Biomedical subjects
Publications and source records attributed to E Banzhaf.
The case of a 38-year-old woman is reported who developed manifest incontinence of urine following spontaneous parturition on two occasions. An extensive sacrococcygeal meningocele was identified. The paper refers to special features of such clinical after-manifestations.
The authors report on a cervical arteriovenous malformation in the current region of the A. vertebralis dextra. The clinical neurological deficiencies improved after ligature of this artery. Attention is drawn to problems of differential diagnosis and the differentiated application of neuroradiological methods of examination.
A case of an acute intoxication with an alkyl phosphate (trichlorphon) with neurological complications in the sense of an intermediate polyneuroradiculography in the late phase is described. On the basis of the literature toxicological peculiarities of trichlorphon are discussed, particularly with regard to the effect on the nervous system. The appearance of the neurological disturbances after a latency period of several weeks and the long phase of restitution of the pareses with in most cases good prognosis are emphasized.
In a 66-year-old woman a polymyositis with subacute course was observed. The proof of very rare antiribosomal antibodies with a high titre on the serum was remarkable. Only after a cytostatic immunosuppressive therapy a clinical improvement developed, parallel to which there was a tendency to normalisation of immunological and enzyme-pathological parameters. The decrease of the titres of the autoantibodies is evaluated as indicators of the effectivity of the medicamentous immunosuppression and using the special literature is discussed in its importance also concerning the possibilites of the control of the clinical course.
Diagnostic angiography was carried out in 50 soft tissue tumors--23 benign and 27 malignant--of the extremities. All of the malignant tumours could be diagnosed correctly. We obtained false positive results in 2 benign tumours and in 5 inflammatory processes. These cases showed several criteria of malignancy. Angiographic diagnosis is important for the definition of the place of excision for histological examination. Combined use of angiography and computed tomography seems to be the optimal diagnostic procedure in the pre-operative phase.
Among 1916 cerebral angiographies carried out in the years 1973 to 1977, the examination was made in 160 patients (= 8.4 per cent) after verified subarachnoid haemorrhages. In 107 cases (= 67 per cent) a morphological substrate was secured angiographically. Arterial cerebral aneurisms and arteriovenous angiomas were the most frequent causes of a haemorrhage with an occurrence of 32.5 and 16.3 per cent, respectively. Further causes were: degenerative diseases of the cerebral vessels in 11.9 per cent, intracerebral haematomas in 3.1 per cent, haemorrhages in tumours in 1.9 per cent and stenosis of the aortic isthmus in 1.3 per cent of the cases. In 33 per cent of the cases a morphological substrate could not be ascertained angiographically. Including the authors' own experiences, diagnostic criteria are derived which to a large extent co-determine the decision with regard to an operation including the respective technical procedure.
Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.
The influence of the triiodinated angiographic contrast medium Visotrast 370 on haemostasis was studied in a total of 30 angiographic examinations with and without previous injection of 5,000 IU heparin. The contrast medium alone caused prolongation of bleeding time and inhibition of plasmatic coagulation. The effect of the contrast medium was enhanced by injection of heparin. The fibrinogen concentration remained unchanged in all cases. Aggregation of platelets enhanced by the contrast medium was found to be further increased by heparin. Enhanced platelet aggregation is considered an essential factor in the incidence of thromboembolic complications during engiographic examinations. Since heparin does not inhibit platalet function, the use of inhibitors of aggregation is discussed.
Reference is made to aspects of differential diagnosis in the context of three space-demanding intracranial processes in puerperae. Puerperal psychosis with no organic cause had been the primary appraisal due to the absence or only discrete appearance of neurological symptoms and the superficial, apparent presence of psychopathological phenomena. --Comprehensive neurological testing is required, if cerebroorganic disorders are to be ruled out safely. Neuroradiological methods, such as cerebroscintigraphy and cerebral angiography, may be necessary. Close interdisciplinary cooperation will be essential to effective diagnosis with minimum stress on mother and child.
The diagnostic efficacy of angiography in soft tissue tumors of the extremities (15 malign, 16 benign) has been examined. Each of the malignant processes could be diagnosed correctly. We obtained two wrong positive results in chronic inflammatory processes. Both cases showed several angiographically malignant criteria.
It is reported on the use of an intraarterial infusion therapy by means of indwelling catheter in arterial obstructive disease. The catheters were shoved forward towards the opposite side in Seldinger's techinque under X-ray control antegrade and retrograde through the bifurcation of the aorta. The infusions were performed during several hours with above all metabolically effective substances in combination with various antibiotics. The simultaneous use of aimed surgical measures is to be aspired too. In 6 out of 8 cases a healing of the necroses could be achieved.
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