[Hemangiopericytoma of the chest wall: case report (author's transl)].
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Biomedical subjects
Publications and source records attributed to U Gullotta.
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Intrabronchial retention of large plugs of inspissated mucous in cases of disturbed bronchial secretion and impaired clearing mechanism leads often to chronic inflammation and to formation of "proximal" bronchiectasis. Mucoid impaction may occur in many bronchial diseases and is radiologically characterized by the so-called "mucous bronchogram".
In 75 patients with lymphoma (46 Hodgkin's disease, 29 non-Hodgkin lymphomas) computed tomography was performed in order to detect neoplastic invasion of the abdominal organs (55 new cases) or to control the results of treatment (20 cases). In 30 cases enlarged retroperitoneal or mesenteric lymphnodes and/or liver or spleen enlargement were found. Neoplastic involvement of lymphnodes without enlargement was missed in two cases. CT failed also to demonstrate microscopic malignant invasion of liver and spleen. The false-negative rate in our series was 10.9%. Computed tomography is a non-invasive method which is very well suited for staging malignant lymphoma.
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CT diagnosis of intraabdominal abscess was confirmed in 18 patients by laparatomy and in two by autopsy. In CT abscess is characterized by an expansive soft-tissue lesion with different density values, mostly with a central fluid collection and a thickened wall. The peripheral inflammatory reaction leads to obliteration of fat planes surrounding the adjacent organs. Further symptoms are contrast enhancement of the wall and extraluminal gas collection. The combination of all these signs together with a suitable history and clinical findings allow a reliable diagnosis of abscess formation. When only isolated signs are found, differentiation from tumor, pseudocyst or hematoma may be difficult.
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27 patients with testicular tumours were examined by lymphography and computerized tomography for evaluation of metastatic spread in the retroperitoneal lymphnodes. A good correlation of results was found in 23 patients. In 4 cases lymphography failed to show metastatic disease, which was easily recognized by CT. In account of the lymphatic spread pathways of testicular tumours leading mainly to the lymphnodes close to the kidney pedicle CT appears to be method of choice in the staging of these patients, as the lymphnodes in this area are often not demonstrated by lymphography. Computerized tomography allows the exact localisation and extension of neoplastic lymphnodes and at the same time a good evaluation of the surrounding organs.
X-ray permeability is one of the important criterions which qualify a material as orthopedic cast. By using a phantom (amputated human lower leg) standardized conditions were created to compare the five customary casts: Cellamin, Lightcase II, Hexcelite, Neofrakt and Baycast. For judging the perceptibility of osseous structures, especially the details of the fracture, the lower and the upper number of clinically used layers were considered. The blank tested valuation showed the well-known advantages of the plastic materials in comparison with plaster of Paris. Within the group of the plastic materials distinct differences were also found.
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Algorithms in the diagnosis of malignant disease have the aim to produce a diagnosis as quickly, as certainly and as simply as possible. The first phase consists of general non-invasive methods which should be as simple as possible. If the results are positive this should be followed immediately by percutaneous biopsy in order to produce cytological confirmation of the diagnosis as quickly as possible. If the original investigations were negative, those special methods of investigation should be used which are most likely to make a diagnosis. This is followed by investigations which throw light on the most appropriate form of treatment. This scheme has been illustrated by special algorithms for carcinoma of the bronchus, the pancreas and the breast.
Report is given on three cases of dacryolithiasis. All cases were demonstrated by dacryocystography. Two dacryoliths were obtained at operation, another one by spontaneous passage through the nose. Histopathological examination of the dacryoliths in two cases revealed the presence of a mycotic infection, most likely with Candida albicans. The casts were found to be composed of layers of neutral and acid mucoproteids and lipids, accompanied by an infiltration with leucocytes.
Prompt surgical treatment of the solitary form of bronchiolo-alveolar-cell carcinoma offers a good survival rate in comparison with bronchogenic carcinoma; the prognosis of the diffuse form is poor. Review of 28 cases of solitary BAC showed an airbronchogram in 36% and a tail sign in 85% of cases; both features were found in 32% of tumors. The air bronchogram seems to be specific for this type of tumours, the tail sign is found with granulomatous or inflammatory diseases as well. In the differential diagnosis of a peripheral coin lesion with air bronchogramm and tail sign, without calcifications and atelectasis, a BAC should be taken into serious consideration.
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After successful rescue from drowning there may develop a situation which is called secondary drowning, resulting in acute respiratory distress characterized by interstitial pulmonary oedema, hypoxaemia, hypercapnia and acidosis during drowning, direct alteration of the alveolar membrane by aspirated water and particulate matters and a volume overloading by adsorption and--not seldom--inept therapy. This situation requires mechanical ventilation and forced diuresis, combined with high doses of steroids, antibiotics and digitalis. We present the case of an eleven year old patient whose clinical course demonstrate the necessity of exact clinical observation after rescue from drowning. After development of acute respiratory distress only the immediate utilization of the therapeutic modalities of an intensive care may result in a satisfactory outcome. Four months later our patient had normal pulmonary function except for a moderate reduction of compliance.
By using a PE-catheter for catheterising the tear ducts, dacrocystography becomes a simple and rapid investigation. It permits excellent morphological demonstration of pathological changes, since films can be obtained under screening control. A water-soluble, low viscosity contrast medium is recommended. Amongst more than 100 dacrocystograms, there were no serious complications.
Results and X-ray findings of 125 dacryocystographies are discussed. Type II obstruction is the commonest pathological finding, Type I is caused often by a trauma. DCG gives a good morphological picture of tear drainage system and represents a very important method for planning surgical therapy.
In three patients on cytostatic drugs acute bilaterally symmetrical pulmonary infiltrates developed. Bacterial, viral or mycotic infections were excluded. The histological findings in the lungs of two had died were those of nonspecific alveolitis. Clinical and radiological findings, as well as the rapid regression of the infiltrates after stopping the cytostatic drugs in the third patient and the marked similarity of the X-ray picture to some similar cases reported in the literature, suggest that these infiltrates resulted from an acute allergic reaction to the cytostatic drugs.