Biomedical subjects
Publications and source records attributed to H Gahbauer.
A 29-year-old male presented with a two month history of intermittent low back pain following a febrile illness. Two planar bone scans performed with Tc-99m MDP were normal despite roentgenographic and SPECT scintigraphic evidence of discitis. This case demonstrates the increased sensitivity of SPECT in the diagnosis of discitis.
The rectus sheath hematoma is a generally rare disease, however the frequency of occurrence has increased with introduction of anticoagulant therapy. It almost always mimics the symptoms of acute abdomen. In 7 out of 14 cases, which we observed, an anticoagulant therapy was administered. During this therapy 5 rectus sheath hematomas occurred spontaneously. In the remaining 2 patients severe coughing attacks were reported additionally. The case histories of the other 7 patients included 3 patients with bronchitis, 2 patients with trauma and 2 patients without a relevant history ("spontaneous"). The correct diagnosis of rectus sheath hematoma could primarily be revealed by sonography in 8 of 14 patients, after which an appropriate therapy followed. In 6 patients a laparotomy was performed, because rectus sheath hematoma was not considered. The correct diagnosis was found intraoperatively as a surprising assessment. By inclusion of rectus sheath hematoma in the differential diagnosis of acute abdomen and the verification by sonography an emergency laparotomy because of a false diagnosis in the often severe ill patients can be avoided in favour of a minor and more appropriate procedure.
A prospective study was performed in 156 patients with acute pancreatitis to find out the value of computed tomography for the diagnosis and early prognosis. The CT finding leads to a diagnosis and differentiation in 3 risk groups similar to the clinical staging. The prognostic value of CT depends on the reproducible grading of pancreatic swelling and the grade of extrapancreatic fluid collections. CT finding correlates with early prognostic factors and the clinical staging, leading to different risk groups which allows an adequate stage-depending therapy of patients with acute pancreatitis.
The main purpose of noninvasive high-resolution B-mode sonography of the extracranial carotid artery is to detect clinically relevant arteriosclerotic lesions. That is the reason why reproducible parameters are needed for the description of normal and pathological echo patterns of the vascular lumen and the vascular wall. From an experimental evaluation of 100 carotid specimens examined with a high resolution real time scanner a list of definitions for sonomorphologic parameters is derived. These parameters refer to the clinical importance of luminal and intramural changes. Because of its high sensitivity for even minimal arteriosclerotic lesions, B-mode sonography is a useful method for clinical and epidemiological studies of extracranial carotid disease.
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Patients with cerebro-vascular insufficiency in stages I to IV had their extracranial carotid arteries examined with a high resolution real time ultrasound scanner. In 227 cases, carotid angiograms were available for comparison. Provided good image quality was obtained, sonography was able to distinguish with certainty between a normal and a pathological narrowed vascular lumen. Mural changes could be shown down to 0.5 mm. Under suitable conditions it was possible to differentiate between smooth and irregular plaques. Occasionally, ulcers were visible. High resolutions real time sonography is the only noninvasive method which provides information on the appearance and movements of vascular walls and of changes within these. It is possible to detect atherosclerotic changes at an early stage without risk, and to observe their development.
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The purpose of this study was to determine what advantages the use of paramagnetic contrast material might have in evaluating patients clinically suspected of having spinal infection. To determine this we prospectively examined with noncontrast and contrast magnetic resonance (MR) 33 such patients and correlated the MR diagnoses with clinical and pathologic data. Our results showed the following advantages of gadolinium-enhanced MR: it (a) provided excellent anatomical delineation of all epidural abscesses, routinely differentiating them from the adjacent compressed thecal sac even when this was not possible by noncontrast MR; (b) increased observer confidence in the diagnosis of disk space infection and osteomyelitis in patients with equivocal noncontrast MR; (c) localized those portions of paraspinal masses most likely to yield a positive percutaneous biopsy; and (d) identified active infections from those that had responded adequately to antibiotic therapy. We conclude that contrast MR is a valuable adjunct to noncontrast MR when diagnosis, anatomical clarity, and/or lesion activity requires further elucidation.
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A Riechert Mundinger stereotaxic device was modified to enable artifact-free computed tomographic (CT) scanning with the stereotaxic frame attached to the patient's head. A localization system was developed allowing determination of the XYZ coordinates of the target point directly from the CT cut. Angiography was performed intraoperatively with the stereotaxic frame attached. Coronal and sagittal CT reconstructions were enlarged to the radiographic magnification to allow direct comparison with angiography. CT offered optimum localization of the target, whereas angiography determined the safest approach. Computer programs were developed to enable three-dimensional radiotherapy planning. 125I seeds were implanted for treatment of low-grade gliomas and solid craniopharyngiomas. Yttrium-90 was applied in cystic craniopharyngiomas. Intracavitary rhenium-186 application was abandoned because of frequent cyst recurrence and leakage from the cyst.