Biomedical subjects
Publications and source records attributed to H Czembirek.
Accessory spleen hypertrophy is usually related to hematologic, lymphomatous, and rheumatoid diseases. We describe here the case of an 18-year-old asymptomatic woman who presented with a very large accessory spleen occupying the lower abdomen. Its appearance on abdominal sonogram, computed tomogram, and hepatosplenic scintigraphy is correlated with the resected specimen.
Our experience with sonography of the neck (about 1,500 examinations) indicates that most of the structures that are of therapeutic importance can be demonstrated by ultrasound. The cervical nerves, however, cannot be differentiated sonographically from perivascular fat because there is insufficient impedance difference presented by the myelin sheaths. The typical sonographic anatomy of the anterior and lateral cervical muscles, of the major vessels, the thyroid and parathyroid and salivary glands has been analysed. The structures that can be shown by sonography have been related to dissections of the neck.
The authors describe the appearance of focal sparing in otherwise diffuse fatty infiltration of the liver found in 35 patients. These are pseudotumours which are less echogenic than the surrounding abnormal parenchyma. They are sharply marginated, of triangular shape and show no mass effect--neither by displacement of vessels nor by deformity of the contour of the liver. These characteristic morphologic features allowed a differentiation from neoplasms or abscesses in 80% of our cases. Hence, biopsies are rarely indicated in these patients.
48 patients with partial or complete portal vein thrombosis or tumor stenosis were examined by pulsed Doppler duplex scanning. In addition to the analysis of morphological changes, the pulsed Doppler duplex system yields functional data on the acceleration of blood flow in stenosis, flow in partial thrombosis and in differentiation between tubular cystic structures like arterial vessels, venous collaterals and dilated bile ducts. Qualitative and quantitative measurements of portal blood flow were performed in 55 cirrhotics and 15 healthy volunteers. Portal venous velocity and portal venous blood flow were significantly reduced in patients with cirrhosis. In 46 cases a hepatopetal blood flow was shown. In five cases a hepatofugal flow and in four cases a stagnant flow was found in the portal vein. Spontaneous portal systemic collaterals with hepatofugal flow were shown in 41% of cases. 11 patients with surgical portacaval shunts were examined. Patency was demonstrated in five patients where the anastomotic site was visible. Pulsed Doppler duplex sonography proved a valuable tool in the assessment of morphologic changes and revealed qualitative and quantitative data of portal venous hemodynamics.
Pulsed duplex sonography is a routine method for evaluation of superficial vessels. Especially in the assessment of the extracranial vessels of the head and neck region duplex sonography proved to be the method of choice. Modern technology allows the investigation of deep vessels by pulsed Doppler sonography. This study tries to define the value of the combination of real time sonography and pulsed deep doppler sonography in the abdomen on the basis of the author's experiences. Value and limitations of this method will be discussed.
The diagnostic value of real-time-sonography was evaluated in 62 patients with suspected and occult testicular tumors. In 28 patients intratesticular tumors were identified on real-time-sonograms. In addition 7 clinically occult tumors were diagnosed by real-time-sonography. It was not possible to differentiate between orchitis and tumors on sonograms (3 cases). There was correlation only between the morphologic appearance of tumors on sonograms and the corresponding histology. Using high frequency transducers sonography proved to be an useful diagnostic modality to identify or to rule out occult intratesticular tumors.
The value of high resolution real time sonography for the detection of cervical lymph-node metastases in head and neck cancers was assessed in 118 histological proven cases. The accuracy of sonography (89%) proved to be superior to palpation (80%). In 9 patients a thrombosis of the internal jugular vein was detected. The ability of sonography to detect tumorous infiltration of the arterial vessel wall is discussed in 12 patients. Regarding possible artefacts, sonography is the only imaging modality which can solve this problem. Sonography should be performed preoperatively in all patients with malignant head and neck tumors for cervical lymph-node staging.
In 394 patients with various urological symptoms, the content of the scrotum was examined sonographically. 71 testicular lesions were found, 194 extratesticular pathologies were diagnosed. In 69% the enlargement of the testicle was due to a tumor, in 4 patients due to acute orchitis and in 3 patients due to acute torsion. An unilateral smaller sized testicle was found in chronic inflammation [5], cryptorchism [9], hypoplastic testicle [2] and after corticoid medication [1] and radiation therapy [1]. In normal sized testicles 8 tumors, 19 fibromas of the tunica albuginea, 2 scars after trauma and 1 haematoma were found sonographically. In 91% of patients with epididymitis the epididymis was enlarged. The echo structure was altered in 74%, in 13% abscesses were found. Sonography was useful in evaluation of scrotal herniation, especially when combined with hydroceles. Varicoceles were better detected and graduated by sonography than by clinical examination.
Comparative investigations were done by duplex sonography, thermography and phlebography in 142 patients with 158 varicoceles. Verification of clinical varicoceles (130/158) was performed by duplex sonography in all cases and by thermography in 93%. Measurement errors were due to dorsally located varicoceles near the radix of the penis (3/130) and by small, two-sided varicoceles (6/130). Small subclinical varicoceles (28/158) were detected by real-time sonography in 89%, by Doppler sonography in 64%, and by thermography in 53%. In three patients with normal real-time sonography, subclinical varicoceles were found by Doppler sonography alone. The combination of both sonographic methods is highly sensitive for the detection of subclinical varicoceles and should be done in all cases without therapeutic results.
