery.
Three observers twice assessed coronary artery lesions of 10 patients in three oblique views using the films obtained before, immediately after, and six months after percutaneous transluminal coronary angioplasty. In order to improve accuracy of the interpretation, the stenoses were traced from the cine projector and the diameters measured with a calibrated magnifying glass. Interobserver and intraobserver variability of the commonly used method assessing only the projection showing the most severe stenosis was compared to that of a method assessing the mean of three projections. The interobserver coefficients of variation were 7.0% for using the one projection showing the most severe stenosis and 6.4% for using the mean of three projections (not significant). The intraobserver coefficient of variation was significantly reduced from 16.0 to 10.5% (P less than 0.0001) by using the mean of three projections. The assessment of three projections instead of one justifies the additional time needed by significantly increasing assessment reliability which is of great importance in evaluating and comparing anatomical results of percutaneous transluminal coronary angioplasty.
The radiological findings in three patients who had had surgery for constrictive pericarditis are reported: 1. acute myocardial dilatation after pericardectomy for constrictive pericarditis, with good restitution of ventricular function; 2. abnormal ventricular appearances after pericardial resection during childhood; 3. diastolic prolapse of the cardiac apex after fenestration of the pericardium.
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Two patients with angio-follicular lymph node hyperplasia are described, and the literature is reviewed. In one symptom-free man, the chest x-ray showed a tumour of the upper mediastinum the size of a fist (which is known to have been present for 20 years), in another man there was a 4 cm. node in the right hilum, which was shown by computer tomography not to be due to vessels. In each case the tumour was removed. Histologically they proved to be a hyaline-vascular type of angio-follicular lymph node hyperplasia. This is probably an inflammatory-reactive process.
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Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.
In a prospective study (238 men, mean age 53 years) the changes of the native vessels were studied 3 months after a-c-bypass operation and 5 months after preop. angiography. Progression was defined as increase of stenoses of at least 20% or new total occlusion. Progression was significantly more frequent in vessels with than without bypass and was located proximally to the anastomoses in most cases, less frequently at the anastomoses and very rarely distally to the anastomoses. Proximal progression was significantly more frequent with patent than with occluded bypasses. Stenoses at the anastomoses were significantly more frequent with occluded than with patent bypasses. Stenoses of higher degrees had a stronger tendency for progression than slighter stenoses. Regression was rare and nearly always caused by surgery.
A paramediastinal shadow in the right upper lobe resembled a cavitary lesion in conventional tomography. Computed tomography displayed an anomalous course of the right brachiocephalic vein in the upper lobe.
1 year after left-sided pneumonectomy (for carcinoma of the lung) a pulsating mass developed under the thoracic scar. This was shown by computed tomography to be a partly intra-, partly extrathoracic metastasis.
A partial pericardial defect with aneurysm of the left appendage was demonstrated by two-dimensional echocardiography in two asymptomatic patients, and in one of them also by computed tomography.
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