Biomedical subjects
Publications and source records attributed to W Dewes.
Kallmann's syndrome is characterized by hypogonadotropic hypogonadism and anosmia. Postmortem studies have revealed either hypoplasia or aplasia of the rhinencephalon, respectively, in patients with hyposmia and anosmia. This anatomical defect has now been demonstrated in vivo in four patients with Kallmann's syndrome by magnetic resonance imaging.
A rare case of a thymoma metastatic to brain is reported. This tumor was localized intraoperatively with the use of transdural ultrasound imaging, and gross total resection was accomplished. Radiation therapy was administered to both brain and mediastinum. The growth characteristics, classification, and treatment of thymomas are discussed.
We introduced a modification of T2-weighted rapid sequence imaging which combines the advantages of conventional spin echo sequences with those of gradient echo sequences. It provides a method which is suitable for clinical routine use. Using a 1.5 Tesla field, one obtains good image quality with contrast comparable to spin echo sequences, while reducing the time taken to examine the brain to one-half and that of the spine to one-third. Our experience in 54 patients is described.
CT scans were made prior to and following radiotherapy in eleven patients with primary or secondary malignant lymphomas of the CNS. Six patients were additionally submitted to MR tomography with calculated T1 and T2 images. Radiotherapy induced a very rapid regression of the lymphomas. A measurable quantitative influence of the irradiation could thus not be visualized in the MR scans. The survival curve of our patients was calculated, too. The median survival after radiotherapy is 17.4 months.
During a period of 24 months, ultrasound-guided percutaneous nephrostomies were performed in 51 patients in the Hospital at Köln-Merheim. The procedure was carried out with a modified nephrostomy instrument manufactured by Angiomed, Ettlingen, according to our own design. The procedure was successful in 49 patients. In one case it had to be abandoned because of lack of patient co-operation. In one patient a pyonephrosis was found and the patient was treated surgically.
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Between January 1981 and September 1985, invasive thymomas were diagnosed in 13 patients attending the municipal hospital at Köln-Merheim. All these patients were examined radiologically and the tumour removed at thoracotomy, and irradiated in our Radiotherapy Clinic. Invasive thymomas appear as space-occupying lesions on chest radiographs taken in two planes, or on computed tomography. Infiltration by the thymoma in stages III and IV can be demonstrated by computed tomography.
Four examples are given to demonstrate the problems, methods and advantages of intra-operative sonography for intra-spinal tumours. The value of intra-operative sonography for localising the tumours and for judging their extent is demonstrated and related to other imaging methods, such as myelography, CT and MR.
The radiological and scintigraphic findings in the rare condition of hypertrophic osteoarthropathy (Marie-Bamberger) were followed up for a period of two years. They are described and compared. Skeletal scintigraphy shows the abnormalities in the skeleton at an earlier stage than does radiology and also shows more extensive manifestations. The specific symmetrical distribution of abnormally increased uptake in the diaphyses and metaphyses of the long bones of the extremities, with sparing of the axial skeleton, produces highly specific appearances which can be considered as diagnostic.
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MR tomography provides images equal to, or superior to, CT of lymph node involvement in the thorax or abdomen. It may be possible to achieve tissue characterisation by means of T1 and T2 images. Chronic inflammatory diseases causing lymph node enlargement, such as sarcoidosis, show characteristic T1 intervals (about 650 msecs), whereas lymphomas show intervals of 900 msecs. Enlarged lymph nodes of low malignancy show lower T2 values (78 to 94 msecs), highly malignant show higher T2 values (83 to 145 msecs). Already we believe MR to be the method of choice in evaluating lymphoma and sarcoidosis.
Twenty-six patients with mostly small intracranial space-occupying lesions were examined sonographically during surgery. In all patients, accurate localisation and complete delineation of the intra-cerebral lesion proved possible. The extent of the lesion could be determined accurately and surrounding cerebral structures were identified unequivocally. There were no significant differences in the appearances before and after opening of the dura. The significant advantage of the intra-operative use of sonography lies in the accurate localisation of the space-occupying lesion. This results in a reduction of interference with normal cerebral tissue and in a reduction of the duration of the operation.
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