Biomedical subjects
Publications and source records attributed to W Habscheid.
The clinical value of phospholipase measurements in serum is as yet an open question, particularly with respect to the prognosis quoad vitam. Sensitivities and specificities at different decision levels for unselected intensive care patients are reported and discussed.
Ultrasound screening of the abdomen, the basal segments of the pleural cavities and the deep leg veins was performed in 637 patients in a medical intensive care unit. The findings were classified into significance groups (SG) depending on their clinical relevance (SG 1: crucial; SG 2: of immediate relevance; SG 3: of future relevance; SG 4: of no significance). The investigation was indicated in 172 patients (27%-Group 1), in the other 465 patients (73% - Group II) it was performed despite the absence of indications. Abnormal findings were discovered in 156 patients of Group 1 (90.7%) and were classified under SG 1 in 29.7% of them. SG 2 in 43%, SG 3 in 14.5% and SG 4 in 3.5%. In Group II, abnormalities were noted in 70.1% of the patients, and were assigned to SG 1 in 4.3%, SG 2 in 5.4%, SG 3 in 32.5% and SG 4 in 27.9%. The most frequent significant finding in Group II was deep leg vein thrombosis. In both groups the organ most frequently showing abnormal findings was the liver (41%), followed by the gall bladder (27%) and the kidneys (20.5%), though most of them were insignificant findings of no relevance to the situation at the time and were classified under SG 3 and 4 (34%, 25% and 20% of the subjects examined). After excluding the findings in the pleural cavities (14.1%), aorta (3.4%) and biliary tract (1.2%), most of the findings noted in other organs or regions of the body (leg veins 11.1%, intestine 8.8%, spleen 8.3%, peritoneal cavity 7.2%, pancreas 1.7%) were assigned to SG 1 or SG 2. These results show that, despite the numerous irrelevant findings which it throws up, ultrasonography is of great diagnostic value and should be extensively employed.
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A case of acute fatty liver as a rare cause of pregnancy-induced jaundice is reported. Near term the 25-year-old patient became rapidly jaundiced. On admission laboratory tests showed signs of incipient coagulopathy and impaired renal function. When fetal vital signs deteriorated cesarean section was performed. After surgery the fullblown picture of disseminated intravascular coagulation developed, with profuse bleeding only controllable by rigorous substitution of plasma factors. Acute hepatic insufficiency with ascites followed. Despite the marked bilirubin elevation the hepatic enzymes were only slightly raised. In addition, acute renal insufficiency, pancreatitis and hyperuricemia developed. Under intensive care the patient recovered slowly and was discharged after 4 weeks with a healthy baby.
The incidence of femoral artery pseudoaneurysms (p.a.) complicating diagnostic catheter procedures is only reported in studies regarding clinical symptoms. Since the diagnosis of aneurysms can (provided the vessel is visible) easily be done by ultrasound we made a prospective investigation of patients following coronary angiography. The unmistakable picture of p.a. consists of a rounded sonolucent, synchronic to the heart-beat eccentric expanding structure near the femoral artery, which can be differentiated from the more echorich usually not clear confined surrounding hematoma. We found 16 p.a. (5.24%) in 305 investigated patients. The size varied from 1.5 x 1.5 to 4 x 3.5 cm. In eight cases thrombosis of the p.a. was seen in follow-up controls. Operation was performed in 8 cases. Four patients had no visible hematoma; pulsation was palpable in 10, a systolic murmur heard in 12 patients. An examination by color Doppler ultrasound was done in 11 patients. Intracavitary flow and systole-diastolic jet stream in the neck of the p.a. are typical findings. We conclude that the diagnosis of femoral artery p.a. can be done accurately by ultrasound. Its incidence in patients with diagnostic catheter procedures is higher than hitherto suspected. A mild course with spontaneous thrombosis is seen frequently. Color Doppler ultrasound is recommended as a complementary investigation. In most cases angiography seems to be unnecessary.
The case of a 36 year old patient with acute pancreatitis is presented whose clinical course was dominated by extensive peripancreatic fluid exsudation and formation of cysts. Risky surgery in the acute phase of the disease could be avoided by ultrasonic guided percutaneous punction and placing of several, partly transhepatic, catheters. The fluid collections could be drained completely and showed no recurrence.
