Biomedical subjects
Publications and source records attributed to C Zeller.
The authors report the case of a 22-month-old boy who presented a spondylocostal dysostosis associated with preaxial polydactylia. This peculiar malformation syndrome seems to be the first reported in the literature till today.
The authors describe the radiological features of a patient with Behcet's disease, who had oesogastric ulcers and a terminal ileitis as major part of this clinical syndrome. The radiologic appearance of these localisations are discussed. The similarities of Behcet's disease to Crohn's disease are outlined.
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The case histories of more than 5000 outpatients with respiratory diseases were stored in free text from 1974 untill 1977. The retrieval efficiency was tested using STAIRS-IBM program product with the syntax operators "or", "and", "not", "with", and "adj". Chronic bronchitis in lung cancer patients was chosen as an example. The first word constellation was compiled as a retrieval argument for chronic bronchitis. The second word constellation was used as a retrieval argument for chronic bronchitis subsisting for more than 5 years before the diagnosis of lung cancer. The third word constellation retrieved documents without clear time relationship between chronic bronchitis and lung cancer. The review of each history of the 473 lung cancer patients issued a first group of 219 cases composed of lung cancer patients with histories of chronic bronchitis for more than 5 years. A second group of 180 patients had no history of preexisting chronic bronchitis. This manual selection of cases (reading of all 473 case histories) took 3 months compared to 4 h by computer dialogue selection. 87% of the first group (preexisting chronic bronchitis for more than 5 years) and 74% of the second group (no history of chronic bronchitis) were correctly obtained by the brief computer dialogue. This efficiency of the computer dialogue was further improved without difficulty by slight modifications of the dialogue strategy, so that only approximately 10% of documents remained falsely classified. It can be seen that free text analysis of case histories is possible by the STAIRS-IBM program and enables a doctor to observe new clinically important correlations in a very short time. Final deductions, however, must be followed by careful checking of all individual histories.
The case histories of 474 patients with lung cancer were screened. Chronic bronchitis was assumed to precede lung cancer if chronic cough and sputum had been present for more than five years. Daily consumption of cigarettes, cigars (= 5 cigarettes) or pipes (= 1 cigarette) and the number of pack-years were noted. FEV1 in percent of the slowly inspired vital capacity (FEV1 %VC) was regarded as a sensitive index for the degree of bronchial obstruction. Group 1 included 221 lung cancer patients with a clear history of preexisting chronic bronchitis. Group 2 included 175 cases without such history. Heavy smokers and severely obstructed patients were found more often in group 1 than in group 2 (p less than 0.0005). A lack of correlation was evident between smoking habits and FEV1 %VC when group 1 was fused with group 2: r= -0.071, p greater than 0.20. Indeed, light, heavy, and very heavy smokers were evenly distributed in group 1 among severely and slightly obstructed patients. However, in group 2 heavy and very heavy smokers were found more frequently in patients with slight bronchial obstruction than in patients with severe bronchial obstruction (p less than 0.01). It appears that an important subgroup of heavy and very heavy smokers with lung cancer are protected from chronic bronchitis as well as from bronchial obstruction. The reasons for this protection are not clear.
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In 83 patients with severe, largely irreversible bronchial obstruction (FEV1/VC less than 40% and FEV1 after orciprenaline inhalation less than 120% of the control value) and radiologie evidence of AD-emphysema, arterial PCO2 and PO2 were measured at rest in supine position and on the bicycle ergometer during a steady-state exercice of 5 min. Alveolar hypoventilation (PCO2 greater than 45 mm Hg) was most often observed in the cases with FEV1 less than 1.01 (in 22 patients [27%] at rest and in 26 patients [31%] during exercise). However, there was no significant correlation of the PCO2 increase with the degree of bronchial obstruction. In all patients there was a marked inhomogeneity of the alveolar ventilation or the alveolar-capillary O2 transfer in relation to alveolar blood perfusion. Indeed, the alveolar-arterial PO2 difference was increased (40 mm Hg at rest and 45 mm Hg during exercise). The additional increase of this gradient during exercise was due to an unequal distribution of alveolar O2 diffusing capacities in connection with the alveolar blood flow (preceding measurements of the N2 gradient between alveolar air and arterial blood revealed a mean fall from 18 at rest to 8 mm Hg during exercise). The observed deterioration of hypoxemia during exercise (without additional hypercapnia) is to a great extent related to the degree of bronchial obstruction measured by simple spirometry. Thus, measurements of PCO2 and PO2 at rest and during exercise appear to be a helpful adjuvant to routine spirometry in the diagnosis of subclinical emphysema.
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The authors had examined by double contrast barium enema in 115 cases of Crohn's ileo-colitis. They described the radiological double contrast features. The "early lesions" are always surrounded by a healthy-looking mucosa. The advanced lesions are segmentary: shallow limited ulcers, shallow confluent ulcers, cobblestone pattern and nodular pattern. Several types of lesions may appear in the same patient. The distribution of the lesions is asymmetrical with skip areas and gradual size of the lesions. The parietal lesions are well demonstrated by double contrast, especially the sacculations. Our radiological findings are confirmed by endoscopical features and excised specimens in 100 cases. A double contrast barium enema is necessary to well described the lesions especially the "early lesions" which are important for differential diagnostic, with ulcerative colitis, for surgical treatment in evaluating the extend of the disease and possibly even for prognosis in this disease.