Biomedical subjects
Publications and source records attributed to E Grabbe.
Ultrasonography, especially real-time-B-mode, is outstandingly suitable for detecting larger alterations of abdominal blood vessels or stenosis of the truncus coeliacus. This stenosis could be detected in 18 cases by real-time-scanning. 10 of these diagnosis were confirmed by angiography. The clinical value of these findings is discussed.
Ultrasonography, especially real-time-B-mode, is outstandingly suitable for detecting larger alterations of abdominal blood vessels or stenosis of the truncus coeliacus. This stenosis could be detected in 18 cases by real-time-scanning. 10 of these diagnosis were confirmed by angiography. The clinical value of these findings is discussed.
Serial computed tomography following intravenous bolus injection of contrast agent is an important development in computed tomographic diagnosis. The technical necessities and methods of examination are discussed. Our experience with 108 examinations is evaluated. The additional information in terms of morphology and function is described.
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The results of computed angiography in 12 patients with renal transplants are described. In five patients with normal function of the transplant and normal appearances on a conventional angiogram, under-perfusion averaging 36% was demonstrated. In two out of three patients with a stenosis at the anastomosis, the effect of the stenosis on function could be shown. In two patients with acute rejection of the graft and hypoxia of the tubules, the differential diagnosis could be clarified by means of computer angiography. Computer angiography can therefore be regarded as a valuable addition to conventional angiography for the differentiation between tubular hypoxia and acute rejection and for underperfusion of a renal transplant.
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A prospective study was performed in 59 patients with acute pancreatitis evaluating the following 11 diagnostic parameters in regard to prognosis quo ad vitam: clinical (ileus, age), laboratory tests (LDH, blood glucose, urea, creatinine, calcium), CT-scan (fluid in the retroperitoneal space, enlargement of the retroperitoneal space, air-fluid levels, ascites). These data were collected during the first 24-48 hours after hospitalisation of the patients and turned out to be of considerable prognostic value. 70-80% of the patients from groups in which 5 or more of these parameters were pathological died. 90% of all patients who died belonged to the aforementioned groups.
The diagnostic significance of computerized tomography in the diagnosis of destructive and deforming processes of the sacrum is demonstrated by means of 69 examinations of 55 patients. The results are compared with those obtained by means of conventional roentgenography, including tomography and bone scintigraphy. It is confirmed that recent CT scanners are the most sensitive instruments in existence for the visualization of affections of the sacrum in respect to identification and extension.
Knowledge of common complications of central venous catheters is completed by a case of bacterial tricuspid endocarditis with recurrent pulmonary infarction. This rare, life threatening complication should be considered in differential diagnosis, when in case of central venous catheter sepsis, changing pulmonary infiltrations with pleural effusion as well as different auscultatory findings above the tricuspid valve do occur. The diagnosis can be supported by echocardiographic demonstration of tricuspid vegetations.
The diagnostic value of computed tomography was assessed in 44 patients with alveolar or cystic echinococcosis. The CT-examination was concentrated mainly on the liver, which was involved in all patients. It was extended to other organs, i.e. to lung, intra- or retroperitoneal space, bone and brain if necessary. The CT image of the liver in cystic echinococcosis was often characteristic. It showed sharply outlined masses with attenuation values similar to water. Internal structures were caused by daughter cysts. Furthermore, typical marginal calcium deposits indicated regressive changes in the host membrane. In all cases with alveolar echinococcosis in indistinct solid mass was found, often with central necrotic colliquation and plaque-like calcifications within the tumor.
141 angiographic examinations of the upper abdomen were made of a randomized group of patients to check the arterial supply of the liver, thus giving the opportunity to test anastomoses in the hilus of the liver and to find out their frequency. These vascular connections are of importance for surgical treatment as well as for angiotherapeutic procedures such as chemotherapy infusion or embolization of the hepatic artery.
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By the use of a 36 cm image intensifier, its position under the table top and its great focus-image intensifier distance radiation geometric conditions were produced which are identical with the full-size film technique. With this equipment angiographic examinations of the thorax, abdomen as well as extremities were possible with the help of indirect fluorography, In accordance with examinations at anatomical models it turned out that the detail perception of the image intensifier-series fluorography was almost comparable to conventional full size film technique. Aside from the lower radiation dose and the shorter exposure time indirect fluorography offered additional advantages: By means of the fluoroscopic control of the contrast medium and the fluoroscopically controlled exposure a reduction of the methodical procedure was possible with regard to numbers of exposures and series just as saving of time for the complete examination. The evaluation and clinical demonstration of the 100 mm films were critically tested in the daily routine work.
After duodenopancreatectomy the roentgenpattern of the upper gastrointestinal tract resembles the pattern after Billroth I- or Billroth II- resection. A different aspect results after Y-Roux anastomosis. The follow-up of pseudocysts drained into the stomach poses no problems. The follow-up of pseudocysts drained into the small bowel demands a roentgenexamination with duodenal intubation. The use of hypotonia is advisable in the diagnosis of malignancy. Problems may arise in roentgendiagnostics after palliative operations.
The arc of Bühler between the celiac and superior mesenteric arteries has to be considered as an embryological persistence of the portion of the ventral longitudinal anastomosis. The collateral development of the anastomosis refers to a different hemodynamic in the upper visceral arteries. We discovered the arc of Bühler in 14 cases among 340 selective celiac and superior mesenteric arteriographic studies. Its existence permits conclusions about further angiographic procedures and facilitates the interpretation of visceral collaterals.
Follow-up of 20 patients with incurable carcinoma of the pancreas is described, who were treated with palliative chemo- or radiotherapy. It was concluded that the course of the disease can be adequately followed by sonography and CT. Control of palliative therapy can be achieved by non-invasive means with little stress to the patient. Whether the attempt to do so is justifiable depends on the success of modern forms of treatment.