Biomedical subjects
Publications and source records attributed to E Bücheler.
A 59-year-old female with hepatic hemangioendothelioma was embolized twice. The first embolization with fiobrospumparticles was without permanent success. The second embolization with Ethibloc provoked a regression of the tumor.
Focal nodular hyperplasia was diagnosed angiographically in 14 patients and confirmed histologically. Differentiation of this benign lesion from other space-occupying diseases of the liver can be very difficult, since focal nodular hyperplasia produces a variable angiographic appearance. The typical angiogram showing radial vessels in the arterial phase and sharply demarcated foci in the parenchyma phase is found in only one third of patients. Angiographic differential diagnosis includes adenomas and carcinomas of the liver. Resection of the tumours in case of malignant tumours is not indicated. Foci at the margin of the liver, or if they are pedunculated, should be removed in case of spontaneous perforation. Tumours in the centre of the liver should be observed (computer tomography). Oral contraceptives stimulate the growth of these foci. They may diminish in size after stopping these drugs. 70% of cases of focal nodular hyperplasia remain clinically silent and were discovered accidentally or at autopsy.
In 8 male subjects with normal testicular function, blood was drawn from the left spermatic vein and from the right cubital vein before and during an infusion of 4,000 IU human chorionic gonadotropin (hCG) (preceded by a bolus of 1,000 IU) or of 500 IU hCG plus human menopausal gonadotropin (hMG), respectively, within 30 min. Testosterone levels in the spermatic vein blood increased rapidly up to 518 or 215%, respectively. An increase of estradiol-17 beta and of 5 alpha-dihydrotestosterone concentrations in spermatic vein blood was observed only in 1 and 2 subjects, respectively. It was shown that the human testicle releases also 5 alpha-androstane-3 alpha, 17 beta-diol and testosterone-glucosiduronate. Both steroids did not respond to the short-term infusion of gonadotropins. The same holds true for all five steroids measured in peripheral vein blood.
In a joint study carried out by the radiological university clinics of Bonn, Hamburg, Cologne, Leuven and Munich, 483 computer tomographs of the pancreas were evaluated. A correct histological diagnosis, or one confirmed at surgery, was obtained in 74.5% of 168 cases; in a further 9% an abnormality was seen in the pancreas or in its immediate vicinity, but was wrongly interpreted. The computer tomographic criteria of inflammatory processes and of tumours of the pancreas are given, and the not uncommon difficulties in distinguishing between these are discussed.
Computer tomography has been found to be of value in the study of deformities and narrowing of the spinal canal in 52 patients with Paget's disease of vertebral bodies. To a limited extent it can also be used for evaluating the intervertebral foramina. Deformities of the spinal canal were classified into three degrees of severity. The most severe changes were found in the lower thoracic region. The presence of neurological complications is an indication for CT studies.
Computed tomography findings in the pelvis after resection of the rectum, obtained from 48 patients primarily suspected of recurrent carcinoma, are represented. Compared with conventional radiographic methods CT demonstrates directly in most cases the presence of a pelvic mass, its extension and relationship to adjacent soft tissue. In some cases this is advantageous for further diagnostic procedures, but also for treatment and further check-up. False conclusions are discussed. The distinction between recurrent carcinoma and retroperitoneal fibrosis in the pelvis, frequently enhanced by retarded healing of the sacral cavity, remains a problem. Progress in the early diagnosis of recurrence of pelvic mass could be made by regular CT check-up during the first two years after resection of the rectum, to increase the value of palliative radiotherapy treatment indicated in any case. As CT, however, is expensive and not always available, this demand cannot be met and the value of conventional radiographic methods remains at present unquestioned.
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In 400 examinations of the thorax results of computer tomography were compared with respective pa chest films and conbentional tomograms. In the peripheral areas of the lung, interstitial parenchymal alterations and metastases were better visualized by CT. The size of central bronchial carcinomas and space-occupying lesions of the thoracic wall can be determined with greater accuracy by CT. Primary tumors, lymphnode enlargement and vascular alterations can be differentiated and localized more precisely by CT. The size of the heart chambers, intracavitary tumors as well as septal and myocardial wall thickness can be determined non invasively.
