Biomedical subjects
Publications and source records attributed to H G Reichelt.
The case of an elderly woman is reported, presenting with a bilateral-symmetrical occlusive disease of the subclavian-brachialis-axis in combination with Horton's arteriitis. Early intraarterial thrombolysis may be an appropriate first-line treatment to favourably influence complicated coagulation phenomena.
Radionuclide studies today can specify the actual state of gastrointestinal bleeding. "Radionuclide monitoring" characterises a method that allows a long-term surveillance of the patient for hours or even days (sequential scintigraphy). Labelling of the intravasal space is best met by in vivo/vitro labelling of the red blood cells with 99mTc, "Radionuclide monitoring" may positively influence current concepts of diagnosis or treatment control of patients suffering from gastrointestinal bleeding.
One benign and one malignant schwannoma of the stomach are presented. The gross appearance, degree of local invasion and the complications are demonstrated by double-contrast radiology technique and CT. Benign schwannomas can only be distinguished from the malignant ones on the basis of histological and immunohistochemical criteria.
Atypical radiologic and scintigraphic findings of a benign bone cyst in a 49-year old male are presented. The cyst is surrounded by a polygonal thick uneven sclerotic rim and shows radionuclide uptake.
Radionuclide monitoring was done in 50 patients to assess gastrointestinal bleeding, activity and location. Monitoring with 99m-Tc-in vivo-labelled erythrocytes was performed as sequential scintigraphy in increments of 1-2 hours up to 62 hours. 23 patients without active GI bleeding were correctly identified. 27 patients showed pathologic activities in abdominal blood-pool scintigraphy. In 25 patients peristaltic movement of these activities were seen--in each case we correctly diagnosed active GI bleeding. In 2 patients the activity stayed for a longer period in the same location--one patient had a liver hemangioma, the other patient had an aneurysm of the superior mesenteric artery. The great impact of radionuclide monitoring on diagnostic and therapeutic management of gastrointestinal bleeding is emphasized.
Clinical, radiographic and scintigraphic abnormalities in primary oxalosis of a 52 years old female are demonstrated. Severe oxalosis-nephropathy and oxalosis-arthropathy/enthesiopathy are shown. For the first time an intense myocardial uptake of 99 m Tc-HDP and 99 m Tc-MDP is described in connection with oxalosis. It is suggested that in the appropriate clinical setting this pattern may be suggestive of oxalosis-cardiomyopathy. Review of literature.
Forty-eight patients with failing arteriovenous dialysis fistulas were evaluated in an 18-month period. Forty-six of dialysis access fistulas were of the Brescia-Cimino type; two were fistulas in the upper forearm. PTA was technically feasible in twenty-three patients (44%). 54% dilatations with polyethylene balloons were initially successful and patent at 3 months; 43% were patent at 6 months; and 24% after more than 9 months. Two complications were encountered. PTA is recommended in Brescia-Cimino type dialysis fistulas, as the procedure prevents damage to the arterial and venous vessels suitable for a new fistula at the same forearm. The procedure may be performed on an outpatient basis.
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Loco-regional intra-arterial infusion chemotherapy is gaining momentum in modern tumor therapy. Cytostatica are delivered by an implantable system. Because of high tissue toxicity of chemotherapy functioning of the system must be assured and controls should be simple and reliable. The system implanted in 10 pat. with bladder-cancer (p T3 a-b) was checked by radiological and radionuclide diagnostic means before each chemotherapy. Both techniques proved valuable. Good and deficient functions are demonstrated.
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37 patients with bilio-digestive anastomosis--18 choledocho- and 19 hepatico-jejunostomies Roux-en-Y--had been followed up for 6--62 months. Hepato-biliary sequential scintigraphy showed in 26 patients both unimpeded bile passage and normal function of the jejunal loop. 6 patients had stenosis in the common bile duct or the anastomotic region with cholangitis and cholostasis. In 5 patients we observed an impaired function of the jejunal loop. Though all of these patients had clinical symptoms only one patient developed cholostasis.
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The hepatobiliary sequential-scintigraphy is a nuclear diagnostic procedure useful in assessing the function of liver and biliary system. 40 patients with and 20 patients without complains following cholecystectomy were examined. The value of this method in establishing biliary causes for such complains is demonstrated by typical cases. Simplicity and safety in application as well as diagnostic sensitivity should place the method in the first place evaluating postcholecystectomy complains. Succeeding indirect and direct radiologic techniques then may be used systematically with benefit for the patient and physician. Results indicate, that the procedure will be essential as well in evaluation as in analysis of nature and frequency of such complains by its superior presentation of intrahepatic bilestasis and functional mechanisms of the biliary system including the sphincter of Oddi.
One often finds complicating diagnostic uncertainties, when evaluating cholestasis in the early postoperative phase as well as in the follow-up of orthotopic liver transplants. One potential complication is the obstruction of the biliary tract caused by various conditions. The diagnostic value of hepatobiliary sequential imaging is demonstrated in there patients. This method is a noninvasive, simple way of investigating the bile flow after orthotopic liver transplantation, and therefore proves a valueable tool among the diagnostic procedures used for differentiation of the cholestasis syndrome.
The increase in accidental abdominal trauma with liver injury and the wide spread of invasive gastroenterologic/radiologic procedures with the risk of liver or biliary tract damage necessitate diagnostic methods for detection and postoperative control of such lesions. Diagnostic procedures in acute liver damage are discussed. Hepato-biliary sequential scintigraphy proves reliable in detection of bile leakage into the peritoneal cavity. Because of the sensitivity, the method should be used before radiologic investigations, e.g., in diagnosis of postoperative biliary structures and in the examination of functional behavior of biliodigestive anastomoses. Intrahepatic bile stasis is recognized as the forerunner of cholangitis.
Hepato-biliary sequential scintigraphy is an isotope method in the diagnosis of liver and biliary disease. The value and accuracy of the diagnostic information depends on the development of high resolution gamma cameras and new radiopharmaceuticals; these are described briefly. Our investigations on 350 patients were carried out (99m)Tc-Soloscint-Hepatobida. A number of clinical examples illustrate the scope and value of the examination; from these the indications can be deduced. Hepto-biliary scintigraphy will not replace proven gastro-enterological and radiological methods of investigation, but may be added to these in order to obtain rapid and reliable information. This will be of assitance both to the physician and the patient in deciding which of the more complex methods should be employed next.
Using the radiopharmaceutical Solcoscint-Hepatobida (99mTc) and a high definition camera, sequential hepato-biliary scans were performed. Twenty-five patients were used to demonstrate the value of the method for the evaluation of biliodigestive anastomoses and for the recognition of post-operative complications. The method can be recommended in combination with radiological procedures or in situations where radiology cannot be used.