[Clinicopathological conference. Recurrent hematochezia with an unremarkable colon. Freiburger gastroenterological discussions].
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Biomedical subjects
Publications and source records attributed to U Blum.
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Between 1974 and July 1989 110 operations for thoracic aortic aneurysms in 107 patients (69 males, 38 females) were performed, whose ages ranged from 14 to 74. 37 patients had an aortic valvular disease, 15 had Marfan's syndrome, 28 of these patients had a history of thoracic trauma or of previous aortic or cardiac surgery (14 posttraumatic aneurysms, 9 aneurysms after cardiac surgery, 5 after repair of aortic coarctation), 29 patients had hypertension. 63 patients underwent repair of dissecting aneurysms, 47 of non-dissecting (saccular or fusiform) thoracic aortic aneurysms. 67 repairs were emergency and 43 elective. The hospital mortality for the entire series was 34.5%. The analysis of multiple preoperative and intraoperative variables showed that mortality following thoracic aortic aneurysm repair is higher with increasing age (65.7% mortality for operations between the 60th and 70th year of age, 100% mortality beyond the 70th year of age) and emergency surgery (hospital mortality 52.2% compared with 6.9% for elective operations). A significant increase in mortality was noted related to the aneurysm type (poorer prognosis in DeBakey type I and II), to history of hypertension, to preoperative shock or to perforation of the aneurysm, including haemopericardium or haemothorax.
We report a case of rupture and fragmentation of a PET-balloon catheter during percutaneous transluminal coronary angioplasty of a calcified LAD-obstruction. When the insufflation pressure was increased to 12 atm, the balloon ruptured. During withdrawal of the balloon catheter the tip of the shaft and a fragment of the balloon tore off and remained within the atheroma. Emergency operation was necessary to remove the fragments and to prevent a large myocardial infarction. Although this is an unusual complication of PTCA, care should be taken when PET-balloon catheters are used in calcified coronary obstructions.
The radiological findings in pulmonary lymphangitic carcinomatosis and in leukemic pulmonary infiltrates mirror the tumor-dependent monomorphic interstitial pathology of lung parenchyma. It is a proven fact that pulmonary lymphangitic carcinomatosis is caused by hematogenous tumor embolization to the lungs; pathogenesis by contiguous lymphangitic spread is the exception. High-resolution CT performed as a supplement to the radiological work-up improves the sensitivity for pulmonary infiltrates in general and thus makes the differential diagnosis decided easier. Radiological criteria cannot discriminate the different forms of leukemia. Plain chest X-ray allows the diagnosis of pulmonary involvement in leukemia due to tumorous infiltrates and of tumor- or therapy-induced complications. It is essential that the radiological findings be interpreted with reference to the stage of tumor disease and the clinical parameters to make the radiological differential diagnosis of opportunistic infections more reliable.
Since the introduction of ultrathin angioendoscopes into clinical application conventional or digital angiography have been controlled by using the same approach like in angiography. In dogs and angiography patients this new angioscopic method for arteries without surgical intervention has been developed. The approach is transfemoral. Endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and a new kind of stents and their application. An ultrathin endoscope with an outer diameter of 1.6 mm and working channel of 0.35 mm is used. Guide wires, contrast media and drugs for local thrombolysis can be applied through this channel. The endoscope is placed into the region of interest under fluoroscopic control and view is obtained by using 0.9% NaCl for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. It was possible to demonstrate the proceedings of dilatation, recanalization, local lysis, stent-application and thrombus-extraction.
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Gastric pseudolymphoma is an uncommon benign lesion which poses a difficult problem in diagnosis and management. Lymphoid hyperplasia of the stomach, however, may occasionally precede true gastric lymphoma. Endoscopic, radiologic and pathological findings are not generally helpful in establishing the diagnosis preoperatively. Benign gastric lymphoid hyperplasia could be mistaken radiologically for ulcerated gastric carcinoma and pathologically for malignant lymphoma. Recognition of this condition is important to prevent unnecessary treatment by surgery or radiotherapy. About 140 case reports have been published to date. This paper describes the cases of two further patients.
We reviewed retrospectively the clinical records of 28 patients with AIDS staged group IV according to CDC-criteria. Among these, 19 had pulmonary disease: most of them (n = 17) had pneumocystis carinii pneumonia (Pcp). 12/17 patients with proven Pcp displayed typical x-ray findings with diffuse perihilar interstitial infiltration sparing lung periphery. 3/17 had atypical features and 2 normal chest x-ray findings. These data are important to identify patients with pulmonary complications of AIDS.
The exact radiographic localisation of supraganglionic lesions of the brachial plexus provides important information for the prognosis and clinical management of these injuries. The authors report on the results of enhanced CT scanning and MRI of the cervical spine in five patients with surgically proven root avulsions caused by traction injuries. All lesions were correctly diagnosed by enhanced CT scanning. MRI, by comparison, identified only about 70% of the neural lesions.
The indications, complications and results obtained in asthma bronchiale are described on the basis of 132 thoracal vagotomies according to Kux. The operation was found to be effective in 60% of the patients, without however being able to compare them by means of control examination conducted with a comparative group.
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Early postoperative angiographic control is important for prognosis and medical therapy for patients undergoing coronary bypass surgery. Grafts from the internal mammary artery had been shown to be superior to venous bypasses for anastomoses to the left anterior descending coronary artery. Thus, the need for angiographic demonstration of graft patency and function is increasing. We report on the angiographic analyses of 73 patients after left internal mammary artery (LIMA) bypass surgery by filling of the graft via retrograde injection of contrast medium into the left brachial artery. In all cases the bypass, anastomosis and downstream vessel were clearly visualised. No complications or side effects were observed.
This report describes two cases of Castleman's disease (male 48 yrs, female 33 yrs). Two intrathoracic lymphomas were accidentally discovered during routine x-ray examination. Histologically, follicular hyperplasia, prominent interfollicular vascularity and sheets of mature plasma cells (intermediate variant) were seen. The etiology of this benign lymphoma remains unknown. Its significance lies in its differential diagnosis from malignant tumours.
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Since the introduction of ultrathin angioendoscopes into clinical application, it has been possible to subject the findings of conventional or digital angiography to objective verification. In dogs and in patients, this new angioscopic method for visualization of arteries without surgical intervention has been carried out. The approach is transfemoral. Endoscopy is combined with angiography and, when indicated, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and insertion of a new type of stent. An ultrathin endoscope with an outer diameter of 1.6 mm and a working channel of 0.35 mm is used. Guidewires, contrast media and drugs for local thrombolysis can be employed through this channel. The endoscope is placed in the region of interest under fluoroscopy and direct visualization is obtained by using 0.9% NaCl for decreasing blood flow. Image recording is achieved by video or high-speed camera. With this method, the intraluminal events of dilatation, recanalization, local lysis, stent application and thrombus extraction can be visualized.
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