Biomedical subjects
Publications and source records attributed to H Assmann.
Case report. A 59 year old woman was thought to suffer from a neoplasm of the hypophysis. This "tumour" was simulated by a giant aneurysm of the infraorbital segment of the left carotid artery. For technical reasons the left carotid artery had not been demonstrated in the angiogram. For final clarification CT as well as bilateral angiography of the carotid arteries will be helpful.
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Problems of early diagnosis of space-occupying intraspinal lesions are discussed in relation to 335 patients on whom surgery had been carried out. Advances in neuroradiological methods are considered. The development of new contrast media has resulted in a reduction of the risk of invasive procedures and this should lead to diagnosis of space-occupying spinal lesions at a very early stage. It is now possible to diagnosis small tumours before they cause compression of the cord or of nerve roots.
The morphology and indications for performing post-operative contrast examinations have been analysed in 131 myelograms. Leptomeningeal reactions and adhesions were found in varying degrees of severity in 34 to 75% of post-operative cases; it proved difficult to correlate this finding with the neurological features. The value of repeat myelograms is much reduced after surgery or after previous contrast examinations. It is probable that this is due in part to tissue changes resulting from the surgery or from a proliferative reaction induced by the contrast medium.
Myelography with Amipaque was carried out in a group of 28 patients who had had previous Dimer-X-myelography, but no surgery. In 12 cases there was radiological evidence of a meningeal reaction. In all these cases there were chronic changes in the lumbar subarachnoid space. The original myelograms showed no evidence of adhesive changes in the root pouches. It was not possible to correlate the radiological findings of the meningeal changes with the severity or type of neurological diseases.
Pneumocephalus occurs as a complication after frontobasal skull fractures and points to a pressure difference between the extracranial and the intracranial space. From 8 cases observed during a period of 10 years, four case histories demonstrate the diagnostic principles and the surgical consequences. The diagnostic value of tomography of the frontal base for gaining an accurate picture of the topographic situation, and for proper application of intradural duraplasty, is underlined and characterized as a reliable procedure.
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It is reported on two rare complications occurring in the pulmonary catheterisation with long-term control of the pressure of the pulmonary artery. In case 1 in confluenting bronchopneumonias the formation of an abscess in the region of the point of the catheter developed, in which case by the infusion therapy with very peripheral position of the catheter local lesions are very probable. In case 2 the catheter via an atrial septum defect passed into a pulmonary vein in PCA-position. A haemorrhagic infarction of the lung developed. In the two cases after removal of the catheter and adequate therapy the pulmonary complications healed.
A report is given on 40 spinal cord tumours in children and infants, the diagnosis of which was considerably delayed in part. 28 children were hospitalised because of fixed paralysis, incomplete or complete compression of spinal cord or cauda. Persisting pain in various sections of the spine, often combined with abnormalities in posture and position are suspicious on tumour as long as another cause is proved. X-ray pictures and analysis of lumbarcerebrospinal fluid are in the most cases of decisive importance for a progressing diagnosis. Myeloscintigraphy is specially useful for an early and exclusing diagnosis.
A report is given on 10 children and adolescents who were surgically treated because of prolapses of lumbar intervertebral discs. Besides a detailed anamnesis, the preoperative diagnosis was mainly based on general medical and neurological findings as well as X-ray pictures of the lumbar vertebral column. In case of the absence of radicular neurological failures and pecularities in the X-ray picture, e.g. signs of a spinal process of displacement, destructive changes in the osseous structures of the vertebral column, assimilation disturbances in the lumbosacral transition region, there is the indication for Dimer-X myelography. For all patients, histologically distinct to high-degree degenerative changes in the withdrawn vertebral disk material were found. Reliable signs of a traumatic genesis of the intervertebral disk prolapse were not seen.
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After preceding lumbar intervertebral disk operations, 88 Dimer-X myelographies were carried out. The examinations were performed with the patients in a lying position; if required, function pictures were taken in a sitting or standing position. Only in three cases the X-ray findings were unconspicuous. The findings included 12 prolapses at other levels, 6 prolapses, 5 massive scars, one pronounced osteophytosis, two cases of serious reticulitis, two meningoceles and one neurinoma outside the field of operation. The dorsal or lateral narrowing of the contrast band typical of prolapses found in the first dimer-X myelogram were only produced by scars in the renewed operation. The authors warn against pantopaque myelography for lumbar intervertebral disk diagnosis because of proven arachnoidal adhesions. The necessity of surgical procedures avoiding as far as possible tissue damage leaving scars and adhesions is stressed.
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On the basis of 500 myelogramms carried out with hexaiodated, water soluble, and rapidly absorbable Dimer X, the experiences gained in the diagnoses of damages of the lumbar intervertebral disks are presented. It can be stated that Dimer-X myelography has proved to be very useful for the recognition of space-narrowing processes in the lumbar region. No serious complications were observed. Most of the troubles, including, for example, transitory headache and the like, correspond to those sometimes found after simple lumbar punctures.