[Ultrasonic diagnosis of gallbladder and bile ducts].
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Biomedical subjects
Publications and source records attributed to R Nilius.
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Though also in future roentgenological and endoscopic bioptic techniques determined the practice in the diagnostics of tumours of the large intestine the routine use of sonography may shorten the way to diagnosis in numerous cases when the so-called cocard phenomenon (= infiltrated intestinal wall) is proved. On the other hand, the cocard phenomenon may serve as an additional criterion of malignity when a roentgenological and/or endoscopic suspicion of malignoma at first cannot be confirmed bioptico-histologically.
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23 patients with liver cirrhosis of diverse etiology and of different activity levels and grades of compensation of the portal circulation were examined with regard to the systemic endotoxinaemia. The endotoxin was determined using the Limulus-Amoebocyte-Lysat-test. Endotoxin was traceable in the venous blood of 7 out of 23 patients (= 30,4%). No relation was found between endotoxaemia and the activity or grade of severity of liver cirrhosis; nor were there any accumulation of endotoxinaemia in patients with collateral circulation or portal decompensation. Consequently, as a result of our findings, the prognostic value of the symptom endotoxinaemia remains debatable, then endotoxinaemia does not always mean endotoxicosis. Particularly high immunoglobulin concentration and low albumin values in serum of endotoxin-positive cirrhotics indicate a "spillovet" of antigen substances and also of endotoxines in the body circulation resulting from insufficiency of the liver-RHS. Parallel analysis of microbian small bowel flora in 10 patients indicate that coli-dysbiosis appears to play a role in the development of systemic endoxinaemia, although the latter was also traceable in borderline cases of eubiosis/dysbiosis. Our findings strengthen the view that it is not possible to simply translate the findings in animals on to human liver diseases. Quite a number of the mechanisms being discussed are still with uncleared details and they give only a blurred picture of the pathophysiology of endotoxinaemia.
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The criteria important for the sonographic judgment of the liver and the value of the sonography in the strategy of the diagnostics of liver diseases are described. Since none of the symptoms mentioned, such as size of the liver, ventral contour, lower margin of the liver, demarcability, sound conduction as well size, density and distribution of the structural reflexes, is typical for a certain disease, an approximate diagnosis or the exclusion of certain diseases is a possible only taking into consideration several symptoms and also extrahepatic, sonographically probable ones. On account of the simplicity and of the undangerousness of the examination it is obvious to use the sonography immediately after the examination and thus to organize the selection of further diagnostic measures more rational.
Issuing from the physical principles of the ultrasound technique and the explanation of the different investigation methods, the possibilities of the ultrasonic diagnosis are demonstrated on own results in 1,166 cases of struma nodosa and 154 palpatorically and radiologically, respectively, localised enlargements of the organs or demands of space in the abdominal region. The establishment of 46 cysts in 357 scintigraphically warm nodes of the thyroid gland allows the conclusion that a relatively high percentage of the warm nodes contains solid cold regions. In several cases the ultrasonic diagnosis makes a clear diagnosis, in other cases it is an important supplementation to the other diagnostic possibilities. The A-picture-apparatuses produced in the GDR are suitable for the differential diagnosis of palpatorically or radiologically localised enlargements of the organs or space demands. In diffuse diseases of the organs and for the search of disturbances in extended regions B-picture-apparatuses with improved resolving power are necessary.
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First in 1972 under the preliminary term pseudo-lupus-erythematodes-syndrome a clinical picture was represented which clinically resembles the lupus erythematodes disseminatus and which is characterized by the proof of antimitochondrial antibodies and the lack of antinuclear factors. We report on a female patient with this syndrome and interstitial concomitant nephritis. Possible causal factors, clinical picture, typical laboratory findings, therapy and prognosis are discussed with the help of the casuistics.
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In early use the sonography may facilitate and accelerate the differential diagnosis of the jaundice. In parenchymal hepatic icterus frequently pathologic changes of the liver may be proved sonographically. The typical findings of dilated and thus sonographically demonstrable intra- and extrahepatic biliary ducts speak for obstructive jaundice. Characteristic constellations of dilated segments of the bile duct allow conclusions to the localisation of the occlusion. Changes which cannot be explained by sonography are a cause for further examinations.
The name of the disease coma hepaticum is a collective notion for etiologically, pathologo-anatomically and biochemically different kinds of a failure of the function of the liver. A demarcation of different forms of the liver coma is necessary above all for prognostic and therapeutic reasons: hepatic disintegration coma, coma in hepatic failure, mixed coma, false hepatic coma, ferment block coma. Despite certain progress the therapeutic possibilities in hepatic coma cannot satisfy in recent years. Also the use of different, partly very expensive methods of the so-called liver substitute (exchange function and plasmapheresis, heterologous and homologous extracorporal liver perfusion, parasymbiotic crossed circulation, haemoperfusion with encapsulated activated charcoal, liver transplantation) up to now did not lead to a decisive improvement of the nearly infaust prognosis of the hepatic disintegration coma. Therefore preventing measures and careful control of endangered patients deserve particular attention.