[Diagnosis of infective spondylitis. Value of bone marrow scintigraphy with 99mTC monoclonal granulocyte antibodies in combination with 99mTc-DPD bone scintigraphy].
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Adult↗
Biomedical subjects
A Kaim
Publications and source records attributed to A Kaim.
[Xanthogranulomatous pyelonephritis with phlegmonous abdominal wall infiltration. Diagnosis and assessment of extent via computerized tomography].
A 34-year-old woman who 14 years previously had undergone a left nephrotomy for nephrolithiasis complained of pain in the left renal fossa which was reddened and painful on percussion. She had a fever of 38.2 degrees C. C-reactive protein was raised to 80 mg/l, the white cell count to 14,620/microliters (83% neutrophils). Protein and white cells were found in the urine together with a significant number of E. coli on urine culture. Plain film of the abdomen showed a staghorn calculus and ultrasonography demonstrated renal enlargement with a possible paranephritic abscess. The computed tomography diagnosis was xanthogranulomatous pyelonephritis, on the basis of renal enlargement, staghorn calculus, hypodense areas with typical density values (10-15 Hounsfield units), contrast enrichment and extrarenal extension of partly phlegmonous partly fused-together inflammatory changes. The abscessing parts were drained under computed tomography control. Starting 7 days pre-operatively the patient had been receiving ciprofloxacin (0.4 g daily) intravenously. A nephrectomy had to be performed subsequently. Antibiotic treatment was discontinued 2 weeks later and she was discharged symptom-free. The diagnosis of diffuse xanthogranulomatous Pyelonephritis was confirmed by histological examination of the surgical specimen.
Abdominal Abscess↗
[Perimesencephalic subarachnoid hemorrhage: clinical and computer tomography aspects].
AIM: The blood distribution on CCT and the prognosis of patients with nonaneurysmal subarachnoidal haemorrhage were retrospectively studied and compared to a patient group with aneurysmal haemorrhage. METHODS: The blood distribution on CCT (72 h after bleeding episode) of 26 patients with nonaneurysmal subarachnoidal haemorrhage confirmed by two normal cerebral angiograms was compared to the blood distribution of 76 patients with aneurysmal haemorrhage. The clinical condition of these patients was further analysed, 4-60 months after the bleeding episode. RESULTS: In 62% of patients with nonaneurysmal haemorrhage the blood distribution was perimesencephalic. The aneurysmal blood distribution pattern was more extended and only one patient showed a perimesencephalic pattern. 80% of the patients without aneurysms in angiography had no limitations in daily functional capacity. CONCLUSION: The perimesencephalic pattern is frequently found in patients with nonaneurysmal subarachnoidal haemorrhage, the prognosis of these patients is excellent. Rarely is the perimesencephalic haemorrhage caused by a ruptured aneurysm. It needs thorough angiographic evaluation.
Adult↗
[The findings and value of computed tomography in pleural empyema].
Chest radiographs and CT images of 25 patients with pleural empyemas were compared retrospectively with those of 20 patients with pleural exudates and transudates in order to determine criteria for differential diagnosis and to define the place of CT in the diagnosis of pleural empyemas. The sign which was most suggestive of an empyema on a chest radiograph was an encapsulated effusion in an atypical position (18/25); this was found in only 4 out of 20 exudates and in none of the transudates. On CT, changes in the pleura, the subcostal tissues and the configuration and position of the fluid were suggestive of an empyema. In nearly all patients with a pleural empyema there was thickening and increased contrast uptake of the parietal pleura (22/25) and thickening and increased density oft the subcostal tissues (23/25). Usually, empyemas were encapsulated and biconvex (20/25). None of the patients with pleural transudates showed any of these changes. In the presence of some pleural exudates, pleural (14/20) or thoracic (11/20) changes were noted. In part, these changes were due to previous treatment (sclerotherapy) or tumour infiltration (7/20). An attempt to correlate the CT findings with changes in the pleura and subcostal tissues with the clinical empyema stages I-III, according to Light, showed that CT was unable to distinguish between early and late empyemas. Consequently, diagnostic aspiration remains necessary for correct treatment.
Adult↗
[Magnetic resonance tomographic diagnosis of periarticular cystic space-occupying lesions in the knee joint].
The MR images of the knee joint of 100 successively examined patients were evaluated in retrospect with regard to periarticular cystic lesions. There were 18 popliteal cysts, 8 meniscal cysts and 4 ganglion cysts. Localisation and internal structure of the lesions were of main importance in respect of differential diagnosis. All meniscal cysts were associated with horizontal meniscal tears. Spin-echo and 3D gradient-echo images did not enable differentiation because of signal intensity values. A spin-echo sequence with long repetition time in double-echo technique was best suited to assess the periarticular cystic lesions as well as the intraarticular pathological changes which were often concomitant.
Adult↗
Coronal acetabular fractures: the anterior approach in computed tomography-navigated minimally invasive percutaneous fixation.
PURPOSE: To demonstrate the technical feasibility of the anterior approach to the coronal roof component of carefully selected acetabular fractures in computed tomography (CT)-navigated closed reduction and percutaneous fixation (CRPF). METHODS: Four patients with nondisplaced or slightly displaced coronal fractures of the acetabular roof were treated with percutaneous screw fixation. Screws were implanted over guidepins placed under CT navigation. Mean clinical and radiological follow-up was 16 months. RESULTS: All screws could be placed as intended. There were no peri- or postoperative complications. Radiological follow-up showed primary osseous union. Clinical results were excellent according to a median Merle-d'Aubigné score of 18. CONCLUSION: Nondisplaced or slightly displaced coronally oriented fractures of the acetabular roof can be treated by minimally invasive percutaneous CT-navigated fixation through an anterior approach that does not endanger the sciatic nerve. Early clinical results are encouraging. Close cooperation between trauma surgeons and radiologists and careful selection of cases is mandatory.
Acetabulum↗
Subependymoma of the third ventricle after partial resection of a craniopharyngioma and repeated postoperative irradiation.
We present the case of a 28-year-old man who underwent craniotomy and subsequent radiotherapy for a suprasellar craniopharyngioma at the age of 8 years. The patient suffered from a severe pituitary deficiency until his death. The cause of death was a bronchopneumonia. At necropsy epithelial tissue characteristic of craniopharyngioma was no longer found, but instead a subependymoma of the third ventricle. Up to now most reported primary central nervous system tumors associated with subependymomas were ependymomas. However, in 1 case very similar to ours a subependymoma was associated with a craniopharyngioma. Furthermore, only rare examples of subependymomas of the third ventricle have been reported. The growth of a subependymoma might have been induced by intense reactive gliosis as a response of the adjacent brain tissue to the craniopharyngioma. However, in view of the repeated post-operative irradiation in our case the possibility of radiation-induced glioma has also to be considered.
Adult↗