[Occlusive and nonocclusive mesenteric ischemia: radiologic aspects].
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Biomedical subjects
Publications and source records attributed to G Kauffmann.
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The activity curves (sucking, breathing, eye movements) of 18 babies were inspected for alterations which might indicate reactions of hearing. In 10 cases, 4 of them also confirmed by ABR findings, we found it possible to deduce the hearing threshold from alterations of the respective activities alone even without knowledge of the occurrence of the stimulus (blind experiment, addition of the stimulus time after identification of activity alterations). Greater discrepancies are discussed with respect to the experience of the investigator and to different methods of audiometry.
The MIRA is based on the simultaneous registration of sucking and breathing activities and of eye movements together with the stimulus indicator. Alterations of these activities are analysed in respect of stimulus time and intensity. The combination with biofeedback (frequency-modulation of the stimulus by the electrical analog of sucking, or chewing, activity) results in more distinct alterations of the activities than MIRA alone and furthermore points to the development of the feedback loop between articulation and hearing, a prerequisite of speech development.
Multichannel infant reflex audiometry, applicable up to about 1 year of age, is based on the simultaneous registration of sucking and breathing activities and of eye movements together with marks which indicate the side, beginning, and end of the stimulus. Sucking and breathing are reduced or altered by suprathreshold stimuli. The threshold of responses is 20-40 dB lower than that obtained with behavioral tests and comparable in most cases with BERA thresholds.
Three rare variations of the large arteries of the thigh are known: Hypoplasia or aplasia of the superficial femoral artery in combination with persistent sciatic artery which normally is present during embryogenesis for a few days only. Typical finding is a large dorsal artery in the thigh accompanied with a hypoplastic superficial femoral artery. For the first time angiography of this vascular situation is shown in two projections. Complications of persistent sciatic artery include aneurysm (25%) and occlusion (embolic or thrombotic). Duplication of the superficial femoral artery. Absence or duplication of the deep femoral artery caused by separately originating branches. Knowledge of embryogenesis of the vessels helps to understand these artery variations.
A new method for evaluation of hearing threshold in babies is presented. The method does not require much time, cost or personnel and is practicable for infants up to about 12 months. It is based on synchronous electrical registration of sucking and breathing activities as well as of eye movements evoked by acoustic stimuli. Sucking and breathing are reduced by supra-threshold stimuli, preparing the baby for attentive listening. Eye movements are directed towards localizing the site of the stimulus.
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In 12 rats tumors have been induced chemically by intraperitoneal application of dimethylnitrosamine. This method is simple and reliable and the effect of tumor embolisation can be followed easily. Thymus aplastic nude mice with transplanted human tumors deserve strict care. Tumor microangiograms of 48 animals demonstrate a close similarity with angiograms of corresponding human tumors. The vascular pattern does not alterate after several transplantations, after cytostatic therapy a slight hypervascularisation develops.
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Post-anastomotic arterial stenosis after renal transplantation requires active intervention in order to save the transplant. As an alternative to a taxing surgical reoperation selective transluminal catheter dilatation was performed in one case and severe stenosis was removed. Rapid normalisation of blood pressure and recovery of excretory function should encourage further such therapeutic attempts in stenoses in these high-risk patients.
The value of the catheter occlusion therapy is analyzed in 92 cases retrospectively, and the indication, and complication risk of these procedures are considered. In the following vessel areas occlusion with different methods have been performed with decreasing frequency; kidneys, pelvis, legs, gastrointestinal tract, external carotid and internal carotid artery. Serious complications have been observed in therapeutic investigations at the head, especially in occlusions of the external carotid artery. In this group embolisation therapy should be performed with strict indication only.
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Three inoperable patients with massive GI-bleeding were embolized. In all three patients hemostasis via the angiographic catheters was successful without producing intestinal wall necrosis. Indication and risk of an intentional vascular occlusion by transcatheter technique should be evaluated separately for each patient.
Presentation of an eleven year follow-up of a case of angioblastoma of the cerebellar hemisphere and multiple bilateral renal hamartomas in a female patients. Malignant degeneration of these hamartomas was detected early due to regular and careful follow-up examinations.
In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.
The arterial blood supply of the anastomosis in 6 stomach resected dogs (Billroth II) is examined by common angiographic technique in vivo, microangiography, and microscopy. In all animals there are at the site of the gastrojejunostomy bizarre tortuous vessels which cross the anastomosis. These arteries have a diameter between 50 to 2000 mu. They are newly formed vessels which cannot be demonstrated by common coeliaco- and mesentericography in animal experiments or in patients.
Caroli's disease is a rare familial anomaly with circumscribed saccular dilatations of enlarged intrahepatic bile ducts coated by regular or pseudopapillomatous epithelium. The disease may be combined with additional malformations of the extrahepatic biliary tract as well as with medullary sponge kidney. Infection and stone formation are frequent complications. Surgery is indicated if the disease is limited to one love which should be resected or if biliary obstruction in diffuse disease necessitates biliodigestive anastomosis. Antibiotics and CDCA-mediation are essential for symptomatic therapy. We analysed the findings in 40 cases including one own observation.
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