Biomedical subjects
Publications and source records attributed to W Jaschke.
Percutaneous fixation with Kirschner wires is recommended for supracondylar fractures of the humerus with displacement in children. The advantages of this easy technique are demonstrated.
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In 12 patients with nephrocalcinosis, radiographs were compared with computed tomography, sonography and histology. Computed tomography detects nephrocalcinosis at a very early stage of the disease, gives a better picture of the density and extent of nephrocalcinosis and may detect other findings (e. g. cysts). Radiographs may show many more details than computed tomography; they seem to be more suitable for observing the course of the disease and have a lower radiation dose. Sonography has not been helpful in the diagnosis of nephrocalcinosis. Histology correlates only moderately with the degree of nephrocalcinosis demonstrated in radiographs and computed tomography.
One hundred and three patients with a suspected space-occupying lesion in the kidney were examined by one or both of the above methods. The findings were compared with the histological (45 cases) or final clinical diagnosis (58 cases). In the group in whom the diagnosis was confirmed at operation or histologically, echography proved correct in 41 patients and computer tomography in 44. The latter method was able to show metastatic deposits in lymph nodes, in the liver, the supra-renals and the other kidney, as well as tumour thrombi in the vena cava in patients with tumours. In the group diagnosed only clinically, where the diagnosis had not been confirmed by operation or biopsy, the striking feature was the inaccuracy of echography in the demonstration of small cysts and the uncertainty in differentiation fluid from solid lesions for the exclusion of tumours.
The computer tomographic criteria of splenic rupture, new or old haematomas of the spleen (pseudocysts) and perisplenic or subphrenic abscesses are described with reference to three cases. It is shown that all the relevant problems in the pre-operative stage can be clarified by computer tomography, making arteriography unnecessary. The differential diagnosis between old haematomas and perisplenic abscesses can only be made by taking account of the history and other clinical information.
The value of computer tomography (CT) in the diagnosis of diastematomyelia (DM) was studied in our own clinical material. Thirty-one patients with congenital spinal anomalies were examined; in 21 a DM could be demonstrated. CT has two major advantages in the radiological investigation of spinal abnormalities, such as spinal dysraphism and DM: 1. Cross sections of the spinal canal can be obtained without overlying opacities and 2. The demonstration of intraspinal soft tissues structures, corresponding to their attenuation characteristics and the relative differences in absorption of the x-rays.
Considering our own results with treating 96 children by Küntscher nailing we cannot agree with other authors who prefer conservative treatment of femoral shaft fractures in infancy. Using a special technique which avoids injuries of the epiphyseal zone, we neither found unphysiological differences in legs length nor varus or valgus displacements three months to five years after nail removal. Bacterial infections are extremely rare. Healing mostly follows without complications. In well defined cases we think operative treatment has the following advantages: short period of hospitalization, early mobilization, easy medical care, little x-ray exposition and lowering of costs.
Report of the result of CT and venography in 12 patients with suspected adrenal disease, venography being combined with selective blood sampling for hormone analysis. In one patient CT showed a 1.6 cm big pheochromocytome in the left adrenal gland, not demonstrated by venography, but proven by analysis of the blood sample. Both methods showed hyperplasia of both adrenals in one patient with Cushing Syndrome with elevated Cortisol levels found in the analysis of the blood smples. Of 3 patients with hyperaldosteronism, venography was able to demonstrate 2 Conn adenomas, not seen on CT; whereas CT showed the third 2 X 1.5 cm big Conn adenoma hidden in an enlarged adrenal gland. Hormone analysis was helpful in 2 of these cases, while in the third it was misleading. The authors believe that both methods should be employed to localise over adrenal disease with endocrine activity.
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Knowledge of the patho-anatomic variants of the hypernephroid renal carcinoma as well as of its computertomographic correlate facilitates diagnosis and prevents fatal diagnostic errors. Measurements of density by computer tomography, as well as on-target application of contrast medium, are of great importance for arriving at the correct diagnosis.
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Two patients with sub-capsular haematomas of the spleen are described. In both patients the diagnosis was made by ultrasound examination. Ultrasound fills a gap in the diagnosis of splenic rupture, since sub-capsular haematoma cannot be satisfactorily demonstrated by angiography.
During 7057 conventional cholecystectomies (1972-1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93%, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean follow-up period after surgery was 7.4 +/- 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.
Placement of a balloon-expandable metallic stent (Strecker-Stent) for biliary drainage has been attempted in 30 patients. The stent was successfully implanted in 22 patients; in the remaining 8 patients, dilatation of the biliary stricture prior to stent placement was inadequate and delivery of the Strecker-Stent was, therefore, not possible. Insufficient balloon dilatation was related to the rigid nature of the stricture and to pain experienced during dilatation. During 2-9 months follow-up, 3 of 21 patients (14%) presented with reocclusion of the stented bile ducts. In all other patients, biliary drainage remains adequate. No major complications related to stent placement were observed.
PURPOSE: To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic stents. METHODS: Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35-72 years, mean 54 years) underwent the TIPS procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies, wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n = 48) and self-expanding (n = 45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3-24 months) were obtained in 39 of these patients. RESULTS: Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy, the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n = 1) and late shortening (n = 4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant complications related to the TIPS insertions. CONCLUSION: An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.