Several days after not eating anything while drinking heavily a 45-year-old alcoholic developed severe ketoacidosis. He was admitted to hospital in a stable cardiovascular condition, but already in a comatose state with Kussmaul breathing. There was a marked metabolic acidosis (pH 6.8; base deficit -30 mmol/l), the urine was positive for ketone bodies, and serum lactate was 24 mmol/l. There was a marked hypoglycaemia (40 mg/dl). Despite intensive treatment it was not possible to prevent multiple organ failure, of which the patient soon died.
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Real-time ultrasonography was performed on both legs of 104 patients with suspected deep-vein thrombosis of the legs. The results were compared with those of phlebography (146 one-extremity phlebograms) independently performed. During the first part of the study (69 individual phlebograms) only the upper leg and popliteal region were assessed: absent compressibility of the vessel lumen was the only criterion of thrombosis. In the second part (77 phlebograms) the lower leg was also investigated: non-compressible, echo-poor vessels were typical of thrombosis. Phlebography demonstrated 21 thromboses of the common femoral vein, 36 of the superficial femoral vein, and 41 of the popliteal vein. The 77 phlebograms in the second part demonstrated 29 thromboses of the deep veins of the lower leg. Sonography had a sensitivity of 100% and a specificity of 99% for the region of the common femoral vein, 95% and 99%, respectively, for the superficial femoral vein, 95% and 99% for the popliteal vein and 89% and 100% for the deep veins of the lower leg. Real-time ultrasonography of the deep-vein system of the leg is thus of great diagnostic value both for the upper and the lower leg and is very useful as the initial physical method of examination if thrombosis is suspected.
In a 61-year-old man in terminal renal failure from bilateral renal polycystic degeneration abdominal sonography chanced to demonstrate in the left lobe of the liver a saccular, pearl string-like dilatation of the, at first no further definable, duct systems. Hepatobiliary scintigraphy revealed them to be bile-draining and thus confirmed Caroli's disease, which had previously been asymptomatic for any hepatic involvement. Since in the majority of cases of Caroli's disease renal changes are symptom-free associated findings, the question arises whether in this case there is the coexistence of polycystic renal disease and Caroli's disease or whether the biliary tract and renal changes constitute a nosological entity in the sense of atypical Caroli's disease.
Hemangioma is the most frequent benign liver tumor with an incidence of 0.4-7.3%. The tumors are typically small, asymptomatic and detected accidentally by ultrasound or CT. Hemangiomas extending a diameter of 2-3 cm can be proved by dynamic contrast CT or scintigraphy with 99-m Tc erythrocytes. Hemangiomas with a diameter less than 2 cm are a diagnostic dilemma. In case of a typical ultrasonic picture (small white tumor) in an asymptomatic patient, a consequent ultrasonic follow-up is indicated. It is yet unclear whether MRI will be an additional diagnostic tool to identify small hemangiomas.
51Cr-EDTA activity was measured in urine and blood of patients receiving non-steroidal anti-inflammatory (NSA) drug treatment and of healthy subjects and other patients (controls), after oral intake of 51Cr-EDTA, for the purpose of deciding whether NSA treatment increases urinary excretion of oral 51Cr-EDTA as an expression of increased intestinal permeability. 51Cr-EDTA activity in urine and blood of patients with rheumatoid arthritis (13) being treated with NSA was significantly higher (similar to results in 13 patients with Crohn's disease) than that of a control group (14) of patients with rheumatoid arthritis without such treatment (9) and patients without rheumatic disease (5). Both in patients with rheumatoid arthritis receiving NSA drugs and patients with Crohn's disease there was a highly significant correlation between urinary and blood activity. There was no effect of NSA drugs on renal function. The results indicate that NSA drugs increase interenterocytic permeability to an extent comparable to permeability abnormalities in Crohn's disease.
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The ultrasonic findings of 37 patients with acute pancreatitis were related to the severity of the disease according to the Ranson criteria (RK). Pathologic findings of the pancreas were found in every case of severe pancreatitis (oedema, necrosis, conglomerate tumour), whereas in the large group of mild pancreatitis (0-2 RK, n = 26) only 17 patients showed an oedematous swelling of the organ. In 5 patients with mild pancreatitis a tryptic exudation was observed in the peripancreatic area, which must be considered as necrosis in 4 cases because of its long-lasting persistence in follow-up. Five patients in this group showed a rapid reversible ascites representing an effusion due to peritoneal irritation. In the group of severe pancreatitis, peripancreatic exudations were seen in 10 of 11 patients; the higher the severity of disease, the higher was the incidence of ascites, pleural effusions and sonographic signs of ileus.
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