Biomedical subjects
Publications and source records attributed to G Stampfel.
The authors report on a two-stage rupture of the kidney that occurred in an eight-year old boy after a bicycle accident and was confirmed by sonographic diagnosis and by urography and surgery. Attention is drawn to the advantage and necessity of sonography, which is rapid, can be repeated any number of times, remains non invasive and is very accurate, as a diagnostic tool in renal trauma.
Four cases are described in which livedo reticularis was associated with repeated cerebrovascular accidents, which eventually resulted in severe disability in two cases. Patients with severe disability had a history of many years, whereas two patients with little or moderate residual disability had a follow-up of 3 years each. CT scan revealed multifocal cerebral infarctions and cortical atrophy in all cases. Repeated cerebral angiograms, done in three cases, showed no signs of a vascular disease. There were no parameters that pointed to active immunological or inflammatory disorder. Neither clinical evidence of heart or large vessel disease was found. Observations suggest that a so-far unknown progressive cerebral vessel disease associated with livedo is the cause of a steady increase in multiple small cerebral infarctions. Because of the progressive character of the disease the search for effective therapy is needed.
Ten patients were selected from a clinical material comprising 336 sonograms of the scrotal contents in order to discuss the differential diagnosis of testicular and extra-testicular conditions. The decision whether a tumour is testicular or extra-testicular does not usually pose a problem, but may be impossible for small peripheral tumours. The shape of the epididymis and vas deferens and the structure of the testes is of significance in the differentiation between torsion and epididymitis. Rare diseases--myxoliposarcoma, infiltrating urothelial carcinomas from the bladder growing along the vas, lymphangiomas--are considered in the differential diagnosis of space-occupying lesions. Lymphangiomas produce a typical appearance on ultrasound. The criteria for the diagnosis testicular trauma, rupture, parenchymal tears and haematocoeles are defined. Differentiating liquid from solid is rarely a problem. A testicular abscess in the presence of chronic orchitis can simulate a solid tumour.
Arthrography provides accurate information concerning abnormal changes and function of the soft tissue components of the T.M.J. It is superior to all other clinical and radiological methods of examination for elucidating functional abnormalities. The increasing incidence of functional T.M.J. abnormalities and improvements in treatment make arthrography of the T.M.J. of increasing importance. The importance of views in the sagittal plane and of video recordings is stressed.
In two patients with a traumatic carotid-cavernous fistula, permanent occlusion of the lesion was observed following cerebral angiography and confirmed by further angiography. A delay is therefore recommended between performing angiography and carrying out further treatment, which may carry some risk. Possibly the use of ionic contrast media, which irritate the vessels, compression of the carotid artery, which reduces flow through the fistula, and general anaesthesia, which may drop the blood pressure, initiate thrombosis in the cavernous sinus.
Two male and one female patients, between the ages of four and 25 years, involved in road traffic accidents, sustained isolated ruptures of the right proximal ureter in addition to severe injuries to the skull and extremities. The typical urographic finding of an absent ureter was seen only once. In one incomplete rupture of the ureter from a solitary kidney, the ureter filled with contrast and there was no dilatation of the renal pelvis and in another case, the appearance of the ureter was simulated by a peri-ureteric contrast leak. Ultrasound examinations following abdominal trauma should be directed at finding peri-renal fluid; this should be followed by an urogram in order to recognize ureteric rupture at an early stage, when there may be few symptoms.
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In 6 patients with a trauma in wintersport we observed carotid artery injuries in the past 13 years. The diagnosis were two occlusions, one dissection, a bilateral stenosis, a traumatic aneurysm and a subclavian steal phenomenon. A spontaneous bilateral thrombosis of the carotid artery was seen during skiing. A carotid artery lesion should be diagnosed as soon as possible followed by an adequate therapy.
An aortopulmonary fistula in case of a bag-shaped aneurysm of the aortic arch is demonstrated via angiography. A diagnosis to the effect that the existence of this phenomenon is suspected, can already be arrived at when examining the plain radiography of the thorax. We can say that a sign of an aortopulmonary fistula is represented, in case of an aneurysm of the aorta ascendens and of the arcus aortae, by the existence of a left-right shunt with hypercirculation in the pulmonary circulation, in most cases also signs of right ventricular insufficiency. This is often combined with a typical previous history of sudden dyspnea and thoracic pain. The article points out the theoretical possibility of balloon catheter occlusion of the fistula to relieve the acute right ventricular load.
Angiography after shooting injuries may have to be carried out as an emergency in the acute stage, because of vessel injury, or because of early or late complications. Of twelve examinations, one-third were carried out during the acute phase and more than half for late complications. In order to prevent serious late complications, it is necessary to perform angiography in the acute stage, even when the injuries appear to be of a minor nature. This has been our own experience and is shared by others. If angiography is not carried out in the acute phase, for whatever reason, the examination should be performed at a later stage, if there is the slightest chance of an arterial injury.
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The examination technique, results and diagnostic value of sonography were evaluated in a retrospective study of 70 patients with pericardial effusion. Small effusions of less than 100 cc can be detected by observing a separation of the epicardium from the pericardium. With larger effusions sonography allows an approximate estimate of the volume. Since ultrasonography is non-invasive, and since it has a very high diagnostic accuracy and only few false-negative findings, it is the method of choice for the examination of patients suspected of having a pericardial effusion.
The increasing use of central venous catheters requires knowledge of possible hazards. Complications such as pneumothorax, hemothorax, hematomas in the chest wall or mediastinum and pulmonary emboli caused by the catheter are easily seen on plain chest films. Cardiac tamponade, perforation of vessels, air emboli and thrombosis have to be considered as a possible cause in case of sudden deterioration of a patient.
Between 1976 and 1978 percutaneous needle aspiration biopsies of 120 pulmonary and pleural lesions were performed. Cytologic examination of malignant and benign lesions was correct in 64% of the cases, false negative results were obtained in 19%. Complications included: pneumothorax in 21 patients (11 requiring chest tube placement); insignificant hemothorax in 5 and hemoptysis in 1. Needle biopsy of intrathoracic lesions proved to be technically simple and relatively safe. This procedure allows early diagnosis of malignant lung tumours which may improve long term prognosis.
The problems in the radiological investigation of adults with the nephrotic syndrome are illustrated by three patients. In one it was due to spontaneous thrombosis of the cava, in the second there was renal vein thrombosis from self-administered overdose and the third patient had glomerulonephritis without renal vein thrombosis. In view of the therapeutic implications, radiological investigation of the renal veins is essential and should be carried out in every patient with the nephrotic syndrome.
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