Radiologic diagnostic in urology has to be considered according to the new imaging modalities as sonography and computertomography. The basic investigation is still the modern high dose urography. Sonography is of special value, because many pathological changes in the kidneys can be seen during screening investigations of the abdomen. Indications and values of different methods will be discussed on the basis of clinical situations.
The results of 185 percutaneous transluminal angioplasties (PTA) of the iliac (n = 62) and femoropopliteal segment (n = 123) with a double-lumen balloon catheter (Olbert) are presented. The mean age of the 150 patients was 64 years (range 39 to 91). While there were 87% stenoses and only 13% occlusions of the iliac segment, in the femoropopliteal segment the respective ratios were 46% and 54%. 71% of the patients suffered from intermittent claudication and 29% were severely ischaemic cases (Fontaine stages III and IV). Platelet inhibition was induced by means of acetylsalicylic acid 1 g/day prior to and during the procedure, and afterwards heparin was also administered for 4 days. The primary success rate in the iliac segment of 88.7% (of which 12.9% were classified as a partial success) was identical with that in the femoropopliteal region. Stenoses were successfully treated in 94.6% cases (9.9% being partial successes), occlusions in 79.7% (partial success in 16.2% of these cases). Complications occurred in 8.6% of cases, whereby surgical correction was required in half of these. When the procedure was complicated by major embolization into the distal popliteal artery, this was handled successfully by means of local thrombolytic therapy. Over the follow-up period of up to 21 months reocclusion--or high-grade restenosis--occurred in 26 patients. The cumulative patency rate 1 year after PTA was 92% for the iliac and 70% for the femoropopliteal segment.
The absence or hypoplasia of the hepatic segment of the inferior vena cava with azygos continuation is a rare entity, sometimes associated with congenital heart disease, situs inversus or polysplenia syndrome. Ultrasonography as an easy, non-invasive procedure enables reliable diagnosis of this anomaly replacing inferior cavography. Ultrasonic scans performed in various directions allow a more subtle analysis of vessels and location of azygos continuation. We present an analysis of the sonographic feature in this anomaly, as studied in 2 patients. The diagnosis of this usually incidental finding (chest X-ray) can be of major clinical importance e.g. if special surgical procedures such as ligature of the azygos vein are considered.
An attempt has been made to classify varicoceles by means of real time sonography in accordance with the findings on palpation. The maximal diameter of the pampiniform plexus and of individual veins was determined sonographically and compared with the results of palpation in 74 patients with varicoceles. The sonographic findings are more accurate than is palpation. Fifteen subclinical varicoceles were discovered by sonography which could not be detected by palpation. It has been found convenient to classify the lesions in four sonographic stages. Maximal transverse diameter of the pampiniform plexus up to one centimetre is regarded as normal. A diameter of one to two centimetres corresponds to grade I, two to three centimetres corresponds to grade II and greater than three centimetres to grade III.
Sonography is the primary imaging method for staging malignant lymphomas. The accuracy of sonography in diagnosing hepatic and splenic involvement was examined in 132 histologically proven cases. Focal involvement was differentiated from diffuse lymphoma. The value of sonography is discussed with reference to cases showing involvement of the gastro-intestinal tract, kidneys, suprarenals, pancreas, testes, breast, thyroid, parotid and muscle.
Forty-one patients were examined by pulsed duplex sonography immediately before and then one, four and twelve weeks following sclerotherapy of a varicocele. The severity of the varicocele was determined by sonography before treatment and confirmed by phlebography. Sonographic follow-up showed reduction, or disappearance, of the varicocele in 78% of cases. Doppler examination confirmed successful treatment in 85% of patients. Pulsed duplex sonography, combining a non-invasive imaging method and a functional technique, is well suited for the follow-up of varicoceles after treatment.
Ultrasound (US) proved highly effective for detection, localization, and delineation of enlarged lymph nodes of the neck. Infiltration of adjacent structures, specifically the common, internal, and external carotid arteries, and the neck muscles was reliably demonstrated. Benign and malignant lymph node enlargement could not be differentiated. US examinations changed the operative course of 56% of patients studied. In 41%, a more radical operative procedure was performed than was previously planned; in 14%, US demonstrated inoperability. Small-parts US is a very useful adjunct to current imaging techniques of cervical lymph node disease.
Pulsed duplex sonography was used for the diagnosis of lower pole arteries, which cross the uretero-pelvic junction and are possibly the reason of hydronephrosis. We could identify the crossing vessel in 8 patients by pulsed duplex sonography. The diagnosis is easy, though optimum patient preparation is required, and Duplexsonography may help to reduce the frequency of angiography in this special clinical situation.
Radiological staging of pulmonary oedema was compared with the determination of extra-vascular lung water by means of a double indicator dilution technique. One hundred and forty-six ward chest radiographs were evaluated and compared with the results of simultaneous measurements of lung water. Seventy-seven cases could be evaluated statistically. Chest x-rays regarded as normal corresponded to extra-vascular lung water of 5 to 9 ml./kg. body weight. Interstitial oedema (radiological stage I and II) corresponded to extravascular lung water levels of 8 to 12 ml./kg. Differentiation of stages I and II was not possible. During stage III, extra-vascular lung water was 15 to 21 ml./kg. A comparative analyses of these findings revealed a discrepancy of 34%. The reasons for this are discussed.