One of the indications for chest radiography in intensive care units is the diagnosis for mishaps or sequelae arising, e.g., from failure to insert a central venous catheter, wrong position of the catheter, a too deeply inserted tracheal tube, a wrongly sited gastric catheter; also to find the causes of, e.g., lack of stimulation by a pacemaker or ineffective thorax drainage. Success in this type of diagnostic radiography presupposes a competent technique, radiopaque catheter material and a thorough acquaintance on the part of the radiologist with the procedures employed in intensive care. Abb. 7 a.
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The complicated and expensive diagnostic apparatus available today has to be applied in an orderly sequence. This order depends on certain prerequisites, e.g. on the disease, urgent complications, patient tolerance, apparatus potential, hospital structure and organisation etc. The more rational the indication is to use certain methods, the more efficient will be the results. The appropriate concepts and suggestions for certain general and specific examples, used by us at present are demonstrated. Complicated and expensive diagnostic procedures have to be decided primarily on an interdisciplinary level. The increased costs of these procedure are balanced by a decrease in hospital stay and fewer operative explorations too. At other places different actions will be taken for equally good reasons.
So far whole body CT has not yet been used very often in children. The main reason for this are patient-related factors which impair the recognition of details on the scans such as frequent lack of intra abdominal fat tissue, and so called movement artefacts. The search for tumors is the predominent indication for CT in children. The advantages of CT are discussed and the authors' own measurements of radiation exposure are given.
We report on a radio opaque substance for the embolization of kidney tumours which consists of amino acids mixed up with a contrast medium. It is relatively easy to be injected and can be well directed because of its radio-opacity. Past and recent histological examinations of embolized pig kidneys show that this material provides a durable closure of the vessels and that there is no essential tendency of intravasal dissolution. It is therefore also suitable for palliative embolizations. The first results in clinical trial have proved to be encouraging.
An operation to prevent reflux was carried out in 36 patients with oesophageal varices; its aim was to prevent ulceration of the oesophageal mucosa due to gastric or duodenal secretions. The anti-reflux plasty consists of a distal gastrectomy with orthograde, isoperistaltic interposition of 20 cm. of jejunum between the gastric remnant and the duodenum, and fixation of the fundus and fornix. During the first three months, and even somewhat later, there was a little passage of contrast from the interposed jejunum into the stomach and duodenum. The reflux from the duodenum was, however, very small and only reached the vicinity of the stoma so that a duodeno-gastric reflux could be practically excluded. The fundus-fornix fixation resulted in absence of radiologically demonstrable gastro-oesophageal reflux. The interposed jejunal loop took over in part the function of the stomach, regulated gastric emptying and acted as a valve during upper gastro-intestinal transport.
Malignant change is to be expected in about 1% of patients with Paget's disease. Usually these are osteosarcomas. Fibrosarcomas, benign and malignant giant cell tumours and chondrosarcomas are less common. The present case concerns the development of an immunoblastic sarcoma in the humerus, which was affected by Paget's disease. Only one other similar case is recorded in the literature. Other myelogenous tumours, such as plasmocytomas, are very rare in association with Paget's disease. Consequently there is no evidence for a causal connection between Paget's disease to these tumours, whereas sarcomas arising from bine tissue may be regarded as a form of malignant degeneration of Paget's disease.
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A new computer-aided x-ray technique is presented which, unlike conventional cine- or video-densitometry, allows a high-resolution quantitative display of the parameters of renal blood flow as so-called 'functional images'. The parameters include blood flow velocity and local perfusion of the kidney. This technique, which we call computer angiography, has decisive advantages; the functional images provide more, and more rapid, information on renal blood flow dynamics than can be obtained by the qualitative evaluation of a series of pictures. The clinical relevance of computer angiography is illustrated by a nephrotic syndrome, polycystic disease and a hypernephroma.